Fentanyl

• sublingualthe delivery of medication beneath the tongue, allowing for rapid absorption into the bloodstream. More – 15 – 30 minutes ⁵, ⁶.
• insufflatedInsufflating, commonly referred to as snorting, is a method of drug administration where powdered substances are inhaled through the nose. More – 15 – 30 minutes ⁵.
• transdermal – 2 – 4 hours ⁵, ⁶.

• sublingualthe delivery of medication beneath the tongue, allowing for rapid absorption into the bloodstream. More – 1 – 4 hours ⁵, ⁶.
• insufflatedInsufflating, commonly referred to as snorting, is a method of drug administration where powdered substances are inhaled through the nose. More – 1 – 4 hours ⁵.
• transdermal – 48 – 72 hours ⁵, ⁶.

Fentanyl is an opioid analgesicpain relieving. Fentanyl interacts predominately with the opioid mu-receptor but also binds to kappa and delta-type opioid receptorsnerve endings that sense changes in the body More. These mu-binding sites are discretely distributed in the human brain, spinal cord, and other tissues. In clinical settings, Fentanyl exerts its principal pharmacologic effects on the central nervous systembrain and spinal cord. Its primary actions of therapeutic value are analgesiadecreased pain awareness. More and sedationthe state of being relaxed or sleepy because of a drug More. Fentanyl may increase the patient’s tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More for pain and decrease the perception of suffering, although the presence of the pain itself may still be recognised. In addition to analgesiadecreased pain awareness. More, alterations in mood, euphoriafeelings of joy and happiness and dysphoriaexperiencing little or no joy in their life, and drowsiness commonly occur. Fentanyl depresses the respiratory centres, depresses the cough reflex, and constricts the pupils ⁷.

Bioavailability is 92% following transdermal administration and 50% following buccal administration ⁷.

7 hours (range 3 – 12) ⁷.

Fentanyl is metabolised primarily via human cytochrome P450 3A4 isoenzyme system and mostly eliminated in urine. Within 72 hours of IVintravenous More fentanyl administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with less than 10% representing unchanged drug ⁷.

LD50the amount of a material, given all at once, which causes the death of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning potential (acute toxicity) of a material in mice – 62 mg/kg subcutaneously, 11.2 mg/kg intravenously ⁸. Fentanyl has an LD50the amount of a material, given all at once, which causes the death of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning potential (acute toxicity) of a material of 3.1 milligrams per kilogram in rats, and, 0.03 milligrams per kilogram in monkeys. The LD50the amount of a material, given all at once, which causes the death of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning potential (acute toxicity) of a material in humans is not known ⁷.

Opiate receptorsnerve endings that sense changes in the body More are coupled with G-protein receptorsnerve endings that sense changes in the body More and function as both positive and negative regulators of synaptic transmission via G-proteins that activate effector proteins. Binding of the opiate stimulates the exchange of GTP for GDP on the G-protein complex. As the effector system is adenylate cyclase and cAMP located at the inner surface of the plasma membrane, opioids decrease intracellular cAMP by inhibiting adenylate cyclase. Subsequently, the release of nociceptive neurotransmitters such as substance P, GABAGamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter in your brain, meaning it slows your brain's functions. GABA is known for producing a calming effect., dopamine, acetylcholine and noradrenaline is inhibited. Opioids also inhibit the release of vasopressin, somatostatin, insulin and glucagon. Fentanyl’s analgesicpain relieving activity is, most likely, due to its conversion to morphine. Opioids close N-type voltage-operated calcium channels (OP2-receptor agonist) and open calcium-dependent inwardly rectifying potassium channels (OP3 and OP1 receptor agonist). This results in hypopolarization and reduced neuronal excitability ⁷.

Due to the extreme potency of fentanyl users should not attempt to inject fentanyl. There is no safe way to inject fentanyl outside of a medical environment.

There is no way to safely measure a dose of fentanyl without an extremely sensitive scale which would be well outside the price range of the typical consumer. Fentanyl is so powerful that it only takes a tiny difference in dosagee to be fatal. Injection is an extremely fast and efficient method of administration with no recourse if the dose was too high, excepting a naloxone injection which would have to administered very quickly by trained medical professionals ⁸.

Fentanyl powder may be snorted, but it is not recommended ⁹.

The gel inside patches can be smoked. The powder also may be smoked, although it is not recommended ⁹.

Regular use of fentanyl may cause –

• mood instability,
• reduced libido,
• constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More,
• menstrual problems,
• respiratory impairment ³, ⁴.

• physical euphoriaan intense feeling of pleasure and well-being More,
• pupil constriction,
• appetite suppression,
• cough suppression,
• orgasm suppression,
• pain relief,
• respiratory depressionslowing the drive and effectiveness of breathing More,
• sedationthe state of being relaxed or sleepy because of a drug More,
• constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More,
• difficulty urinating,
• increased perspiration,
• itchiness ⁵.

• cognitive euphoriastate of intense well-being, happiness, and excitement More,
• compulsive redosing,
• dream potentiationcan be described as a cognitive component which increases the intensity, vividness and frequency of sleeping dream states. This effect also creates higher detail and definition within dreams alongside of an increase in the likelihood of one's dreams becoming lucid. More,
• anxiety suppression,
• decreased libido ⁵.

• analgesiadecreased pain awareness. More,
• euphoriafeelings of joy and happiness,
• feelings of relaxation ⁹.

• sedativeOne of a diverse group of drugs manufactured for medical purposes to relax the central nervous system. More effects,
• changes in focus,
• changes in attention ⁹.

• respiratory depressionslowing the drive and effectiveness of breathing More,
• diarrhoeaWhere you frequently pass watery or loose faeces,
• nausea,
• constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More,
• dry mouth,
• somnolenceis a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods. More,
• confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation,
• weakness,
• sweating,
• headache,
• fatiguea feeling of weariness, tiredness, or lack of energy. More,
• dizziness,
• nervousness,
• anxiety,
• urinary retentiondifficulty urinating. More,
• hallucinationswhere someone sees, hears, smells, tastes or feels things that don't exist outside of their mind ⁹.

• confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation,
• depression,
• difficulty walking,
• muscle stiffness,
• slowed/altered heart rate,
• laboured breathing,
• weakness,
• dizziness, lightheadedness, and fainting,
• shaking,
• sleepiness,
• slurred speech,
• weight loss,
• visual hallucinationswhere someone sees, hears, smells, tastes or feels things that don't exist outside of their mind,
• nausea and vomiting,
• itching & scratching,
• pinpointthe pupils are very small. More pupils ¹⁰.

There is a risk of post-acute withdrawal effects which could include –

• diarrhoeaWhere you frequently pass watery or loose faeces,
• depression,
• anxiety disorder,
• psychosis, or even
• suicidal ideation in extreme cases ⁹.

The following are some of the symptoms of a Fentanyl overdose –

• slow, shallow breathing,
• decreased urge to breathe,
• breathing difficulties,
• swallowing difficulties,
• drowsiness,
• dizziness,
• confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation,
• fainting ¹¹,
• respiratory depressionslowing the drive and effectiveness of breathing More,
• chest pain,
• cyanosisbluish tinge to fingers and lips, caused by inadequate blood supply,
• seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More,
• passing out,
• coma,
• death ⁴.

If you experience any of these symptoms, stop using fentanyl and call your healthcare provider immediately or seek emergency medical treatment ¹¹.

There are a number of signs that you are addicted to the drug – ones you might not always be willing to accept or notice. These include –

• being incapable of making proper judgments (i.e., choosing continued drug taking over all other responsibilities),
• experiencing difficulty in finding pleasure from everyday occurrences from friends and friends,
• taking large doses of the drug for a long period of time,
• doctor shopping or other questionable methods to make sure you get enough prescriptions of the drug to satisfy your compulsive use ¹².

Apart from affecting the mind and how you may feel emotionally, fentanyl addiction takes a physical toll, which can manifest as a number of negative health effects. If you think you might be addicted to fentanyl or that someone you know might be addicted to the drug, you will want to look out for the physical symptoms associated with fentanyl addiction ¹². These include –

• nausea,
• constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More,
• confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation,
• sedationthe state of being relaxed or sleepy because of a drug More,
• slowed breathing,
• drowsiness,
• intermittent loss of consciousness, and
• coma ¹².

Fentanyl addiction can dramatically increase the risk of severe respiratory depressionslowing the drive and effectiveness of breathing More or respiratory failure as a consequence of overdose ¹².

• Ketamine – Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspirationvomit being inhaled into the lungs, a potentially life-threatening condition More if they are not placed in the recovery position.
• MXE – This combination can potentiate the effects of the opioid.
• DXM – CNSthe Central Nervous System, upon which certain drugs act depression, difficult breathing, heart issues, hepatoxicrelating to or causing injury to the liver. More, just very unsafe combination all around. Additionally if one takes dxm, their tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More of opiates goes down slightly, thus causing additional synergistic effectsan effect arising between two or more agents, entities, factors, or substances that produces an effect greater than the sum of their individual effects More.
• Cocaine – Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate wears off first then the opiate may overcome the patient and cause respiratory arrestRespiratory arrest is caused by airway obstruction, decreased respiratory drive, or respiratory muscle weakness. More.
• Alcohol – Both substances potentiate the ataxialoss of motor coordination More and sedationthe state of being relaxed or sleepy because of a drug More caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspirationvomit being inhaled into the lungs, a potentially life-threatening condition More from excess. Memory blackouts are likely.
• GBL / GHB – The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspirationvomit being inhaled into the lungs, a potentially life-threatening condition More is a risk if not placed in the recovery position.
• Tramadol – Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergisticallyThe effect arising between two or more agents, entities, factors, or substances that produce an effect greater than the sum of their individual effects. More present.
• Benzodiazepines – Central nervous systembrain and spinal cord and/or respiratory-depressant effects may be additively or synergisticallyThe effect arising between two or more agents, entities, factors, or substances that produce an effect greater than the sum of their individual effects. More present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspirationvomit being inhaled into the lungs, a potentially life-threatening condition More is a risk if not placed in the recovery position. Blackouts/memory loss likely ⁶.

• PCP – PCP can reduce opioid tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More, increasing the risk of overdose.
• Nitrous oxide – Both substances potentiate the ataxialoss of motor coordination More and sedationthe state of being relaxed or sleepy because of a drug More caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspirationvomit being inhaled into the lungs, a potentially life-threatening condition More is a risk if not placed in the recovery position. Memory blackouts are likely.
• Amphetamines – Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate wears off first then the opiate may overcome the patient and cause respiratory arrestRespiratory arrest is caused by airway obstruction, decreased respiratory drive, or respiratory muscle weakness. More.
• MAOIsMAOIs may be used to treat the symptoms of depression. More – Coadministration of monoamine oxidase inhibitors (MAOIsMAOIs may be used to treat the symptoms of depression. More) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresisexcessive sweating, hyperpyrexiaan excessive elevation of body temperature above the average normal temperature. More, flushing, shivering, myoclonusa brief, involuntary twitching of a muscle or group of muscles. More, rigidity, tremor, diarrhoeaWhere you frequently pass watery or loose faeces, hypertensionhigh blood pressure, tachycardiarapid pulse rate, seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More, and coma. Death has occurred in some cases ⁶.

Fentanyl can be detected in the urine for 8 – 24 hours ¹¹.

A blood test can identify Fentanyl for up to 12 hours ¹¹.

A saliva test can detect Fentanyl for up to 1 – 3 days ¹¹.

Fentanyl, like many other drugs, can be detected with a hair follicle drug test for up to 90 days ¹¹.