The strongest opioid used today in human medicine is fentanyl. Developed in the 1950s by the amazing, late Dr. Paul Janssen, it was first used only in a hospital setting for the induction and maintenance of anesthesia and for the relief of severe post-surgical pain. As time went on, the 1990s saw the advent of fentanyl for expanded use. The drug became available in a skin patch in the mid-1990s called Duragesic. Applied once every three days, the patch released a steady hourly dose ranging from 25 to 100 micrograms. People, that’s micrograms. Not milligrams. A milligram is one-thousandth of a single gram, but a microgram is one-millionth of a gram. A gram of table salt would be very roughly about a quarter teaspoon. Imagine that amount divided up one million times. That’s the astounding and nearly incomprehensible power of fentanyl. Even a slight overdose is deadly. Now you know why. Read on to find out more about fentanyl as we discuss this question: What is the strongest opioid pain medication and how to avoid addiction to it?
More About Fentanyl
Now, fentanyl is far from the strongest opioid of all. It’s the strongest one used in human medicine, but fentanyl has some serious chemical cousins called analogs. One of them in particular is known as carfentanil. This one is 10,000 times the strength of morphine, 100 times the strength of fentanyl and about 5,000 times the potency of heroin. A dose as small as a single microgram (not milligram) is a potentially fatal human dose. In other words, an amount barely visible, if it’s visible at all, is enough to kill. Carfentanil has no use in human medicine, but it’s available on the black market and especially the dark market. It’s responsible for many human deaths, likely involving victims who didn’t know or understand what they were really taking.
Carfentanil is used in veterinary medicine to anesthetize very large animals like elephants, hippos, water buffalo and rhinos. The amount of the drug required to completely knock out a multi-ton elephant is just 13 milligrams. That’s about the same as 13 grains of salt. Imagine such a small amount compared to the size of the animal and you will begin to appreciate the power of this fentanyl analog. Just two milligrams or about the same amount as two grains of salt is enough to kill 100 humans!
Dr. Paul Janssen
Dr. Janssen developed fentanyl while he was working with a group of compounds called phenyl piperidines. This group includes the synthetic opioid meperidine with the brand name Demerol. Today, the drug is available as a skin patch, in a lollipop form called Actiq. as a sublingual tablet and as a nasal spray. It’s also available in an injectable form, but this use is limited to the hospital and professional medical setting. Fentanyl has a very short half-life, is not very long-lasting and therefore cannot be taken as a swallowed tablet. It works best when it’s continually administered, and it passes readily from the oral tissues of the inside cheek and under the tongue into the bloodstream.
Anyone using the fentanyl patch must be very careful to dispose of them properly because even a completely used patch still contains enough drug to kill a small child or pet. Tragedy has occurred when a curious child fished a used patch out of the trash and either chewed on it or applied it their skin as they had seen a parent do. Pets, especially dogs, may chew a used patch. Always dispose of used patches properly. This means either using a secured container, such as that for used syringes, or by sticking the patch together by folding it in half and flushing it down the toilet. Children may be especially attracted to Actiq, thinking it’s candy. Make sure your child knows the difference, and keep the product where small hands can’t reach.
Fentanyl produces a very serious addiction and horrible withdrawal syndrome if suddenly stopped. Just a tiny error when handling it can kill. The only sure way to avoid addiction to any substance is to never take it to begin with.
If you must use fentanyl:
- Never use fentanyl unless you must. Alternatives exist. Ask about them
- Never increase your dose without precise direction from your doctor
- Never take it more frequently than directed. Never change a fent patch sooner than directed
- Never wear more than one patch at a time unless directed to do so by your doctor
Addiction is not the same as physical dependence. You will become physically dependent on fentanyl if you use it regularly, but addiction is a different thing altogether. Work with your doctor to avoid problems with this powerful drug. Never forget: Fentanyl kills if not used exactly as directed. Safeguard others by keeping your patches or other supply of fentanyl under lock and key.
Do you Need Help?
We’ve had a lot of experience with fentanyl and other strong opioids. If you have any concerns, we’re here for you 24 hours a day at 844-903-2111 for questions and referrals for drug treatment and information. We’re here to help.