Fentanyl has been used as a painkiller for decades. Recently though, fentanyl has been mixed with heroin, or sold alone as a street drug. Clusters of fentanyl-related deaths have occurred in heroin users sporadically over the years. The current outbreak is unusual for its duration, widespread geographic pattern, and the sheer number of associated deaths. Of the 1374 opioid-related deaths in Massachusetts where toxicology data were available, fentanyl was found in 75% of cases.

Where is the fentanyl from?

Historically, the fentanyl that made its way into circulation came from patients and providers who had access to medical fentanyl, or from pharmacy thefts and fraudulent prescriptions. In the mid-2000’s, clandestine fentanyl manufacturing in the United States was slowed by limits placed on precursor chemicals. Recently, those fentanyl precursors have been available in China, and clandestine fentanyl has been exported to the United States, Mexico, and Canada. The Chinese government has made several of those precursors illegal, and placed limits of several fentanyl derivatives; the impact of these laws remains unclear.

Why is fentanyl causing a spike in deaths?

The amount of fentanyl required to produce an overdose is the size of a few grains of salt, because fentanyl is a stronger (more potent) opioid* than heroin. Like other opioids, fentanyl causes users to stop breathing in high doses, which can rapidly lead to death. Many heroin users are unaware that their heroin contains fentanyl. In these cases, a fatal overdose can happen easily.

Does naloxone still work for fentanyl?

Naloxone reverses the effect of opioids, and is available for bystander use in many communities. Naloxone will reverse a fentanyl overdose, but high doses are sometimes required to reverse the effects of fentanyl. So it is always safest to call emergency medical services for a suspected opioid overdose – they will bring more naloxone to the scene in case it is needed.

*Opioids are a class of medications and drugs that are often used as painkillersn or to “get high.” Common opioids include heroin, morphine, codeine, Vicodin, Percocet, methadone, and fentanyl.

Authors: Dr. Matt Griswold and Dr. Kavita Babu

Further reading:

CNN article on Chinese government action to limit fentanyl availability:

A CDC report on a fentanyl-associated cluster of deaths in Connecticut.

2016 data on opioid-related overdose from Massachusetts

An interview with Dr. Griswold from the Telegram Gazette.