Fentanyl

Effects

Analgesiaeuphoriafeelings of relaxationsedative effectschanges in focusattentionrespiratory depressionnauseaconstipationdry mouthsomnolenceconfusionweaknesssweatingfatiguedizzinessanxiety TS

Overview

Fentanyl (also known as Fentanil and by the brand names Sublimaze, Actiq, Durogesic, Duragesic, Fentora, Matrifen, Haldid, Onsolis, Instanyl, Abstral, Lazanda among others) is a potent opioid substance of the anilidopiperidine class. It is a strong agonist at the μ-opioid receptors and approximately 40 to 50 times more potent than pharmaceutical grade (i.e. 100% pure) heroin and roughly 80 to 100 times more potent than morphine.[1–6] PW⚠ PsychonautWiki itself has flagged this text: citation needed.

Fentanyl is a synthetic opiate analgesic with a rapid onset and short duration of action. It is a strong agonist at the μ-opioid receptors and is historically used to treat breakthrough pain. Fentanyl is approximately 100 times more potent than Morphine, and is commonly used as a patch. Sometimes used as an adulterant for heroin, which has led to many overdose deaths. TS

Fentanyl is a highly potent synthetic opioid of the piperidine family, used primarily as pain medication. It is 50 to 100 times more potent than morphine. Its primary clinical use is in pain management for cancer patients and those recovering from surgery. Fentanyl is also used as a sedative for intubated patients. Fentanyl has a short duration of action. Fentanyl works by activating μ-opioid receptors. Brand names include Actiq, Duragesic, and Sublimaze, among others.[7–11] WP

Fentanyl was first synthesized by Paul Janssen in 1960 and was approved for medical use in the United States in 1968. In 2015, 1600 kg were used in healthcare globally. As of 2017, fentanyl was the most widely used synthetic opioid in medicine; in 2019, it was the 278th most commonly prescribed medication in the United States, with more than a million prescriptions. It is on the World Health Organization's List of Essential Medicines.[10][12–17] WP⚠ The source also gives this in other units.

The effects of fentanyl are similar to those of other opioids, causing sedation and analgesia at clinical doses. The most common adverse effects are respiratory depression, emesis, and asthenia. Bradycardia and apnea are uncommon side effects but are serious and can lead to death outside of clinical settings. Fentanyl exerts its actions as an agonist of the μ-opioid receptor and κ-opioid receptor. The μ-receptor agonism is responsible for the respiratory depression and generalized analgesia whilst the κ-receptor agonism is responsible for sedation and spinal analgesia. Fentanyl is a potent μ-receptor agonist but has less affinity for the κ-receptor. WP

Fentanyl is contributing to an epidemic of synthetic opioid drug overdose deaths in the United States. From 2011 to 2021, overdose deaths involving prescription opioid (natural and semi-synthetic opioids and methadone) per year remained stable, while synthetic opioid (primarily fentanyl) associated overdose deaths per year increased from 2,600 overdoses to 70,601. Fentanyl was involved in the most drug overdose deaths in the United States in 2018. The United States National Forensic Laboratory estimates fentanyl reports by federal, state, and local forensic laboratories increased from 4,697 reports in 2014 to 117,045 reports in 2020. Fentanyl is often mixed, cut, or ingested alongside other drugs, including cocaine and heroin. Fentanyl has been reported in pill form, including pills mimicking pharmaceutical drugs such as oxycodone. Mixing with other drugs or disguising as a pharmaceutical makes it difficult to determine the correct treatment in the case of an overdose, resulting in more deaths. Emerging adulterants have further complicated the evolving fentanyl supply.[9][18][19][20] WP

In an attempt to reduce the number of overdoses from taking other drugs mixed with fentanyl, drug testing kits, strips, and labs are available.[21][22] WP

History

History

Fentanyl was first synthesized in Belgium by Paul Janssen under the label of his relatively newly formed Janssen Pharmaceutica in 1959. It was developed by screening chemicals similar to pethidine (Demerol) for opioid activity. The widespread use of fentanyl triggered the production of fentanyl citrate (the salt formed by combining fentanyl and citric acid in a 1:1 stoichiometric ratio). Fentanyl citrate entered medical use as a general anesthetic in 1968, manufactured by McNeil Laboratories under the brand name Sublimaze.[29–33] WP

In the mid-1990s, Janssen Pharmaceutica developed and introduced into clinical trials the Duragesic patch, which is a formulation of an inert alcohol gel infused with select fentanyl doses, which are worn to provide constant administration of the opioid over 48 to 72 hours. After a set of successful clinical trials, Duragesic fentanyl patches were introduced into medical practice.[34] WP

Legal status

• Austria: Fentanyl is legal for medical use under the AMG (Arzneimittelgesetz Österreich) and illegal when sold or possessed without a prescription under the SMG (Suchtmittelgesetz Österreich). PW⚠ PsychonautWiki itself has flagged this text: citation needed.
• Australia: Fentanyl is placed under Schedule 8, meaning that it is available for medical use, but possession, production or supply of it is illegal without authority.[35] PW
• Canada: Fentanyl is a Schedule I drug in Canada's Controlled Drugs and Substance Act.[36] PW
• Germany: Fentanyl is a controlled substance under Anlage III of the BtMG. It can only be prescribed on a narcotic prescription form.[37] PW
• Netherlands: Fentanyl is a List I substance of the Opium Law. PW
• Russia: Fentanyl is a Schedule II controlled substance.[38] PW
• Switzerland: Fentanyl is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.[39] PW
• Turkey: Fentanyl is a 'red prescription' only substance and illegal when sold or possessed without a prescription.[40] PW⚠ PsychonautWiki itself has flagged this text: citation needed.
• United Kingdom: Fentanyl is a controlled Class A drug under the Misuse of Drugs Act 1971.[41] PW
• United States: Fentanyl is a Schedule II controlled substance per the Controlled Substance Act. Distributors of Abstral are required to implement an FDA-approved risk evaluation and mitigation strategy (REMS) program. Health insurers have begun to require precertification and/or quantity limits for Actiq prescriptions. PW

Legal status

Effective from May 2019, China officially classified all forms of fentanyl as controlled narcotics.[42] WP

In the UK, fentanyl is classified as a controlled Schedule II, Class A drug under the Misuse of Drugs Act 1971.[43] WP

In the Netherlands, fentanyl is a List I substance of the Opium Law.[44] WP

In the US, fentanyl is a Schedule II controlled substance per the Controlled Substances Act. Distributors of Abstral are required to implement an FDA-approved risk evaluation and mitigation strategy (REMS) program. In order to curb misuse, many health insurers have begun to require precertification and/or quantity limits for Actiq prescriptions.[45–49] WP

In Canada, fentanyl is considered a schedule I drug as listed in Canada's Controlled Drugs and Substances Act. Some fentanyl precursors, such as the piperidones (after October 2023) have been banned under its Precursor Control Regulations, which have been in place at least since November 2016.[50][51][52] WP

Enforcement

The fentanyl supply chain in Mexico consists of a vast and elusive network, potentially involving hundreds of players. U.S. and Mexican anti-narcotics officials acknowledge that the exact number is unknown. Some brokers operate as specialists within major cartels, while others act independently. A major challenge in disrupting this trade lies in the global chemical industry. Many of the compounds used to manufacture fentanyl have legitimate industrial applications, classifying them as dual-use chemicals. These substances are often unregulated or only lightly controlled in key countries such as the United States, Mexico, and China. This regulatory gap enables brokers to evade detection, navigating between the legal chemical trade and the illicit drug market to acquire the necessary precursors.[53] WP

Several large quantities of illicitly produced fentanyl have been seized by U.S. law enforcement agencies. In November 2016, the DEA uncovered an operation making counterfeit oxycodone and Xanax from a home in Cottonwood Heights, Utah. They found about 70,000 pills in the appearance of oxycodone and more than 25,000 in the appearance of Xanax. The DEA reported that millions of pills could have been distributed from this location over the course of time. The accused owned a tablet press and ordered fentanyl in powder form from China. A seizure of a record amount of fentanyl occurred on 2 February 2019, by U.S. Customs and Border Protection in Nogales, Arizona. The 254 lb of fentanyl, which was estimated to be worth US$3.5M, was concealed in a compartment under a false floor of a truck transporting cucumbers. The "China White" form of fentanyl refers to any of a number of clandestinely produced analogues, especially α-methylfentanyl (AMF). One US Department of Justice publication lists "China White" as a synonym for a number of fentanyl analogues, including 3-methylfentanyl and α-methylfentanyl, which today are classified as Schedule I drugs in the United States. Part of the motivation for AMF is that, despite the extra difficulty from a synthetic standpoint, the resultant drug is more resistant to metabolic degradation. This results in a drug with an increased duration.[54–59] WP⚠ The source also gives this in other units.

In June 2013, the United States Centers for Disease Control and Prevention (CDC) issued a health advisory to emergency departments alerting to 14 overdose deaths among intravenous drug users in Rhode Island associated with acetylfentanyl, a synthetic opioid analog of fentanyl that has never been licensed for medical use. In a separate study conducted by the CDC, 82% of fentanyl overdose deaths involved illegally manufactured fentanyl, while only 4% were suspected to originate from a prescription.[60][61] WP

Beginning in 2015, Canada has seen several fentanyl overdoses. Authorities suspected that the drug was being imported from Asia to the western coast by organized crime groups in powder form and being pressed into pseudo-OxyContin tablets. Traces of the drug have also been found in other recreational drugs, including cocaine, MDMA, and heroin. The drug has been implicated in the deaths of people from all walks of life—from homeless individuals to professionals—including teens and young parents. Because of the rising deaths across the country, especially in British Columbia where 1,716 deaths were reported in 2020 and 1,782 from January to October 2021, Health Canada is putting a rush on a review of the prescription-only status of naloxone in an effort to combat overdoses of the drug. In 2018, Global News reported allegations that diplomatic tensions between Canada and China hindered cooperation to seize imports, with Beijing being accused of inaction.[62–66] WP

Fentanyl has been discovered for sale in illicit markets in Australia in 2017 and in New Zealand in 2018. In response, New Zealand experts called for wider availability of naloxone.[67][68][69] WP

In May 2019, China regulated the entire class of fentanyl-type drugs and two fentanyl precursors. Nevertheless, it remains the principal origin of fentanyl in the United States: Mexican cartels source fentanyl precursors from Chinese suppliers such as Yuancheng Group, which are finished in Mexico and smuggled to the United States.In the past several months before February 2025, China began scheduling fentanyl precursors that are internationally banned. In February 2025, US president Trump imposed a 10% tariff on Chinese imports, claiming the move as a way "to pressure China into taking action on fentanyl" but experts have expressed concern that these tariffs could reverse the progress made under the Biden administration and weaken the international cooperation necessary to combat global drug trafficking.[42][70–74] WP

India has also emerged as a source of fentanyl and fentanyl precursors, where Mexican cartels have already developed networks for the import of synthetic drugs. It is possible that fentanyl and precursor production may disperse to other countries, such as Nigeria, South Africa, Indonesia, Myanmar, and the Netherlands.[42][71] WP

In 2020, the Myanmar military and police confiscated 990 gallons of "methyl fentanyl", as well as precursors for the illicit synthesis of the drug. According to the United Nations Office on Drugs and Crime, the Shan State of Myanmar has been identified as a major source for fentanyl derivatives. In 2021, the agency reported a further drop in opium poppy cultivation in Burma, as the region's synthetic drug market continues to expand and diversify.[75][76] WP

According to the national archives and the Drug Enforcement Administration (DEA), direct fentanyl shipments from China have stopped since 2022. The majority of illicit fentanyl and analogues now entering the U.S. from Mexico are final products in the form of "tablets", and adulterated heroin from previously synthesized fentanyl. From the sophistication of full fentanyl synthesis and acute toxicity in laboratory environments, 'clandestine' labs in Mexico prefer to make an illicit dosage form from available fentanyl rather than the synthesis itself. Based on further research by investigators, fentanyl and analogues are likely synthesized in labs that have the appearance of a legal entity, or are diverted from pharmaceutical laboratories.[77–81] WP

Investigations and convictions of members of the Sinaloa drug cartel by federal agencies made a clear connection between illegal arms trafficking from the U.S. to Mexico and the smuggling of fentanyl into the U.S. Mexico had repeatedly made official complaints, since illegal guns are easily purchased (for example in Arizona and as far north as Wisconsin and even Alaska) according to U.S. intelligence sources. The guns are transported onto Mexican territory through a chain of American brokers and couriers, often financed by those drug cartels that also engage in money laundering. Therefore, the lack of arms controls in the U.S. has directly contributed to the U.S. opioid overdose crisis.[82][83][84] WP

The opioid epidemic in the United States is largely fueled by drugs smuggled from Mexico; approximately 98% of fentanyl entering the U.S. comes from Mexico. In January 2025, President Trump said that tariffs on Mexico were intended to reduce the U.S. trade deficit and force the country to secure its border with the U.S. against fentanyl smuggling and illegal immigration.[85][86] WP

Brand names

Brand names include Sublimaze, Actiq, Durogesic, Duragesic, Fentora, Matrifen, Haldid, Onsolis, Instanyl, Abstral, Lazanda and others.[2][87–91] WP

Economics

In the United States, the 800 mcg tablet was 6.75 times more expensive as of 2020 than the lozenge. As of 2023, the average cost for an injectable fentanyl solution (50 mcg/mL) is around US$17 for a supply of 20 milliliters, depending on the pharmacy. In a 2020 report by the Australian Institute of Criminology, a 100-microgram transdermal patch was valued from between AU$75 and AU$450 on illicit markets. Furthermore, in another 2020 study, the average price per gram of non-pharmaceutical fentanyl on various cryptomarkets was US$1,470.40 for offerings of less than five grams; the average for offers over five grams was US$139.50. In addition, on DreamMarket furanfentanyl (Fu-F), the most common analog on said market, the average price per gram was US$243.10 for retail listings and US$26.50 per gram for wholesale listings.[92–96] WP

Storage and disposal

The fentanyl patch is one of a few medications that may be especially harmful, and in some cases fatal, with just one dose, if misused by a child.[97][98] WP

In British Columbia, Canada, where there are environmental concerns about toilet flushing or garbage disposal, pharmacists recommend that unused patches be sealed in a child-proof container that is then returned to a pharmacy. In the United States, where patches cannot always be returned through a medication take-back program, flushing is recommended for fentanyl patches, because it is the fastest and surest way to remove them from the home, preventing ingestion by children, pets or others not intended to use them.[98][99][100] WP

Pharmacology

Classification

Fentanyl is a synthetic opioid in the phenylpiperidine family that has high protein binding and lipophilicity.[102][103] WP

Structure-activity

The structures of opioids share many similarities. Whereas opioids like codeine, hydrocodone, oxycodone, and hydromorphone are synthesized by simple modifications of morphine, fentanyl and its relatives are synthesized by modifications of meperidine. Meperidine is a fully synthetic opioid, and other members of the phenylpiperidine family like alfentanil and sufentanil are complex versions of this structure.[104] WP

Fentanyl is a weak base that is highly lipid-soluble, protein-bound, and protonated at physiological pH. All of these factors allow it to rapidly cross cellular membranes, contributing to its quick effect in the body and the central nervous system.[102][104][105] WP

Fentanyl analogs

Fentanyl analogs are types of fentanyl with various chemical modifications on any number of positions of the molecule, but still maintain, or even exceed, its pharmacological effects. Many fentanyl analogs are termed "designer drugs" because they are synthesized solely to be used illicitly. Carfentanil, a fentanyl analog, has an additional methyl ester group attached to the 4 position. Carfentanil is 20–30 times as potent as fentanyl and is common in the illicit drug chain. The drug is commonly used to tranquilize elephants and other large animals.[106] WP

Mechanism of action

Fentanyl acts on opioid receptors. These receptors are G-protein-coupled receptors, which contain seven transmembrane portions, intracellular loops, extracellular loops, intracellular C-terminus, and extracellular N-terminus. The extracellular N-terminus is important in differentiating different types of binding substrates. When fentanyl binds, downstream signaling leads to inhibitory effects, such as decreased cAMP production, decreased calcium ion influx, and increased potassium efflux. This inhibits the ascending pathways in the central nervous system to increase pain threshold by changing the perception of pain; this is mediated by decreasing propagation of nociceptive signals, resulting in analgesic effects.[104][107][108] WP⚠ Wikipedia itself has flagged this text: unreliable medical source?.

The affinity of fentanyl to the μ-opioid receptor is similar to that of morphine. The reasons for fentanyl's increased potency in vivo are unclear, however differences in efficacy and pharmacokinetics may be involved. It has high lipid solubility, allowing it to penetrate more easily the central nervous system. It attenuates "second pain" with primary effects on slow-conducting, unmyelinated C-fibers and is less effective on neuropathic pain and "first pain" signals through small, myelinated A-fibers.[102][104][105][109] WP

Fentanyl can produce the following clinical effects strongly, through μ-receptor agonism:[110] WP

• Supraspinal analgesia (μ₁)[110] WP
• Respiratory depression (μ₂)[110] WP
• Physical dependence[110] WP
• Muscle rigidity[110] WP

It also produces sedation and spinal analgesia through Κ-receptor agonism.[110] WP

Detection in biological fluids

Fentanyl may be measured in blood or urine to monitor for abuse, confirm a diagnosis of poisoning, or assist in a medicolegal death investigation. Commercially available immunoassays are often used as initial screening tests, but chromatographic techniques are generally used for confirmation and quantitation. The Marquis Color test may also be used to detect the presence of fentanyl. Using formaldehyde and sulfuric acid, the solution will turn purple when introduced to opium drugs. Blood or plasma fentanyl concentrations are expected to be in a range of 0.3–3.0 μg/L in persons using the medication therapeutically, 1–10 μg/L in intoxicated people, and 3–300 μg/L in victims of acute overdosage. Paper spray-mass spectrometry (PS-MS) may be useful for initial testing of samples.[111][112] WP

Detection for harm reduction purposes

Fentanyl and fentanyl analogues can be qualitatively detected in drug samples using commercially available fentanyl testing strips or spot reagents. Following the principles of harm reduction, this test is to be used directly on drug samples as opposed to urine. To prepare a sample for testing, approximately 10 mg of the drug should be diluted into of water. Research in Dr. Lieberman's lab at the University of Notre Dame has reported false positive results on BTNX fentanyl testing strips with methamphetamine, MDMA, and diphenhydramine. The sensitivity and specificity of fentanyl test strips vary depending on the concentration of fentanyl tested, particularly from 10 to 250 ng/mL.[113][114][115] WP⚠ Part of this sentence could not be copied from the source. Open the source to read it in full.

Receptor binding · Wikipedia

Fentanyl at opioid receptors

Every row cites [101]

Chemistry

Formula

C22H28N2O PC

CAS number

437-38-7 PC

Molar mass (g/mol)

336.5 PC

IUPAC name (computed by PubChem)

N-phenyl-N-[1-(2-phenylethyl)piperidin-4-yl]propanamide PC

SMILES

CCC(=O)N(C1CCN(CC1)CCC2=CC=CC=C2)C3=CC=CC=C3 PC

InChIKey

PJMPHNIQZUBGLI-UHFFFAOYSA-N PC

PubChem CID

3345

Pop culture

No references added yet.

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