Fentanyl is a potent opioid painkiller used clinically for pain management, anesthesia, and sedation. Fentanyl analogs are synthetic opioids chemically similar to the drug from which they’re derived. They can be extremely dangerous because users may not be aware of the strength of their dose, and even small amounts of fentanyl analogs can cause an overdose. Moreover, analogs are often combined with other substances that can further increase the risk of harm.
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What Are Analogs of Fentanyl?
Fentanyl analogs are modified versions of traditional, medically-used fentanyl. They have slightly different chemical structures and properties than their parent drug and can vary in potency and intensity of effects. Analogs are designed to circumvent drug laws and serve as a less expensive, more potent alternative to heroin and other opioids. Fentanyl analogs have become a tremendous concern in recent years due to their potential for misuse and overdose.
Types of Fentanyl Analogs Include:Â Â
- Carfentanil—Carfentanil is a highly potent synthetic opioid estimated to be 10,000 times stronger than morphine. (1) It was designed as a tranquilizer for large animals such as elephants. Unfortunately, it has also been found in illicit drug markets and has caused many overdose deaths.
- Acetylfentanyl—Estimated to be between 15 and 80 times stronger than morphine, this analog is often used illicitly as a heroin substitute. (2) It has been linked to many drug poisonings and overdose fatalities.
- Furanylfentanyl—At approximately 50 times stronger than morphine, this analog is often sold on the black market as a replacement for heroin or other opioids. (3)
- Alfentanil and Remifentanil—These drugs are administered by injection and used for severe pain in various medical settings, including surgery, intensive care units, and emergency departments. (4)(5)
- Methoxyacetylfentanyl—This analog is up to three times as potent as fentanyl. It is frequently found on the illegal drug market as a fentanyl substitute. (6)
Using any fentanyl analog can be extremely dangerous due to its potency. Illicit production and distribution of fentanyl analogs are not subjected to quality control. Therefore the effects of these drugs are often unforeseeable.
What Are Fentanyl Analogs Used For?
Fentanyl analogs are created by modifying fentanyl’s molecular structure to produce substances with similar effects but different properties. While fentanyl analogs, in general, are not approved for medical use in the United States, a few have been developed for clinical purposes. For example, sufentanil is used as an anesthetic in certain medical settings. Likewise, alfentanil and remifentanil are administered as painkillers during surgery.
Most fentanyl analogs are not used for medical purposes and instead are sold on the black market. These are typically used as a more affordable and potent substitution for opioids like heroin or prescription painkillers. They are sold under various street names and are often mixed with other drugs or substances to increase their effects or extend dealers’ supply.
Are Fentanyl Analogs Legal?
In the United States, fentanyl analogs were added to the Schedule I controlled substances list in 2018, meaning they have a high potential for misuse and no accepted medical use. In addition, possession, distribution, and manufacturing of fentanyl analogs can lead to criminal charges and significant penalties.
Illicit fentanyl analogs are manufactured in secret labs using various chemical synthesis methods. This involves modifying the molecular structure of a precursor chemical to create the analog. The precise process varies depending on the particular analog being produced and the resources accessible to the manufacturer.
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How Long Do Fentanyl Analogs Stay in Your System?
The duration fentanyl stays in a person’s system depends on several factors, including the dose, frequency of use, and individual metabolism. Fentanyl has a short half-life, which means it is rapidly eliminated from the body. In general, fentanyl can be identified in urine for up to 3 days (the most common test method), in blood for up to 24 hours, and in saliva for up to 72 hours after the last use. Hair follicle tests can detect fentanyl for up to 90 days or more, but these are rarely used.
Which Is the Shortest-Acting Fentanyl Analog?
One of the shortest-acting fentanyl analogs is sufentanil, which has a near-immediate onset of action of 1-3 minutes. Sufentanil is often used for short-term pain relief, such as surgery or other medical procedures. It can quickly relieve pain without causing extended sedation or respiratory depression. Other fentanyl analogs, such as alfentanil and remifentanil, also have relatively short onsets of action.
Side Effects of Fentanyl & Its Analogs
Health-Related Side Effects of Fentanyl & Fentanyl Analogs Include:
- Respiratory depression, such as shallow breathing.
- Sedation, including drowsiness, confusion, and reduced alertness.
- Nausea and vomiting.
- Constipation.
- Itching and sweating.
- Hypotension, leading to dizziness and fainting.
- Withdrawal symptoms upon discontinuation.
- Tolerance, dependence, and addiction.
U.S. Legal Response to Increase in Federal Fentanyl Analog Crimes
The U.S. Drug Enforcement Administration (DEA) has identified several fentanyl analogs commonly trafficked into the country, including acetyl fentanyl, furanylfentanyl, and methoxyacetylfentanyl. The increase in federal fentanyl analog crimes has provoked a response from lawmakers and law enforcement officials at the federal and state levels.
Legal Responses to Analog Drug Issues Include:
The Federal Analogue Act
Passed in 1986, the Federal Analogue Act allows the federal government to prosecute individuals who manufacture, distribute, or possess substances structurally similar to controlled substances, even if they are not explicitly listed as controlled substances. (7)
The Synthetics Trafficking & Overdose Prevention (STOP) Act
The 2018 STOP Act requires the U.S. Postal Service to collect and transmit electronic data on international packages, which can help law enforcement officials identify and intercept packages containing illegal drugs, including fentanyl and its analogs. (8)
State-Level Laws
Many states have passed laws targeting fentanyl and its analogs. For example, some states have increased penalties for trafficking or possessing fentanyl analogs. Others have expanded access to overdose-reversal agents, such as naloxone.
Increased Law Enforcement Efforts
Federal, state, and local law enforcement agencies have increased efforts to identify and disrupt the trafficking of fentanyl and its analogs. This includes efforts to take down illicit drug manufacturing operations and increase agency cooperation.
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(1)https://www.cdc.gov/mmwr/volumes/67/wr/mm6727a4.htm
(2)https://www.deadiversion.usdoj.gov/drug_chem_info/acetylfentanyl.pdf
(3)https://www.nh.gov/safety/divisions/fstems/ems/bulletins/documents/bulletin35.pdf
(4)https://www.mayoclinic.org/drugs-supplements/alfentanil-intravenous-route/precautions/drg-20406201
(5)https://www.apsf.org/article/remifentanil-safety-issues-with-a-new-opioid-drug/
(6)https://www.emcdda.europa.eu/system/files/publications/7925/20181015_TDAS18002ENN_PDF.pdf
(7) https://www.law.cornell.edu/uscode/text/21/813
(8)https://www.dhs.gov/news/2021/03/04/stop-act-regulations-fight-opioid-smuggling-be-published
