Fentanyl is one of the deadliest opioids, and one way that it’s prescribed is as the so-called “fentanyl lollipop.” Learn more about fentanyl, fentanyl dosages and other important facts about this powerful opioid, which is a prescription drug.

What is Fentanyl?

Fentanyl is a strong synthetic opioid, similar in action to morphine but significantly more potent. In fact, fentanyl is anywhere from 50 to 100 times stronger than morphine. Fentanyl is available as a prescription pain reliever, but it’s also made illicitly and sold on the black market.

Someone is usually prescribed fentanyl for the treatment of strong pain related to cancer. Fentanyl may also be prescribed to patients who have chronic, ongoing pain and who are tolerant to other opioids. Tolerance means other weaker opioids are no longer effective at treating pain.

Brand name versions of prescription fentanyl include Actiq, Sublimaze and Duragesic.

Fentanyl can be prescribed as a transdermal patch that goes directly on the skin. Another way fentanyl is prescribed is as a lozenge, also known as a fentanyl lollipop.

As with other prescription opioids, fentanyl can be diverted from medical use and abused for the euphoric high it creates. Fentanyl is also made illegally, and that’s often what’s even more deadly. People buying illicit fentanyl on the black market have no idea how strong it is. Therefore even a tiny amount can lead to a fatal overdose.

How Is Fentanyl Used?

When a doctor prescribes fentanyl, it is in the form of an injection, a patch for the skin, or a cough drop-like lozenge, aka the fentanyl lollipop.

When someone uses fentanyl, it binds to their opioid receptors in the central nervous system and brain. Most specifically, fentanyl and other opioids affect parts of the brain that control pain as well as emotions.

Some of the signs and symptoms of fentanyl use include:

• Euphoria or intense happiness
• Drowsiness
• Itchiness
• Nausea
• Constipation
• Confusion
• Sedation
• Breathing problems
• Loss of consciousness

Is Fentanyl Addictive?

One of the primary side effects of any opioid medication is addiction. The risk of addiction is higher with misuse and abuse. Fentanyl is a highly addictive pain medication because of the way it affects the brain.

When someone takes fentanyl, not only are opioid receptors activated in a way that changes the response to pain but also activates the release of feel-good neurotransmitters such as dopamine.

The activation of neurotransmitters that make you feel good creates the high associated with opioids. This is also what leads to addiction because the flood of certain neurotransmitters into the brain can trigger a reward response.

Why Is the Fentanyl Lollipop Prescribed?

There are a few main ways a doctor may prescribe fentanyl as an opioid medication. One is a patch, and the other is a lollipop. The fentanyl lollipop, with the brand-name Actiq, combines fentanyl with citrate.

When someone uses the fentanyl lollipop, the active ingredient, which is fentanyl, absorbs through the mucous membrane of the mouth. There is a sweet flavor with this form of fentanyl, because of the citrate, although this can lead to tooth decay.

Fentanyl lollipops are very tightly controlled and are intended only for use in cancer patients who are experiencing breakthrough pain. Breakthrough pain in cancer patients occurs the person is on around-the-clock pain relief and still experiences some periods of pain that breakthrough their underlying treatment.

Someone who uses fentanyl should have a tolerance to other opioids because fentanyl is so powerful that it can cause an overdose in a person who isn’t tolerant to opioids.

Doctors are extremely cautious about the use of the fentanyl lollipop to treat pain in cancer patients, because of the risks. It can only be administered every four hours, at a minimum. The dosages of the fentanyl lollipop vary from 200 to higher doses of 1600 micrograms.

What is a Fentanyl Patch?

The other option for someone who needs fentanyl is the transdermal patch, also known as transdermal fentanyl. Compared to oral transmucosal fentanyl citrate, the patch is applied directly to the skin and its intended to release regular doses of fentanyl over a period of time. Typically the fentanyl patch is applied every 72 hours, and dosages range from 12.5 micrograms an hour up to 100 micrograms an hour.

Fentanyl Abuse

Unfortunately, while fentanyl can be an important treatment option for patients with cancer pain, it’s a drug of significant abuse. Prescription versions such as the fentanyl lollipop can be diverted from medical use, but there’s also black market fentanyl.

Anytime someone uses fentanyl outside of how it’s prescribed, or without a prescription, it’s considered abuse.

Fentanyl is more powerful than heroin, which is why it’s become so popular as a street drug.

Signs of a Fentanyl Overdose

If someone is abusing the fentanyl lollipop or any other kind of opioid, there is a risk of overdose. If someone mixes opioids with other central nervous system depressants such as alcohol or benzodiazepines, it increases the risk of an overdose. Signs of a fentanyl lollipop overdose are:

• Fingers and lips with a bluish tint
• Cold, clammy skin
• Vomiting
• Weakness
• Slow or stopped breathing
• No responsiveness
• Coma
• Death

If someone overdoses on fentanyl, it’s a medical emergency. The opioid reversal drug naloxone may help, but due to the potency of fentanyl, several doses of naloxone are often required.

A fentanyl overdose can occur because opioids slow the central nervous system. The central nervous system controls functions like breathing, so one effect of Actiq and other types of opioids is respiratory depression. If someone doesn’t have an opioid tolerance and takes too much or higher doses of fentanyl, they may have respiratory depression so profound that they experience coma, brain damage or death.

Fentanyl Statistics

The following are some important things to know about fentanyl lollipops and other forms of fentanyl:

• Synthetic opioids like fentanyl accounted for more than 45 percent of opioid overdose deaths in 2016. In 2017, 59 percent of opioid-related deaths involved fentanyl.
• More than 70,200 Americans died from drug overdoses in 2017
• In 2017, the biggest increase in death rates from overdoses was related to fentanyl and fentanyl analogs—these drugs led to more than 28,400 overdose deaths that year alone
• Illegal fentanyl is sold in various forms including powders, on blotter paper, in nasal sprays, and as a pill that mimics the look of real prescription opioids
• Fentanyl is often mixed with other drugs including cocaine and heroin, so often people are unaware they are even using it, significantly upping the risk of an overdose
• Recently the Drug Enforcement Administration issued a national alert about the rapid rise of incidents related to fentanyl and fentanyl seizures
• In 204, 80 percent of all fentanyl seizures were concentrated in 10 states. These states were Ohio, Massachusetts, Maryland, New Jersey, Kentucky, Virginia, Florida, New Hampshire, and Indiana

There are often stories about fentanyl’s strength in the news. For example, many first responders are having to wear special protection to avoid coming into contact with fentanyl. Just a tiny bit accidentally inhaled or absorbed can cause symptoms including shortness of breath and slow breathing.

Since fentanyl is 50 to 100 times more potent than morphine and 30 to 50 times more powerful than heroin, just a quarter of a milligram has the potential to kill someone. That is 0.25 milligrams. To compare, you can think about a baby aspirin tablet which is 82 mg. If that tablet were cut into 324 pieces, one piece would then represent a quarter-milligram.

 

Sources:

Kounang, Nadia. “What you need to know about fentanyl.” CNN. November 5, 2018. Accessed March 25, 2019.

NIH National Institute on Drug Abuse. “Fentanyl.” February 2019. Accessed March 25, 2019.

NIH National Institute on Drug Abuse. “Overdose Death Rates.” January 2019. Accessed March 25, 2019.