Consumption and Standard Dose

• Fentanyl is cheap and easy to produce. It is often cut with, or substituted for, other opioids, specifically heroin and street-bought oxycodone.
• Assume any street-bought opioid could have Fentanyl in it. A tiny amount is all it takes to overdose on Fentanyl, even if you have a high tolerance to other opioids.
• Is often taken unknowingly by users who think they are using heroin or street-bought oxycodone
• Occasional cross-contamination with other drugs has occurred, where trace-amounts of Fentanyl have gotten into cocaine, and MDMA. Although rare, such cases have often resulted in overdose
• Fentanyl is in 4.8 % of cocaine, according to Canada’s national drug labs.

The Buzz

• Fentanyl is a powerful, synthetic opioid 50-100 times more potent than morphine. In hospital settings is used to treat severe, chronic pain
• Fentanyl that shows up in street-opioids, is usually a mixture made to mimic hospital-grade Fentanyl. As such, potency between batches varies widely.
• As an opioid, Fentanyl induces feelings of pleasure or euphoria. Medically-administered Fentanyl is meant to be absorbed over time, through a trans-dermal patch, relieving pain
• Taken recreationally, a minuscule amount causes an euphoric, dreamy, blissful state, with varying degrees of comprehension and awareness.
• This sleepy state lasts for several hours
• Skin flushes and pupils dilate
• Breathing slows
• Feeling of heaviness throughout body

Overdose and other negative effects

• Overdose is extremely common with recreational use, as most users are dosing as if they were taking heroin or oxycodone, unaware of Fentanyl contamination
• Many reactions are severe, and include an almost instant loss of consciousness, respiratory depression, uncontrollable body movements, heart palpitations, heart attacks, seizures, inability to move, and unresponsiveness to shaking and yelling.
• Other reactions include gastrointestinal issues, numbness, slurred speech, confusion, irrationality, loss of memory, and inability to think as usual

Risk Reduction with Fentanyl Use

Fentanyl use is very risky and unpredictable, even for long-term drug users, who are tolerant of heroin and oxycodone. The smallest amounts of Fentanlyl can cause overdose-death.

Never use heroin or street-purchased oxycodone alone. Assume any recreational opioid is contaminated with Fentanyl.

Make use of supervised injection facilities if you can access one.

If you currently are unable to access a supervised facility, use with friends, people you trust to get you to a hospital, and always with someone who knows how to administer Naloxone, and has some on hand.

Keep at least 2-3 Naloxone kits nearby for each user who will be using at any one time. Kits are low-cost at pharmacies, or else free from Toronto Public Health.

Always try a small sample of any opioid first: a fraction of your usual dose to check potency.

If you inject, always use new, unused injection drug gear, and inject safely. You can get unused injection drug gear through any site associated with The Works through Toronto Public Health.

Avoid sharing needles, cookers, cotton filters, water, or alcohol pads. Sharing injection drug gear can transit HIV, Hepatitis C and other blood-borne infections. Used needles can damage veins as well. Prepare your injection on a clean surface, also clean your skin with soap and water or an alcohol pad.

Fentanyl and HIV Medication

• NRTIs: No evidence found for interactions with this class of medications
• NNRIs: Co-administration may increase Fentanyl levels
• Protease inhibitors: Co-administration of Fentanyl with ritonavir boosted or un-boosted protease inhibitors may increase Fentanyl plasma concentrations, prolong Fentanyl half-life, and increase potential for adverse drug reactions
• Integrase inhibitors: Co-administration of fentanyl and elvitegravir/cobicistat/tenofovir/emtricitabine may increase Fentanyl plasma concentrations, prolong Fentanyl half-life, and increase potential for adverse drug reactions
• Entry inhibitors: No evidence found for interactions with this class of medications

Sex on Fentanyl

Fentanyl is usually taken unknowingly, cut into, or substituted for what is assumed to be another opioid, such as heroin or oxycodone. Opioids are known for minimizing libido, and has a sedative effect. Many users pass out or overdose on Fentanyl (or drugs cut with Fentanyl), so it is not considered a drug for mutual and consensual sexual activities.