What is fentanyl, the drug that pushed overdose deaths to a record high in 2017?

A new report from the Centers for Disease Control and Prevention paints a grim picture of the opioid crisis facing the United States. According to provisional estimates, more than 72,000 deaths were caused by drug overdoses in 2017 alone, and 30,000 of those were the fault of synthetic opioids like fentanyl. That’s up from 9,000 opioid deaths in 2016. Overall, the number of overdose deaths represents a 9.5% increase from the previous year and, if broken down, works out to about 200 overdose deaths each day. Needless to say, those numbers are chilling.

“Opioids trick the brain into a false sense of pleasure,” Dr. Brent Boyett, chief medical officer with addiction treatment center Pathway Healthcare, told HelloGiggles. “They provide a sense of comfort or pain relief.”

That “false sense of pleasure” is highly addictive, experts say, and like the start of any addiction, it’s that extreme euphoria that initially gets you hooked.

So what is fentanyl, and why is it causing all these deaths?

Fentanyl—the drug that killed both Prince and Tom Petty—is a prescription pain reliever in the opioid family, which includes the prescription drugs oxycodone, hydrocodone, codeine, morphine, and more. Opioids are drugs that “interact with opioid receptors on nerve cells in the body and brain,” according to the National Institute on Drug Abuse. Heroin is also an opioid, though fentanyl and the other prescription drugs noted here are all synthetic opioids made in labs.

Historically, fentanyl use was reserved for the management of severe pain in a controlled setting, like a hospital operating room or during end-of-life care. However, “over the last two to three decades…use of fentanyl found its way into the treatment of chronic, non-terminal pain—a trend believed by many to be a mistake,” Dr. Boyett told HG.

That’s because fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. “It has a long duration of action, which puts the user at a much higher risk of experiencing an overdose,” according to Dr. Neeraj Gandotra, chief medical officer at Delphi Behavioral Health Group.

Opioids like fentanyl function as pain killers in a physical and psychological sense, according to Dr. Sal Raichbach of the Ambrosia Treatment Center. “With repeated use, the brain forms new pathways and associations between pleasure and opioids. In a way, the brain is hijacked into thinking that to feel good, it needs the drug,” he said.

When someone who is addicted stops taking fentanyl, their brain goes into “survival mode.” They’re willing to do anything to get that good feeling back, Dr. Raichbach explained. Since tolerance to opioids develops quickly, people typically require more and more of the drug to reach the same high as they had initially.

In 2016, the CDC reported that overall life expectancy in the U.S. had dropped due to the surge of deaths caused by opioid overdose. The National Institute on Drug Abuse called it a “serious national problem that affects public health, as well as social and economic welfare” in 2017.

Earlier this year, research by the American Medical Association found that nearly half of all overdose deaths involved fentanyl. It’s a trend that was also found in the recent CDC report.

Fentanyl has a direct effect on the part of the brain that controls the respiratory system. So during an overdose, breathing may slow to dangerous levels, sometimes even stopping altogether. At the same time, the individual’s heart rate may slow down drastically. “Without enough oxygen in the blood, the brain begins to ‘starve,’” Dr. Raichbach explained. An individual may also experience dulled pain, euphoria, pupillary contraction, hypoxia, bluing of the fingertips and lips, or nausea and itching.

In many cases, opioid overdose deaths may actually be the result of respiratory depression. According to Dr. Boyett, the patient can receive so much chemical pleasure from the drug that they become unbothered by a lack of oxygen.

“The reason that we breathe is because we become uncomfortable if we go too long without taking a breath, so we are compelled to make that action a priority,” he said. “When a person dies of a drug overdose, they are actually dying of an overdose of pleasure.”

An especially scary part of all this is that some people may not even know they’re taking an opioid.

One of the biggest reasons we see so many opioid overdoses is that fentanyl is turning up in all sorts of street drugs, not just heroin. For instance, fentanyl-laced cocaine has become a deadly problem for many users, according to the Drug Enforcement Agency.

“People with no tolerance for opioids take fentanyl without knowing it,” Dr. Raichbach said. “For someone with little or no tolerance to opioids, a tiny amount can kill, something like what would come out of one shake of salt.”

Overcoming a fentanyl addiction is very possible, though.

Treatment for fentanyl addiction won’t be easy—according to Dr. Raichbach, it may even be a lifelong journey. But it’s possible.

It usually begins with a medical detox, which can be extremely uncomfortable both physically and psychologically. Relapses are likely without medical intervention, and Dr. Raichbach says post-detox therapy is critical to overcoming an opioid addiction.

There’s a bit of good news in all this: The CDC report found that a number of states saw decreases in overdose deaths last year. In more recent months, the numbers have fallen further. Although it’s too soon to tell if this will become a trend, it’s encouraging.