Factors contributing to deaths:
(1) toxic contaminants contained in the preparation
(2) overdose if the concentration of the drug is misjudged
The nonpharmaceutical fentanyl can be distinguished from the pharmaceutical grade by analyzing the product (which contains impurities), but it is indistinguishable once absorbed.
The diagnosis of nonpharmaceutical fentanyl abuse requires:
(1) analysis of the drug prior to ingestion
(2) exclusion of a pharmaceutical source
(3) information from fellow drug abusers
Clinical effects of fentanyl (opiate-type effects):
(1) euphoria
(2) depression or apathy
(3) drowsiness or lethargy
(4) mental confusion
(5) slurring of speech
(6) papillary constriction (miosis)
(7) nausea and vomiting
(8) constipation
(9) repeated nodding of the head
Since fentanyl is a synthetic opiate it may not be detected by common tests for opiates, which tend to detect the naturally-occurring agents. A specific assay for fentanyl is needed to detect it.
