A new study has revealed that the synthetic narcotic painkiller fentanyl has been identified as a major culprit in America’s opioid crisis.

Linda Richter, PhD, director of policy research and analysis for the National Center on Addiction and Substance Abuse said regarding the study, “The findings …. confirm what front-line health care and law enforcement professionals in towns and cities across the country know from firsthand experience: deadly synthetic opioids like fentanyl are now the main drivers of drug overdose deaths in the United States.”

Web MD asked Richter and other experts about fentanyl, its mechanism of action, and why the drug is so lethal when misused.

Fentanyl is a powerful synthetic opioid, which has been approved by the FDA for use as a painkiller and anesthetic. Created in 1960 and introduced as an anesthetic later that decade, fentanyl can easily and inexpensively be produced in a laboratory.

When taken, fentanyl binds to opioid receptors in the brain, and does so faster and in smaller doses than heroin or morphine. Similar to other opioids, fentanyl increases levels of the chemical dopamine, which controls feelings of reward, pleasure, euphoria, and relaxation. Because of its chemical structure, fentanyl has rapid and potent effects on the brain and body, and even minute amounts can be extremely dangerous.

“It only takes a tiny amount of the drug to cause a deadly reaction,” Richter says. “Fentanyl can depress breathing and lead to death. The risk of overdose is high with fentanyl.”

In medical settings, fentanyl is used to treat patients who require long-term, continuous relief from severe pain, and to mitigate pain following surgery. It is often administered via an injection, through a patch on the skin, or in lozenges.

Fentanyl has become a common illegally abused drug because it is approximately 50-100 times more potent than morphine and 50 times more potent than many forms of heroin. Abusers of fentanyl usually swallow, snort or inject the drug.

Web MD reported, “Despite the relatively low rate of fentanyl prescriptions, it has become a major player in the opioid epidemic. Illegal versions of fentanyl were largely responsible for the tripling of overdose deaths from synthetic opioids in just 2 years — from 3,105 in 2013 to 9,580 in 2015, according to the National Institutes of Health.”

According to Richter, some fentanyl users become addicted to the drug and then move on to heroin. “Many drug cartels realized they could quickly and cheaply produce fentanyl — and then cut heroin with it,” she said. “Instead of heroin being cut and made weaker, fentanyl makes the substance exponentially more dangerous.”

Fentanyl overdoses can be reversed with the medication naloxone (Narcan), but fentanyl is so potent that patients often require higher doses of the medication for an intervention to be successful.

Addiction to fentanyl can be treated using FDA-approved medications such as methadone, buprenorphine, or naltrexone, prescribed and managed by a health care professional. Treatment also includes professional therapy and recovery support systems, such as group counseling.

“There are medical interventions that work, and every person with an opioid use disorder should receive such professional care and have the treatments covered by insurance,” Richter says. “Nobody chooses to have addiction. It is a treatable disease.”

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