Fentanyl was first produced in Belgium in the late 1950s. Fentanyl, with an analgesic potency of about 80 times that of morphine, was introduced into medical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze. Thereafter; two other fentanyl analogues were introduced; alfentanil (Alfenta), an ultra-short (5-10 minutes) acting analgesic, and sufentanil (Sufenta), an exceptionally potent analgesic (5 to 10 times more potent than fentanyl) for use in heart surgery. Today, fentanyls are extensively used for anesthesia and analgesia. Duragesic, for example, is a fentanyl transdermal patch used in chronic pain management, and Actiq is a solid formulation of fentanyl citrate on a stick that dissolves slowly in the mouth for transmucosal absorption. Actiq is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil) is an analogue of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals.
Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical community and continues to be a problem in the United States. To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic. The biological effects of the fentanyls are indistinguishable from those of heroin, with the exception that the fentanyls may be hundreds of times more potent. Fentanyls are most commonly used by intravenous administration, but like heroin, they may also be smoked or snorted.
Fentanyl has been diverted by pharmacy theft, fraudulent prescriptions and illicit distribution by patients, physicians and pharmacists. Theft has also been identified at nursing homes and other long-term care facilities. Fentanyl oral transmucosal lozenges (Actiq) are typically sold at $20-25 per unit or $450 per carton (contains 24 units) while transdermal patches (Duragesic) are sold at prices ranging from $10 to $100 per patch depending upon the dose of the unit and geographical area. There is evidence of large illegal distribution rings selling fentanyl products with the other opioid pharma products.