Wednesday 24 April 2024

2024 Fentanyl





                                  EDUARDO C. GERDING



“It is only a matter of time before fentanyl becomes an epidemic in Latin America” - 6

               General Laura Richardson, Commander, US Southern Command.



Given the importance that fentanyl consumption has acquired worldwide, this article aims to review the main concepts about opioids.

What is opium

Opium is a highly addictive non-synthetic narcotic that is extracted from the green heads of the plant known as poppy (Common poppy or Papaver somniferum). Opium is the main source of many narcotics including morphine, codeine and heroin.


What effects does opium have?

The main desired effects of opium are: relaxation, intense sensation of well-being and gratification, absence of hunger, absence of pain, sensation of daydreaming, increased ability to imagine and perceive, greater critical distance with respect to internal and external things, pupil contraction  (pinpoint pupil).

Opium Wars

In 1729, the Chinese emperor Yong-Tcheng issued an edict prohibiting the importation of opium. Poppy juice was then introduced clandestinely, first financed by the Portuguese and from 1773 thanks to the British East India company, which had a monopoly on the plantations.

The British introduced the drug to China from India, causing consumption to spread throughout the territory among the working classes.


In 1830, Emperor Daouguang banned the buying and selling of opium, resulting in a violent war with Great Britain. Two opium wars broke out between England and China: the First lasted between 1839 and 1842. The Second, in which France involved with the British, broke out in 1856 and lasted until 1860.

 The causes of the Opium Wars were the commercial interests that created British smuggling of opium into India and China and the efforts of the Chinese government to impose its laws on that trade.

 The first war concluded with the Treaty of Nanjing by which China paid reparations and handed over Hong Kong to England.


These wars and the subsequent treaties signed between the powers resulted in several ports in China opening their trade with the West, partly causing the decline of the Chinese economy. The Chinese defeat (with 4,000-5,000 dead) in both wars forced the government to tolerate the opium trade.

In the West, the upper classes and intellectuals went to opium dens to consume recreationally or treat their ailments. Laudanum (a preparation composed of opium, white wine, saffron, cloves and cinnamon) was a frequent companion for those who wanted to treat some ailments, and on some occasions it also served to shorten life. 5


What are opioids?

Opioids are a broad group of medications aimed at relieving pain that act on brain neurons.

They can be made from the opium poppy, for example, in the case of morphine, or synthesized in a laboratory, e.g: fentanyl.

Other known opioids include codeine, hydrocodone, and oxycodone and methadone.

 Where opioids work

Opioids travel through the blood stream and attach to their corresponding receptors on brain neurons. They tell the brain to block pain and also make you feel calm and happy.

At low doses, they can cause drowsiness. However, at higher doses, they can slow heart rate and breathing, and this, in turn, could lead to death.


Opioids and Addiction

The pleasure they generate can increase the desire to take them at higher doses and more frequently, which can lead to addiction: they affect the brain and behavior to such an extent that the patient will no longer be able to control the use of opioids in the future.


What is Morphine

Morphine, the alkaloid found in the highest percentage in opium (11-16%), was the first to be isolated from the opium poppy plant by Friedrich Wilhelm Adam Sertürner (1783-1846) of Paderborn, Germany in 1804.

Morphine was used as an analgesic, antitussive, antidiarrheal and even for respiratory problems.

 Morphine was made injectable by Scottish physician Dr. Alexander Wood in 1853. Its widespread use in the American Civil War (1861-1865) left some 400,000 victims addicted to morphine, and it became known as the “soldier's disease.” .


What is Heroin (Diacetylmorphine)

Heroin is a highly addictive, illegal opioid drug produced from morphine.

Heroin was synthesized from morphine in 1874 by Charles Romley Alder Wright of Southend on Sea, Essex (UK).

It was marketed through the German laboratory Bayer between 1898 and 1910 as a cough sedative and as a substitute for morphine, mistakenly thinking that it was less addictive.

 Heroin with a high degree of purity can be snorted or smoked. Impure heroin (crude processing method), known as black tar, is diluted and injected via EV, SC, or IM.


What is Fentanyl

Fentanyl is a potent synthetic opioid analgesic derived from phenylpiperdine that interacts predominantly with the mu(μ) receptor in the brain and spinal cord. Fentanyl binds to opioid receptors in brain areas that control emotions and pain. 4

Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine. A 2 milligrams dose of fentanyl is lethal.

It is prescribed for patients with severe pain, especially after cardiac surgery.

The father of fentanyl is a Belgian chemist named Paul Janssen. It was introduced in 1960 for clinical use to replace morphine. In 1985, Janssen opened the first Western laboratory in China to manufacture fentanyl.

Fentanyl is also produced in rainbow-colored pills to make them look like candy.10



There are four types of opioid receptors; mu(μ,) kappa, delta (limbic system) and ORL-1 (nociceptin). All of them coupled to the G protein.



Fentanyl is addictive due to its potency. More than 150 people die every day from overdoses related to synthetic opioids like fentanyl.

 Abstinence syndrome

When a person who is addicted to fentanyl stops using it, they may have withdrawal symptoms, such as problems sleeping, chills, desire to use the drug again, but also muscle and bone pain, diarrhea, vomiting and uncontrollable leg movements.

 Global Fentanyl Consumption

The countries that recorded the highest consumption of fentanyl in the world in 2021 were the United States, Germany and Spain.

On October 26, 2017, US President Donald Trump and the Department of Health and Human Sciences (HHS) declared that the number of deaths from opioid overdoses constituted a public health emergency. 8

In 2020, the opioid death rate in the US was 20.7 per 100,000 people. 8

Fentanyl is currently the leading cause of death for Americans between the ages of 18 and 49, even surpassing suicide cases.

 According to the Pentagon, between 2017 and 2021, there were 332 overdose deaths among US military personnel. Deaths due to fentanyl doubled, and half of the cases were seen in the Army. (Kelsey Baker-You can' t fix the problem if you're in denial: The military's emergence of Fentanyl Overdoses-Military.com-Feb 17, 2023)

 The US Navy and Marine Corps doubled the number of cases. Seven sailors died in 2017 and 21 in 2021. The Marines lost five men in 2017 and 10 in 2021. In five years Fort Bragg, NC lost 5 men to overdoses which is the highest number of any military installation. Washington state had the highest death rates, 29.5 deaths per 100,000 military personnel followed by Texas at 28.6. (Rose L. Thayer/Stars and Stripes-Death among active-duty troops from fentanyl overdose rise sharply Pentagon says-American Legion-Feb 16,2023)

Germany faces an alarming increase in crack and fentanyl use with 2,000 deaths recorded in 2022. 7

According to the report of the International Narcotics Control Board in Spain, about 124.6 kg of this substance were consumed, 11.8% of the world total. 6

 Argentina is no stranger to the global situation: the recent seizures in Villa Fraga (Chacarita) demonstrate this. A batch of cocaine cut with a derivative, carfentanil, already caused a wave of deaths in the suburban two years ago.3. Carfentanil is often used as a sedative for large animals such as elephants.

In 2018, hospitalizations linked to opioids in the United Kingdom increased by 49% from 2008 to 2018 and, in 2019, it had the highest global figures for opioid use. Deaths linked to opioids have increased by 388% since 1993 in England and Wales. In 2020 the opioid death rate in England was 4.0 per 100,000 people. 8



Illicit fentanyls and isotonitazenes caused spikes in deaths in England in 2017, 2021 and 2023.Nitazenes are synthetic opioids more powerful than heroin. They come from China and have caused 54 deaths in the United Kingdom.1,2

Nitazenes were developed in the 1950s as painkillers but proved to be so powerful and addictive that they were never approved for medical use.


Penalties in the USA 3

Of all federal crimes in 2022 in the US, 31.5% corresponded to drug offenses and the majority of these were linked to fentanyl. In the United States federal system, mandatory minimum sentences are established based on the amount in possession and the type of drug.

 For example, for 40 grams of fentanyl, sentences of 5 years in prison apply, and for 400 grams, 10 years. In the case of fentanyl analogues, 10 grams are equivalent to 5 years in prison and 100 grams are equivalent to 10 years.

Political implications

According to investigations by journalist Peter Schweizer, there is currently an unrestricted war by China to destroy the United States from within using fentanyl. The Chinese triads and the Mexican cartels would participate. 9

  The complexity of the issue has been addressed by Georgetown University which stated that:

The fight against fentanyl trafficking requires a complex suite of policies and strategies. A direct military response to an admittedly serious challenge to U.S. national security is not the best solution to this crisis.( Annie Pforzheimer-Soft power with teeth : Looking beyond Military action in solving the fentanyl crisis-Georgetown Journal of International Affairs-March 2, 2024)


What is Naloxone

Naloxone is a medication that can reverse an overdose of opioids, including heroin, fentanyl, and prescription opioid medications. Naloxone is safe and easy to use. It can be administered as an injection or prepackaged nasal spray.

Its antagonistic effect is evident in 1 to 2 minutes after intravenous administration and in 2 to 5 minutes after intramuscular injection; Its result is maximum in 5 to 15 minutes and persists for 45 to 60 minutes.

When naloxone is used

1. Slow breathing or cessation of breathing.

2. Lack of response, even when shaking the person or calling his or her name.

3. Blue, gray or white lips and nails.

4. Small pupils.

5. Snoring or chirping sounds.



 1-Guidance for local areas and planning to deal with potent synthetic opiods-Office for Health Improvement and & Disparities.Gov.UK.



2-Homer, Alex, Johal, Navyej-Street Drugs stronger than heroin linked to 54 deaths in UK.BBC-December 10,2023.



3-Martello, Walter-La aparición de fentanilo en Argentina es más que una advertencia-Provincia de Buenos Aires-Defensoría.



4-Mucio-Ramirez, Manuel y col-El receptor ORL-1 y su péptido endogeno, la Nociceptina/Orfanina FQ-Nuevos miembros de la familia de los opioides-Salud Mental.ISSN 0185-3325-Vol 24, No 6,2001,´pag 43.-54


5-Nuño, Ada-Auge y caída de los fumaderos de opio: Asi eran hace un siglo-El Confidencial,26 de enero,2021.


6-Pérez-Izquierdo, Laureano-Laura Richardson:¨Es solo cuestión de tiempo para que el fentanilo se convierta en epidemia en America Latina¨-INFOBAE-6 de abril,2024


7-Pieper,Oliver-Crack and fentanyl abuse on the rise in Germany.DW. 3/17/24.



 8-Roberts, Antonia Olivia et al-Is England facing an opiod epidemic? - Br J Pain. 2023 Jun; 17(3): 320–324.



9-Schweizer, Peter- Inside the CCP’s Fentanyl Warfare Strategy to Kill Americans-Epoch TV April 18,2024


10-What is Rainbow Fentanyl? Colourfull pills drive new warnings about deadliest drug in the US-CNN, September 25,2022-