Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine and heroin. Initially developed in the 1960s, it is used in medical settings primarily for pain management. It’s often prescribed for patients experiencing severe pain that cannot be controlled with other medications. This includes being used as part of anesthesia for surgeries, post-surgical pain, or chronic pain. It is also a palliative pain management tool that helps alleviate extreme discomfort in terminally ill patients. Fentanyl is classified as a Schedule II prescription drug, indicating it has a high potential for abuse, with use potentially leading to severe psychological or physical dependence.

Fentanyl is also used by individuals outside of the medical field. While pain relief is one of the effects that those individuals look for, at lower doses fentanyl can also produce a euphoric high, similar to heroin but much more potent. It induces a deep state of relaxation and sedation, which some users seek to escape stress.

Medically, fentanyl is available as patches, lozenges, tablets, sprays, and injectables. On the street, fentanyl can look like white powder, counterfeit pills (often resembling prescription opioids), or as part of other drugs, making it challenging to identify without proper testing.

A concerning trend in the illicit drug market is the increasing presence of fentanyl being laced into other drugs. This practice is driven by several factors and poses severe risks to unsuspecting users. Fentanyl is relatively cheap to produce compared to heroin or other opioids. Dealers often mix it into other drugs to increase potency while reducing costs. Adding fentanyl to drugs like heroin, cocaine, and methamphetamine enhances their effects, attracting users seeking a more potent and intense high. Additionally, sometimes users often do not know their drugs are laced with fentanyl, dramatically increasing the risk of accidental overdose. Users unaware of fentanyl contamination cannot adjust their dose appropriately, leading to inadvertent overdosing. Even a small amount can be lethal. Individuals who are not regular opioid users are particularly at risk, as their bodies are not accustomed to the drug’s effects.

Some not-so-fun facts and statistics: 

• Between January 2016 and September 2018, more than 10,300 Canadians lost their lives to apparent opioid-related overdoses. 93% were accidental. 
• Most accidental apparent opioid-related deaths occurred among males (75%). 
• 73% of accidental apparent opioid-related deaths involved fentanyl or fentanyl-related substances. 
• During the COVID19 pandemic, the supply issue got even worse. In Ontario, about 55 people per week were dying from overdose, up from an already staggering 44 people per week pre-pandemic. In British Columbia, May and June 2020 successfully broke records for highest number of overdose deaths in a month, a record last set in December 2016. 

Recognizing the signs of a fentanyl overdose is crucial for timely intervention. Symptoms can include:

1. Severe respiratory depression: Slowed or absence of breathing is the most dangerous symptom. Fentanyl's potency can cause a rapid and profound suppression of respiratory function.
2. Unconsciousness: An individual may be difficult or impossible to wake.
3. Pinpoint pupils: Extremely small pupils are a classic sign of opioid use.
4. Discoloured lips and fingernails: Due to a lack of oxygen from lack of breathing, the skin can turn a bluish or grayish colour.
5. Cold and clammy skin: Skin may feel unusually cold and clammy to the touch.
6. Choking or gurgling sounds: As breathing becomes depressed, choking or gurgling noises may occur.

Immediate response to a suspected fentanyl overdose can save a life. Steps include:

1. Call emergency services: Dial emergency services immediately to get professional medical help on the way.
2. Administer Naloxone: If available, administer naloxone according to instructions. Multiple doses may be necessary due to fentanyl’s potency. Naloxone comes in various forms such as nasal spray or injection. 
3. Perform rescue breathing or CPR: If the person is not breathing, provide rescue breathing or chest compressions if trained to do so.
4. Stay with the person: Keep the person awake and monitor their breathing until emergency responders arrive.
5. Follow up: Even if the person appears to recover after naloxone administration, they need immediate medical attention due to the risk of re-overdose when naloxone wears off.

Preventing fentanyl overdoses involves a combination of strategies aimed at reducing use, increasing awareness, and providing support. It starts with education; by informing the public, particularly at-risk populations, and raising awareness about the dangers of fentanyl and how to recognize an overdose. Harm reduction is another key factor. By using a harm reduction approach, such as using Test Your Poison Fentanyl Testing Kit where users can test their substances for fentanyl contamination, allows individuals to make informed decisions and have the right to their safety. It is a quick identification test that will show the presence of fentanyl. With this test you are able to find out whether fentanyl is present in your sample. It is important to stay clear of substances cut with fentanyl. Fentanyl is very easy to overdose making it one of the larger contributors of the overdose epidemic. It is very important to test your substances for fentanyl and stay clear of any samples that come back positive. Another strategy is close prescription monitoring, which involves physicians ensuring fentanyl is prescribed and used appropriately to prevent misuse. As well, providing supervised spaces where users can consume drugs under medical supervision can significantly reduce the risk of fatal overdoses. We can also increase the availability of naloxone (Narcan), check your local pharmacy or safety injection site as these can be given out for free. Lastly, increasing support services such as providing access to addiction treatment and counseling to help users manage their substance use.

Fentanyl’s potency makes it both a powerful medical tool and a dangerous drug when misused. Recognizing the symptoms of an overdose, understanding the risk factors, and knowing how to respond can significantly reduce fatalities. Harm reduction strategies play a critical role in preventing and mitigating the impact of fentanyl overdoses. Through concerted efforts, communities can better manage the risks associated with fentanyl and save lives.