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Why is fentanyl so dangerous?

Fentanyl is extremely potent and drugs like cannabis are amplifying the effects of it!

In the recent past there has been a lot of noise in the media about people dying from fentanyl in combination with other drugs, like MDMA and even cannabis. Is this a thing ? Can that happen ? The answer to that question is: Yes, it absolutely can ! So while there may be some debate about how likely, or widespread of a problem fentanyl laced cannabis is, there is no doubt that it is very dangerous to consume both cannabis and fentanyl together. In this article we will give you some context of what fentanyl is, why it is dangerous when combined with cannabis and then give you a primer on “Narcan”, a drug which could potentially save your life.

Because this is so important I am going to front-load the 5 key ideas I would like you to take away from this article :

  1. All drugs that seem safe can be life-threateningly dangerous at the wrong dosage or when combined with other drugs. There is no such thing as completely safe. The context in which a drug is taken determines whether or not it is safe.
  2. Fentanyl is an opioid that is 200 fold stronger than morphine, but cannabis supercharges opioids, which makes fentanyl even more deadly, even at low-dosage. Fentanyl is already dangerous by itself but mixing it with anything else, especially psychedelics can be catastrophic
  3. Naloxone (marketed as Narcan) can counter the effects of opioids but only within a very narrow timeframe of 30 - 90min. However, fentanyl is very strong, especially when combined with cannabis so it will likely take multiple doses and may not be enough. Therefore, always call 911 along-side administering narcan to someone who is overdosing.
  4. Avoid illicit sources of cannabis and prioritize licensed and regulated sources.
  5. Fentanyl testing kits exist and are cheap and easy to use.

In the arms of morpheus

So what is fentanyl? Fentanyl is a synthetic drug that is classed as an opioid. Opioids are one of the most important classes of drugs humankind has discovered. They were historically sourced from the opium poppy plant. Cultivation of opium poppy plants has been documented all the way back to the ancient Sumerians who around 5000 B.C. referred to it as Hul Gil or “plant of joy”, named after its strong euphoria inducing effects.

Throughout history there are many examples of it being used to relieve pain, especially for surgical analgesia (pain killing), alongside alcohol, mandrake and cannabis. But it took until the early 1800s for the active compound to be isolated, when a German pharmacist’s apprentice named Friedrich Serturner isolated the principium somniferum, the active compound he later named morphium after the Greek god of dreams: Morpheus. This paved the way for purely synthetic opioids like fentanyl. 

In our modern days, a good 90% of chronic pain patients receive opioids of varying degrees of potencies. Opioids function by binding to opioid receptors on the nerve cells throughout the body, from the brain to your spinal cord, peripheral organs, and block the nerves from transmitting their messages. In a best case scenario that means pain messages don’t get sent. In a worst case scenario the signals that tell your lungs to breathe won’t arrive. 

Opioids can have a lot of complications. 

Firstly, as with many drugs, your body will eventually try to recalibrate itself to compensate for the presence of opiates. In other words, opioid receptors aren’t supposed to be blocked because your body needs them. If they become and remain blocked, you will develop tolerance and it will require an ever-increasing dose to sustain its pain relieving properties while increasing the risk of physical and psychological dependencies. 

Beyond that there are many unwanted side-effects such as bladder dysfunction, immune modulation, cardiovascular changes, and many more. Consequently from a medical perspective you’ll want to use as little opioids as possible—just enough to kill the pain. This is where cannabis offers an exciting opportunity as it has been shown to amplify the effects of opioids. This means if you combine cannabis with opioids you can achieve the same effect at a much lower dose of opioid. In a medical context this can be great because if you get away with lowering the dose of opioids you can potentially mitigate more of the negative side-effects. But in the context of fentanyl laced cannabis this can have disastrous consequences. 

Fentanyl is a synthetic opioid that is about 200 fold more potent than morphine. Because of its potency it has been successfully deployed as medical treatment for severe chronic pain since the 60s. Aside from its analgesic effects it also produces strong euphoric effects like heroin and just like heroin this opens the door for misuse and dependence. 

Since the 90s, fentanyl has become more available in the illicit market, as it can be both synthesized or extracted from medical transdermal patches which are commonly available. However, when fentanyl is combined with cannabis, fentanyl becomes 2000 fold more potent than morphine. In other words, you can overdose on minuscule amounts of fentanyl if you are also consuming cannabis at the same time. 

When fentanyl is combined with cannabis, fentanyl becomes 2000 fold more potent than morphine.

It is unlikely that drug dealers in the illicit market intentionally lace cannabis with fentanyl. If that were the case there would be more clusters of deaths occuring, which negates any montery incentive for the dealers. However, fentanyl is often used to cut, or dilute, illicit opioids like heroin, and if the same source is also handling your cannabis, then there is a very real risk of accidental cross-contamination. But whether or not your cannabis was accidentally laced won’t help you if you are overdosing on fentanyl and your brain is no longer able to tell your lungs to breathe. So your best way of preventing an overdose is to acquire your cannabis from licensed and regulated sources that properly handle and test their products. Also, you can invest in fentanyl testing strips. Testing kits are very affordable, easy to use and can help you avoid trouble.

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Narcan can save your life

Should the worst case scenario occur and you find yourself overdosing on fentanyl, there is really only one way to save your life. You will require :

  • ⁠A) A friend nearby
  • B) Have quick access to Narcan (Naloxone)
  • C) Have instructed your friends on the use of Narcan 

Narcan is a drug that can neutralize the effects of opioids. It can only do this in a narrow time window between 30 and 90 minutes—after that you are out of luck. If you’re lucky and have both Narcan, and a friend nearby who notices that you are unable to breathe, then it could save your life. However, since fentanyl is so powerful and becomes even more potent when combined with cannabis, it will likely take several doses of Narcan to save your life, and even that might not be enough. So, if you find yourself in a position where you have to administer Narcan to someone you must also always call 911.

Context matters

There is a phrase that stuck with me ever since I heard my biochemistry professor say it in graduate school: “everything can be a poison at the wrong concentration.” We cannot survive without oxygen and water—both are essential to our existence. At the wrong concentrations however, either one can kill you. Intuitively we know that if you don’t have enough water or oxygen you will die. But the same is true if you have too much of either. Too much of a good thing can be bad. This applies to all drugs. Context matters. In the medical context, combining cannabis with opioids can be desirable, but accidentally combine fentanyl and cannabis and you are in trouble. Every drug can kill you given the right context. 

So go get some Narcan!

References:

Benyamin, R., Trescot, A. M., Datta, S., Buenaventura, R., Adlaka, R., Sehgal, N., Glaser, S. E., & Vallejo, R. (2008). Opioid complications and side effects. Pain physician11(2 Suppl), S105–S120.
https://pubmed.ncbi.nlm.nih.gov/18443635/

F Aragón-Poce, E Martı́nez-Fernández, C Márquez-Espinós, A Pérez, R Mora, L.M Torres, History of opium,International Congress Series,Volume 1242,2002,Pages 19-21,ISSN 0531-5131,
https://www.sciencedirect.com/science/article/abs/pii/S0531513102006003?via%3Dihub

Noori, A., Miroshnychenko, A., Shergill, Y., Ashoorion, V., Rehman, Y., Couban, R. J., Buckley, D. N., Thabane, L., Bhandari, M., Guyatt, G. H., Agoritsas, T., & Busse, J. W. (2021). Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies. BMJ open11(7), e047717. https://doi.org/10.1136/bmjopen-2020-047717

Hamilton, G. R., & Baskett, T. F. (2000). In the arms of Morpheus the development of morphine for postoperative pain relief. Canadian journal of anaesthesia = Journal canadien d'anesthesie47(4), 367–374. https://doi.org/10.1007/BF03020955

NIDA. 2022, January 11. Naloxone DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/naloxone