Fentanyl has been getting much attention in the United States these days, and rightfully so. The overdose rates across the US, and other countries, have risen dramatically because of the use and abuse of Fentanyl and its analogues. Fentanyl users are seeking a feeling of euphoria, extreme relaxation, pain relief, sedation, or the ultimate “feel good” feeling.
Fentanyl is a potent synthetic opioid drug which was developed in Belgium in 1959 and was introduced during the 1960s. It was approved by the US Food and Drug Administration as a pain reliever and anesthetic. It is reported be 80 to 100 times more potent than morphine and 50 times more potent than heroin.
According to the US Drug Enforcement Administration, legal Fentanyl products have been largely obtained through theft. This theft is a result of prescription fraud, corrupt pharmacists, corrupt physicians, and patients who sell the drugs to dealers and other customers.
According to the Centers for Disease Control and Prevention (CDC), Fentanyl was involved in approximately 3,000 overdoses which resulted in deaths during the early years after 2010. The steady increase in the years after, due to trafficking and abuse of Fentanyl, led to overdose deaths rising to over 31,000 by 2018. Recently, there have been over twelve different analogues of Fentanyl produced in secret labs, which have been identified across the U.S.
Currently, Fentanyl pharmaceutical products are available in a variety of forms. These products are Duragesic®, transdermal patches, Actiq®, transmucosal lozenges often called Fentanyl lollipops, Fentora®, effervescent buccal tablets, Abstral®, sublingual tablets, Subsys®, sublingual sprays, Lazanda®, nasal sprays, and forms which can be injected intravenously.
When Fentanyl was first synthesized it was introduced into medical practice as an intravenous anesthetic called Sublimaze®. Later, other analogues were introduced under trade names. They were Alfenta®, alfentanil which is a quick acting analgesic, Sufenta®, sufentanil which is an extremely potent analgesic is up to ten times more potent than Fentanyl and used in heart surgery.
Today, Wildnil®, which is Carfentanil, is an analogue of Fentanyl with an analgesic potency 10,000 times more than morphine. It is used to drug large animals by veterinarians.
When Fentanyl abuse became prevalent, products containing Fentanyl like Duragesic® patches were abused by removing the contents and then injecting or ingesting the drug. This type of abuse still occurs but Fentanyl is far more available because of the illicit import of the drug into the US from Mexico and China. Fentanyl patches may also be frozen, cut into pieces, and placed under the tongue or cheek.
In 2016, the DEA uncovered an operation making counterfeit oxycodone and Xanax containing Fentanyl in Cottonwood Heights, Utah. They seized approximately 70,000 pills and discovered the suspect owned a tablet press and ordered Fentanyl in powder form from China.
In 2019, U.S. Customs and Border Protection in Nogales, Arizona seized 254 pounds of Fentanyl with an estimated street value of $3.5M which was concealed in a secret compartment under a false floor of a truck transporting cucumbers. Also in 2019, the NY DEA Task Force (DEA, NYPD, and NYSP) seized 20,000 counterfeit M30 pills with a street value of up to $600,000.
Illicitly produced Fentanyl is encountered in powder form or in counterfeit tablets. One such common tablet is known as M30 or 30M which is a 30 mg Oxycodone pill in a small blue form. In 2021, it has been prevalent across the US and found in east coast cities, west coast cities and the Midwest. In its counterfeited form, it commonly contains Fentanyl or carfentanil.
In the Kansas City, MO, metropolitan area, from February to April 2021, counterfeit 30M pills have been referred to as “deadly as cyanide” and credited with dozens of overdose deaths.
Fentanyl’s technical names include: 1-Phenetyl-4-N-propionylanilinopiperidine; N-(1-Phenetyl-4-piperidyl)propionanilide; Propanamide, N-phenyl-N-[1-(2-phenyletyl)-4-piperidinyl].
It is a Schedule II Controlled Substances, under the Controlled Substance Act. It is classified as a depressant. Fentanyl, or one of its analogues, carfentanil, and alfentanil, can be found in powder form, tablets, pills, or when diverted prescription forms can be in transdermal patches.
Fentanyl has many street, or slang, names, such as Apache, China Girl, China Town, Dance Fever, Friend, Goodfellas, Great Bear, He-Man, Jackpot, King Ivory, Murder 8, and Tango & Cash. In pill form, it is often called M30 or Mexican Oxy, a counterfeit form of the 30M oxycodone pill manufactured by Mallinckrodt Pharmaceuticals.
The obvious signs of Fentanyl Use can include:
- slurred speech
- white film on the mouth
- itchy nose
- constricted pupils
- sweating and
- flushed face.
The symptoms of abuse can include:
- track marks
- thin, pale skin
- collapsed veins
- ‘nodding’ (falling asleep while standing or sitting and then waking)
- black, tarry stools
- stomach pain
- low red blood cell count
- swelling of the arms hands, legs and feet
- decreased blood pressure
- light-headedness or fainting
- extreme drowsiness
- heart rhythm changes
- chest pain
- stiff muscles
- trouble walking
- high body temperature
- swelling of the face, throat, or tongue
- respiratory depression (slowed breathing) and
- respiratory arrest (breathing stopped).
The many risks of abuse of Fentanyl includes, but is not limited to:
- Hepatitis C
- risk of injury from diminished capacity and ability to walk or be alert
- Blood infections
- low red blood cell count
- muscle spasms
- high blood pressure
- heart attack
Fentanyl and its analogues are highly addictive and there is an extreme risk of overdose and death.
Fentanyl can be packaged in a variety of methods and packages. Large quantities of Fentanyl are packaged in plastic wrap covered by duct tape. Small quantities are usually packaged in small glassine (waxed) envelopes, sometimes sealed in clear plastic. Tin foil has been used for small amounts. Powder is pressed into pills and can be poured into a small gelatin capsule. Paraphernalia associated with Fentanyl include hypodermic syringes, metal spoons, bottle caps, matches, lighters, cotton balls, cigarette filters, blotter paper, patches, pill presses, straws, etc. A variety of cutting (dilution) agents are Procaine, Lidocaine, Mannitol, Caffeine, Lactose, Acetaminophen, Cocaine, Methamphetamine and other precursor chemicals and drugs.
Fentanyl can be injected, snorted, sniffed, smoked, taken orally by pill or tablet, or spiked onto blotter paper. Fentanyl patches are abused by removing its gel contents and then injecting or ingesting these contents. Patches have also been frozen, cut into pieces, and placed under the tongue or in the cheek cavity. Illicitly produced Fentanyl is sold alone or in combination with heroin and other substances. It has been identified in counterfeit pills, mimicking pharmaceutical drugs such as oxycodone.
As seen frequently across the US in 2020 and 2021, common overdose symptoms can range from:
- urinary retention
- pupillary constriction and
- respiratory depression to stupor, cold and clammy skin
- coma and
- respiratory failure leading to death.
The street prices of Fentanyl vary across the United States and Canada, but the average cost is $1 to $20 and $20 to $60 for a single dose pill, in the form of a counterfeit M30. One gram sells for $60 to $250. One ounce sells for $1400 to $3000, and a 1 kilogram of Fentanyl sells for an average of $20,000 to $35,000. One kilogram of Fentanyl sells on the dark web for an average of $4,000 to $5,000. Fentanyl can be stepped on (cut/diluted) and yield as many as 300,000 single doses and yield an estimated $1.5 million in retail sales.
Keep in mind, Fentanyl and its analogues pose of serious threat to any law enforcement officer encountering the potent drugs.
Extra precautions should be taken with any substance or packages suspected of containing Fentanyl. Officers should increase awareness about Fentanyl, its various analogues, variety of packaging and its high potential to be pressed into pills and tablets or appear in counterfeit forms of less potent drugs.
Protective equipment is highly recommended when Fentanyl is suspected. Protective equipment should include latex gloves, eyewear, respirators, and a hazmat suit. Avoid field testing any substance suspected of containing Fentanyl and keep naloxone (Narcan®) handy in case of exposure. Undoubtedly, the prevalence of Fentanyl is rising and the adherence to precautions must be paramount for officers.
“Above all, it’s about going home at the end of the shift … “
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This article is an excerpt from the second edition of ‘Street Drugs and Drugs of Abuse’ by Lou Savelli, which will be released in the summer of 2021. Lou is a retired NYPD sergeant, is the President of Homefront Protective Group, a law enforcement training company.
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