Fentanyl: A Guide On The Painkiller

If you suffer from severe chronic pain, for example, pain associated with cancer, your doctor may prescribe Fentanyl. Fentanyl is very strong and although effective in treating pain, but it could be deadly! So, what is Fentanyl and how does it affect your body?

What is Fentanyl?

Fentanyl is a very strong painkiller, a synthetic opioid drug (synthetic: made in the lab, not naturally available) and certainly, it is NOT an Over The Counter (OTC) medication meaning that only doctors can prescribe it. Due to its strength, doctors usually prescribe fentanyl when it comes to treating chronic pain.

This drug should not be used for short-term pains such as pain from bad headaches or migraines, or pain from injuries, or even regular surgeries for that matter.

Fentanyl chemical formula is C22H28N2O and its 50-100 times stronger than some of the known opioids such as morphine or heroin.

What is Fentanyl Used For?

Fentanyl must be used for treating pain in patients who need around-the-clock relief from extreme pain. These patients usually need a painkiller for long-term.

So, Fentanyl is usually prescribed for cancer patients or patient’s with severe pain after specific surgeries. Fentanyl is usually given in a shot, lozenges, or a patch on the skin.

Fentanyl Powder

Fentanyl powder is the non-pharmaceutical version of fentanyl. It’s in powder form because it makes Fentanyl abuse and snorting an option.

Fentanyl powder is even more dangerous than regular fentanyl. It makes accidental exposure to different areas of the body more likely. Compared to oral ingestion, snorting fentanyl is a quicker route to the brain which leads to severe and dangerous effects.

If snort, the concentration of fentanyl in the brain can rise pretty quickly which results in overwhelming the body and life-threatening side effects such as respiratory depression.

Fentanyl Patch

Similar to some other drugs, Fentanyl is available in transdermal patches. These are adhesive patches that are placed on the skin for delivering specific doses of Fentanyl through the skin into the bloodstream.

The amount of Fentanyl in the patches depend on the size (surface area) of the patch and it could be anything roughly from 2-17 mg.

What Are The Effects Of Fentanyl?

Similar to other opioids, Fentanyl binds to receptors in the brain which are responsible for emotion and pain. This interaction leads to release of dopamine in the body which makes you feel the euphoria and relaxation.

However, since Fentanyl is a much stronger opioid than other opioids, one should be extra careful while taking it.

Recommended Dosage For Fentanyl

The medicinal Fentanyl is found with different strength. Your doctor prescribes different dosages depending on the pain level and type of drug administration route (IV injection vs. patch). The highest dosage is 200 micrograms per hour (mcg/h) and the lowest is usually 12 mcg/h.

For surgery premedication, 50-100 mcg/dose IM or slow IV 30 to 60 min prior to surgery is normal. If Fentanyl is going to be used for regional anesthesia: 25-100 mcg/dose slow IV over 1 to 2 min is what’s recommended. For anesthesia in some of the minor surgical procedures: 0.5-2 mcg/kg/dose IV is considered and for analgesia, the dose could go anywhere from 25 up to 200 mcg/hr.

One of the considerations in choosing the dose aside from pain level is previous opioid exposure and history of the patients with opioids. Some bodies can tolerate higher initial doses. Yet, this is another reason not to take Fentanyl or any opioid pain medication for that matter, without consulting with your doctor.

Sometimes Fentanyl needed dosage is estimated based on the needed morphine dosage. For example, 45-134 mg/d of morphine is equivalent to 25 ug/d of transdermal Fentanyl (through Fentanyl patch).

Are There Any Fentanyl Equivalents?

Fentanyl is a strong opioid painkiller and therefore other strong opioid painkillers such as morphine are the alternatives or equivalents. But, equivalent doesn’t mean that similar amounts of morphine and Fentanyl are as effective!

One could say Oxycodone, Hydrocodone and Codeine are all opioid painkillers and so are equivalent to Fentanyl. But again, the strength of these opioids are significantly different.

You may have heard about Carfentanil! This synthetic opioid is a chemical analog of fentanyl. Chemical analogs have similar structures but differing from each other with respect to a certain component!.

Interestingly, Carfentanil is 100 times more potent than Fentanyl. It’s 5,000 times stronger compared to heroin, and 10,000 times stronger than morphine. Go figure!

Total legal production of Carfentanil in 2016 in the US was 19 grams! This drug is not an alternative to Fentanyl. It is used minimally in combination with other drugs in tranquilizer darts for large mammals.

Unfortunately, there have been several cases of drug overdose deaths related to Carfentanil which people took unknowingly as it was mixed with heroin or codeine! This chemical is so dangerous that it is considered a weapon of mass destruction!

The bottom line is, Carfentanil is not an alternative to Fentanyl. The most common equivalent to Fentanyl which is legally used in hospitals is morphine!

Fentanyl vs Morphine


Morphine and fentanyl are both opioids. They interact very similarly with the brain receptors which leads to feelings of sedation. Fentanyl is approximately 100 times stronger than morphine.

Fentanyl is usually prescribed for severe chronic pains and those who need strong painkiller round-the-clock. Morphine is used to treat moderate to severe pain after surgery for example if the pain can’t be controlled by using other painkillers such as Hydrocodone for example!

Both Fentanyl and Morphine are contributors to the opioid epidemic. Because Fentanyl is stronger, people who abuse opioids are more prone to overdose and even death by Fentanyl. Fentanyl, in particular, was the reason for more than 500 percent increase in opioid overdose deaths within the past few years.

Fentanyl Side Effects

Fentanyl is a strong opioid and it comes with side effects. Though some side effects may not occur or may be mild, one may experience serious side effects. Both common and severe side effects are listed below:

Common Side Effects

There are some factors that may play an important role in the efficiency and side effects of Fentanyl. Physical condition, age, weight, opioid history, other medications taken at the same time, and obviously the dosage of the drug.

Based on these factors patients may or may not experience the following side effects:

  • The decrease in the amount of urine
  • The decrease in the frequency of urination
  • Constipation
  • Nausea
  • Vomiting
  • Diarrhea
  • Reduced appetite
  • Cramps
  • Drowsiness
  • Impaired balance
  • Weakness or fatigue
  • Euphoria
  • Incoherent or slurred speech
  • Lowered blood pressure
  • Sweating
  • Itching
  • Hoarseness
  • Difficulty breathing or swallowing

Severe Side Effects

Some of the side effects could be more severe and if any of the following should happen, you should call the doctor or 911 immediately:

  • Seizures
  • Cold, clammy skin
  • Blue or purple color to the skin
  • Severe drowsiness
  • Fainting
  • Very slow heartbeat
  • Severe troubled breathing
  • Irregular menstruation
  • Decreased sexual desire
  • Severe chest pain
  • Swelling of the eyes, face, mouth, lips or throat

Fentanyl May Depress Breathing

Fentanyl causes slowdowns in breathing rate. This is actually the leading cause of death in opioid overdoses. Illicit fentanyl is so dangerous that first responders must be wearing hazmat suits when dealing with overdose situations to avoid accidental Fentanyl exposure and inhaling particles of it.

What Are The Effects Of Mixing Fentanyl And Alcohol

You probably heard how dangerous it is to mix alcohol with opioids. In the case of Fentanyl, it can be deadly. You must be extremely cautious when taking Fentanyl. Even a very small amount of fentanyl can be a lethal dose if it is mixed with alcohol.

Buying Fentanyl Online

Unfortunately, though illegal, there are websites that you can order Fentanyl from! In a report released by the Senate earlier this year, it was found that Chinese websites are selling fentanyl and even carfentanil and sadly enough, these websites are incredibly responsive and supremely confident that they can get the drug into the US.

Obviously, these are not legitimate and buying strong opioids from these websites could end up risking yours and others lives!

Fentanyl Abuse And Addiction

Based on the data from the National Vital Statistics System, fentanyl involvement in opioid overdose deaths rose from 14.3 percent in 2010 to 46 percent in 2016 which was almost half of opioid-related overdoses. Unfortunately, Fentanyl has contributed to more deaths compared to prescription opioids or even heroin. Sometimes.

Fentanyl may be habit-forming, especially if it’s used for a long time. This could happen with any form of Fentanyl including patches. Snorting fentanyl powder is a great the risk for Fentanyl addiction. Obviously, the likelihood of addiction developing is significantly higher when the drug is abused.

Snorting specifically creates a rapid high concentration in the brain in a short time which causes immediate euphoric feeling and at the same time coming down from the high feeling which causes a craving for use again.

This situation becomes specifically dangerous if the drug abuser has a low tolerance to opioids.

It’s been reported that among the 72,000 or so deaths related to the opioid crisis in 2017, the sharpest increase occurred among Fentanyl-related deaths with nearly 30,000 overdose deaths.

There are Fentanyl addiction treatments available through hospitals and other care centers (Fentanyl rehab) to deal with opioid addiction situations.

Fentanyl Withdrawal Symptoms

If one stop using Fentanyl suddenly after being on it for a while, symptoms of withdrawal may occur. Again, if any of the symptoms listed below occur to you after stopping Fentanyl use, call your doctor immediately. Fentanyl withdrawal symptoms include:

  • Restlessness, Anxiety
  • Pain in the joints
  • Difficulty falling asleep or staying asleep
  • Weakness
  • Yawning
  • Teary eyes
  • A runny nose
  • Sweating
  • Muscle pain or stomach cramps
  • Black circles in the center of the eyes
  • Loss of appetite
  • Vomiting
  • Nausea
  • Fast heartbeat
  • Rapid breathing

Alternatives To Fentanyl

There are opioids and nonopioids alternatives to Fentanyl. Read on to see what the alternative are but you have to realize that all alternatives mentioned below are way weaker than Fentanyl.

Opioid Alternatives

Other legal opioids that are prescribed by doctors such as Codeine, Hydrocodone, or Morphine are alternatives to Fentanyl, however, these are all weaker than Fentanyl. Morphine which is a strong known opioid is roughly 100 times weaker than Fentanyl.

Non-opioid Alternatives

One could say that non-opioid alternatives to Fentanyl are Ibuprofen or other NSAID painkillers but these painkillers effect on the pain are nothing close to Fentanyl. Again, we are talking about one of the strongest (if not the strongest) opioids in the market!

One interesting non-opioid alternative to Fentanyl or other opioids for that matter are Cannabidiol or CBD. CBD is a natural pain medication. Read on to know more!

The Natural Alternative: CBD As Pain Medication


A very common alternative to Fentanyl for chronic pains is Cannabidiol or CBD. CBD is a non-opioid natural painkiller. There are natural chemicals called cannabinoids which are relatively safe, non-toxic and they don’t cause addiction.

They can be extracted from cannabis plants. CBD is present in hemp, which is a close relative of marijuana. Aside from CBD, tetrahydrocannabinol (THC) is another chemical that can be extracted from cannabis plants. These chemicals can be used to treat moderate or even severe pains!

While CBD is good for treating moderate to severe pains, interestingly enough, it doesn’t make you high! Also, CBD doesn’t cause many of the side effects that opioids cause and that’s what makes them interesting.

One of the interesting differences of CBD from other cannabinoids, or chemicals which are found in hemp and cannabis is that CBD has a very little effect on two of the major receptors in the brain called CB1 and CB2.

While other cannabinoids such as THC have interaction with these two significant receptors in the nervous system, CBD has a very little effect on these. So, CBD does not induce a mind-altering state.

How CBD Helps With Pain

Similar to opioids painkillers, CBD interacts with receptors in the brain and immune system and cause feelings of ease, euphoria, and anti-inflammatory and painkilling effect occur as the result.

Where To Get CBD

CBD is available in different forms such as oil, cream or pills. Variety of brands are available through Amazon, Whole Foods and Groupon.

Why Choose CBD Over Fentanyl

CBD is not habit forming, it is effective in treating pain and its natural. CBD is not addictive and it doesn’t need a doctor’s prescription. So, there must be enough reasons why choose CBD over Fentanyl.

Final Thoughts

Fentanyl is a very strong opioid which must only be prescribed by your doctor! If abused, serious side effects and even death may occur. Fentanyl and heroin are among the top leading causes of overdose-related death incidents in the US.

Farma Health Desk Editor

Click Here to Leave a Comment Below 1 comments