May 25, 2023 - Health

What to know about the fentanyl crisis

Illustration of skull-shaped pills coming out of a prescription bottle.

Illustration: Lindsey Bailey/Axios

Addressing the fentanyl crisis has become a priority in an often-deadlocked federal government with the Biden administration calling on Congress to pass a bill aimed at tackling fentanyl trafficking in the U.S.

Why it matters: The overdose death rate involving the synthetic opioid fentanyl in the U.S. nearly quadrupled between 2016 and 2021, according to the Centers for Disease Control and Prevention.

How fentanyl works

Legally prescribed fentanyl was introduced in the U.S. in the 1960s. It works by blocking pain signals in a patient's brain and is used to treat severe pain, typically for post-surgery or advanced-stage cancer.

  • The CDC says fentanyl is up to 50 times stronger than heroin and up to 100 times more potent than morphine. Its extreme potency means that only very small doses are needed for its effects to be felt.

When prescribed legally, fentanyl can be administered as:

  • A shot
  • A patch
  • A lozenge

Why illegal fentanyl is so deadly

Illegally produced fentanyl in the U.S. mostly comes from drug cartels in Mexico, according to the Wall Street Journal. The National Institutes of Health says the illicit form is often sold as a powder, dropped on blotter paper, or put in eye droppers or nasal sprays. It can even be made into pills made to look like other types of drugs.

  • Drug dealers will often mix fentanyl into other drugs like cocaine, heroin, methamphetamine and MDMA because so little has to be added for an increased high. Fentanyl's potency increases the risk of an overdose because a person may unknowingly take the stronger opioid or take a larger dose than their body can handle. As little as two milligrams can be lethal.

Driving the news: The U.S. is awash in illegally produced fentanyl. Last year, the Drug Enforcement Administration seized enough fentanyl to kill every American.

What happens when you overdose

The effects of an overdose can happen within minutes of ingesting fentanyl. An overdose can have effects on many different organs, especially the brain. Drowsiness or loss of consciousness is common.

  • The biggest and most immediate threat in an overdose is that breathing can slow or even stop, according to UCHealth. The resumption of breathing is the first priority in treating someone who has overdosed. Once regular breathing has been established, treating the overdose's other effects becomes the focus.

How Narcan works

Naloxone, best known under the brand name Narcan, attaches to opioid receptors in the body, blocking the effects of other opioids such as fentanyl. It can be administered as an injectable or a nasal spray. When administered to someone who is overdosing, it can rapidly restore breathing.

  • However, stronger opioids may take multiple doses of naloxone to be counteracted, according to the NIH.
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