In 2022, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that 991,000 Americans misused prescription fentanyl, while another 686,000 Americans misused illegally-made fentanyl (IMF).¹ Along with this reporting came a word of caution, explaining that many people are unaware that they are misusing IMF; therefore it is important to recognize that this statistic is a underestimate of how many people are actually using IMF throughout the United States.¹

This article will discuss the history of fentanyl, including its origins, its medicinal uses, and how it has infiltrated the illicit drug scene in ways that have led to tens of thousands of deaths and a years-long national public emergency.

What is Fentanyl?

Fentanyl is a synthetic opioid that is classified as a Schedule II narcotic, meaning that it has a high potential for misuse that can lead to psychological or physical dependence.²It first received approval from the FDA back in 1968, when it was introduced for use as an intravenous anesthetic.^3,4 Today, prescription fentanyl is used to treat post-surgical pain and severe physical pain.⁵Available in a variety of dosage amounts, it is typically sold under the following brand names and in the following formats:⁴

Actiq® — oral transmucosal lozenges (or fentanyl “lollipops”)
Fentora® — effervescent buccal tablets
Abstral® — sublingual tablets
Subsys® — sublingual sprays
Lazanda® — nasal sprays
Duragesic® — transdermal patches
Formulas administered via injection

Pharmaceutical-grade fentanyl used by medical professionals is not the same formulation as illegally-manufactured fentanyl (IMF), which is made illicitly and distributed on the streets.⁶ Also referred to as Apache, Jackpot, and Tango & Cash, IMF is often combined with other drugs to make them more potent and affordable.⁶ Unfortunately, combining IMF with other drugs also makes them more dangerous and addictive.⁶

Those factors, plus the fact some people aren’t aware that their drugs contain IMF, presents significant danger, as fentanyl in itself is an extremely potent substance. It is 50 times stronger than heroin and 100 times stronger than morphine, and just 2 milligrams (the amount that can fit on Abraham Lincoln’s cheek on a penny) of IMF is considered a lethal dose.⁴

History of Fentanyl

The history of fentanyl spans several decades, with its grim tale illustrating not only how deadly it is, but also its high probability of addiction. From a pharmacological standpoint, fentanyl does have medicinal merit, as it is very effective for anesthetic purposes and in treating severe physical pain.⁴Over the years, however, it has also become a driver of addiction.

1960s

Fentanyl was first developed in 1960 by Belgian chemist Dr. Paul Janssen and was introduced to several Western European countries by 1963.⁷

In 1968, fentanyl received FDA approval, but only when it was combined with droperidol, a medication used to prevent nausea and vomiting caused by surgical procedures.^7,8 It was not approved to be used alone out of concern for its habit-forming nature.⁷

1970s

By 1972, the FDA modified their approval and allowed fentanyl to be used on its own.⁷ It became a popular drug for use in vascular and cardiac surgery.⁷ The first cases of misuse and overdose surfaced in the mid-1970s, and in 1979, overdoses became associated with IMF created in illegal labs.⁷This was not prevalent enough at the time to raise much concern, but it didn’t take long for that to change.

1980s

In 1981, the drug went off-patent, and U.S. sales exploded.⁷ Towards the end of the decade, a fentanyl transdermal drug delivery patch was being worked on by a pharmaceutical company in California.⁷This patch would eventually become known as Duragesic and received FDA approval in the 1990s.^7,9While advancements like these were in the making during the 1980s, overdose deaths continued to emerge.

1990s

In the 1990s, the transdermal skin patch and other dosing forms of fentanyl were made available to patients by prescription.⁹ It was during this time that the lozenge, lollipop, tablet, and nasal spray versions of fentanyl were also made available.⁹ These easy-dosing methods made the drug much easier to misuse, which led to a rise in the fentanyl analog market.⁹ Illegal manufacturing sites became more prevalent, with many creating designer drugs that had modified chemical structures to skirt controlled substance laws.⁹

It was also during this time that pharmaceutical companies began to downplay opioid pain medications (like OxyContin) and their habit-forming potential.¹⁰ Many of these medications did not include safety features, like tamper-resistant formulations, and pharmaceutical companies failed to issue addiction-related warnings in their promotional activities or drug packaging.¹⁰ Instead, they allegedly misrepresented opioids as safer than alternative medications.¹⁰ Eventually, these actions led to countless lawsuits filed by medical professionals and entities in the late 1990s and early 2000s, with many still in process today.¹⁰

2000s & 2010s

Between 1999 and 2011, opioid-related overdose deaths nearly quadrupled throughout the United States.⁹ This significant and drastic increase in overdoses occurred within the same timeframe that illicit fentanyl-laced pills were first detected.⁹By 2013 and 2014, opioid-related overdoses increased even more.⁹

Street use of fentanyl began to grow in popularity around 2013, especially in the Northeastern United States.⁷ States such as New Hampshire and Massachusetts began seeing an influx of illicit fentanyl use, which eventually spread out towards states like Ohio, Florida, and different areas of the U.S.⁷ Trafficking of fentanyl from other countries, such as Mexico and China, also became more prominent, aiding in the increase of availability of illicit fentanyl in the United States.⁷

In 2013, the U.S. Department of Health and Human Services declared an opioid epidemic in the country.¹¹ Fast forward to 2017, where the opioid crisis was officially declared a national public health emergency, and has been re-declared as such every year since.⁷

Fentanyl and the Opioid Epidemic

The opioid epidemic did not engulf the country in a single wave. Instead, it came in three separate waves, all adding to the one that came in before it:¹²

2000: First wave – Overdoses involving prescription opioids began.
2007: Second wave – Overdoses involving heroin began, with deaths surpassing those that occurred during the first wave.
2013: Third wave – Overdoses involving synthetic opioids, fentanyl, and fentanyl analogs began, and deaths of the first and second waves started leveling off, while deaths of the third wave continued to rise in 2017 and the years that followed.

The greatest concerns regarding fentanyl today are the very reasons why it is so dangerous. It is a highly potent drug that can be lethal at very small doses.¹² But there’s more than the potency that is raising alarm. The purity of the product, especially when combined with other drugs like heroin, can make it highly deadly.¹² There are great fluctuations in the levels of fentanyl on the street market, making overdose more likely to occur.¹²

There have been several steps taken to help curb fentanyl overdoses and reduce addiction rates. The U.S. government has increased monitoring and regulation of how opioids are prescribed and used within the medical community.¹² In March 2023, the FDA approved Narcan for over-the-counter use. This allows retailers to sell the opioid-reversal drug over the counter and without a prescription.¹³Distribution of sterile syringes at supervised consumption places are also being used as a harm reduction strategy, however there is still a significant amount of work to do.¹²

Finding Fentanyl Addiction Rehab for Teens and Adolescents

Fentanyl addiction can be very difficult to overcome, especially if you are trying to do it alone. Even with the support of family and friends, it can be a significant challenge. Professional treatment for opioid addiction can help.

At American Addiction Centers, our network of rehab facilities spans the entire United States, so you can choose a location that works best for you.

If you or someone you love is struggling with fentanyl addiction, there is hope. Call us today or visit our website and get the help that you need. Our compassionate admissions navigators can guide you towards the help that you need and deserve.

The History of Fentanyl