Brief description of Fentanyl
Fentanyl is a very powerful opioid analgesic a cousin of heroin which is similar to morphine but more potent than morphine by 50 to 100 times. Although it is a synthetic opioid, a cousin of heroin, it is much deadlier than heroin since Fentanyl is more than 50 times potent than heroin making is much deadlier. A comparison to show how lethal the two drugs shows that a lethal dose of heroin, at 30 milligrams, is equal to a dose of 3 milligrams of fentanyl. It is highly fatal to a point that when rescuers are responding to the intoxication of fentanyl should be extra careful because touching or inhaling the drug can be fatal (Kuczynska et al., 2018). The reason why fentanyl is more potent than heroin is the variance in chemical structure. Although both drugs bind to the “mu-opioid receptor,” in the brain, fentanyl gets to the point of binding in the brain faster than heroin. The reason for that is because it can pass through the fat in the brain more easily than heroin. Another reason why it is dead is that the fentanyl can grab onto the “mu-opioid receptor” tightly that it takes too little to trigger opioid effects in the brain. Fentanyl has been categorized as a schedule II drug since it has a high potential for abuse, with its use having a potential of grave psychological effects and physical dependence (Stanley, 2014). Fentanyl is also considered a Schedule II drug because it is highly dangerous. Fentanyl is a strong opioid and has been used in the management of pain for a long time but its popularity as a drug of abuse has steadily increased despite various government regulations and this has resulted in various socio-economic adversities in the society.
History of Fentanyl
Fentanyl has been used in the United States in the medical field to prevent extreme pain since the 1960s. Illicit entry and use of fentanyl in the United States started a few decades ago from Mexico. Drug cartels prefer to deal with fentanyl because they have was to produce it more easily and cheaply than heroin. The rate of manufacturing fentanyl is faster than that of heroin. Many overdoses were fatal a causing an alarm because of the severity of the situation. The concerns called for special toxicological testing which would detect the presence of fentanyl (Pichini et al., 2018). Most state crime laboratories could not do the special testing and this made the drug use spread rapidly with detection. By the year 2014, the number of fentanyl drug seizures reported by forensic laboratories rose from 618 in 2012 to 4,585. The most affected states in the United States with over 80 percent of the cases were New Jersey, Indiana, Massachusetts, Florida, Maryland, Virginia, Pennsylvania, New Hampshire, and Kentucky. In 2013, Massachusetts’ police crime laboratory found pure fentanyl in just six cases but by 2015, the lab recorded 425 cases. It was in 2016 that the Drug Enforcement Administration (DEA) issued an alert about fentanyl in the whole country (Kuczynska et al., 2018). The DEA said that the occurrence rates of the overdoses related to fentanyl were alarming throughout the United States and that the trend was an important threat to the safety and health of the public.
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Effects of Fentanyl
The effect of fentanyl on the brain is by binding to the brain’s receptors which is similar to that of morphine, heroin, and other opioid drugs. The receptors affected are found in areas that control emotions and pain. After the continuous use of fentanyl, the brain adapts to it reducing the sensitivity to making it difficult to have pleasure except for the drug. The drug, therefore, takes over their lives and seeks the drug to have pleasure making them addicted to it. With prolonged use of fentanyl, a habit is formed which is hard to eliminate (Pichini et al., 2018). The drug may cause serious harm to the user which may include even death. Fentanyl and other opioid analgesics accounted for about half of all the cases that were treated in the American emergency wards in 2012. The patients showed the short-term effects of fentanyl which include, depressed or difficulty breathing, coma, excessive sweating, stiff or rigid muscles, nausea, decreased heartbeat, weakness, dryness of the mouth, constipation, unconsciousness, slow respiration, constriction of pupils, and confusion. The long term effects are based on the addiction of the drugs which make a person dependent upon the drug. The long-term psychological effects of the drug are signs of misjudgments and making poor decisions while at work or even in personal situations (Stanley, 2014). Sustained fentanyl use caused anoxia, reduced supply of oxygen which then leads to multiple organ damage. It also increases the chances of overdose causing death and also harms relationships. Another long-term effect of the drug is that it initiates or stimulates pre-existing psychological issues such as labile and depression with changing moods.
The impact of Fentanyl in the society
Fentanyl abuse not only hurts the individual using it but it also causes socioeconomic problems to the nation. The people who are closest to a person abusing fentanyl are the most affected and especially their families. The burden the drug has on the families in terms of costs, influence and trauma is significant and worrying. It causes stress to the family of the user and also it drains the national resources treating the people addicted to it and also trying to stop the use of the drug. Fentanyl is a major contributor to many social issues in society such as poverty, homelessness, child abuse, and poor health care. The use of the drug also increases the levels of violence in society, there is also a distortion of interpersonal family relationships. There is also a family breakdown of one of the partners is abusing fentanyl or if the parents of a child who is using the drug disagree based on the child’s behavioral change caused by the drug. Moral decay due to the misuse of fentanyl is common with reported cases of robbery, homicide, rape, and domestic violence in society ((Kuczynska et al., 2018).
Current policies, laws and/or regulations of Fentanyl
In 2018, the FDA rolled out an extended-release and long-acting opioid analgesics which covered fentanyl. They formulated a Risk Evaluation and Mitigation Strategy (REMS) which laid down the requirements for the immediate release of opioid analgesics which are intended for use to an outpatient. The stringent requirements help in reducing the misuse of the drug and also to ensure that every amount of the drug is accounted for to avoid selling it to individuals intending to misuse it. The FDA also updated the boxed warnings on the labeling of the container to include the Risk Evaluation and Mitigation Strategy REMS information. The Risk Evaluation and Mitigation Strategy also, for the first time, stretched its requirements to dictate that all health care workers, inclusive of nurses and pharmacists, who manage patients going through excruciating pain, be trained to avoid misuse of fentanyl and other opioid analgesics. The government has, in response to the risk posed by fentanyl, taken steps to strongly regulate the steps taken when seeking the drug to reduce and curtail the access to fentanyl. To prevent new incidences of addiction in the United States the FDA has reduced the exposure to fentanyl (Pichini et al., 2018). The regulation requires that there is a rationalized prescription of the drug. the move will ensure that not only fewer prescriptions of fentanyl are made, but also that the dose prescribed comports with clinical situations and the health need of the patient. There is a formal entry declaration that is implemented by the CBP which is the regulatory authority in charge of all shipments. They interdict any shipment of fentanyl and other opioid analgesics and take them for examination by the FDA.
Treatment options for addiction to Fentanyl
Although it is difficult to treat fentanyl since it is usually used with other expensive drugs because it is cheap, naloxone can be used to treat fentanyl overdose is given early. Naloxone works by rapidly binding on the receptors the fentanyl is binding on and therefore blocking the effects the drug has on a victim. Since fentanyl is a very strong drug than many opioids, several doses of Naloxone have to administer to counter the effects of the drug. To treat addiction, other methods used to treat opioids addictions are applied. For example, a combination of medication and behavioral therapies is effective in treating fentanyl addiction. To reduce the cravings and withdrawal symptoms associated with fentanyl, methadone and Buprenorphine are used. The two drugs bind to the receptors that fentanyl binds to and therefore the body does not crave them. Counseling can be used to treat addicts by applying behavioral therapies. Cognitive-behavioral therapy helps the patient to modify his/her attitudes and behaviors that are related to drug use. It also helps an addict effectively manage stress and triggers (Pichini et al., 2018).
Conclusion
In conclusion, fentanyl is a powerful synthetic opioid that binds to brain receptors. The drug is related to morphine although it is much stronger. It was introduced in the 1960s as a pain reliever and later it got abused with its use increasing rapidly. It causes addiction and it is fatal when it overdoses. Its effects on an individual are life-threatening. It has caused major impacts on society with the increase in robbery, rape, and irresponsibility which have large implications for societal order. Treatment of fentanyl addiction is comprised of a combination of medical and psychological therapy. To alleviate fentanyl use In the society, it is important to provide civic education to youths on the effects of the drug and also give them alternatives to deal with stress which is the major contributor of fentanyl abuse. It is also important to reduce the use of fentanyl to prevent new incidences of addiction.
References
Gold, M. S., Melker, R. J., Dennis, D. M., Morey, T. E., Bajpai, L. K., Pomm, R., & Frost-Pineda, K. (2006). Fentanyl abuse and dependence: further evidence for second hand exposure hypothesis. Journal of addictive diseases , 25 (1), 15-21.
Kuczyńska, K., Grzonkowski, P., Kacprzak, Ł., & Zawilska, J. B. (2018). Abuse of fentanyl: An emerging problem to face. Forensic science international , 289 , 207-214.
Stanley, T. H. (2014). The fentanyl story. The Journal of Pain , 15 (12), 1215-1226.
