Fentanyl

Fentanyl has a strong analgesic and sedative effect and is effective in the smallest doses. However, its euphoric effect is less pronounced than that of other opioids. It is used in emergency medicine for surgical procedures and anesthesia, and for breakthrough pain in cancer patients. For chronic pain, fentanyl patches are used, which release the active ingredient slowly. Due to its opioid properties, fentanyl rapidly leads to dependence when taken over a long period of time and should not be discontinued abruptly and only under medical supervision.

Onset of effect

Injected: after a few seconds
Swallowed and snorted: after approx. 15 - 30 minutes
Patch: after approx. 2 - 4 hours

Duration of action

Swallowed and snorted: approx. 1 - 4 hours

Patch: the active ingredient is delivered during 48 - 72 hours

Light: 10 - 25 µg
Medium: 25 - 50 µg
Strong: 50 - 75 µg

Fentanyl is extremely potent and therefore very difficult to dose. Therefore, overdoses can easily occur. For first-time use, doses should be low, as the risk of respiratory arrest is increased.

Appearances

As infusion solution (emergency medicine), lozenges, nasal spray, patches and in powder form.

• Mixing with other downers (alcohol, benzodiazepines, drugs, GHB/GBL, heroin, opioids) can lead to dangerous interactions and an intensification of the effect and there is a risk of respiratory depression up to respiratory paralysis, a drop in blood pressure, a coma and in the worst case can lead to death!
• The combination with methoxetamine (MXE, Metha-Keta) increases the opioid effect.
• Mixing opioids with DXM is generally not recommended - there is an increased risk of central nervous system disorders as well as heart and respiratory problems. In addition, DXM lowers the individual opioid tolerance, which is why the risk of overdose increases considerably.
• Mixed use of opioids with stimulants (such as cocaine, amphetamine, methamphetamine) puts extreme strain on the body and the cardiovascular system. The effects can mask each other, so that they are subjectively felt to be weaker. If the effect of the stimulants wears off before the opioids, there is a risk of delayed overdose and even respiratory depression.

‍

• Opioids are highly effective medications that should only be used for a limited time and, at best, with a doctor's supervision.
• Start with a low dose and wait for the effect and tolerance before adding more.
• After a period of abstinence, use a much lower dose! The usual dose before the abstinence phase can otherwise quickly have life-threatening consequences.
• If you inject opioids, dose even more carefully, as the range between desired effect (rush) and dangerous overdose is even more difficult to assess. Avoid injecting opioids; the risk of overdose is particularly high. Always use new (clean and sterile) injection material! Never exchange syringes, filters, water, disinfection swabs to avoid transmission of hepatitis and HIV.
• Do not rely on dosage information from colleagues who regularly use opioids. Due to habituation or dependence, their doses are significantly higher and can be fatal for new users.
• Take longer breaks (at least several days) between consumption.
• Refrain from citrus fruits (especially grapefruit) before or during consumption. The combination can lead to an increase in the effect of the opiate and/or respiratory depression.

In addition to the deliberate consumption of fentanyl by users, there is a risk that fentanyl will be used as an extender in illegal substances (especially heroin and other opioids, but also cocaine). Unconscious use carries considerable risks of (fatal) overdoses, as fentanyl is effective in significantly lower doses than heroin, for example.

As the Taliban government in Afghanistan is successfully combating opium poppy cultivation - according to the UNODC, the area under cultivation has been greatly reduced - illegal substances laced with fentanyl or other synthetic opioids could also appear on the Swiss drug market in the future. The European Monitoring Center for Drugs and Drug Addiction (EMCDDA) estimates that synthetic opioids are currently still of relatively minor importance in Europe, but could pose a growing threat to users and public health in the future.