What is fentanyl, what is it used for, and why illegal use is so dangerous

In America, opioid addiction has reached epidemic numbers. The problem has distant origins, and since 2013 it mainly concerns synthetic opioids, molecules developed in the pharmaceutical sector but now also very popular on the international illegal market. Precisely due to the large global dimension of the problem, in recent days the government has launched a national prevention plan against the improper use of fentanyl and other synthetic opioids, which aims to limit and monitor their illegal trade in the drug dealing centers of our country.

Let’s take a closer look at what fentanyl is, a drug that plays a fundamental role in the surgical field and in the management of chronic pain in cancer patients, but which can become a very dangerous narcotic substance when used for recreational purposes. As the American case demonstrates: in 2022, in fact, fentanyl caused almost 70% of the over 100,000 opioid overdose deaths recorded in the United States.

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Il fentanyl

The molecule is a synthetic opioid, developed in 1960 by Paul Janssen, the founder of Janssen Pharmaceutica. It is used in the treatment of chronic pain, especially in cancer patients undergoing palliative care, and as a post-operative anesthetic and sedative in surgery. Its action is that of a strong agonist of the μ opioid receptors, and has a potency equal to 100 times that of morphine and 50 times that of heroin. Precisely for this reason, it is extremely dangerous when used for recreational purposes, without medical supervision: in fact, just 2 milligrams are enough to reach a potentially lethal dose for most people.

In Italy it is included, together with approximately 30 of its analogues, in table 1 of narcotic substances. Its use is therefore permitted only in the medical field, upon prescription with a non-repeatable prescription. It appears as a white powder, is administered as solutions by injection, or used in the form of patches to be applied to the skin or as “lollipops” in tablet form.

The effects: from anesthesia to pain therapy

L’therapeutic use it is linked to the effective analgesic and anesthetic action. The side effects in this case are mainly nausea, vomiting, constipation and dizziness. As amazing it produces a sense of relaxation and euphoria, but also quickly induces dependence, and a growing tolerance that leads to increased consumption.

When use is discontinued, the characteristic symptoms ofabstinence, such as sweating, anxiety, diarrhea, bone pain, abdominal cramps, chills and goosebumps. The dangers during use are linked to the onset of respiratory depression, unconsciousness, coma, cardiac arrest, which can lead to death. The effects of the substance can be counteracted with the timely administration of naloxone, which therefore represents an authentic life-saving antidote in the event of an overdose of the substance.

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The diffusion

The illegal circulation of fentanyl is a global problem. It is sold as a narcotic substance, but also, and above all, used to cut other drugs such as heroin, given that the powerful narcotic action makes its use extremely economical.

The United States are currently the main world market: in 2022, seizures of fentanyl and its analogues reached record levels, for a total of over 6 tonnes in powder and 59.6 million counterfeit tablets containing fentanyl (the quantities seized are equivalent to over 398 million lethal doses of fentanyl, almost double those carried out in 2021).

Also in Europa the availability of fentanyl on the illicit market has increased significantly since 2012, as have deaths attributable to its use. In 2021, 137 fentanyl-related deaths were reported in EU countries: 88 in Germany, 18 in Lithuania, 9 in Austria, 6 each in Denmark and Finland, 4 in Estonia, 2 each in Slovenia and Portugal, 1 in Hungary and in Latvia.

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No emergency in Italy

In Italia it is believed that the illegal circulation of fentanyl is still limited overall. From 2016 to today, the national rapid alert system of the Department for Anti-Drug Policies has released 2 communications for deaths (one in 2018 and one in 2019), 5 communications regarding non-lethal intoxications and 2 reports relating to the consumption of fentanyl detected by the analysis of biological samples of as many people being treated at the Serd.

Between 2018 and 2023 the police force seized 123 grams of fentanyl powder, 28 doses of tablets and another 37 packs of patches, bottles and boxes of medicines.