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The Differences Between Illicit and Pharmaceutical Fentanyl


Fentanyl is a synthetic opioid more potent than heroin and 100 times stronger than morphine, notes the CDC. In the U.S., it contributes significantly to fatal overdoses and nonfatal overdoses.

Fentanyl comes in two forms: pharmaceutical and illicitly made. They both fall into the category of synthetic opioids. Doctors use pharmaceutical fentanyl to treat severe pain, primarily after surgery and for cancer patients in advanced stages.

Recent cases of overdoses related to fentanyl are, however, linked to illicitly manufactured fentanyl. Illicitly manufactured fentanyl is sold through illegal drug markets and mimics the effects of heroin, the CDC adds. The extreme potency of this drug, which makes drugs cheaper, more powerful, and more addictive, is often added to other drugs.

Pharmaceutical Fentanyl

Fentanyl belongs to the narcotic (opiate) analgesic class of medications. This type of medication alters the way the nervous system and brain react to pain. As such, pharmaceutical fentanyl is often used for managing acute or chronic pain.

More specifically, treatment of breakthrough pain (pain episodes that occur despite round-the-clock pain medication use) can be achieved by taking Actiq brand lozenges, which are available in doses of either 25 or 50 mg daily. pharmaceutical fentanyl can also be taken by patients who are taking a regularly scheduled dose of another narcotic pain medication and are tolerant of narcotic pain medications.

There are various forms and strengths of pharmaceutical fentanyl, including:

  • Transdermal patches (Durogesic®, APO-fentanyl® and generic versions)

  • Lozenges/lollipops (Actiq®)

  • Intravenous injection (Sublimaze® B. BRAUN FENTANYL®)

Usually, Fentanyl is administered four times a day for breakthrough pain, but not more frequently. You should carefully follow the directions on your prescription label, and ask your doctor or pharmacist for clarification if you don't understand anything.

Starting off with a low dose of fentanyl will probably be followed by a gradual increase in dose until you find the dose that relieves your breakthrough pain. Discuss with your doctor how well the medication is working and any side effects you are experiencing, so your doctor can adjust your dose as needed.

Illicit Fentanyl

Fentanyl (IMF) fabricated illegally is available on the drug market in a variety of forms such as liquids and powders.

Compared to many other drugs, fentanyl powder looks very similar. This drug is commonly mixed with heroin, cocaine, or methamphetamine, and then made into pills that mimic other prescription opioid drugs. Drugs laced with fentanyl are extremely dangerous, and many people may not be aware that the drugs are laced with this toxic substance.

IMF can be found in liquid form as nasal sprays, eye drops, or as a drop on paper or candy.

The drug is primarily manufactured abroad, and it is smuggled into the United States via Mexico, states the DEA. Licensed fentanyl is distributed around the country and sold illegally. Due to the lack of official oversight or quality regulation, these counterfeit pills usually contain lethal doses of fentanyl, with no indication of what the promised drug is.

Fentanyl has been intentionally contaminated with illegal drugs in a significant number of cases. Since fentanyl's potent properties and low cost make it attractive to drug dealers, they mix it with heroin, cocaine, methamphetamine, and other drugs without thinking about the risk of a deadly interaction.

It is not an exact science to produce illicit fentanyl. The lethal dose of fentanyl depends on the person's body size, tolerance, and history of use. Analyses conducted by the DEA have found counterfeit pills containing amounts of fentanyl as high as 5.1 milligrams (more than twice the lethal dose).

  • Fentanyl was detected in 42% of pills tested, which is considered a potentially lethal dosage.

  • The distribution of fentanyl by drug trafficking organizations usually takes place in kilogram quantities. Approximately 500,000 people can die from one kilogram of fentanyl.

Fentanyl can be found in many pills without a user knowing it. The pill may contain fentanyl, but a lethal dose cannot be determined until it is taken.

U.S. overdose deaths are primarily caused by synthetic opioids (like fentanyl), according to the CDC. Comparing the 12-month period ending January 31, 2020, with the 12-month period ending January 31, 2021, during this period:

  • The number of opioid overdose deaths rose by 38.1%.

  • Overall drug overdose deaths have increased by 55.6 percent in the past three years, mainly due to synthetic opioid overdoses (primarily illicitly manufactured fentanyl).

Without the prescription and the dispensing by a legitimate pharmacy, you can't tell if a drug is genuine or not. The amount of fentanyl in an individual pill or the amount added to one of the drugs cannot be calculated without laboratory testing. Because of its potency, fentanyl is a particularly dangerous substance.

Street names for IMF include;

  • Apace

  • China Girl

  • China Town

  • China White

  • Dance Fever

  • Goodfellas

  • Great Bear

  • He-Man

  • Jackpot

  • Murder 8

  • Poison

  • Tango & Cash

How Fentanyl Affects the Body

Drug use is never safe at any level. There is always some risk associated with the use of drugs. Be cautious when taking any type of drug.

As with other opioid analgesics, Fentanyl specifically produces relaxation, euphoria, pain relief, sedation, confusion, sleepiness, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.

If the dose is too high, or it’s illicit, you might overdose. These signs include;

  • Tiny, constricted "pinpoint pupils"

  • Losing consciousness or falling asleep

  • Breathing slowly, weakly, or not at all

  • A gurgling or choking sound

  • Limp body

  • Skin that is cold and/or clammy

  • Discolored skin (especially in lips and nails)

If you or someone you know are experiencing these symptoms, call 911 immediately.

There are resources and services available to assist you or someone you know with screening, treatment, and recovery if you have a mental health condition or substance use disorder such as SAMHSA’s National Helpline.


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