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Main Ingredients, Cutting Agents, and Adulterants: Fentanyl (brand names include Abstral, Actiq, Duragesic, and Subsys) is a synthetically manufactured opioid drug.1,2 In its various formulations, fentanyl is indicated for use in treating chronic and/or severe pain, such as breakthrough cancer pain.1,2
Illicit sources of fentanyl have been known to go by various street names, such as China girl, China white, Tango & Cash, and poison.7When recreational users refer to a drug being “cut,” it could mean that the drug is diluted or combined with some substance that may or may not be inert in order to produce a larger volume of the drug.
However, in some cases where dealers are attempting to increase the potency of low-grade drugs, fentanyl can be used as an additive to heroin. Fentanyl is often passed off as heroin on the street, and because it is far more potent than heroin, it can increase the risk for a fatal overdose.7
Itself a street drug adulterant, fentanyl may be encountered in combination with numerous other substances, including:8
Illegally manufactured forms of fentanyl are thought to be a major factor in the increasing prevalence of overdoses on heroin and other opiate drugs.9 It is difficult to estimate the number of people who use fentanyl each year, as many people may not know that they are using products that have been cut with fentanyl.
In 2017, there were more than 70,200 deaths estimated to be due to drug overdoses.10 Overdoses attributed to fentanyl or similar drugs (fentanyl analogs) rose the most steeply, with approximately 28,400 deaths in 2017.10 59% of deaths related to opioid use involved fentanyl in 2017, compared to 14.3% in 2010.11
Medical use of fentanyl can be safe when under the supervision of a physician. There are numerous potential side effects of fentanyl that can be monitored in clinical situations, such as in instances of fentanyl being used for postoperative pain or other short-term periods.
Some of the side effects associated with fentanyl use include:11,12
Overdose risks are high when fentanyl is misused. Fentanyl overdose can result in respiratory arrest and hypoxic brain damage. Overdoses with fentanyl or other opioids can be quickly fatal and may require immediate medical attention.11,12
Like all opioid products, the risk to develop significant physiological dependence on fentanyl is extremely high, particularly for people who misuse the drug.12 The development of physical dependence is coupled with a high likelihood of unpleasant opioid withdrawal. Withdrawal symptoms associated with abrupt fentanyl discontinuation are not likely to be fatal, but can be very painful, can compel immediate relapse, and may potentially be associated with certain medical complications such as excessive vomiting, diarrhea and increased risks of dehydration, electrolyte disturbances, and potential aspiration/choking hazards.12,13