Fentanyl is a potent narcotic analgesic, about 80 times more potent than morphine, whose abuse leads to addiction. Fentanyl and its derivatives (Alfentanil, Sufentanil, Remifentanil and Carfentanil) are used as anesthetics and analgesics in humans and in veterinary medicine (Carfentanil). A structural analogue, the 3-methylfentanyl, it would be illegally synthesized and sold as "synthetic heroin" or mixed with heroin itself.
Fentanyl can be taken intravenously (Sublimaze®), via transdermal patches (DUROGESIC®), with candy for the transmucosal assumption (Actiq®), or through oral tablets (Effentora®). The non-medical use of fentanyl is reported through various routes unrelated to the pharmaceutical formulation: by injection, ingestion of candy (trans-mucosal assumption), through the use of patches. Fentanyl powder or from patches is also smoked or assumed intranasally (sniffing).
The emergence of fentanyl on the illicit drug market, at European level, dates from the first half of the 90s. Limited illicit products in the European market are represented by fentanyl and 3-methylfentanyl, and recently by the para-fluorofentanyl.
Chemical structures of fentanyl and of its analogue carfentanil
In addition to the analgesic effect, fentanyl is able to produce drowsiness and euphoria, even if the euphoric effect is less pronounced compared to that produced by morphine and heroin. The main side effects include nausea, dizziness, vomiting, fatigue, headache, constipation, anemia and peripheral edema. After repeated use of fentanyl, tolerance and dependence develop quickly. When its use is interrupted, manifestation of the characteristic symptoms of abstinence, such as sweating, anxiety, diarrhea, bone pain, abdominal cramps, chills, goose bumps are observed.
Intoxication cases registered in Italy
Since 2009, in Italy, the National Early Warning System has recorded some cases of acute intoxication related to fentanyl consumption that required admission in the emergency room.
Fentanyl and its derivatives including the non-pharmaceutical analogues but still highly potent, such as the 3-methylfentanyl, are subjected to international control.
In Italy, the fentanyl molecule and some of its structural analogues are included in the tables of controlled drugs (Law on narcotics and psychotropic substances, prevention, treatment and rehabilitation of drug addiction, Presidential Decree 309/90 as amended). In case of positivity driving a car, motorcycle or scooter, the law enforcement may withdraw the license, impound the vehicle, impose fines, make report to the Prefecture, pick up the passport.