Fentanyl
Also known As:
Apache, China girl, China town, China white, murder 8, jackpot, poison, TNT, tango, and cash.
What is it?
Fentanyl is a powerful pain medication and depressant. It is an opioid, like morphine, codeine, oxycodone (oxys) and methadone. Medical fentanyl can be given in the form of injections and tablets, and is most often prescribed as a slow-release patch to people with long-term, severe pain. When used in this way, it can be effective and safe. (CAMH, 2019)
Fentanyl is much stronger than most other opioids—up to 100 times stronger than morphine—and is very dangerous if misused. Even a small amount can cause an overdose and death.
Canada’s illegal drug supply is being contaminated with fentanyl and other fentanyl analogues such as carfentanil. You can’t see, taste or smell fentanyl and a few grains can be enough to kill you. Fentanyl is a cheap way for drug dealers to make street drugs more powerful and it is causing high rates of overdoses and overdose deaths. Drug dealers who make fake pills may not know or control carefully how much fentanyl goes into each pill. In addition. sometimes drugs may accidentally contain fentanyl when drug dealers use surfaces and equipment contaminated with fentanyl (Government of Canada, 2019).
Did you know?
A few grains of fentanyl or a single grain of carfentanil are enough to kill someone.
Where does street fentanyl come from?
Street fentanyl can come from two sources:
Illegal drug labs in Canada or other countries
Fentanyl patches that have been sold by or stolen from people the they were prescribed to
What does it look like?
Most street fentanyl in Canada is produced illegally as a powder. Street fentanyl may be swallowed, smoked, snorted or injected, and is odourless and tasteless.
Prescription fentanyl is released from fentanyl patches by smoking or chewing.
Fentanyl is sold as a powder or a pill, or is cut into (mixed with) drugs such as heroin or cocaine. This type of fentanyl is often sold as another substance, so people may swallow, snort or inject it without knowing it. Many overdoses have occurred because people did not know that the drugs they were taking were contaminated with fentanyl.
Is there a Safe Dose?
Under prohibition and with illicit drugs, there is no safe dose because you may not know the contents or potency of your drugs. There is no safe dose of fentanyl because the drug is extremely potent, and so a dose that is safe for one person under certain circumstances, may be lethal for another.
Testing for fentanyl
Drug checking services help people find out what's in their drug, including if they contain toxic substances like fentanyl. Testing illegal drugs before you take them is one way to reduce the harms of drug use. The most accurate way to test your drugs for fentanyl is to go to a supervised injection or consumption site that offers drug checking services.
If you decide to use fentanyl test strips, it’s important to know there are limitations. No fentanyl test strips are specifically designed to check street drugs before consumption. Fentanyl test strips may not detect fentanyl-like drugs, including carfentanil which may be even more harmful (Government of Canada, 2019), and do not tell you what amount of fentanyl is in your drug. It is important to note that fentanyl could be absent in one part of your drug sample, and present in another. This is why it can be important to test your entire batch of drugs, by dissolving it into a liquid and testing the liquid.
If you do use opioids or drugs that may be contaminated with fentanyl, do not use alone, know the signs of an opioid overdose, and carry naloxone. Naloxone is a medication that can temporarily reverse the effects of an opioid overdose and allow time for medical help to arrive.
Effects
When they're used properly to treat pain, opioids reduce pain and the emotional response to pain. However, when they are misused, they may produce:
Effects include:
Euphoria
Drowsiness
Relaxation
Difficulty concentrating
Physical effects include:
Constricted pupils
Slowed breathing
Nausea
Vomiting
Constipation
Loss of appetite
Sweating
Overdose
Respiratory depression
Death
Cautions and Oversdoses
When someone overdoses on fentanyl, they first become sleepy, and it is hard to wake them. Their breathing becomes slow and shallow. They may snore, and they may pass out.
The person’s body may become limp, their face pale or clammy, and their pulse weak or slow. For lighter-skinned people, the lips and finger tips may turn blue or purple. For darker-skinned people, the inside of the lips may become blue or purple. (CAMH, 2019)
If someone is overdosing, call 911 right away!
While you are waiting for medical help to arrive, you can use your naloxone kit to temporarily reverse the effects of the overdose.
The Good Samaritan Drug Overdose Act protects you from being charged or convicted for drug possession if you call 911 to report an overdose, or if you are at the scene when emergency services arrive. This is true even if you are on probation for possession.
Is it dangerous?
Fentanyl is dangerous for many reasons:
It is often impossible to tell if a powder or pill contains fentanyl. You can’t see it, smell it or taste it. Even your dealer might not know what they are selling or how strong it is.
Because fentanyl is so strong, the difference between a dose that will get you high and a dose that can kill you is very small.
You can overdose even if you use someone's prescription patch and know the dose. Everyone handles fentanyl differently. One person’s dose can kill another person. (CAMH, 2019)
Therapeutic Uses?
Medical fentanyl can be given in the form of injections and tablets, and is most often prescribed as a slow-release patch to people with long-term, severe pain. When used in this way, it can be effective and safe (CAMH, 2019). However, without medical supervision, fentanyl can be extremely dangerous and lethal in small doses.
Harm Reduction Tips
to reduce the possible harms of Fentanyl, the following is suggested:
When taking illicit (street) drugs, there is no safe dose because of the potency of fentanyl and carfentanil
Know your source
Test your supply for fentanyl and do a test dose
Do not mix with other drugs: depressants, such as opioids, alcohol, and sedatives like Ativan, Valium, and Xanax greatly increase your risk of overdose
Note that fentanyl patches, if cut into smaller pieces, may result in unreliable doses and a faster (and more dangerous) release of drugs into your system
If injecting, snorting, or smoking fentanyl, follow safer use tips
Do not use alone and stagger or alternate your drug use with other people
Always carry naloxone and know how to recognize and respond to an overdose
Legal Status: Use, Possession, & Distribution
Fentanyl is only legal when it is prescribed by a physician.
Purchasing, possessing, and using fentanyl without a physician is illegal in Canada
The Canadian government is increasing sanctions against people who traffic and sell fentanyl, and in some cases, is attempting to persecute traffickers with manslaughter
While fentanyl is illegal, the Good Samaritan Drug Overdose Act protects most people who overdose and respond to overdose emergencies from simple possession charges
A way forward?
We are in the midst of an unprecedented overdose epidemic in Canada, with a huge number of overdose deaths being attributed to opioids including fentanyl.
While education campaigns, alternative pharmaceutical and prescription practices, supervised consumption facilities, and take-home naloxone programs are all important factors in remedying the overdose crisis, we need a safe supply of opioids to end the overdose crisis. This means the decriminalization of drugs, and safe, legal means by which people can get the medicine and medical attention that they need.
Prohibition and criminal sanctions does not decrease the prevalence of strong drugs like fentanyl. Rather, it results in the increasing concentration of these drugs, in an effort to make them easier to transport and distribute in the black market.
Addressing the overdose crisis will require treating fentanyl and other substance use and distribution, like a health and social issue, rather than a criminal one.
References
CAMH (2019). Fentanyl. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/street-fentanyl
Government of Canada. (2019). Fentanyl. Retrieved from https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/fentanyl.html
Image sources
Banner: Heroin, fentanyl, and carfentanil. Washington Post. Retrieved from https://www.washingtonpost.com/graphics/2019/national/fentanyl-questions-and-answers/
Injectable fentanyl. (2018). ABC Australia. Retrieved from https://www.abc.net.au/news/2018-12-03/china-agrees-to-control-fentanyl-at-g20-summit/10576888
Fentanyl powder. (2018). The Washington Post. Retrieved from https://time.com/5477073/fentanyl-overdose-deaths/