On the ground, utilized needles, around quite a few garbage and dirty, torn clothes. The air is dominated by overwhelming, disgusting smells. The space is filled with rows of grey, tiny tents, from which erstwhile again, the shaky step emerges gloomy figures. Their silhouettes are highly thin, gray, strained on the bones and powerfully injured from scratching and needles of skin. Bloodied, collapsed, white eyes, parched lips revealing rotten teeth... Thinned, greasy and long-lost hair speaks a lot about human drama. Trapped in unnatural, curved outside “people – zombies” fight for their next breath. all day, they scope out with their trembling hand for a syringe, most likely borrowed from a distress companion, with another dose of fentanyl. It is in their view the only effective ‘medicine’ for the pain and distress of the grey everyday life. Pursuing happiness, escaping suffering, and... a consecutive way to the grave. This is Los Angeles, Skid Row A.D. 2024. This is life in the zombie dividers, where the illegal drug trafficking of “giant” - fentanyl - reigns. How does it work? Why is it addictive so fast, and why do doctors prescribe it?
Fentanyl in medicine
Fentanyl has circumstantial physical and chemical properties that make it highly effective and frequently recommended by doctors to combat pain. Good solvents are non-polar or poorly polar substances, so that the medicine rapidly penetrates the blood into the brain – the effect of anaesthesia can be achieved even after a fewer minutes. Fentanyl is taken intravenously, intramuscularly, subcutaneously, orally as sublingual tablets or with peculiar patches. Lollipops containing this medicine were besides produced once. In tiny doses, it is utilized to relieve pain during short surgical procedures. Higher doses are given to treat very severe pain, specified as post-traumatic or myocardial infarction or cancer. In many cases, pain levels are besides advanced for another medicines, including morphine, to bring relief. According to experts, the potency of fentanyl is 1 100 times higher than in the case of morphine, making it the world's most powerful analgesic.
How does your body respond to this medicine? The desired consequence of its usage is to relax and to remove any pain – the substance reaches the alleged reward strategy in the brain. Unfortunately, at the same time there are side effects, specified as shortness of breath, bradycardia (slow heart rate), decreased blood force and decreased sensitivity of the strategy to rising levels of carbon dioxide in the blood, resulting in asphyxiation. For this reason, fentanyl is only utilized in hospitals in wards equipped with breathing aids. This opioid besides affects the digestive strategy – it causes constipation, nausea and vomiting. Fentanyl can drastically disrupt the body's mineral economy, halt urine and inhibit the secretion of hormones, including sex. He's a threat to children in the wombs.
In most countries fentanyl is qualified for a group of controlled substances – its production, distribution and sales are strictly regulated by law. In Poland, fentanyl is classified as a psychotropic substance of group I-N (a drug addict with a possibly advanced hazard of abuse) and legally in the pharmacy can only be purchased after a prescription has been given. In June 2024, the Polish Ministry of wellness began to monitor the issue and implementation of opioid prescriptions, so that the number of overdose cases of narcotic medicinal products would decrease. In addition, it was announced that as of September 2024 a prescription for fentanyl would no longer be available without a doctor’s visit and appropriate consultation, and through an electronic system, a prescription or teleporade – but erstwhile the doctor only prolongs the treatment already prescribed by him. The chosen direction seems right, due to the fact that in this substance 1 must be careful and suspicious of patients.
Addiction
Cucuracies utilizing fentanyl (under control) have measurable benefits – they can lead a comparatively average regular life, do not scream out of pain and do not faint. However, if the opioid is utilized for a long time, the body will gradually increase its tolerance – the pain will then return and, in order to relieve it, it will request to increase its doses. This creates a “cursed circle” that can drive the patient into severe addiction. Therefore, consideration of fentanyl – a medicine separated from its negative effects on the patient cannot be conducted. As a highly intoxicating substance, it has found its place on the black marketplace and is utilized extra-therapeuticly. The illicit trade in fentanyl is booming, resulting in an outbreak of premature deaths due to its overdose.
After taking fentanyl, you feel relaxed, euphoria, relief in pain, peace, and talk about “conscious sleep”. any addicts compare this impression to “warm blanket dressing”. What is liable for specified a “blessing” state? Well, fentanyl acts as a trigger for dopamine, the hormone of happiness. Consequently, our brain does not “see” the request for self-control of dopamine secretion – in this respect it is very lazy. For this reason, the central tense strategy of a individual who manages to accomplish a state of sobriety is incapable to produce dopamine, and this in turn makes it highly hard to feel any pleasance or satisfaction. The withdrawal period involves large physical and intellectual suffering, which is why addicts are forced to administer fentanyl regular – they will do anything to escape the pain in sobriety. Signs of withdrawal include: deep depression, goose bumps, chills and excessive sweating, insomnia, tension, irritability, deficiency of appetite, nausea, vomiting, diarrhoea, frequent yawning, runny nose, tears in the eyes, fast heart rate, increased pressure, muscle and bone pain, weakness, as well as excessive, painful sensitivity to contact stimuli. frequently these symptoms are besides strong for an addict to cope with themselves and request professional medical attention. This minimises the hazard of him reaching for another dose of the drug and besides guarding his condition.
Overdosage of opioid is mainly manifested by slowing and shallow breathing, bradycardia (too slow heartbeat), bruising of the skin, then failure of consciousness. In the event of failure to supply adequate assistance on time, death occurs. On fentanyl there is an antidote – naloxone. His application, unless it is besides late, may reverse the effects of the opioid and save the life of a individual who has given himself a fatal conviction by taking besides much fentanyl. Naloxone blocks opioid receptors, which halt the drug from entering the brain, causing it to rapidly return to average breath, and the heart emerges from bradycardia. Unfortunately, it is very frequently besides late for the antidote to save someone's life – fentanyl is very easy to overdose, and it works in a flash. Only 2 milligrams to kill a grown man.
Trade
Both fentanyl produced in secret laboratories (such as the USA, Russia, Belarus, Ukraine, Romania, Greece, Bulgaria, Portugal and Slovakia) and the 1 that entered the illegal trade in pharmaceutical products (pharmaceutical theft, prescription forgery, infirmary waste search). Marcin Zawadzki and Karolina Nowak from the Medical University of Wrocław, in the article “Fentanyl and its derivatives as a group of fresh psychoactive substances (boots)” state:
Both the names and appearance of fentanyl-containing preparations vary. Henderson [...] draws attention [...] to the disparity of texture: from bright, fine powdered to crumb-like dough or powdered milk. On the another hand, differences in naming appear to mention to the colour of the samples: white (Persian white), light opalescent (China white, fentanyl, synthetic heroin), dark brown (Mexican white).
Street dealers sale various “super-mixes” combining fentanyl with another means, specified as heroin, methamphetamine or cocaine, so that there is virtually no anticipation to estimation their opioid dose – the hazard of death increases enormously. The practice of mixing fentanyl with sedatives utilized by veterinarians in horses or cattle was besides detected. Xyllazine was never allowed for human use. “The street” has given specified a mix of respective names: “Tranq”, “Tranq dope“, “AnaSed”, “Rampun”, “Zombie drug”. The killer combination of xylazine and fentanyl prolongs the alleged “haj”, deepens respiratory depression and contributes to the formation of extended areas of brain hypoxia. This combination degrades tissue causing rotting wounds on the limbs, which is hard to fight (amputation may be necessary). The effect of taking fentanyl with xylazine is besides acute osteomyelitis. It is frightening that in this case the previously described antidote – naloxone – will not help. It acts on opioids, and since xylazine is of a different chemical nature, it is insensitive to them and sustains the activity of fentanyl without hindrance.
Is everyone at risk?
In 2023 Dr. Barbara Jankowiak and Mr. Dorota Bogdanowicz from the Medical University of Białystok at work entitled “The influence of the household on the occurrence of drug addiction in adult life” described the causes of psychoactive measures and presented factors conducive to the improvement of addiction:
Often, patients themselves argue for their own scope for addictive substances, the following reasons: the existence of feelings of suffering and interior pain, hard childhood, increasing up in a dysfunctional family, the request to impress in their own surroundings to rise self-esteem, which is due to low self-esteem, chronic stress, depression [...] failure of a loved one. any motives influence the improvement of addiction in teenagers. These are: moving distant from problems where drugs may seem like a way to escape unpleasant reality and cope with problems at school, with peers, parents [...] wanting to adapt to the group [...] feeling bored [...] curiosity.
The investigation done by the Lord of the Belarusian Medical University at the Revenu Psychotherapy Centre in Białystok shows how much influence household relations have on the emergence of drug problem, especially in childhood: In a group of drug addicts surveyed, erstwhile there were "problems with peers, school or others" the father could number on 50% and the parent could number on 46.94%. It is worth noting that about half of the addicts surveyed were afraid of their parents.
Thus, there are certain circumstances that increase the hazard that a individual will go after drugs and thus exposure himself to unimaginable suffering, deplorable life, and an untimely, likely lonely death. However, it should be remembered that nowadays, erstwhile specified a strong preparation as fentanyl is widely available as a cure, not only “street children” or household members with problems are at hazard of drug abuse. Ordinary, exemplary citizens who deficiency happiness and fall into the care of an irresponsible specialist may balance the line of life and death for a long time. It is worth noting that you do not gotta deliberately want to get advanced to die from this substance. There have been unfortunate cases in the past of children who inadvertently encountered the fentanyl patch of their parent – consequently their breath stopped and they were found dead. The usage of fentanyl as a biological weapon, e.g. by Russian peculiar forces trying to take hostages from Chechens who attacked the theatre in Dubrovnik in October 2002 is besides known. 173 people were killed.
Fentanyl present resembles how a thin boundary exists between the drug and the poison. It is undoubtedly a immense challenge for medicine, which is forced to choose between greater and lesser evil – no honest specialist wants to leave his patient in an unimaginable state of pain, or to conviction him to problems with addiction in the future. Everyone must be aware of the risks posed by the usage of fentanyl, and authorities and services should focus on the pursuit of illicit trafficking in this measure. 1 must believe that the “opioid epidemia” in the west will be mastered and it will not be allowed to spread in Poland. Let fentanyl stay what it should be – an effective medicine utilized under the watchful eye of your doctor. Not a death sentence.
Zofia Michałowicz
