Fentanyl: An Increasing Danger

Fentanyl is the single deadliest drug threat our nation has ever encountered. Fentanyl is everywhere. From large metropolitan areas to rural America, no community is safe from this poison. We must take every opportunity to spread the word to prevent fentanyl-related overdose death and poisonings from claiming scores of American lives every day.

Anne Milgram, Administrator, U.S. Drug Enforcement Administration (2023)

Overview of Fentanyl: Pharmaceutical Products vs. Illicitly Manufactured Drugs

Pharmaceutical-grade fentanyl is an important therapeutic tool for managing severe pain. Pharmaceutical fentanyl products currently include the following dosage forms: oral transmucosal lozenges commonly referred to as fentanyl “lollipops” (Actiq), effervescent buccal tablets (Fentora), sublingual tablets (Abstral), sublingual sprays (Subsys), nasal sprays (Lazanda), transdermal patches (Duragesic), and injectable formulations (U.S. Drug Enforcement Administration [DEA], 2022.)

Fentanyl also can be manufactured illicitly, and its use outside of clinical settings readily leads to overdose. Illicit fentanyl can be found as both a powder and as tablets. The DEA classifies fentanyl analogs as Class I drugs which have high addiction potential and no accepted medical use.

These pills are sold as counterfeit pharmaceutical-grade opioids, benzodiazepines or stimulants such as Adderall and Xanax (Gonzalez, 2022). These pills are sometimes made in a variety of colors that may look like candy.

In 2021, 16.1 percent of Texas teens surveyed reported taking prescription pain medications without a prescription or differently than how a doctor told them to use it (CDC, 2021). The prescription drugs most misused by teenagers fall under three categories: opioids (like codeine), depressants (like benzodiazepines) and stimulants used to treat ADHD. Each of these prescription drugs are mimicked by fentanyl-containing fake pills and marketed to teens (Ibid.).

Lethal doses of fentanyl are also being found in illicit drugs including heroin, methamphetamine and “club drugs” such as ecstasy. The drugs are sold as extra-potent pills or powder (Ibid.).

Differentiating Fentanyl from Traditional Opioids

Traditional opioids, including morphine and hydrocodone, are prescribed or administered by a doctor to safely manage severe pain. Misuse of these drugs puts patients at risk for physical dependence, addiction, overdose and death.

Fentanyl, however, is a synthetic opioid that is 50 to 100 times more potent than morphine. The image frequently used to illustrate fentanyl’s potency is that the amount of fentanyl that fits on the tip of a pencil can be lethal.

Fentanyl Abuse and Overdose in Texas

Texas children and families are at high risk for exposure to illicit fentanyl. According to the Texas One Pill Kills awareness campaign, “one in four Texans have experienced an opioid overdose or know someone who has.” About 52% of all unintentional overdoses in Texas involve opioids, and 92% of opioid deaths in Texas children ages birth to 17 years involved a synthetic opioid such as fentanyl (Texas Workforce Commission, 2023).