Buprenorphine (BUP)

Buprenorphine drug testing

Because of its low opiate effect, buprenorphine has a lower potential for abuse than other opioid drugs, but it can still be abused through crushing of tablets for snorting or for injection preparations.

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Cocaine (COC)

Cocaine drug testing

Cocaine (benzoylmethylecgonine) is a crystalline alkaloid drug obtained from the leaves of the coca plant, native to South America, where the leaves are chewed as a mild stimulant.

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Fentanyl

fentanyl drug testing

Fentanyl is a powerful synthetic opioid analgesic with a rapid onset and short duration of action. It can also be used in combination with benzodiazepines as an anesthetic.

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Overdose Deaths Involving Synthetic Opioids

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heroin carfentanil fentanyl

According to the CDC, death rates involving synthetic opioids (other than methadone), which include drugs such as tramadol and fentanyl.

  • In 2017, more than 28,000 deaths involving synthetic opioids (other than methadone) occurred in the United States, which is more deaths than from any other type of opioid.
  • Also in 2017, the largest increase in synthetic opioid overdose death rates was in males aged 25-44.
  • Deaths from synthetic opioids significantly increased in 23 states and the District of Columbia from 2016 to 2017.
  • West Virginia, Ohio, and New Hampshire had the highest death rates from synthetic opioids.1

Synthetic opioid overdose death rates (other than methadone) increased across all demographics, county urbanization levels, and numerous states. State reports have indicated that increases in synthetic opioid-involved deaths have been associated with the number of drug submissions obtained by law enforcement that test positive for fentanyl but not with fentanyl prescribing rates. These reports indicate that increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths, and the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical.2,3,4

There are also fentanyl analogs, such as acetylfentanyl, furanylfentanyl, and carfentanil, which are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Recent surveillance has also identified other emerging synthetic opioids, like U-47700.5 Estimates of the potency of fentanyl analogs vary from less potent than fentanyl to much more potent than fentanyl, but there is some uncertainty because potency of illicitly manufactured fentanyl analogs has not been evaluated in humans. Carfentanil, the most potent fentanyl analog detected in the U.S., is estimated to be 10,000 times more potent than morphine. 5,6

 

References

  1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. WR Morb Mortal Wkly Rep. ePub: 21 December 2018.
  2. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-Involved overdose deaths – 27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65(33):837-43.
  3. Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, et al. Increases in fentanyl-related overdose deaths – Florida and Ohio, 2013-2015. Morb Mortal Wkly Rep. 2016;65(33):844-9.
  4. O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:897–903.
  5. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202.
  6. O’Donnell J, Gladden RM, Mattson CL, Kariisa M. Notes from the Field: Overdose Deaths with Carfentanil and Other Fentanyl Analogs Detected – 10 States, July 2016-June 2017. MMWR Morb Mortal Wkly Rep. July 2018. 67(27);767–768.

What is Fentanyl?

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fentanyl citrate

Fentanyl is a synthetic (man-made) opioid 50 times more potent than heroin and 100 times more potent than morphine. There are two types of fentanyl:

  • Pharmaceutical fentanyl is primarily prescribed to manage severe pain, such as with cancer and end-of-life palliative care.
  • Non-pharmaceutical fentanyl is frequently referred to as illicitly manufactured fentanyl (IMF). IMF is often mixed with heroin and/or cocaine or pressed into counterfeit pills—with or without the user’s knowledge.

Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery and in cases of extreme injury.2 It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.3 Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects.

In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.3,4 Street names for illegally used fentanyl include Apache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash.

Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.5 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.

References

  1. https://www.drugabuse.gov/publications/drugfacts/fentanyl
  2. Nelson L, Schwaner R. Transdermal fentanyl: Pharmacology and toxicology. J Med Toxicol.2009;5(4):230-241. doi:10.1007/BF03178274
  3. Garnock-Jones KP. Fentanyl Buccal Soluble Film: A Review in Breakthrough Cancer Pain. Clin Drug Investig.2016;36(5):413-419. doi:10.1007/s40261-016-0394-y
  4. Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration. Fentanyl Fact Sheet. March 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf.
  5. on. Acetyl fentanyl Fact Sheet. July 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/acetylfentanyl.pdf.

How do people use fentanyl?

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Fentanyl Drugs

When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops.2

The illegally used fentanyl most often associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.3

Some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose. To learn more about the mixture of fentanyl into other drugs, visit the Drug Enforcement Administration’s Drug Facts on fentanyl.

How does fentanyl affect the brain?

Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.4 After taking opioids many times, the brain adapts to the drug, diminishing its sensitivity, making it hard to feel pleasure from anything besides the drug. When people become addicted, drug seeking and drug use take over their lives.

Fentanyl’s effects include

  • extreme happiness
  • drowsiness
  • nausea
  • confusion
  • constipation
  • sedation
  • problems breathing
  • unconsciousness

References

  1. https://www.drugabuse.gov/publications/drugfacts/fentanyl
  2. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776-789.
  3. Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration
  4. on. Acetyl fentanyl Fact Sheet. July 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/acetylfentanyl.pdf.