What is fentanyl and why is it so dangerous?

I read that fentanyl was the drug that killed Prince. What is fentanyl and why is it so dangerous?

Fentanyl was first manufactured in 1960 and has become one of the world's most important and frequently used painkillers. It is a synthetic (or man-made) opioid. Opioids, such as heroin, are derived from a substance produced by the opium poppy, morphine. Other opioids include prescribed medications like codeine and oxycodone.

The drug hit the international headlines when it was established that Prince died as a result of a fentanyl overdose. In the US, fentanyl is one of the drugs blamed for the recent increase in drug overdose deaths. Fentanyl-related deaths have been reported in many parts of the world, including the UK. In Australia, 498 deaths were linked to the drug between 2010 and 2015.

Fentanyl is a short-acting opioid that is similar to, but much more powerful than morphine or heroin. As with heroin, in addition to its pain relief properties, fentanyl use can lead to drowsiness, shutting down of the respiratory system, coma and death. There are also many compounds that are similar in structure (referred to as fentanyl analogues) that vary in strength, effects and toxicity. Some of these are far more dangerous and have received a great deal of media attention, e.g., carfentanil.

Pharmaceutical fentanyl is used for managing acute or chronic pain and is available as lozenges, tablets and nasal sprays, patches placed on the skin and an injectable medicine. These prescribed medications can be misused by people for whom it was not intended. Fentanyl is also illicitly manufactured for use in the illegal drug market. In some parts of the world, fentanyl has been reported as being used as a low-cost additive to increase the potency of street heroin.

What makes fentanyl so dangerous? Quite simply, it is all to do with the strength or potency of the drug. A fatal overdose can be caused by a tiny amount of the drug. Fentanyl is reported to be 50-100 times more potent than heroin and carfentanil is 100 times more powerful than fentanyl. This means that a fatal dose of fentanyl may be equivalent to just 4-6 grains of table salt and a fatal dose of carfentanil may be equivalent to a speck of dust so small it may be very hard to see!

It is no surprise that fentanyl has received a great deal of media attention in recent times. It is a powerful painkiller that, when used as prescribed, can make a huge difference to people's lives. Unfortunately, when misused it can lead to people becoming dependent and, as we have seen in the Prince case, overdose and death.

First published: March 2018