What is fentanyl?

UPDATE: 2018-08-06 Fentanyl is in the news again with new stats and warnings about deaths. Of course, heroin and morphine still account for most illicit drug poisonings (overdoses).

Fentanyl, N-(1-(2-phenylethyl)-4-piperidinyl)-N-phenylpropanamide, is a synthetic opioid type analgesic invented in 1959 but introduced only in the 1990s for palliative care in terminally ill patients. It is 80 to 100 times more active than morphine and about 40 to 50 times stronger than heroin (diamorphine). It also goes by the name of fentanil (sic), Sublimaze, Actiq, Durogesic, Duragesic, Fentora, Matrifen, Haldid, Onsolis, Instanyl, Abstral, and Lazanda1. It works quickly and its effects last only a short time as it trips the mu-opioid receptors in the brain.

It is widely used in medicine (often in skin patches) but, is also a drug of abuse and has been since the 1970s. Unfortunately, its strength means overdosing is a serious risk leading to respiratory collapse rather than liver failure. There have been several prominent cases in the last few months and pundits are talking of a fentanyl epidemic. Perhaps the most prominent recent case is the accidental death of pop star Prince (Prince Rogers Nelson) in April 2016. The Midwest Medical Examiner’s Office announced on 2nd June its findings regarding his death and concluded an accidental death from fentanyl toxicity. You can read the Office’s PDF press release here. Deaths from fentanyl overdose in the drug community are, in some US states, such as New Hampshire, far outstripping heroin overdoses, according to the New York Times. It is, worryingly, used increasingly by drug dealers to cut heroin.

Fentanyl was used by the Russian security forces in a spray to incapacitate people in the Moscow theatre hostage crisis in October 2002. Some 130 of the 850 hostages died from respiratory problems and choking having not received adequate medical attention once the siege was ended, essentially they were not put into the recovery position. BBC report.

As with most drugs of abuse, they are rapidly and widely adopted by popular culture. Fentanyl has many street names including Apache, China Girl, China White, Dance Fever, Goodfella, Jackpot, Murder 8, and TNT.

Updates from March that were shown to be irrelevant

UPDATE: 2018-03-08 As unlikely as it ever sounded, fentanyl was not the ‘agent’ used to attack Skripal and his daughter. Official line is a nerve agent, although they’re not saying which, probably VX. [[Turned out to be a generic Novichok agent that is yet to be identified publicly as of 2018-08-07]]

2018-03-06 Fentanyl is in the news again today with suspicions that it was used to poison Russian former Colonel Sergei Skripal (66) and his 33-year old daughter who was visiting from Russia. Both were seen sitting apparently catatonic on a park bench in the English town of Salisbury, Wiltshire, and eventually taken to the local hospital emergency department. Reports suggest that the pair had eaten at a Zizzi restaurant earlier in the evening. One witness claimed to have seen the man vomiting. Paramedics attended and a police “specialist chemical response unit” had removed an “unknown substance” which had been wrapped in several protective layers. Of course, you don’t lock down a whole A&E department because someone has OD’ed on fentanyl…I will update as and when.