When Paul Janssen first synthesized the narcotic analgesic known as fentanyl in 1959, he intended the powerful mu-opioid agonist to be a radical new treatment for treating acute pain in cancer patients. Far more powerful than morphine, fentanyl was first marketed as an intravenous anesthetic under the brand name, Sublimaze, by his company (now part of the Johnson and Johnson corporation). As a fast-acting analgesic agent which passed out of the system rapidly, fentanyl quickly inspired a variety of analogues including sufentanil, alfentanil, and lofentanil. The 1990s ushered in a new generation of fentanyl derivatives designed to improve quality of life in palliative care patients. Along with the familiar intravenous form, fentanyl doses could also be delivered in the form of transdermal patches, lollipops (sold under the brand name of Actiq) and buccal tablets (Fentora). As the most widely used synthetic opioid in clinical settings, demand has far exceeded available supply and there is currently a fentanyl shortage as a result. Despite adverse side effects including nausea, diarrhea, breathing problems and, in rare cases, aphasia, fentanyl is still regarded as being safer than morphine despite concerns over potential withdrawal effects.
Far more worrying is fentanyl's growing appeal as a street drug. Much like morphine, heroin, and other opioids, fentanyl works by binding to the body's opiate receptors and driving up dopamine levels which can lead to feelings of euphoria and relaxation. While the "high" produced by fentanyl is less intense than heroin, its far greater potency makes it more dangerous, especially given the risk of respiratory distress and fatal overdoses. Since the mid-1970s, transdermal fentanyl patches have been available on the black market under street names such as "Apache", "China girl", "China white", "murder", and "Tango and Cash". Despite attempts by drug manufacturers to adapt fentanyl patches to make removing the drug content more difficult, fentanyl abusers can still get a high through smoking, snorting, injecting, and even eating the patches directly. The number of fentanyl deaths has risen sharply over the past twenty years although available statistics largely focus on cases in the United States. Studies of fentanyl-related overdoses show that victims are typically female, white non-hispanic, and older than the usual overdose demographic. Even the Actiq lollipops are becoming increasingly available on the black market (where they are commonly known as "percopops"). Though most prescription pain medications have become popular as street drugs, fentanyl is rapidly becoming a drug of choice given its extreme potency. Some dealers are even mixing it with heroin which has led to a rash of overdose deaths across the United States (and elsewhere). Much of the fentanyl sold on the black market comes from Mexico but black market labs manufacturing fentanyl and counterfeit oxycontin tablets have also been found in the United States and Canada. The high potency and extended duration of some fentanyl compounds make its manufacture extremely profitable for street use.
Despite controversy over prescribing long-term opioid medications for chronic non-cancer pain, the increasing popularity of these medications has made their availability as street drugs a fact of life. National surveys of drug use have shown that nearly 12 million Americans 12 years old or over (4.8% of the population), have reported non-medical use of prescription pain relievers. ER visits relating to non-medical opioid use have skyrocketed over the past decade and the death rate due to overdose is at an all-time high. While most of those deaths have been linked to more popular opioid pain relievers such as oxycodone (i.e., Oxycontin or Percocet) and hydrocodone combinations (i.e., Vicodin), fentanyl deaths are becoming increasingly more common. As high-profile cases involving accidental fentanyl deaths have demonstrated, that trend is likely to continue.
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