As the opioid epidemic continues to rage, synthetic drugs are leading the charge these days. Deaths involving a synthetic opioid drug jumped nearly 75 percent between 2014 and 2015, CNN reports, and fentanyl is considered the driving force. This powerful opioid is between 50 and 100 times more potent than morphine, the National Institute on Drug Abuse (NIDA) warns. It can be absorbed through the skin on contact or even breathed in accidentally.
Fentanyl is a prescription pain reliever marketed in an injectable form, as a lozenge or lollipop, and as an extended-release patch. It is also made illegally and sold on the black market as it can be manufactured in a lab.
The U.S. Centers for Disease Control and Prevention (CDC) reports that submissions of drugs seized by law enforcement and testing positive for fentanyl spiked more than 400 percent between 2013 and 2014, as the drug has been flooding the American market. Fentanyl is commonly laced into various drugs. Among them are:
Fentanyl is usually manufactured into a white powder form that is nearly impossible to tell apart from drugs like cocaine and heroin. Someone taking one of these drugs may not have any idea that it contains fentanyl. Fentanyl is lethal in doses as small as 2 milligrams, USA Today warns.
Fentanyl is being used to cut drugs like heroin to stretch the product. Heroin comes from the opium poppy plant, and therefore the plant is needed to market the drug. Fentanyl, on the other hand, can be made in a laboratory, making it easier to get and often cheaper than heroin and other plant-based drugs. Fentanyl is often manufactured in China or Mexico and then imported into the United States, The Washington Post reports. It is also mailed through the U.S. Postal Service directly into the country.
Unwittingly taking fentanyl can prove deadly, but there are measures a person can take to try and determine if drugs contain fentanyl. As illegal drugs are not regulated, it can be difficult to be sure exactly what is in them, rendering illicit drugs extremely risky.
Fentanyl can be hidden in plain sight. The majority of the popular sleep aid Xanax (alprazolam) that is being sold on the street is counterfeit and likely laced with fentanyl. Illicitly produced fentanyl can be pressed into pill form and passed off as other opioid pain relievers like Norco (hydrocodone/acetaminophen), CNN publishes. Fentanyl is regularly showing up in the heroin supply, as it can be transported in smaller batches and packs a bigger punch in lower doses, Forbes explains.
As fentanyl, heroin, and prescription painkillers are all opioids, they act on the central nervous system in the same way, increasing the risk of overdose at even lower doses. Fentanyl also is being laced into cocaine. NPR reports that 7 percent of all cocaine seized in New England in 2016 contained fentanyl.
Typically, when a stimulant like cocaine is mixed with a depressant like fentanyl, it is called a “speedball.” This mixture is often intentional to try and counteract the negative effects of each drug. There may be a more vicious intent with lacing fentanyl into cocaine without people’s knowledge, however, and that is because of the high addictive potential of the potent opioid. While cocaine is addictive on its own, fentanyl may be even more so. The combination of both drugs can quickly become deadly, and the effects are often unpredictable and more difficult to reverse.
There is really no way to tell if a drug contains fentanyl just by looking at it. Fentanyl and other white powder drugs like cocaine and heroin are just not different enough to distinguish on sight alone.
Fentanyl test kits exist, and they are relatively cheap to obtain. The journal Scientific American publishes that they cost about $1, and they are very close to 100 percent accurate on contact. The test kits are being handed out at some harm reduction and clean needle exchange program sites in some U.S. cities in an attempt to reduce the number of accidental overdoses involving fentanyl. Knowing that a drug contains fentanyl may keep people from taking it at all, or it can at least alert them to take a lower dose or take it in the presence of someone who is carrying the opioid antagonist and overdose-reversal drug Narcan (naloxone).
Test kits and strips are based on an immunoassay technology, which can tell when a specific antibody binds with an antigen to signal the presence of fentanyl. To use a test strip:
Many fentanyl test kits were initially intended to test urine for the presence of the drug, but now they are being used to see if drugs are “safe” to take. While they seem to be mostly accurate, fentanyl analogs are changing all the time, so there is no way to be entirely sure that an illegal drug contains fentanyl or even some other potentially deadly substance.
As law enforcement cracks down on fentanyl and the chemicals needed to make it, drug manufacturers alter its chemical makeup just enough to avoid detection. This can interfere with the accuracy of a kit designed to test for that specific chemical.
There is no safe amount of an illegal drug. Most are not pure and contain at least some form of a cutting agent, toxic substance, or other drugs. That being said, using a fentanyl test kit can at least help to reduce the risk of a potentially life-threatening overdose, as most people would likely choose to avoid a drug containing the potent and highly addictive opioid because the risk is just too high.
(October 2017). CNN. from https://www.cnn.com/2017/10/24/health/fentanyl-visual-guide/index.html
(June 2016). National Institute on Drug Abuse. from https://www.drugabuse.gov/drugs-abuse/fentanyl
(August 2016). Centers for Disease Control and Prevention. from https://www.cdc.gov/mmwr/volumes/65/wr/mm6533a2.htm
(August 2017). The Washington Post. from https://www.washingtonpost.com/graphics/2017/national/fentanyl-overdoses/?utm_term=.7c49ca8858e3
(February 2018). Fox 11 Los Angeles. from http://www.fox5dc.com/news/counterfeit-xanax-laced-with-deadly-fentanyl-becoming-popular-party-drug
(August 2017). CNN. from https://www.cnn.com/2016/05/10/health/fentanyl-opioid-explainer/index.html
(March 2018). Scientific American. from https://www.scientificamerican.com/article/1-fentanyl-test-strip-could-be-a-major-weapon-against-opioid-ods/