Drug Info » Fentanyl FAQs

FAQ’s-Fentanyl and Fentanyl-Related Substances

Q. What is fentanyl?

A. Fentanyl is a synthetic opioid. Fentanyl is a very powerful anesthetic (30-50 times more potent than heroin and 50-100 times more potent than morphine) most often used with patients who are already taking other opioids to relieve chronic or breakthrough pain (such as the pain caused by cancer).

Q. What are fentanyl-related substances?

A. Because fentanyl is synthesized, chemists can create a wide range of similar synthetic opioids ranging in potency.  Some of the more commonly abused fentanyl-related substances or fentanyl analogs according to the National Forensic Laboratory Information System (NFLIS) are carfentanil (approximately 100 times more potent than fentanyl) acetyl fentanyl, furanyl fentanyl and 3-methylfentanil.

Q. Why is fentanyl dangerous?

A. In its purest form, fentanyl is a white powder or in grains similar in size to grains of salt.  It only takes a very small amount of fentanyl to cause a severe or potentially deadly reaction. As little as two milligrams is a lethal dosage in most people.  Consequently, not only are users exposed to danger, but also others who might encounter fentanyl such as first responders and law enforcement officials.

Q. What does fentanyl do to the brain?

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

Q. What are the effects of fentanyl exposure? 

A. The effects of fentanyl exposure resemble those of heroin and include euphoria, drowsiness, nausea, confusion and sedation.  With repeated exposure comes tolerance, addiction, respiratory depression and arrest, unconsciousness, coma, and death.

Q. What is fentanyl’s legal and medical status?

A. Fentanyl is approved by the Food and Drug Administration for limited use as an analgesic (pain relief) and anesthetic, it is often sold illicitly. Fentanyl is a Schedule II narcotic under the United States Controlled Substances Act.

NOTE: A Schedule II drug does NOT mean it is less potent (or deadly) than a Schedule I drug (click here for a definition).

Q. Why is fentanyl spreading so fast?

A. One of the main reasons for the rapid spread of fentanyl is that it offers a high profit margin for traffickers. For example, traffickers can typically purchase a kilogram of fentanyl powder for a few thousand dollars from a Chinese supplier, transform it into hundreds of thousands of pills, and sell the counterfeit pills for millions of dollars in profit. If a particular batch has two milligrams of fentanyl per pill, approximately 500,000 counterfeit pills can be manufactured from one kilogram of pure fentanyl. According to DEA reporting these pills containing fentanyl or fentanyl-related compounds are being sold at retail at prices between $10 and $20 per pill in U.S. illegal drug markets (depending on the purity of the fentanyl and the dosage).

Q. Where is illegal fentanyl made?

A. Fentanyl is often manufactured in overseas clandestine laboratories and then transported across the Southwest border or sent via mail. Both Mexico and China are major source countries for fentanyl and fentanyl-related compounds.

Q. How is fentanyl being trafficked?

A. The supply lines for fentanyl and heroin are often essentially the same.  Heroin traffickers who travel to the Southwest border to purchase heroin now also purchase fentanyl from the same Southwest border sources of supply.

Q. How is fentanyl being sold and used?

A. The ways in which fentanyl is being abused and the different compounds and formulations in which it is found are constantly evolving, posing new threats to those that use them illicitly.  
In the past fentanyl was typically mixed with other opioids, such as heroin, but that is not always the case today. Fentanyl can also be injected, snorted/sniffed, smoked, taken orally by pill or tablet, or spiked onto blotter paper.

Illicitly produced fentanyl is sold alone or in combination with heroin and other substances and has been pressed into pills, and used to mimic pharmaceutical drugs such as oxycodone.

What are some common street names for fentanyl?

Apache, China Girl, China Town, Dance Fever, Friend, Goodfellas, Great Bear, He-Man, Jackpot, King Ivory, Murder 8, and Tango & Cash.

What are the overdose effects?

Overdose may result in stupor, changes in eye pupil size, cold and clammy skin, cyanosis (bluing of extremities), coma, and respiratory failure leading to death. The presence of triad of symp­toms such as coma, pinpoint pupils, and respiratory depression are strongly suggestive of opioid poisoning.

What is the effect on the body?

Fentanyl, similar to other commonly used opioid analgesics (e.g., morphine), produces effects such as relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.

Can Naloxone work on someone overdosing on fentanyl?

Fentanyl, like heroin, is an opioid and can rapidly block or reverse the effects of both, however because fentanyl is much more powerful than heroin, it often takes more than one dose of Naloxone in emergency situations.

Why is fentanyl use resulting in so many overdoses?

It is much more potent than heroin- up to 30-50 times as potent (and as deadly) as heroin– two milligrams of fentanyl (equivalent to a few grains of table salt) is considered to be a deadly dose for more than 95 percent of the American public. Some compounds such as carfentanyl are even stronger - up to 100 times more potent than fentanyl.

In addition there are no standard dosages of fentanyl and fentanyl related compounds when used illicitly, and as a result the amount of fentanyl can vary greatly between vendors and batches. For example, one 2016 seizure of counterfeit prescription pills had approximately 1.8 milligrams of fentanyl in each pill. Such a large amount of fentanyl in each pill is alarming considering that approximately two milligrams is a lethal dose for most non-opioid-dependent individuals.

What is DEA doing about this?

Combatting the spread of opioids, including synthetic opioids such as fentanyl are a top priority for DEA, with more frequent and larger seizures. Some recent fentanyl cases have been significant, particularly in the northeast and in California, including one 12 kilogram seizure.

During May 2016, a traffic stop in the greater Atlanta, GA area resulted in the seizure of 40 kilograms of fentanyl – initially believed to be bricks of cocaine – wrapped into blocks hidden in buckets and immersed in a thick fluid. The fentanyl from these seizures originated from Mexican drug trafficking organizations.



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