A Brief History of Fentanyl – An Opioid Story

Ethos Ho, BSc Pharmacy Candidate

“This is absolutely the worst drug I’ve ever seen because of how toxic it is. The equivalent of two grains of sand will kill you, quickly.” ⁴

The Beginning

The trend of illegal fentanyl abuse started around 2012 when the major drug company Purdue Pharma L. P. replaced OxyContin^® with OxyNEO^®. Before this change, OxyContin^® was a popular drug of choice for recreational use and was at one point popular among high school students from upper-middle-class families.¹ OxyContin pills were often crushed and either snorted or injected, which led to a much greater effect than when swallowed. To reduce misuse and abuse while maintaining the same effect, Purdue Pharma remade OxyContin^® into a new product called OxyNEO^®. This newer form was designed to turn into a gel when crushed to make it harder to abuse.³ With the new formulation being tamper-proof, however, its popularity dropped rapidly amongst recreational drug users, opening doors for other illegal drugs to take control of the black market.

The Rise of Fentanyl

Initially, illicit fentanyl made its way into the streets by resembling OxyContin® in appearance. Coming in the form of green-coloured tablets with the number “80” stamped on them, these drugs quickly took on the street name “Shady 80’s or “Oxy 80’s” and became a key player in controlling the black market for opioids.¹ Currently, a major source of fentanyl is China, where there is currently no regulation for fentanyl production, making it easy for users or illicit drug manufacturers to produce and ship large amounts directly to Canada or the US (usually as powder).¹ The second source of fentanyl is through illegal re-selling of prescription fentanyl, which typically comes in the form of transdermal patches, tablets, and nasal sprays.

What is Fentanyl and how does it work?

Fentanyl belongs to a class of medications called opioids, which we’ve discussed before in our previous article on codeine. Opioids are primarily used for the management of severe pain in patients who have exhausted weaker options for pain control. What’s unique about fentanyl is that it’s significantly much more potent at lower doses than all other opioids, up to 50 times more potent than morphine.⁴ Due to its strength, fentanyl is almost always avoided in individuals who are opioid naive, meaning people who have never been exposed to long-term, or high-strength opioids.³ In other words, fentanyl is only used clinically as a last-line option and is quite rare compared to other medications.

Opioids work by directly affecting the nervous system, which leads to changes that result in the decreased sensation of pain.³ However, at high doses, opioids can also lead to numerous side effects, which may include dizziness, constipation, or slowed breathing – also known as respiratory depression, which can be life-threatening.

The Dangers of Illicit Fentanyl

One of the most dangerous problems with street-acquired fentanyl products is that the dose or strength can vary significantly from product to product, given that they’re manufactured in clandestine, unregulated labs. These products are also often mixed with other dangerous substances, such as methamphetamine, or sold under completely different drug names, putting many users at risk if they’re unaware of this fact.¹

One extremely dangerous mixture that is appearing on the streets today is fentanyl mixed with xylazine, a powerful anaesthetic used to sedate large animals such as horses and cattle. The danger of added ingredients is that the antidote to all opioids, naloxone, is not effective to non-opioid drugs. Therefore, in the case of emergencies, first-aid responders and hospital workers will not be able to provide proper treatment without knowing what drugs an individual has received.¹

The Bottom Line

Fentanyl is a power opioid that became a popular recreational drug following the replacement of OxyContin^® with OxyNeo^®. The danger of fentanyl lies in its ability to cause respiratory depression and potentially death quickly, and at very low doses. Additionally, the inconsistency in the strength of street-acquired fentanyl products, as well as the addition of other dangerous substances greatly increases the risks of overdose. Lastly, many counterfeit drugs are being sold under the name of different medications, when in reality, they may contain unknown doses of fentanyl.¹

The fentanyl crisis has been an ongoing issue since 2012, and numerous efforts have been made to raise awareness of the dangers of opioid use. Ultimately, the most important message today is that you should never receive any medications that haven’t been prescribed to you by a healthcare provider, and that you should only acquire these medications from a licensed pharmacy. Lastly, if you or someone else you know is currently using opioid medications (whether they’re acquired illicitly or not), consider speaking to a healthcare provider for a naloxone kit, which is offered free and anonymously in many locations and is a safe antidote for an opioid overdose.

As always, we hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear from you.

RESOURCES

1. Alberta Health Services. (2015). Listen and Learn, May 2015 – Fentanyl Awareness [Video file]. Retrieved from https://www.youtube.com/watch?v=UCAj2IBdlMA&feature=youtu.be
2. Maimann, K. (2018). Heroin dwindling as fentanyl takes over Edmonton streets | Metro Edmonton. metronews.ca. Retrieved 30 March 2018, from http://www.metronews.ca/news/edmonton/2016/05/25/fentanyl-taking-over-from-heroin-in-edmonton.html
3. RxTx
4. Alberta officials sound alarm over spike in fentanyl deaths. (2018). The Globe and Mail. Retrieved 30 March 2018, from https://www.theglobeandmail.com/news/national/alberta-officials-sound-alarm-over-spike-in-fentanyl-deaths/article27171340/