What Is Fentanyl and Why Is It So Dangerous?

Drug users who are accustomed to using heroin or prescription pain pills say illicit fentanyl’s effect can be more dramatic and shorter lasting than other opioids, making it more difficult to hold down a job as they seek out drugs every few hours.

Naloxone is an antidote to opioids that can reverse the effects of an overdose within two to three minutes, according to the Mayo Clinic.

Still, according to the National Harm Reduction Coalition, it can be difficult to tell if a person is just very high or experiencing an overdose. People who are high may display slurred speech or seem dazed but still be able to respond to a loud noise or someone lightly shaking them, the group says.

How do you treat an overdose?
Naloxone is an antidote to opioids that can reverse the effects of an overdose within two to three minutes, according to the Mayo Clinic. Naloxone has virtually no effect in people who haven’t taken opioids, according to the World Health Organization.

The overdose-reversal drug binds to opioid receptors and reverses or blocks the effects of opioids. It comes in two forms: nasal sprays and injectables. Nasal sprays such as Narcan are often stocked by first responders and at healthcare facilities. Groups working with drug users typically have an injectable version of the drug on hand that can be injected into the muscle of an arm or leg to reverse an overdose.

The Substance Abuse and Mental Health Services Administration recommends performing cardiopulmonary resuscitation, also known as CPR, if the person isn’t breathing on their own and said it can save a person’s life regardless of whether naloxone is present. The agency says it is important to stay with the person until medical personnel arrive, reassure them and explain what is happening, as they may reawaken agitated, confused or could overdose again if the naloxone wears off before the opioid.

Recently, the U.S. Food and Drug Administration encouraged pharmaceutical companies to apply for approval for over-the-counter versions of overdose-reversal medications such as Narcan to help address a swelling overdose crisis from bootleg versions of the powerful opioid fentanyl.

The pharmaceutical nonprofit Harm Reduction Therapeutics Inc. has already received a priority review from the agency to make an inexpensive naloxone nasal spray for use without a prescription. The company said the FDA gave it a target approval date of April 28.

Emergent BioSolutions Inc., the maker of the Narcan brand of naloxone nasal spray, said its application for over-the-counter status received an expected approval date of March 29.

What is “tranq” drug xylazine?
Xylazine is a veterinary tranquilizer that has increasingly been showing up in illicit drugs, including in fentanyl. The drug, which is authorized only for animals, has been complicating overdoses and producing severe wounds for users that can lead to serious infection and amputation.

Dealers may mix xylazine into fentanyl to save money, federal law-enforcement authorities have said. The drug—known as “tranq” among some users—can be purchased at low prices from Chinese suppliers and offset some of the opioid in the mix.

Drug users often don’t know that xylazine is being mixed into their fentanyl batch and unknowingly become hooked on both substances. Drug users say xylazine can prolong a high from fentanyl but that also often means being unconscious, sometimes for hours at a time.

In February, the FDA said it would restrict imports of xylazine and more carefully scrutinize shipments of the drug into the U.S. to check that they are bound for legitimate use in animals.
What is harm reduction?

Harm reduction is a public-health strategy aimed at reducing as much harm as possible to people while they are using drugs, rather than stopping them from taking substances altogether.

Groups that practice harm reduction for drug users teach about using clean needles to prevent infection and the spread of disease. Some groups provide fentanyl test strips so that users can test drugs for fentanyl and hand out naloxone to prevent deaths from overdose. An increasing number of groups supervise drug consumption. The Biden administration is the first to name harm reduction as a priority for drug policy.

Who is affected by overdose rates?
Disparities in access to treatment are driving up overdose rates among Black and Native American people, the CDC has said. Overdose deaths per 100,000 people increased 44% for Black people and 39% for Native Americans in 2020 from a year earlier, compared with a 22% increase among white people, according to a study in which the CDC analyzed 25 states and Washington, D.C.

Deaths from fentanyl have affected every age group, but particularly the 25-to 34-year-old and 35-to 44-year-old populations. These two groups combined made up more than half of all synthetic opioid overdose deaths in 2021, according to preliminary CDC data.

Young children have also been directly affected by fentanyl. There were 133 opioid-related deaths among children younger than 3 last year, according to federal mortality data.

Overdose rates were higher in areas with more opioid-treatment programs than average, a finding that the study’s authors said demonstrated other barriers to access for some people. Overdose rates were also higher in counties with higher income inequality, according to the study. The findings show how the escalating overdose crisis is exacting a mounting toll on minority groups that are in some cases marginalized by the healthcare system, CDC researchers said.

Some prisons and jails have programs that dispense antiaddiction medications to help put inmates who are addicted to opioids on a path to sobriety and curb overdose rates. The Biden administration has said it wants medication available for drug users in federal custody and at half of the state prisons and jails by 2025.

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