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New research finds that fentanyl affects the brain in unique ways that can stop a person’s breathing four minutes before any other change in consciousness occurs. Bisual Studio/Stocksy
  • New research has found that fentanyl can stop someone’s breathing minutes before they lose consciousness.
  • This finding may help doctors administer the drug in a safer manner.
  • However, it also explains why it’s such a dangerous drug to abuse.
  • Experts say fentanyl is highly addictive and should only be used when absolutely necessary.
  • Patients should always discuss their medications with their doctor to determine the risks vs. benefits.

New research conducted by scientists at Massachusetts General Hospital and published in PNAS Nexus has revealed that the drug fentanyl halts surgical patients’ respiration even before there are any observable changes, including the loss of consciousness.

Elizabeth J. Scharman, PharmD, DABAT, BCPS, FAACT, who is the Clinical and Executive Director at the West Virginia Poison Center as well as Professor of Clinical Pharmacy at the West Virginia University School of Pharmacy and was not involved in the study, explained that fentanyl is a prescription drug commonly used during or after surgery and in intensive care units (ICUs) when people are being ventilated.

It might also be used on an outpatient basis for people in hospice care or with severe cancer pain.

Fentanyl produces unique patterns of brain electrical activity on an electroencephalogram (EEG), according to the researchers, which allowed them to see fentanyl’s effects.

They found specifically that the medication can interfere with people’s breathing about four minutes before there is any notable alteration in their alertness.

This occurred at a 1,700 times lower concentration of the drug than what is required to sedate the patient.

Senior author Patrick L. Purdon, PhD, told The Harvard Gazette that these findings could allow for safer and more precise administration of fentanyl in hospitals, for example, in sedated COVID-19 patients or in people who are undergoing anesthesia during surgery.

Currently, there is no way to know if these medications are working when the patient is unconscious. It might be possible to use EEGs to monitor fentanyl’s effects.

These findings also have important implications when it comes to raising the health risks of recreational drug use. Purdon told The Harvard Gazette that they explain one of the reasons why fentanyl is such a dangerous drug: it can stop people’s breathing before they even realize what’s happening.

According to the United States Drug Enforcement Agency (DEA), fentanyl is being manufactured outside the United States in secret labs and then smuggled into the country, where it is then sold illegally.

They explain that it is being sold as powders and sprays. It is also often made into counterfeit pills that look like real prescription drugs.

Without government monitoring to ensure potency or purity, these fake pills may contain different drugs than claimed or even lethal doses of fentanyl.

According to the DEA, the pills that they have tested have contained anywhere from 0.2 to 5.1 mg of the drug; 2 mg is a potentially fatal dose.

Also, because fentanyl is a potent opioid that drug dealers can obtain for a low cost, they also often mix it with other drugs like heroin, methamphetamine, and cocaine to increase their potency. This means that people may not even be aware that they are being exposed to fentanyl.

According to the U.S. Centers for Disease Control and Prevention (CDC), overdoses from opioids are a growing problem in the United States. In 2020, there were 56,000 deaths involving synthetic opioids other than methadone. In fact, death rates increased by more than 56 percent between 2019 and 2020, accounting for more than 82 percent of all opioid-related deaths. The overdose death rate in this category was 18 times greater than in 2013.

They say that this increase is most likely being driven by illicit rather than prescription fentanyl. However, it should be noted that about 3 to 19 percent of people who take prescription pain medications become addicted to them, which can lead them to switch to more easily available options such as illicit drugs. For example, about 45 percent of people who use heroin originally developed an addiction to prescription opioids.

The National Institute on Drug Abuse explains that due to its potency — it is 50 to 100 times more potent than morphine — fentanyl is addictive.

They note that even a person who is taking the medication as it’s prescribed by a doctor can become dependent on it, which can lead to withdrawal symptoms when they quit taking it. Dependence can potentially lead to a person becoming addicted. People can also build a tolerance to it, leading them to need more and more of the drug to achieve the same effect.

Scharman advised that people should always ask what type of medication they are receiving for their pain, as well as whether the drug is an opioid.

“If the drug is only prescribed for use over a few days, for example, after a surgery, that should not be an addiction concern,” she said. “If the medication is for end-of-life pain, addiction is not a concern.”

However, opioids should never be the first drug a person tries for the management of chronic pain with conditions that are not life threatening, she cautions.

“Because of addiction risk, which is a side effect that must be considered, use of opioids for chronic pain should be restricted for select patients after all other options have been exhausted.”

Sudheer Potru, DO, FASAM, a triple-board-certified anesthesiologist, interventional pain physician, and addiction medicine specialist at Atlanta VA Medical Center, agrees, adding that problems can arise in vulnerable patients, “particularly those with an addiction history or those with a family history of one.”

“Patients always have the choice to either use or not use something that is prescribed to them,” said Potru, “but the most important thing is to ask your doctor about the risks and benefits of using any medication so that you understand fully the consequences of doing so.”

“It’s also important to be upfront with the clinician caring for you, so they understand what you feel comfortable with from a medication standpoint,” he added.