What is Fentanyl?
Fentanyl is nearly always described with the following three words: Potent. Synthetic. Opioid. Let’s look at these terms in reverse order.
Fentanyl belongs to the class of drugs called opioids, which are used to reduce pain. This category also includes morphine, oxycodone and heroin. Of these, fentanyl is one of the most potent, and is approved for medical use as a surgical anesthetic or for people with chronic pain (typically terminal cancer patients). Opioids reduce physical and emotional/psychological pain and can have a euphoric effect in high doses, which is why people sometimes misuse opioids.
Unlike morphine and heroin, fentanyl is not derived from the opium poppy. Rather, it is a synthetic product, meaning it is “formed through a chemical process by human agency”; i.e. it is not derived from plants. This means that it can be produced quickly – it is not dependent on agricultural and harvest conditions. Since the supply is only limited by the availability of the precursor chemicals and the availability of people to make it, fentanyl is exceptionally cheap and easy to make compared to plant-based opioids.
Fentanyl is good at its job. It is a highly effective and efficient pain reliever. It is 50-100 times stronger than morphine. All the properties are amplified, so it takes a lot less fentanyl to get the same effect as morphine or heroin. That has many of implications, for instance:
Just a tiny amount can be lethal, especially if you don’t have a
Fentanyl takes effect faster and wears off sooner, making it highly addictive and harder to kick.
Standardized dosing in a pressed tablet requires precise measures of minute quantities, something that is not guaranteed by illegal suppliers. The difference between high and die is often a few milligrams, or roughly a few grains of salt.
Pharmaceutical-grade fentanyl is a legitimate medication produced by pharmaceutical companies that have developed advanced technology to control the quality and maintain the proper dosages of the end products. Pharmaceutical-grade fentanyl is tightly regulated and is safe when administered by professionals as prescribed.
Deaths from overdosing on pharmaceutical-grade fentanyl are relatively uncommon and often involve misuse or tampering of medications.
Illicit fentanyl is the black market version of the drug obtained or made by dealers and mixed into pills, other powders, blotter papers and liquids, etc. in “labs” with no quality controls. The risk of illicit fentanyl is two-fold. Illicit fentanyl, often made in Mexico, is not manufactured to the same quality standards as the pharmaceutical fentanyl commonly used for medicinal purposes. The potency of illicit fentanyl found in items sold in illegal markets can vary widely from maker to maker, or even from batch to batch, and the buyers don’t know the contents of what they are getting*. Fake pills are then being made, sometimes with inconsistent amounts of illicit fentanyl.
Fake pills are illegally made in garages, basements, and other clandestine settings by unqualified drug makers who do not ensure the quality or consistency of the dose. When batches of fake pills are mixed, each pill may contain a different amount of illicit fentanyl making the dose of each pill impossible to predict.
These products are not regulated and there is no way to ensure consumer safety. Because of this, use of illicit fentanyl is very dangerous. Illegally manufactured fentanyl is involved in the majority of U.S. drug deaths in recent years.
*One of the other negative aspects of poor quality control is that at times, the “illicit fentanyl” is not actual fentanyl. Within an illicit fentanyl supply, there may be unreacted precursor chemicals, byproducts that form due to poor heating or stirring, etc. Also, the amateur chemists can change the ingredients (precursors) of the recipe to form “fentanyl analogs.” Pharmaceutical grade fentanyl is manufactured under strict, government regulated quality control standards so that precursor chemicals or byproducts that are left over from the synthesis process are removed as the final fentanyl product is purified.
In addition to being extremely potent, fentanyl has a very small therapeutic index. This means that the amount of fentanyl it takes to have an effect is almost the same as the amount it takes to kill a person. That is why fentanyl is so carefully dosed and closely monitored in medical settings.
Illicit fentanyl also has a small therapeutic index, but it is manufactured without the necessary quality controls, so the potency of any given batch is an unknown variable. Combine this with improper blending when it is cut into powders and then pressed into pills, and you have a literal recipe for disaster: street drugs made with a potent, sensitive raw material that is unevenly distributed within the end product.
Illicit fentanyl is synthesized by mixing chemical ingredients in the proper proportions. The ingredients are highly regulated in the United States, but are relatively easy to acquire from manufacturers in China and India, as they have other legitimate chemical uses and are not as strictly regulated there.
Manufacturing pharmaceutical-grade fentanyl requires special equipment and conditions, but clandestine laboratories can produce illicit fentanyl of much lower quality without special equipment. Fentanyl manufacturing is not dependent on weather conditions, meaning that fentanyl can be produced quickly and in large quantities, anywhere, at any time.
Beginning around 2014 China was the primary source of illicit fentanyl powder coming into the U.S. and Mexico, shipped directly through postal and shipping services. Drug traffickers based in the U.S. and Mexico then cut the illicit fentanyl powder into heroin and other drugs or pressed it into counterfeit prescription pills.
In May 2019, under international pressure, the Chinese government banned the production and sale of fentanyl analogs, leading to the significant reduction of the amount of illicit fentanyl being shipped directly from China to the U.S. and Mexico. Since then, Chinese vendors have shifted their manufacturing to precursor chemicals, selling them to the Mexican cartels via online networks.Currently, most of the fentanyl in the U.S. illicit drug market comes across the southern border from Mexico. Mexican Drug Trafficking Organizations (DTOs) manufacture fentanyl using Chinese precursors and smuggle it north in powder or pressed pills.
With pressure being put on the Chinese supply chain, India and Mexico have become emerging sources of fentanyl and precursor chemicals, and the DEA expects the number of countries producing these precursor chemicals to increase. DTOs are likely poised to take a larger more significant role in the production and the supply of fentanyl and fentanyl-containing illicit pills to the United States. We can expect that illicit fentanyl production and precursor chemical sourcing will become increasingly global as time goes on.
(Source: DEA)
In toxicology, the lethal dose for a substance is referred to as the LD50, or median lethal dose, which is the amount that is needed to kill 50% of a sample group. Toxicologists point out that it is impossible to determine a precise LD50 for opioids because tolerance builds in lab subjects as the dose is increased. In other words, the lethal dose for any opioid is a moving target, technically speaking.
The DEA says that 2 milligrams (mg) of dry powder fentanyl is a “potentially lethal dose.” This general statement makes the point that a small amount can be deadly. In fact, the actual amount of fentanyl that will cause death varies depending on the person’s weight, whether they have used opioids before, their metabolism, their general health, and more. The amount of fentanyl that will kill a 110-lb person who has never ingested opioids will be different than the amount that will kill a 220-pound opioid dependent user. Therefore, a “lethal dose” may not cause death to everyone who consumes it. Conversely, a person could die from an amount of fentanyl that is less than the “lethal dose” of 2mg.