Fentanyli

Fentanyli is a potent synthetic opioid analgesic used in medicine and also encountered in illicit drug markets. It is among the most powerful analgesics available and is estimated to be about 50 to 100 times more potent than morphine. Its high lipophilicity allows rapid entry to the brain, producing swift pain relief.

Medical use and forms include anesthesia adjuncts and treatment for severe or chronic pain under close medical supervision. Fentanyli is supplied in multiple formulations, such as injectable solutions for hospital use, transdermal patches for ongoing pain control, and lozenges, tablets or nasal sprays for rapid, short-term relief. Dosing and administration are tailored to individual needs and carry a risk of respiratory depression if misused.

Pharmacology and metabolism: Fentanyli acts primarily on mu-opioid receptors in the nervous system, altering pain perception and producing euphoria in some cases. It is rapidly distributed and primarily metabolized in the liver by cytochrome P450 enzymes, especially CYP3A4, to inactive or weaker metabolites such as norfentanyl, with elimination occurring mainly via the kidneys.

Safety, adverse effects, and overdose: Common effects include drowsiness, confusion, nausea, constipation, and slowed breathing. Tolerance and physical dependence can develop with regular use. Overdose, particularly in combination with alcohol or sedatives, can cause severe respiratory depression and death. Treatment relies on supportive care and the opioid antagonist naloxone.

Illicit use and public health: Illicit fentanyli is manufactured illegally and found in powders, counterfeit pills, or mixed with other drugs, notably heroin. It contributes to a high risk of overdose due to its variability and potency. Public health responses include harm reduction, surveillance, naloxone access, and regulation of production and distribution.