Fentanyl 101

Lethal dose of fentanyl next to the lethal dose of heroin to show how much more potent fentanyl is than heroin

So fentanyl’s popped up again. 12 people were hospitalised after taking what they thought was either cocaine or methamphetamine, but it turns out to have been fentanyl. We first found it in 2018, but we haven’t seen it again up until the weekend.

Read our 2018 notification

There’s a lot of misinformation about fentanyl flying around on a global level. In the US the spin is so bad that police officers have fainted from a psychosomatic reaction to seeing what they thought was fentanyl.


The fentanyl section starts at 4:42, but the entire thing is definitely worth the watch.

Much like novel cathinones, if you know what you’re taking, and you’re taking it on purpose with a properly-measured dose, you’re less likely to come to harm. The problems come when you take it thinking it’s something else and get the dose wrong.

Here’s what we know about fentanyl (the no bs version)

Fentanyl is a synthetic opioid analgesic. It’s used in hospitals when morphine or tramadol doesn’t cut it. It’s administered as part of the epidural in childbirth, for cancer patients, or for people with terminal illnesses. It comes as an IV injection, as a nasal spray, or transdermal patches.

Fentanyl is super potent

Fentanyl’s doses are measured in micrograms (μg), where most other substances’ are measured in milligrams. There are 1,000 μg to 1 mg.

Snorted

Substance Light dose Standard dose Heavy dose Dangerous dose
Cocaine 10 – 30mg 30 – 60 mg 60 – 90 mg 90 mg +
Methamphetamine 5 – 10mg 10 – 30mg 30 – 60mg 60mg +
Heroin 7.5 – 20mg 20 – 35mg 35 – 50mg 50mg +
Fentanyl 12 – 25μg 25 – 50μg 50 – 100μg 100μg+

So let’s say, for instance, someone buys some cocaine that is actually a bag of fentanyl.
A 10mg bump of ‘coke’ is actually 10,000 μg of fentanyl. Which is 100x the dangerous dose of fentanyl.

Injected

Substance Light dose Standard dose Heavy dose Dangerous dose
Cocaine 20 – 40mg 40 – 80mg 80 – 100mg 100mg +
Methamphetamine 5 – 10mg 10 – 30mg 30 – 40mg 40mg +
Heroin 5 – 8mg 8 – 15mg 15mg +
Fentanyl 10 – 20μg 20 – 40μg 40 – 80μg 80μg+

Let’s use the same example from before where someone buys ‘cocaine’ that’s actually fentanyl. They inject a light dose of 20mg ‘cocaine’, which is actually 20,000μg of fentanyl. That’s 250 times the dangerous dose of fentanyl by IV.

So you can see how easy it is to get into hospital-levels of trouble when people mismeasure fentanyl, add fentanyl to substances, or substitute the substance completely.

Potent, yes, but not worth the hysteria in the media

It is not potent enough to cause overdose by being in the same room as, or touching a sample, despite what the US media might say.

While you can absorb fentanyl through your skin (hence the transdermal patches), it also needs moisture to act as a pathway into your body. Dry fentanyl can’t get through your skin on its own. Also, it takes roughly 15 minutes to absorb that way under optimal conditions. If you touch one (1) grain of fentanyl powder with unbroken skin it’ll just sit on top of your skin being awkward until you brush it off.

Read the collective eyeroll of doctors as they debunk fentanyl contact hysteria on the STAT website

There’s been a case where someone accidentally spilled a vial of liquid fentanyl on their hand at work and some got in a cut. They washed it off and were absolutely fine. No overdosing, no passing out, no drama anywhere.

Read the full article of the person not dying from accidental fentanyl contact on the National Library of Medicine website

You can detect it in your substances using fentanyl testing strips

Fentanyl testing strips will detect fentanyl in a relatively small sample. It’s an easy process. The DanceSafe instructions are easy to follow and have excellent tips for how to test different substances for fentanyl.

Read the instructions on the DanceSafe website

The test strips can detect fentanyl in

  • MDMA
  • Cocaine
  • Methamphetamine
  • Heroin and other opioids
  • Ketamine

It is worth noting that if you’re testing a stimulant like speed, MDMA or methamphetamine it can sometimes throw a false positive.

If you do get a positive result when testing a stimulant, dilute your original test material with another 50% of water (so if you’ve used 10ml in the original test, add another 5ml), then test it again with a fresh strip.

The strips are sensitive enough to detect miniscule amounts of fentanyl, and this level of dilution will weed out any stimulants.

Who sells fentanyl test strips in Aotearoa?

You can buy fentanyl testing strips online at the NZ Needle Exchange store, and in some regional branches. The Hemp Store Aotearoa also sells these and gives individual fentanyl strips away free as part of some of their reagent testing kits. Fentanyl test strips are legal to import, if you can wait for shipping.

Giving someone who is overdosing on fentanyl Naloxone can save their life

Naloxone (sold as Nyxoid or Narcan) administered as a nasal spray while waiting for an ambulance can be the difference between life and death.

What does a fentanyl overdose look like?

Fentanyl overdose happens when the body receives too much signal from opioid receptors in the brain. This suppresses the activity of the opioid-regulated systems in the body like pain messaging, circulatory, respiratory, and digestive systems.

This looks like:

  • Dizziness
  • Cold, clammy skin
  • Lips and fingertips turning blue
  • Vomiting
  • Breathing either slowed down or stopped completely
  • Heart rate that’s slowed down or weak
  • Sleepiness or Loss of consciousness

It’s the suppressed breathing and heart activity that can kill a person quickly, and if you see these, act immediately. Call 111 and administer Nyxoid spray or naloxone injection if you have it. Don’t wait.

How does Naloxone work?

Naloxone binds to opioid receptors in the brain and blocks other opioids from being taken up. It also yeets other opioids that have bound to the receptors.

Diagram of Naloxone particles booting opioids off opioid receptors in the brain.
Naloxone particles booting opioids off opioid receptors in the brain.
Image credit: The National Harm Reduction Coalition

Read more about how Naloxone works on the National Institution of Health website

Where do I get Naloxone without a prescription?

You can get both the Nyxoid emergency spray and Naloxone injectable ampoules from your local Needle Exchange, depending on where you are.

Auckland, South Auckland, Wellsford, Masterton and Nelson branches have Nyxoid Naloxone nasal spray.

Hamilton, Rotorua, Mt Manganui, New Plymouth, Napier, Palmerston North, Whanganui, Wellington, Christchurch, New Brighton, Dunedin branches have Naloxone injectable ampoules.

Whangarei, Invercargill, Timaru and Ashburton branches don’t have any Naloxone because the local DHB won’t supply it due to the regulations.

You can get Nyxoid emergency nasal sprays over the counter at the pharmacy. But there’s a catch (because of course there is).

Not all pharmacies carry Nyxoid

It’s a bit of a crap shoot as to whether or not your regular chemist is going to have Nyxoid.

Over-the-counter Nyxoid is stupidly expensive

An emergency kit containing two doses of Nyxoid costs $92 from Pharmaco’s online store. If you’re buying it over the counter from the chemist, you’re going to be paying the mark-up price as well.

Why is it so hard to get Naloxone?

Before this weekend’s hospitalisations, nobody thought we had fentanyl here, despite KnowYourStuffNZ finding that sample back in 2018. At the most, it was only thought to affect opioid users and not to affect methamphetamine at all.

Naloxone is used to reverse opioid overdose, a class of drugs with more stigma attached to them than others. Our perceived lack of an opioid crisis put Naloxone on the low-to-almost-not priority list.

Drug stigma happens because

  1. people who take drugs are an easy community to use as a scapegoat for crime, poverty, bad weather, and the inevitable heat death of the universe; and
  2. Drugs have been used to to scare the bejesus out of the public since the 1930s.

This stigma contributes to the belief that people who take methamphetamine or heroin are all criminals and/or addicts that have made their own bed and need to “take responsibility for their actions”, even if that means death. This is, of course, bullshit – but it’s convenient bullshit that enables ignoring these people and therefore not spending money to help them not die.

Rather than putting effort into transparent and honest drug education, policy is based around putting people that take drugs in prison and punishing them until they don’t take drugs any more.

We all know how well that works. While Aotearoa has recently made some small steps towards a health-based approach to drugs, we still have a long way to go before we reach anything that could be considered reform.

Regardless of your politics, people don’t deserve to be hospitalised or die because their dealer has lied to them about what they’ve bought. And until we see meaningful drug law reform in Aotearoa, we continue to risk that outcome.

It’s going to be interesting to see if Naloxone gets easier to get hold of now that fentanyl’s been found in cocaine – a substance that’s popularly viewed as more socially acceptable.

If you’re concerned about fentanyl and want to do something to help, please put pressure on your MP, local government representatives, and anyone else you can think of to advocate for health-focused drug laws and make take-home Naloxone or Nyxoid accessible to those who need it.

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