Why Fentanyl Is So Deadly

Why Fentanyl Is So Deadly by Lynn R. Webster @LynnRWebsterMD

According to Martha Bebinger of WBUR, “About 75 percent of the state’s men and women who died after an unintentional overdose last year had fentanyl in their system, up from 57 percent in 2015 (PDF). It’s a pattern cities and towns are seeing across the state [of Massachusetts] and country, particularly in New England and some Rust Belt states.”

How Dangerous Is Fentanyl?

As Vice News reports, “Fentanyl is so dangerous that some cops [in Canada] now carry an antidote in case they touch it.” Citing CDC statistics, Vox adds, “Fentanyl, an incredibly potent synthetic opioid, is thought to be anywhere from 50 to 100 times more potent than morphine and has commonly been prescribed to manage severe pain after a surgery or debilitating pain from advanced stages of cancer. But in recent years, illegal manufacturing and trafficking of fentanyl has skyrocketed, and as a result, has led to a sharp spike in the number of drug overdose deaths from synthetic opioids.”

It is surprising to see the amount of illegal drugs flooding our communities. It’s particularly sad because, for many people who had never heard of the dangers of fentanyl, the death of musical Prince [Roger Nelson] might have served as a warning. Fentanyl is lethal. As a CNN article reported at the time of Prince’s 2016 fentanyl-related death, “All it takes is a dose of fentanyl the size of three grains of sand to kill.”

How Fentanyl Kills

Fentanyl is far more dangerous than most other opioids. The dose at which fentanyl produces a euphoric effect is very close to the dose that stops breathing. That difference is essentially what clinicians call the therapeutic window (it is not actually a therapeutic window, because when taken to get high, fentanyl is not used for a therapeutic purpose — but it is a reasonable way to explain how it becomes lethal). While still potentially fatal, morphine and heroin have a much wider non-lethal window. It is very difficult to know just the right amount of fentanyl that produces the desirable effects without overshooting and causing breathing to stop.

The other largely unknown risk of fentanyl is called “chest wall rigidity.” When fentanyl is administered rapidly (intravenously), it can cause the chest muscles to go into a spasm. When this occurs, breathing is impossible. There is no exchange of air in the lungs with chest wall rigidity. If the spasm is not broken, the person will suffocate and die. This response to fentanyl commonly occurs when an anesthesiologist begins to anesthetize a patient for an operation using fentanyl. However, when this occurs in an operating room, an anesthesiologist quickly paralyzes the patient so he/she can hook up a machine to breathe for the patient and proceed with the operation. Of course, this kind of rescue is not possible without sophisticated training and expertise.

Why People Use Fentanyl

The Guardian calls fentanyl, “the latest and most disturbing twist in the epidemic of opioid addiction that has crept across the United States over the past two decades.” The article points out, “Prince, like almost all fentanyl’s victims, probably never even knew he was taking the drug.”

So why are people using fentanyl? I suspect most people do not know that the drugs they’re buying, whether it is heroin or diverted prescription opioids, are laced with it. We also have to realize that people with addiction have a compulsion to use substances despite the consequences. So some people may be aware of the risks of using fentanyl, but they have such an overriding craving that they use it, anyway.

People who use drugs that are laced with fentanyl (or carfentanil, which is a more powerful version of fentanyl) may or may not know that they are playing Russian roulette. I suspect there is a spectrum of knowledge about fentanyl ranging from some people who do not know anything about fentanyl to those who have a very sophisticated understanding of it. In either case, it doesn’t matter. Fentanyl doesn’t give an advantage to those who are better educated or even more intelligent.

How to Solve the Fentanyl Problem

Decreasing the number of fentanyl overdoses will be a real challenge. It will require a comprehensive approach. Law enforcement must curb the supply of illegal drugs, and policymakers will have to provide rapid, expansive access to affordable and immediate treatment for opioid addiction. We must also remove the stigma of addiction and the threat of incarceration so that those who need help can feel free to ask for it.

Opioid addiction is a serious problem and threatens every community in America. Those who have the disease must be told that there is no safe dose of fentanyl. If fentanyl is used illegally, it will eventually be lethal.


  1. Dorlee on April 25, 2017 at 5:02 pm

    How are diverted prescription pain pills laced with this? Aren’t they really the counterfeit pills from China with the fentanyl already in them? A good reason to make sure all prescriptions are made in the US.

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