I’ve always heard that a singular dot of fentanyl can kill you. Yet we use it medically, for pain relief. And many people are addicted to it but stay alive while using. Is there like a different method of using it? How do people use it and not die?
In: Chemistry
A “dot” of fentanyl probably weighs milligrams whereas in medicine we use micrograms. Furthermore, fentanyl in medicine is used when only in extreme pain, especially broken bones. Often when used outside of the medical setting it’s in a state of abuse/addiction.
There’s a couple things that lower the possibility of overdose. First being tolerance, people who use fentanyl on the street usually have a very high tolerance to opiates and they will be able to withstand a higher dosage of fentanyl without od. Another is the way pharmaceutical fentanyl is manufactured and designed, most fentanyl prescribed is used through a patch, which limits the amount of fentanyl released into the bloodstream. Some patches will slowly release the dose over a period of 24 hours or longer. Hope I was able to help a bit, let me know if I can answer any questions you have
I used to use fentanyl patches for my bad back and they hardly did anything. No more refills. The doctor says it’s now only prescribed for cancer patients. So now they prescribe me morphine. Yes, it does stop the pain for quite a while.
If they’re administering a drug in hospital, they can put in an IV. If you mix a ‘dot’ of painkiller with a big bag of saline, you can trickle that into a person’s arm so it takes hours for the whole dot to go in. You can get really fine control and give small, steady doses that way, and unlike with pills you can stop the trickle whenever you need to.
There is an “effective dose”, or the amount required to achieve therapeutic effects. This dose increases with tolerance. There is also a “lethal dose”, which also increases with tolerance. The amount to achieve the desirable effects and the amount required to achieve lethal affects over time gets closer and closer together as tolerance increases. The body can only tolerate so much before essential systems are too impaired. Both doses involve achieving a certain concentration of the substance in the body (blood, or possibly another fluid or part of the body). Very potent drugs can be made safer my limiting the ability to form a hazardous concentration of the substance in the body. This can be achieved by limiting the absorption rate (via dermal patches), by limiting the total amount of substance (such as a pill with a fixed, tested, and reproducible manufacturing process containing a therapeutic amount), or by diluting the compound so that one can administer it realistically with available measuring equipment. Street drugs are high purity and users lack the proper education, skills, and equipment to safely dose them selves. Pharmaceuticals are subject to rigid testing and standards that ensure the purity and strength (and identity) of substances, and the ways of dosing them are also tested. Fentanyl cannot be accurately dosed by visual inspection, even in experienced users.
Street fentanyl is on average only 14% pure in the USA according to DEA and around the same in Canada according to our many free drug testing places and databases, but anywhere from 8-20% usually.
The 2mg dosage you see in media is the (suspected) “LD50”, the lethal intravenous dose 50% of adults will die at. so its misleading in general because the media always says “2mg will kill anyone”.
So that 2mg figure you’re used to seeing is more like 20mg on the street, and that’s for IV which is the most bioavailable (efficient) route of administration (ROA).
This makes it easier for street users to not OD especially considering many are smoking it which is much less efficient RoA, and since it’s not even close to pure anyways. Once you take tolerance into account, usage can quickly double, triple, quadruple. This can make it more dangerous despite seeming like itd be safer – because of the discrepancies of potency between batches and the chance of hotspots and other cutting agents or research chemicals like etonitazene or fentalogues.
Most batches are color coded, so users can have somewhat of an idea that the green fent X is selling is maybe the same as the green Y is selling, while if they find a red batch from Z maybe they start at a lower dose and titrate up to ensure it isnt more potent than their last and causes an OD.
As for medical situations, its Volumetric Dosage. 100mg can be put into 100ml then each 0.1ml is 100ug for example. 1mg per ml concentration. People are also given patches which are like a controlled release idea.
Medical tools are very precise, and there’s a reason professions like anesthesiologists who measure out the doses of drugs for stuff like this get paid a handsome salary. A single mistake in jobs like that can kill a patient.
When it comes to drugs, the dosage or the amount is the thin line between treatment and harm. For fentanyl, and surprisingly a lot of important and life-saving medications, the dose required to provide the medicinal effect is extremely small and heavily regulated. When designing medications and the various ways to use it, whether through a pill to swallow or a patch to apply to the skin, they make sure that the amount inside each individual dose is accurate to a high degree, and difficult to overdose from without taking more than the prescribed the amount. When someone is making illegal medications for abuse, their sources may be more concentrated, less pure, and potentially have more harmful substances inadvertently mixed into it. If someone didn’t “cut” or dilute the mixture properly, their customers might get a substantially lower dose or in lethal cases, a slightly higher dose.
When I was administered fentanyl for a 2+ hour dislocated shoulder, I still felt the pain, I just didn’t care.
As a lifelong mountain biker, I’ve had lots of injuries that require medical pain relief and I hate the nausea so much I developed a post hospital routine that I’d drink and vomit a McDonald’s vanilla shake.
Never liked downers unless I was in excruciating pain. Then, they are swell.
Fentanyl is a drug that happens to have a similar shape as particular chemicals, called a neurotransmitter, your body uses to signal itself. The neurotransmitters are released by your body in different places to signal different things and those places in your body respond when they get the signal.
When you take fentanyl, the fentanyl spreads throughout the body and signals several different places all at once.
Key to your question the fentanyl goes to your:
Brain and spinal chord and those places respond by lessening pain perception.
Other parts of the brain respond to fentanyl by releasing another neurotransmitter called dopamine which leads to a feeling of euphoria.
The brain stems responds to fentanyl by slowing breathing and heart rate.
So, how is it that we use Fentanyl as a painkiller, an addictive and euphoric drug, and a deadly drug? Because Fentanyl is shaped like a neurotransmitter the body already uses and taking it as a drug makes your whole body receive lots of neurotransmitters at once. The different parts do all their stuff at once, including lessen pain, euphoria, and possibly death from heart or breathing stopping.
In a clinical setting, the anesthesiologist carefully doses the fentanyl based on your weight and sex and other things so you perceive less pain but keep breathing. In a drug dealer situation, the drug dealer may mix fentanyl into the drugs without the buyer knowing: it’s cheap and strong.
The buyers may not know how much fentanyl they are getting and may be varying levels of tolerant to the drug. Some may die as their tolerance is too low or they take too much.
Ironically, when people OD on particular drugs, other addicts tend to buy *more* of the drugs believing they are stronger.
And give how Fentanyl works the stronger it is the more euphoria and pain relief and the more likely you are to die from it. So the addicts are not totally wrong.
Fun fact: Narcan/Naloxone stick more readily to neurotransmitter receptors but don’t signal them. So, the Fenantyl can’t stick to the receptors because the naloxone blocks them, and the effects of opiods cease very quickly.
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