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Fentanyl ushered in a new era of anesthesia making outpatient surgery safe and, ultimately, commonplace. In contrast to morphine or meperidine (Demerol®), fentanyl is very short-acting, allowing patients to emerge from anesthesia faster. The downside for the safety profile is that fentanyl is 100 times more powerful than morphine. Of course, anesthesiologists (unlike the vast majority of drug users) are trained professionals and are constantly monitoring a patient’s oxygen, breathing, pulse, and blood pressure.
Now that fentanyl has become a street drug; it has become a quick path to death. According to the U.S. Centers for Disease Control and Prevention (CDC), fentanyl is now the top cause of death among U.S. adults (ages 18-45) — more than COVID-19, suicide, and car accidents. Out of 2022’s 105,452 drug overdose deaths, 19 percent were due to fentanyl. According to the Drug Enforcement Administration (DEA), in 2021, fentanyl killed more Americans than guns and traffic crashes combined.
How did it become so popular? Seventy-five percent of overdose deaths are due to opioids. The legal prescriptions for hydrocodone, oxycodone, and oxymorphone had been the leading cause of overdose deaths. But after these medications came under scrutiny and became the subjects of multiple lawsuits, fentanyl hit the streets. Fentanyl is 50 times stronger than heroin. A lethal dose fits on the tip of a pencil. And fentanyl is synthetic — meaning it can be made in a lab from chemicals. (Heroin is made from poppies). But because fentanyl is so cheap, it is slipped into other illicitly-obtained prescription pills unbeknownst to the buyer of the drug.
Fentanyl and its ingredients are mainly smuggled into the U.S. from Mexico by drug cartels and are much cheaper ($4 or $5 per pill) than other opioids ($30 per pill). Fentanyl is a very versatile drug: it can be injected, snorted/sniffed, smoked, taken orally by pill or tablet, and spiked onto blotter paper. Teens have become a large portion of its victims as fentanyl has been sold via some social media outlets. Fentanyl was identified in more than 77 percent of fatal overdoses among adolescents in the first half of 2021.
I’m disturbed that all I am hearing about is naloxone, better known as Narcan®. This drug immediately reverses the effects of narcotics. An over-the-counter version of Narcan®, a nasal spray, was approved for purchase without a prescription by the FDA in March 2023. While this may save a life in the short term, it doesn’t stop drug use. I wonder whether it will make it worse if the user knows there is a reversal. Anecdotally, what I’ve seen after working in the ER, experiencing an overdose does not scare off an addict from using drugs again.
What’s wrong with Americans that they consume so many mind-altering drugs? Hopefully, the $50 billion in settlements by drugmakers will go to the prevention of addiction in the first place.
For information on newer trends in pain management:
Pain Management Best Practices Inter-Agency Task Force Report
https://www.hhs.gov/opioids/prevention/pain-management-options/index.html
Dr. Molly Rutherford is the founder, medical director, and physician at Bluegrass Family Wellness — a direct primary care clinic in Kentucky. She is board certified in Family Medicine and Addiction Medicine and employs a holistic approach to her patients’ physical health. She has more than a decade of experience treating opioid addiction. She was chosen to be part of the federal Pain Management Best Practices Inter-Agency Task Force.
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