Fentanyl: from therapeutic use to pathological addiction

Fentanyl is much more powerful than morphine, about 80 times, has a rapid onset analgesic function and has a short duration of action.

It has always been used for the treatment of chronic pain especially in patients with cancer and is often administered before surgery in combination with a benzodiazepine or other drugs.

Fentanyl: the story
Fentanyl was first prepared and developed by Dr. Paul Janssen in 1959 under a patent held by his company, Janssen Pharmaceutica. In the 1960s, fentanyl was introduced to the drug market as an anesthetic with prodigious effects.

Until the mid-1990s this drug spread like wildfire, especially it was sold in the form of dermal patches. Given the effects, of course, it has also become one of the most produced substances on the illegal market.

As a result, the first cases of drug dealing emerged during the 1970s. Between 2005 and 2007, fentanyl produced in a single Mexican laboratory caused more than a thousand overdose deaths in the United States. Fentanyl is synthesized by Mexican drug cartels at a lower cost than it takes to produce heroin, which is often mixed with to make it more potent.

Fentanyl: what it looks like
Fentanyl is a drug that produces effects similar to those of morphine, but more potent and in lower doses. It causes hallucinatory effects accompanied by a state of well-being that leads the consumer to enjoy the benefits of the substance to the point of not being able to do without it anymore.

Fentanyl is so potent that it’s easy to overdose, even inadvertently. A fentanyl tablet, shaped like that of the common aspirin, may be capable of killing an adult man. Consequently, it is really difficult to dose the right amount from which to be able to benefit from it without risking your life.

Fentanyl is taken via patches, lollipops or tablets, more rarely via injections. In drug form it is suitable for oral, inhaled, transdermal and parenteral administration. It is mainly used for the treatment of breakthrough pain in patients with cancer who are already receiving other opioids for the treatment of chronic cancer pain.

The simultaneous intake of fentanyl and alcohol should be avoided, since the latter increases the drowsiness induced by fentanyl.

Fentanyl may decrease the ability to drive and use machines therefore such activities should be avoided. For those who carry out sporting activities, its use without therapeutic need constitutes doping and also when the drug is taken for therapeutic purposes.

Effects on the central nervous system

Fentanyl at the level of the central nervous system binds to endogenous opiate receptors, located along the pain pathways of our body, producing an analgesic action. Thus, when these receptors are stimulated by the substance, a state of well-being is achieved.

This substance, in some cases, causes respiratory depression probably due to a direct action on the respiratory centers of the brain stem, which are depressed in their electrical stimulation activity and register a reduced reactivity to increases in carbon dioxide. Fentanyl also produces antitussive effects at very low doses and also causes miosis, but it is not clear through which mechanism of action.

Side effects
Fentanyl can cause several side effects, although not all patients experience them, for example: excessive sleepiness, dizziness or headache, tiredness and weakness, lack of energy, alteration of some sense organs such as taste and smell. In addition, psychiatric disorders may also occur, such as: mood swings, depression, paranoia, confusion, disorientation, sleep disturbances, anxiety, restlessness, all accompanied by nausea, vomiting and constipation.

If taken for a long time and regularly it can cause addiction and dependence; as well as a number of skin and respiratory manifestations.