Fentanyl

Fentanyl

Street names include: Apache, China girl, China white, dance fever, Friend, Green beans, Goodfella, Jackpot, Murder 8, Poison, TNT, as well as Tango and Cash.

Fentanyl is much stronger than most opioids – 40 times more potent than heroin and 50 to 100 times stronger than morphine. Fentanyl is extremely dangerous if used non-medically – even a small amount can cause an accidental overdose and death.

What is fentanyl?

Fentanyl is an extremely powerful synthetic opiate analgesic that is similar to but much more potent than morphine. As the most potent opiate pain relief medication available, it is typically prescribed to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to opiates.

Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body’s opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation.

Fentanyl and fentanyl analogues are controlled under Schedule I of the Controlled Drugs and Substances Act. Activities such as sale, possession and production are illegal, unless authorized for medical, scientific or industrial purposes. However, the non-medical use of fentanyl and illicit fentanyl analogues is having a tragic impact on people who use substances, their families, and communities across Canada.

What does fentanyl look like and how is it used?

In its prescription form, fentanyl is known as Actiq, Abstral, Duragesic, Onsolis and Sublimaze.

When prescribed by a physician, fentanyl is administered via injection, transdermal patch, or in lozenge form. When used correctly, it can be very effective and safe.

In non-medical situations, fentanyl is injected, smoked, snorted or ingested in high doses, causing an experience of well-being (euphoria) that is followed by a period of calm lasting 1 to 2 hours. 1

Pharmaceutical grade vs illegal fentanyl

Illegal fentanyl refers to the fentanyl analogues that are designed to mimic the pharmacological effects of the original drug. Illegal fentanyl is produced in clandestine laboratories and mixed with (or substituted for) heroin, cocaine or other drugs in a powder form or pill form, and is associated with accidental overdoses and death.

This type of illegal fentanyl analogue is extremely potent, much more so than prescription-grade fentanyl. When it is mixed with street drugs such as cocaine, heroin, methamphetamine, and MDMA, it markedly increases their potency.

This is especially dangerous because people are often unaware that fentanyl has been added.

The Public Health Agency of Canada reported an estimated 22, 828 Canadians died from an apparent opioid-related overdose between January 2016 and March 2021.

According to Health Canada, the major drivers of this country’s opioid crisis are illegal fentanyl and fentanyl analogues. 2

  • 87% of accidental apparent opioid toxicity deaths involved fentanyl in 2021 (Jan to Mar).
  • 90% of accidental apparent opioid toxicity deaths from January to March 2021 involved a non-pharmaceutical opioid.

Fentanyl enters the Canadian illegal drug market in three ways: 3

  • illegal import from other countries
  • product from illegal laboratories in Canada
  • theft of medical fentanyl products (mainly skin patches)

People who use substances, such as opioids, cocaine, and methamphetamine are experiencing a number of increased risks. Because fentanyl can not be seen, tasted or smelled when mixed with other street drugs, many aren’t aware they are consuming it. There has been a rise of over 2,000 % in street drug samples testing positive for fentanyl.

Health Canada reports that the COVID-19 outbreak made the already deadly and ongoing public health crisis of opioid overdoses and death even worse.

Since the onset of the COVID-19 pandemic, 6,946 apparent opioid toxicity deaths occurred (April 2020 to March 2021), representing an 88% increase from the same time period prior to the pandemic (April 2019 to March 2020 – 3,691 deaths).

A number of factors have likely contributed to a worsening of the overdose crisis during the pandemic, including the increasingly toxic drug supply, increased feelings of isolation, stress and anxiety and limited availability or accessibility of services for people who use drugs. 4

Signs & symptoms of non-medical fentanyl use

Like other opiates, fentanyl has a sedative effect that slows down the way the body and brain function. The heart rate and breathing slows. A person may experience euphoria at first and then depression or confusion. They can have a numbing effect that produces drowsiness if a lot is taken.

Constricted pupils – Opiates including fentanyl can cause the user to have constricted pupils, making them look like pinpoints or small dots.

Nodding – Temporarily falling asleep at an unusual time, like while talking or standing

Covering Arms – A person may wear long sleeves even when it’s hot in order to hide needle marks

Needle Marks – If someone is injecting fentanyl, they may have needle marks on their arms, on their ankles, feet, or behind their knees

Itching – Someone using fentanyl non-medically will scratch and itch frequently

Bad coordination – Their balance might be affected, causing them to trip or stumble while walking

Other signs that someone is using fentanyl may include:

  • Stiffness of muscles
  • Dizziness
  • Fainting
  • Shaking
  • Slurred speech
  • Drowsiness
  • Nausea and vomiting
  • Hallucinations
  • Urine retention
  • Dry mouth
  • Loss of appetite
  • Sleeping problems
  • Swollen arms or legs

It can be difficult to recognize the signs of fentanyl use in a young person. Multiple signs of problematic substance use combined with drug-seeking or other addictive behaviours may point to use of the drug.