Known as the ‘zombie drug’, this synthetic psychoactive substance is causing a public health crisis by killing tens of thousands of Americans every year.

Fentanyl is a synthetic opioid developed in the 1950s in Belgium to reduce pain with an effect 50 times stronger than heroin and 100 times more potent than morphine. The Centre for Disease Control and Prevention points out that there are two types of fentanyl, pharmaceutical fentanyl, prescribed by specialists to treat severe pain in cancer patients or after surgery, and the one that is manufactured illegally for use as a drug, either in liquid, powder or tablet form.

Fentanyl acts on receptors in the brain, causing analgesic and euphoric effects, hence its usefulness in treating severe pain. Thus, fentanyl causes lethargy, sedation, disengagement and a sense of well-being among those who use it on a daily basis. Users even lose control of their bodies, unable to move for the hour they are under the effect of the drug. For this reason, it is known as the ‘zombie drug’.

But why the boom now?

The fentanyl crisis has had three waves over the past 30 years. The first began when big pharma pushed for painkillers to be prescribed indiscriminately and with the acquiescence of health authorities. From the late 1990s and early 2000s, prescriptions were the gateway for thousands of patients with chronic conditions to develop an addiction to synthetic drugs such as oxycodone, known as Oxycontin, a drug that killed pain and didn’t get you hooked. Or so they said.

The second wave was a decade later and was marked by a skyrocketing demand for heroin when the door was closed to medical prescriptions and fentanyl could not be prescribed. The third wave, the current one, came when the cartels realised what a huge business opportunity there was in conjunction with the coronavirus pandemic. Fentanyl completely revolutionised the drug trade: it is used to cut cocaine, to modify heroin, to make “pirate” pills and to adulterate crystal meth, as Clara Fleiz, a researcher at the National Institute of Psychiatry, has explained.

In 2020, overdose deaths exceeded 91,000, in 2021 they were already more than 106,000 in the United States, all because of confinements that ended up aggravating the addiction situation of many people who were struggling with it and turning fentanyl into one of the most potent drugs in the world. By 2022, it accounted for around three quarters of overdose deaths, which US authorities have announced are expected to set a new record, with around 110,000 casualties. That’s more than 2,000 per week.

What is the situation in Spain?

It’s true that the number of fentanyl users in Spain is much lower than in the US. Even so, 15.8% of the Spanish population aged 15-64 reported having taken opioid painkillers with or without prescription on occasion, according to the annual Spanish Survey on Alcohol and Other Drugs (EDADES) published by the Ministry of Health. Although fentanyl use has soared in recent years in Spain, the alarm has not yet been raised.

Moreover, in Spain the prescription of drugs containing fentanyl is only indicated for the treatment of severe cancer pain in adults, and not all pharmacies can dispense these drugs, and those that do must keep a record of patients and units sold. In any case, its use as a recreational drug in Spain is at practically marginal levels due to the controls that exist within the health system.

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