The Current Role of Pharmaceutical Fentanyl in Health Care

Pharmaceutical fentanyl continues to play a significant role in healthcare today. As a powerful opioid analgesic, it is primarily used for pain management, particularly in severe or chronic pain cases. Fentanyl is available in various formulations, including transdermal patches, lozenges, buccal sprays, injectable solutions, and nasal sprays.

Fentanyl patches are commonly used for chronic pain management, particularly in cancer patients. The patches are applied to the skin slowly, releasing the medication over 72 hours. Fentanyl lozenges and buccal sprays are used to treat breakthrough pain, which occurs suddenly and is not relieved by the patient’s regular pain medication. These formulations provide rapid relief of pain when needed.

Injectable fentanyl is used in surgical settings as an anesthetic and for pain management during and after surgery. It is also used in emergency medicine to treat severe pain and as a sedative in critical care settings.

Despite its effectiveness in managing pain, fentanyl is a potent drug with a high risk of addiction and overdose. Therefore, it is generally prescribed only for patients with severe or chronic pain who have not responded to other treatments. Close monitoring is required when using fentanyl, and patients must be educated on the medication’s potential risks and side effects.

When Did Illicit Fentanyl Production & Distribution Become a Crisis?

Illicit fentanyl production and distribution became a crisis in the United States in the early 2010s. The increase in deaths related to fentanyl began to be noticed around 2013, and by 2016, the Centers for Disease Control and Prevention (CDC) declared the opioid epidemic a public health emergency.

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine. It is often mixed with other drugs like heroin, cocaine, or counterfeit prescription pills without the user’s knowledge. The potency and availability of fentanyl have sharply increased overdose deaths in the United States and other countries.

Illicit fentanyl is often produced in clandestine laboratories in China and Mexico and smuggled into the United States through various channels. The crisis has led to increased efforts by law enforcement and public health officials to curb the supply of illicit fentanyl and improve access to addiction treatment services for those struggling with opioid addiction.

Fentanyl’s Role in Opioid Addiction

Fentanyl’s role in the opioid addiction crisis is significant. Because of its high potency, fentanyl use can quickly lead to addiction and severe withdrawal symptoms. Fentanyl is also responsible for many overdose deaths in the United States and other countries.

Fentanyl became part of the opioid crisis in the United States in the early 2010s due to a combination of factors.

Firstly, there was a significant increase in prescription opioid use in the 1990s and early 2000s.

Secondly, there was a shift in the illicit drug market, with the supply of heroin becoming more limited due to crackdowns on production and trafficking.

Finally, illicit fentanyl began to be produced in China and Mexico and smuggled into the United States through various channels, including mail and international drug trafficking networks.

The convergence of these factors has led to a significant increase in overdose deaths related to fentanyl, which is now considered a vital driver of the opioid addiction crisis.

Historical Overdoses From Fentanyl Use

Fentanyl use has been linked to a significant increase in overdose deaths in recent years, particularly in the United States.

Historically, fentanyl was approved for medical use in the United States in the 1960s and was initially used primarily for pain management in cancer patients. However, in the 1990s, fentanyl began to be used more widely for treating chronic pain, including non-cancer pain.

As the use of fentanyl for chronic pain management increased, so did reports of overdose deaths. In 2006, for example, there was a cluster of fentanyl overdose deaths in the United States that were linked to illegally manufactured fentanyl that had been mixed with other drugs like heroin and cocaine.

Since then, fentanyl-related overdose deaths have increased, particularly as illicit fentanyl has become more readily available. Illicit fentanyl is often mixed with other drugs without the user’s knowledge, which increases the risk of overdose and death.

What Countries Are the Greatest Distributors of Fentanyl?

The greatest distributors of illicit fentanyl are believed to be China and Mexico.

China is known to be a major source of the precursor chemicals used to manufacture fentanyl and other synthetic opioids. Illicit manufacturers in China often use these precursor chemicals to produce fentanyl and its analogs, smuggling them into other countries, including the United States.

Conversely, Mexico is a significant transit point for fentanyl and other illicit drugs destined for the United States. Mexican drug trafficking organizations are known to be involved in the production, distribution, and smuggling of fentanyl and other drugs.

Efforts to address the illicit fentanyl supply require a coordinated international response, including cooperation between law enforcement agencies and regulatory authorities in multiple countries.

The Largest Fentanyl Bust in History

The largest fentanyl bust in history was in 2019, when authorities seized a record-breaking 254 pounds of fentanyl powder in a clandestine laboratory in Mexico.

Other large fentanyl seizures have also been reported in recent years, including a seizure of 33 pounds (15 kilograms) of fentanyl in Nebraska in 2017 and a seizure of 70 pounds (31.8 kilograms) of fentanyl in Ohio in 2019. However, the 2019 seizure in Mexico remains the largest on record.

US Customs and Border Protection officers at El Paso ports of entry have intercepted large amounts of drugs since the start of 2023. The seized drugs include 327.78 pounds of methamphetamine, 139.81 pounds of cocaine, and 42.70 pounds of fentanyl.