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Illicit Fentanyl and Prescribed Fentanyl. What Is the Difference?

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illicit fentanyl

Fentanyl now accounts for more than 30,000 deaths each year, a figure which continues to rise sharply in the last decade. Fentanyl is a type of opioid, meaning that it is related to heroin, morphine, and oxycodone. Its unique properties make it a powerful painkiller in medical settings. They also make it exceptionally addictive and prone to causing an overdose. Understanding the difference between prescription fentanyl and illicitly manufactured fentanyl is essential for guiding policy and opioid addiction treatment.

What Is Fentanyl?

Fentanyl is considered a synthetic opioid. Synthetic means the drug is produced in a laboratory setting rather than grown naturally, like morphine derived from poppy plants. Like morphine and other opioids, fentanyl binds to opioid receptors throughout the body and brain. It causes a cascade of events that lead to the numbing of pain.
Fentanyl was initially discovered by scientists looking for additional new types of anesthesia. Nowadays, the drug is still widely used in medical settings. Patients who have cancer or severe chronic pain also benefit from the effects of this medication. Fentanyl is a popular pain-relieving drug because it is so powerful. It is 80 to 100 times more potent than morphine. That means that even very tiny amounts cause a powerful painkilling effect. Fentanyl also binds to reward centers in the brain, causing euphoria or intense pleasure.

Tolerance, Dependence, and Addiction.

Over time, taking fentanyl causes its effects to diminish. The receptors become used to its presence, meaning that it takes more fentanyl to achieve the same effect. This phenomenon is known as “tolerance” and is one of the significant indicators of opioid dependence. At the same time, the brain’s reward centers’ continuous activity causes them to become rewired. Now, the brain starts to depend on fentanyl to feel good. Physical dependence causes intense cravings, which leads to unhealthy drug-seeking behaviors. These behavioral symptoms are known as fentanyl addiction. Addiction is different than physiological dependence. Dependence refers to the body’s tolerance and reaction to fentanyl, while addiction refers to the drug’s psychological and behavioral effects.

Fentanyl Is Driving the “Third Wave” of the Opioid Crisis

Fentanyl is driving what has been called the “third wave” of the U.S. opioid epidemic. The opioid crisis began with prescription drug abuse. Starting in the 1990s, medical providers prescribed millions of doses of opioid painkillers to patients. As prescription painkiller abuse and addiction rates skyrocketed, many individuals turned to cheaper and more potent heroin as a substitute. This spike in heroin addiction was the “second wave” of the crisis. More recently, people suffering from opioid abuse have been turning to synthetic opioids like fentanyl.
This “third wave” of the opioid epidemic has been escalating quickly. Much of the fentanyl in the U.S. arrive from Chinese laboratories. Until recently, it was legal to produce fentanyl in China, which then ships to Mexico, where drug cartels traffic it across the U.S.-Mexico border. Because the supply of fentanyl has been so high and the costs of producing it are so low, the buyer’s cost becomes relatively low. This wide availability has fueled demand among people addicted to opioids. In contrast, prescription painkillers, especially those diverted from the medical supply, tend to be more expensive.

Differences between Prescription Fentanyl and Illicit Fentanyl

On one level, fentanyl is fentanyl. Chemically speaking, there is no difference in the molecular structure of prescription fentanyl versus illicit fentanyl. Both drugs enter the brain and bind to opioid receptors throughout the body.
However, how fentanyl works in real life is a little different. Fentanyl is part of a family that includes multiple related compounds. Carfentanil, sufentanil, remifentanil, and others are closely related in their chemical structure. These “fentanyl analogues” are often developed by pharmaceutical companies for their painkilling properties. Often, their chemical structures are patented, but no company goes through with producing them. Chinese laboratories then obtain information about chemical structure and begin to produce the drugs. As a family, fentanyl analogues can be extremely dangerous because of their potency. For example, carfentanil is 10,000 times more potent than morphine and 100 times more potent than fentanyl.
Even though their chemical structures may be identical, there are fundamental differences between prescription fentanyl and illicitly manufactured fentanyl. Some of the main points of difference include:

DEA Scheduling

Drug Enforcement Agency (DEA) scheduling refers to the classification of drugs by their potential for abuse. Pharmaceutical fentanyl is classified as a Schedule II drug. This means that it has some medical benefits but has a high potential for abuse. Prescription painkillers such as oxycodone (Oxycontin) and hydromorphone (Dilaudid) are also Schedule II drugs. In contrast, fentanyl analogues are considered Schedule I drugs. This means that they have no accepted medical purpose and a high potential for abuse. The more stringent drug scheduling affects the enforcement of laws regarding possession and sale.

Place of Origin

Pharmaceutical fentanyl is produced in laboratories that are well-regulated and meet safety standards. The Food and Drug Administration oversees the production of pharmaceutical-grade medications like fentanyl. In contrast, street fentanyl comes from illicit laboratories, often in China or Southeast Asia. These labs have no regulations, which means that they do not need to meet any particular safety standards.


Because of the more deficient regulation of illicitly manufactured fentanyl, purity varies widely. One of the biggest challenges in helping people with fentanyl addiction is that they do not always know what their street drugs contain. Drug dealers often lace their product with fentanyl as a cheap way to increase its potency. That means that someone using heroin might accidentally overdose because they didn’t know that the heroin contained fentanyl. In contrast, prescription fentanyl has strict regulations. There is standard potency, meaning that a dose will deliver the same intensity each time.

Method of Delivery

Prescription fentanyl is typically available in patch, lozenge, or shot form. Additionally, the illicit form of fentanyl often comes as a powder, which is cheaper and more convenient to ship. Once it arrives at its destination, the drug is mixed with other substances, placed on blotting paper, or into eye droppers.

Likelihood of Causing Addiction

Fentanyl is incredibly powerful. Anyone who takes fentanyl for some time is likely to experience some degree of physiological dependence. As described above, dependence is different than psychological addiction. Furthermore, because street fentanyl is often taken with other drugs, it can be dangerous and place a person at higher risk for overdose.

The Best Choice for Treatment of Fentanyl Addiction

Fentanyl is the fastest rising category of drug use in the United States. The most recent law enforcement data show that confiscations of fentanyl increased by seven times in the last years, with 4,585 confiscations in 2014 alone (more recent official data are not available, though local law enforcement officials report that fentanyl abuse remains high). According to the most recent U.S. Customs and Border Protection press release from Nov. 13, 2020, Border Patrol agents had discovered and intercepted enough fentanyl to kill 200,00 people in Yuma, Arizona. This is a public health emergency!

The rising rates of fentanyl abuse have public health experts worried. The CDC advocates for a multi-pronged approach: prevent opioid use disorder, reverse overdoses as they happen, and treat opioid use disorder. For the millions of people in the U.S. suffering from opioid abuse, the last point is critical. Effective opioid treatment is essential to reducing fentanyl abuse.

Fentanyl Treatment Program

The first step in any fentanyl treatment program is to undergo detoxification. Detox is the process that occurs when you stop taking opioids. Fentanyl detox typically triggers withdrawal symptoms, which can be unpleasant and even dangerous. Common opioid withdrawal symptoms include diarrhea, watery eyes, nausea, vomiting, sweating, muscle pain, abdominal cramping, and elevated heart rate. For people with certain medical conditions, withdrawal can cause serious complications.

The difficulties most people have in overcoming a fentanyl withdrawal make rapid detox and medically assisted detox become such an essential part of recovery treatment. Medical detox is a process that eases the discomfort of withdrawal while ensuring vitals and other critical physiological occurrences are being adequately managed by a doctor. Being in a hospital through opioid detoxification is the safest option. In a hospital, patients can receive higher doses of medications to ease withdrawal symptoms, allowing them to detox safely, comfortably, and with dignity.

Waismann Method® Rapid Fentanyl Detox

For all the reasons above, Waismann Method® Opioid Treatment Specialist admit patients coming off fentanyl to a private room of an accredited hospital. Being in a full-service hospital allows patients access to immediate 24/7 response, supervision, and specialized medical care. This medically assisted form of drug treatment maximizes safety, success while providing a caring environment to begin recovery. In addition to in-hospital medical detox, Waismann Detox also offers recovery care through the regulation and transitional phases. We understand there are no overnight solutions when dealing with fentanyl addiction, and inpatient treatment length should be established based on each individual health needs and not a pre-set protocol. Rapid fentanyl detox can be a life-saving procedure if performed responsibly by an experienced board-certified anesthesiologist.

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