It attenuates "second pain" with primary effects on slow-conducting, unmyelintated C-fibers and is less effective on neuropathic pain and "first pain" signals through small, myelinated A-fibers.Fentanyl can produce the following clinical effects strongly, through μ-receptor agonism. Supraspinal analgesia (μ1)
Respiratory depression (μ2)
Physical dependence
Muscle rigidityIt produces sedation and spinal analgesia through Κ-receptor agonism. Therapeutic effects
Pain relief: Primarily, fentanyl provides the relief of pain by acting on the brain and spinal μ-receptors. Sedation: Fentanyl produces sleep and drowsiness, as the dosage is increased, and can produce the δ-waves often seen in natural sleep on electroencephalogram. Suppression of the cough reflex: Fentanyl can decrease the struggle against an endotracheal tube and excessive coughing by decreasing the cough reflex, becoming useful when intubating people who are awake and have compromised airways. After receiving a bolus dose of fentanyl, people can also experience paradoxical coughing, which is a phenomenon that is not well understood. Detection in biological fluids
Fentanyl may be measured in blood or urine to monitor for abuse, confirm a diagnosis of poisoning, or assist in a medicolegal death investigation. Commercially available immunoassays are often used as initial screening tests, but chromatographic techniques are generally used for confirmation and quantitation. The Marquis Color test may also be used to detect the presence of fentanyl. Using formaldehyde and sulfuric acid, the solution will turn purple when introduced to opium drugs.
The drug has been implicated in multiple deaths from the homeless to young professionals, including teens and young parents. Because of the rising deaths across the country, especially in British Columbia where 1,716 deaths were reported in 2020 and 1,782 from January to October 2021, Health Canada is putting a rush on a review of the prescription-only status of naloxone in an effort to combat overdoses of the drug. In 2018, Global News reported allegations that diplomatic tensions between Canada and China hindered cooperation to seize imports, with Beijing being accused of inaction.Fentanyl has been discovered for sale in illicit markets in Australia in 2017 and in New Zealand in 2018. In response, New Zealand experts called for wider availability of naloxone.In May 2019, China regulated the entire class of fentanyl-type drugs and two fentanyl precursors. Nevertheless it remains the principal origin of fentanyl in the United States: Mexican cartels source fentanyl precursors from China which are finished in Mexico and smuggled to the United States. Following the 2022 visit by Nancy Pelosi to Taiwan, China halted cooperation with the United States on combatting drug trafficking.India has also emerged as a source of fentanyl and fentanyl precursors, where Mexican cartels have already developed networks for the import of synthetic drugs. It is possible fentanyl and precursor production may disperse to other countries such as Nigeria, South Africa, Indonesia, Myanmar, and the Netherlands.In 2020, the Myanmar military and police confiscated 990 gallons of methyl fentanyl, as well as precursors for the illicit synthesis of the drug.