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Fentanyl, an opioid up to 100 times more potent than morphine, is currently flooding American streets, often with deadly consequences. What do you need to know about this "modern heroin"?

Fueled by a nation-wide epidemic of prescription-medication abuse that has killed over 165,000 people since 1999, a new street drug is now taking America by storm. Fentanyl is a hard-core pain killer, an opioid used as a last resort in people suffering from extreme pain and that doctors certainly wouldn't hand out to just anyone without the most careful risk assessment. Even in the tiniest doses, fentanyl can be deadly to those who weren't already taking other opioid medications. Now, it's no longer confined to the cancer ward of your local hospital, but being sold on the streets, often with fatal consequences. 

What do you need to know about fentanyl's rise in popularity? 

What Exactly Is Fentanyl?

Fentanyl is a schedule II opioid drug that has been around since the 1960s. Chemically similar to other opioids such as heroin and morphine, it binds to the brain's opiate receptors. It also sends dopamine rushing into the brain's reward areas, resulting in very potent pain relief along with strong feelings of relaxation and euphoria.

Fentanyl differs from heroin and morphine a great deal in one respect however: it is much stronger. Fentanyl can be 50 times more potent than heroin, and 100 times stronger than morphine. 

In hospital settings, fentanyl is administered only to those who were already using other opioids — and for whom they were no longer working because they built up tolerance. The drug is generally prescribed to patients experiencing the most severe agony, but only for short periods of time, and is well-known as a medication that can help battle cancer pain. In this context, fentanyl — which goes by various trade names, including Actiq, Duragesic, and Sublimaze — is offered intravenously, as a nasal spray, skin patch, film that dissolves in the mouth, as lozenges, lollipops, and sometimes as pills. 

When doctors prescribe fentanyl to patients in severe pain, they use the most extreme caution. They know, after all, that fentanyl comes with a huge list of side effects, including drowsiness and lightheadedness, constipation, trouble urinating, breathing difficulties, and skin reactions, as well as being highly addictive in nature. There are numerous contraindications, and fentanyl should not be used by those whose pain can successfully be managed using less potent medications, or those who have not been taking other opioid drugs already. 

Fentanyl is, in short, a last-ditch and hugely powerful pain medication that can provide relief to patients for whom nothing else will do the trick. When used right, fentanyl can make the difference between agony and peace. 

In the wrong hands, however, it has become something quite different — not a pain killer, but a murderer. CA State Senator Patricia Bates describes fentanyl simply as "get high and die". 

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