Fentanyl is a powerful opioid anesthetic and analgesic, the use of which has caused an increasing public health threat in the United States and elsewhere. Fentanyl was initially approved and used for the treatment of moderate to severe pain, especially cancer pain. However, recent years have seen a growing concern that fentanyl and its analogs are widely synthesized in laboratories and adulterated with illicit supplies of heroin, cocaine, methamphetamine, and counterfeit pills, contributing to the exponential growth in the number of drug-related overdose deaths.
Fentanyl was first developed in 1960 by Paul Janssen as a potent opioid anesthetic and analgesic. At the time, fentanyl was the fastest-acting opioid discovered to date and more powerful than morphine (50–100 times) and heroin (30–50 times). Transdermal, intravenous, and transbuccal fentanyl administration and several other drugs with chemical structures that are similar to fentanyl have been developed, approved, and used for surgical anesthesia and the management of severe cancer pain and perioperative pain, eventually becoming the most often used synthetic opioid in clinical practice. Since 1979, fentanyl and its analogs have been synthesized in laboratories and sold as heroin substitutes or mixed with other illicitly sourced drugs, leading to an increase in fentanyl-related overdose deaths
Based on data from the National Vital Statistics System, 599,255 drug overdose deaths occurred from 1979 to 2016 in the United States, and the overall mortality rate has seen exponential growth. Fentanyl-related overdose deaths predominantly occurred in the northeastern United States, mostly affecting younger people (20–40 years of age), and grew sharply since 2013.
Rapid death from ingesting fentanyl has become increasingly more common. Its high potency, fast onset of action, and duration of the desired effect may be particularly important contributing factors to the higher risk of overdose deaths and social consequences. Fentanyl has become a major contributor to cocaine-related fatal overdoses. The rate of fentanyl-related overdose deaths increased 55% between 2015 and 2017 in New York city. Synthetic opioids are also increasingly detected in illicit supplies of heroin, methamphetamine, and counterfeit pills.
Moreover, the number of fatal overdoses from synthetic opioids, primarily fentanyl and its analogs, was 19,547 in 2016 in the United States, and this rate increased by 88% per year from 2013 to 2016.
Deaths that were attributable to illicit fentanyl use were first reported in the early 1980s and occurred sporadically in the United States. A surge in the occurrence of fentanyl-related fatalities among illicit drug users occurred in 2006. A total of 1013 deaths in six states occurred from April 4, 2005, to March 28, 2007. Since then, the prevalence of opioid-related mortality has increased persistently, and the number of reported fentanyl-related deaths more than doubled (from 2628 to 5544) between 2012 and 2014. The rate of fentanyl-related overdose deaths increased from <15% in 2010 to ~50% 2017 marion county, indiana. the presence of fentanyl and its analogs has become a central contributor increase number opioid-related overdose deaths. preliminary estimates opioid deaths united states 2016 revealed that have contributed nearly half moreover, were attributable illicitly manufactured quadrupled between july 2015 june montgomery ohio. heroin-positive cases declined while methamphetamine-positive increased these victims. is ~30–50 times more potent than heroin, smaller volumes heroin other drugs are adulterated with can produce powerful effects lower production costs. crisis likely around world, especially when they mixed drugs, route administration. high risk was found among this vulnerable population exhibited exposure, thus highlighting pressing need develop appropriate harm-reduction strategies, despite beneficial clinical anesthetic pain-relieving fentanyl, frequent use primarily affects nervous system (cns) gastrointestinal, cardiovascular, pulmonary systems cause several side effects. rewarding abuse potential. repeated leads development tolerance drug dependence. analyses adverse-event reporting states, europe, kingdom shown fentanyl-related misuse, abuse, dependence, withdrawal steadily 2004 2018, resulting prolonged hospitalization or death. mental disorders, such as depression, insomnia, suicidality, also occur contributing relapse higher respiratory depression treatment disorders may help prevent fatalities achieve abstinence. conclusion, overdoses, analogs, major threat both individual public health. cardiovascular effects, neuropsychiatric symptoms associated lethality. *pieces collected from nature.com