Fentanyl, once feared by users as a deadly substance that could potentially be mixed into their supply, is now sought-after on the streets. Experts say this is indicative of a tolerance to opioids like heroin and a desire to achieve the same high with deadlier options. Fentanyl, a synthetic opioid, is up to 50 times stronger than heroin.“Two years ago, I would have thought this was crazy,” said Dr. Akhil Anand, a psychiatrist at the Cleveland Clinic who specializes in addiction. However, he has seen fentanyl use increase drastically in Ohio.Fentanyl was proved for use to alleviate pain in cancer patients in clinical settings. It can also be used for severe, chronic pain experienced by non-cancer patients. But the purpose of the drug was initially limited to these settings. It first made its way onto the streets a decade ago with supply mainly coming from China. Since the white powder looks like heroin, but it’s cheaper, dealers began to mix the two drugs together and pass the substance off as heroin, often without any regard for the strength of fentanyl. The synthetic has also been used to cut non-opioid drugs such as cocaine and it’s been passed off in fake prescription pills.

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All of these uses have increased the number of overdose deaths significantly over the years. In fact, according to the Centers for Disease Control and Prevention (CDC), by 2021, fentanyl was involved in the majority of overdose deaths in the U.S.Mary Ward, president of the McLeod Addiction Center in Charlotte, North Carolina, said fentanyl is now “a preferred drug” where she’s from. “Some people thought they were buying heroin on the street, and it turned out to be fentanyl,” Ward said. “They ended up liking it better.”Users are now experimenting with new ways to use the once feared drug, too. Previously, fentanyl patches were being used or users were injecting it. Now, more and more, people are opting to smoke it.“My prediction would be that smoking fentanyl will be the norm within a year,”, said Dr. Daniel Ciccarone, a professor of family community medicine at the University of California, San Francisco. “It’s nice to not have to use your veins or not inject, and so a lot of people would prefer not to be doing that. I think we’re going to see more and more people smoking fentanyl than injecting it.”Some addiction specialists believe that smoking fentanyl rather than injecting it can be seen as a means of harm reduction because this limits the spread of infection. However, that’s not to say that smoking fentanyl should be promoted.“I don’t know that we’re at a place where we can say, ‘Hey, maybe you should smoke it instead,’” said Dr. Kris Kast, clinical director of the Addiction Consult Service at Vanderbilt University Medical Center in Nashville. “It would be hard for me to feel confident in recommending that to somebody.”In any case, a preference for fentanyl is changing the landscape of drug use and experts are scrambling to come up with new ways to reduce the number of deaths on the streets. Due to the drug’s potency, however, with more and more users opting to use the synthetic, there is likely to be a larger spike in overdose fatalities for some time to come.

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Once feared, illicit fentanyl is now a drug of choice for many opioids usersUMass Chan News What is fentanyl and why is it behind the deadly surge in US drug overdoses?