Contaminated: the fentanyl crisis in St. Louis

Fentanyl is the most lethal drug ever created. News 4 spent months looking into how it impacts the St. Louis community, where it comes from, and what can be done to alter its deadly path. For more stories, resources & what you can do to help fight the fentanyl crisis go to


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Clinical data
Pronunciation/ˈfɛntənɪl/ or /ˈfɛntənəl/
Trade namesActiq, Duragesic, Fentora, Sublimaze, others
License dataEU EMAby INNUS DailyMedFentanyl
Routes of
BuccalepiduralIMITIVsublingualskin patch
Drug classOpioid
ATC codeN01AH01 (WHON02AB03 (WHO)
Legal status
Legal statusAU: S8 (Controlled drug)BR: Class A1 (Narcotic drugs)CASchedule IDEAnlage III (Special prescription form required)UK: Class AUS: Schedule IIEU: Rx-only
Pharmacokinetic data
Bioavailability92% (transdermal)
89% (intranasal)
50% (buccal)
33% (ingestion)
100% (intramuscular)
55% (inhaled)
Protein binding80–85%
MetabolismLiver, primarily by CYP3A4
Onset of action5 minutes[2]
Elimination half-lifeIV: 6 mins (T1/2 α)
1 hours (T1/2 β)
16 hours (T1/2 ɣ)
Intranasal: 6.5 hours
Transdermal: 20–27 hours[3]
Sublingual/buccal (single dose): 2.6–13.5 hours[3]
Duration of actionIV: 30–60 minutes[2][4]
ExcretionMostly urinary (metabolites, < 10% unchanged drug)[3]
showIUPAC name
CAS Number437-38-7 
PubChem CID3345
CompTox Dashboard (EPA)DTXSID9023049 
ECHA InfoCard100.006.468 
Chemical and physical data
Molar mass336.479 g·mol−1
3D model (JSmol)Interactive image
Density1.1 g/cm3
Melting point87.5 °C (189.5 °F)

Fentanyl, also spelled fentanil, is a potent opioid used as a pain medication. Together with other drugs, fentanyl is used for anesthesia.[3] It is also used illicitly as a recreational drug, sometimes mixed with heroincocainebenzodiazepines or methamphetamine. Its potentially deadly overdose effects can be neutralized by naloxone.[5] Fentanyl is commonly used to create counterfeit pills disguised as OxyContinXanaxAdderall, among others. It has a rapid onset and its effects generally last under two hours.[3] Medically, it is used by injectionnasal spray, or skin patch, or absorbed through the cheek as a lozenge or tablet.[3][6]

Common adverse effects of fentanyl include nauseavomitingconstipationitchingsedation, confusion, and injuries related to poor coordination.[3][7] Serious adverse effects may include respiratory depressionhallucinationsserotonin syndromelow blood pressure, or development of an opioid use disorder.[3][7] Fentanyl works by activating μ-opioid receptors.[3] It is around 100 times stronger than morphine and about 50 times stronger than heroin. Fentanyl was first made by Paul Janssen in 1960 and approved for medical use in the United States in 1968.[3][8] In 2015, 1,600 kilograms (3,500 pounds) were used in healthcare globally.[9] As of 2017, fentanyl was the most widely used synthetic opioid in medicine;[10] in 2019, it was the 278th most commonly prescribed medication in the United States, with more than 1 million prescriptions.[11][12] It is on the World Health Organization’s List of Essential Medicines.[13]

In 2021, fentanyl and fentanyl analogues accounted for most drug overdose deaths in the United States with 71,238 deaths.[14][15][16][17][18][19] Compared to heroin, it is more potent, has higher profit margins, and, because it is compact, has simpler logistics. It can be cut into, or even replace entirely, the supply of heroin and other opiates.[20] Factories in China manufacture fentanyl or fentanyl precursors; it is then smuggled into other countries for illicit sale; in the United States, the Chinese-manufactured fentanyl is smuggled primarily via Mexico.[21]


Medical uses[edit]


Intravenous fentanyl is often used for anesthesia and to treat pain.[22] To induce anesthesia, it is given with a sedative-hypnotic, like propofol or thiopental, and a muscle relaxant.[23] To maintain anesthesia, inhaled anesthetics and additional fentanyl may be used.[23] . . . .

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