One Fact, One Act: Why fentanyl is so addictive, “re-narcotization,” and preventing an overdose
ONE FACT
Fentanyl is a powerful synthetic opioid that can be 50 times more potent than heroin. Often unknowingly, people get exposed to fentanyl when it is mixed in with other drugs they are using (such as heroin). Because it is so potent, someone who takes fentanyl will develop tolerance (or the need to take more of a drug to experience the same effects) to opioids that don’t contain fentanyl very quickly. This means that for a person who has taken fentanyl, other opioids (like heroin) that are fentanyl-free will not be strong enough to make them feel their rewarding or pleasurable effects. This can lead them to seek out more powerful substances – either fentanyl, or drugs that are laced with it.
What about fentanyl makes it so addictive?
Potency: a little goes a long way. A very small amount of fentanyl has a huge effect.
Affinity: our brain cells have chemical “receivers” that are known as receptors. Drugs like fentanyl with high affinity for the receptors can “stick” to them and activate them easily.
Efficacy: a drug’s intrinsic efficacy refers to how strongly it can activate the brain cell’s “receiver” or receptor. Fentanyl has high intrinsic efficacy, so when it sticks to the receptor and activates it, the effect is extremely strong – this translates to a very intense experience of euphoria, or a rush of intense pleasure.
It gets into the brain very rapidly. The more immediately a drug gets into the brain and produces a physical and psychological response, the more addictive it is.
Why is fentanyl so lethal?
Fentanyl accumulates in fat tissues, so when someone uses it regularly, they develop a “depot” of fentanyl in their body. When they take it, since they already have some fentanyl stored in their fat, the effects can last longer. This means that if they overdose on fentanyl, and receive lifesaving treatment (i.e., Narcan), the slow-release compartment, or “depot” of stored fentanyl in their body can cause “re-narcotization.”
Re-narcotization is when a person who has been treated with Narcan and revived after an overdose stops breathing again. This happens because the adverse effects of fentanyl when someone overdoses (i.e., slowing down or stopping someone’s breathing), can outlast the lifesaving effects of Narcan. This is especially likely to happen when there’s a depot supply of fentanyl in a person’s body from using it regularly. For some people this can happen more than once, making it challenging to effectively reverse the overdose, and requiring repeated dosing of Narcan and more extended observation by qualified medical personnel.
Because it enters the brain so rapidly, when a person overdoses on fentanyl, its adverse effect of depressing the respiratory center (i.e., stopping someone’s breathing) occurs extremely quickly. This leaves a very small window of time to act with a lifesaving treatment like Narcan.
ONE ACT
How to bring the ONE FACT in this newsletter into your life: If you know or love someone who uses prescription opioids, heroin, or even other drugs that can be laced with fentanyl with or without their knowledge (e.g., stimulants like cocaine or methamphetamine, or pills that they buy outside of a pharmacy to use recreationally or to self-medicate anxiety or other symptoms), encourage them to carry Narcan (which is available over the counter at local pharmacies, and accessible free of charge here), and consider carrying it yourself.
It is also important to be aware that there are highly effective treatments available for people who become addicted to opioids like fentanyl. Though the overdose fatality risk linked with fentanyl use is high, people do recover from opioid addiction if they are able to access and sustain treatment with evidence-based medications for opioid use disorders, including methadone and buprenorphine (also known as suboxone). Effective treatment to help someone live opioid-free is the best way to prevent an overdose. To find qualified providers who can treat opioid use disorders, start by searching the American Society of Addiction Medicine or the Substance Abuse and Mental Health Services Administration.
This topic is covered in greater depth in my upcoming book, which you can find here.
Talk to you next week!
Dr. Suzette Glasner
Would love to learn more about what types of public health policies have been effective in reducing the harm fentanyl is causing in communities. Maybe a future One Fact, One Act topic!