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What is fentanyl and why is it so dangerous?

“I read that fentanyl was the drug that killed Prince. What is fentanyl and why is it so dangerous?”

Fentanyl was first manufactured in 1960 and has become one of the world’s most important and frequently used painkillers. It’s a synthetic (or man-made) opioid. Opioids, such as heroin, are derived from a substance produced by the opium poppy called morphine. Other opioids include prescribed medications like codeine and oxycodone.

The drug hit the international headlines when it was established that Prince died as a result of a fentanyl overdose. In the US, fentanyl is one of the drugs blamed for a significant increase in drug overdose deaths. Fentanyl-related deaths have also been reported in many other parts of the world, including the UK and Australia.

Fentanyl is a short-acting opioid that’s similar to, but much more powerful than morphine or heroin. As with heroin, in addition to relieving pain, fentanyl use can lead to drowsiness, the slowing or shutting down of the respiratory system, coma and death. There are also a range of compounds that are similar in structure (referred to as fentanyl analogues) that vary in strength, effects and toxicity. Some of these are far more dangerous and have also received a great deal of media attention, e.g., carfentanil.

Pharmaceutical fentanyl is used for managing acute or chronic pain and is available as lozenges, tablets and nasal sprays, patches placed on the skin and an injectable medicine. Unfortunately, these prescribed medications can be misused by people for whom they’re not intended. Fentanyl is also illicitly manufactured for use in the illegal drug market. In some parts of the world, fentanyl has been reported as being used as a low-cost additive to increase the potency of street heroin.

What makes fentanyl so dangerous? Quite simply, it’s all to do with the strength or potency of the drug. A fatal overdose can be caused by a tiny amount of the drug. Fentanyl is reported to be 50-100 times more potent than heroin and carfentanil is 100 times more powerful than fentanyl. This means that a fatal dose of fentanyl may be equivalent to just 4-6 grains of table salt and a fatal dose of carfentanil may be equivalent to a speck of dust so small it may be very hard to see!

It’s no surprise that fentanyl has received a great deal of media attention in recent times. It’s a powerful painkiller that, when used as prescribed, can make a huge difference to people’s lives. Unfortunately, when misused it can lead to people becoming dependent and, as we have seen in the Prince case, overdose and death.

First published: March 2018
Reviewed and updated: October 2023

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