Poppies, the original source of opium…
A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009.
For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose. Fentanyl is a potent medication, useful in the operating room to cover the intense but short-lived stimulation of surgery. The onset of action is very fast, and the time that the drug effect lasts is relatively brief.
But fentanyl was never intended for casual use. Fentanyl is many times more potent than morphine; 100 micrograms, or 0.1 mg, of IV fentanyl is roughly equivalent to 10 mg of IV morphine. In March, the LA Times reported that 28 overdoses — six of them fatal — occurred in Sacramento over the course of just one week. The victims had taken pills that resembled Norco, a common pain reliever, but in fact the pills were laced with fentanyl. Even tiny amounts were enough to be lethal.
Like all opioids, fentanyl reduces the drive to breathe, and after a large enough dose a patient will stop breathing entirely. In addition to its effect on respiratory drive, fentanyl may also produce rigidity of the muscles in the chest and abdomen, severe enough to hamper attempts to ventilate or perform CPR.
What exactly is fentanyl?
Fentanyl is an inexpensive member of a class of drugs called “opioids”, which are powerful pain relieving medications. The word “opium” is derived from the Greek word for juice, because the juice of the poppy flower was the original source of opium. Starting in Mesopotamia, the opium poppy has been cultivated since at least 3000 BC. The term “opiate” is used to designate drugs derived from opium. Morphine was the first of these, isolated in 1803, followed by codeine in 1832.
The development of techniques to synthesize drugs in a laboratory, as opposed to the cultivation of poppy fields, has led to the use of the term “opioids” to refer to any and all substances that treat pain by acting on opioid receptors in the central nervous system. The term “narcotic” is often used as a synonym. It’s derived from the Greek word for stupor, and is used to refer to any morphine-like drug with the potential for addiction.
Fentanyl is cheap, and the powdered form is being synthesized in clandestine laboratories in the U.S. and Mexico according to news reports. What’s leading to the spate of new overdoses is the fact that some dealers are quietly adding fentanyl to heroin to increase the “high”. A user injects what he thinks is his usual quantity of heroin, not realizing that it may be mixed with fentanyl. The mixture is far more potent and may be deadly.