Editing Fentanyl (section)

== Society and culture ==
=== Legal status ===
Effective from 1 May 2019, China officially classified all forms of fentanyl as controlled narcotics.<ref>{{Cite web |title= Fentanyl Flow to the United States | date = January 2020 | id = DEA-DCT-DIR-008-20 | work = DEA Intelligence Report | publisher = U.S. Drug Enforcement Division |url= https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-008-20%20Fentanyl%20Flow%20in%20the%20United%20States_0.pdf |archive-url= https://web.archive.org/web/20250306072958/https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-008-20%20Fentanyl%20Flow%20in%20the%20United%20States_0.pdf |archive-date= 6 March 2025 |access-date=10 March 2025 |url-status=live }}</ref>

In the UK, fentanyl is classified as a controlled Class A drug under the [[Misuse of Drugs Act 1971]].<ref>{{cite web|url=http://www.legislation.gov.uk/ukpga/1971/38/schedule/2|title=Misuse of Drugs Act 1971|access-date=22 March 2017|archive-url=https://web.archive.org/web/20121114181829/http://www.legislation.gov.uk/ukpga/1971/38/schedule/2|archive-date=14 November 2012|url-status=live}}</ref>

In the Netherlands, fentanyl is a List I substance of the [[Opium Law]].<ref>{{cite web |title=Opiumwet |trans-title=Opium Act |url=https://wetten.overheid.nl/BWBR0001941/2009-07-01#BijlageI |website=Ministerie van Binnenlandse Zaken en Koninkrijksrelaties |trans-website=Ministry of the Interior and Kingdom Relations |access-date=19 January 2023 |language=nl |archive-date=19 January 2023 |archive-url=https://web.archive.org/web/20230119041050/https://wetten.overheid.nl/BWBR0001941/2009-07-01#BijlageI |url-status=live }}</ref>

In the US, fentanyl is a Schedule II controlled substance per the [[Controlled Substances Act]]. Distributors of Abstral are required to implement an FDA-approved [[Specialty drugs#Risk evaluation and mitigation strategies (REMS)|risk evaluation and mitigation strategy]] (REMS) program.<ref name="relayhealth_2011">{{cite web |url=http://www.relayhealth.com/news-and-events/press/ProStrakan-Chooses-RelayHealth-for-Approved-Abstral-REMS-Program-.html#sthash.GRwKE7Wc.dpuf |title=RelayHealth's pharmacy connectivity network and reach, aligned with McKesson Specialty Care Solutions' REMS expertise, expands cancer patients' access to pain therapy |date=20 January 2011 |access-date=5 November 2015 |location=Atlanta |archive-url=https://web.archive.org/web/20160129072751/http://www.relayhealth.com/news-and-events/press/ProStrakan-Chooses-RelayHealth-for-Approved-Abstral-REMS-Program-.html#sthash.GRwKE7Wc.dpuf |archive-date=29 January 2016 |url-status=dead }}</ref><ref name="pharmaceuticalcommerce">{{cite news | vauthors = Shelley S |date=22 April 2011 |title=With a few stumbles, REMS begins to hit its atride |website=Pharmaceutical Commerce |url=http://www.pharmaceuticalcommerce.com/brand_communications?articleid=2389%22%20%5Ct%20%22_blank |access-date=5 November 2015 | url-status=dead | archive-url = https://web.archive.org/web/20160129174603/http://www.pharmaceuticalcommerce.com/brand_communications?articleid=2389%22%20%5Ct%20%22_blank |archive-date=29 January 2016 }}</ref> In order to curb misuse, many health insurers have begun to require [[Managed care|precertification and/or quantity limits]] for Actiq prescriptions.<ref>{{cite web | title = Procedures, programs and drugs that require precertification: Participating provider precertification list | url = https://www.aetna.com/content/dam/aetna/pdfs/health-care-professionals/2021-precert-list-july.pdf | publisher = Aetna Inc. | access-date = 4 July 2021 | archive-date = 9 July 2021 | archive-url = https://web.archive.org/web/20210709183129/https://www.aetna.com/content/dam/aetna/pdfs/health-care-professionals/2021-precert-list-july.pdf | url-status = dead }}</ref><ref>{{cite web | title = Notice regarding precertification requirement | date = 5 November 2007 | publisher = BlueCross BlueShield of Arizona | url = http://www.azblue.com/pdfs/medications/pharmacy/QlList.pdf | archive-url = https://web.archive.org/web/20080828155557/http://www.azblue.com/pdfs/medications/pharmacy/QlList.pdf | archive-date = 28 August 2008}}</ref><ref>{{cite web | title = Medications requiring precertification | publisher = Oxford Health Plans | url = https://www.oxhp.com/druglist/drug_precert_list.html | archive-url = https://web.archive.org/web/20061015232701/https://www.oxhp.com/druglist/drug_precert_list.html | archive-date=15 October 2006}}</ref>

In Canada, fentanyl is considered a schedule{{nbsp}}I drug as listed in Canada's [[Controlled Drugs and Substances Act]].<ref>{{cite web |title=Canada's Controlled Drugs and Substances Act |website=Canada Justice Laws Website |url=http://laws.justice.gc.ca/eng/acts/C-38.8/page-12.html#h-34 |access-date=8 September 2018 |archive-date=28 September 2018 |archive-url=https://web.archive.org/web/20180928212208/http://laws.justice.gc.ca/eng/acts/C-38.8/page-12.html#h-34 |url-status=live }}</ref>

[[Estonia]] is known to have been home to the world's longest documented fentanyl epidemic, especially following the [[Taliban]] ban on opium poppy cultivation in Afghanistan.<ref>{{cite web | vauthors = Naylor A | date = 6 January 2020 | title = What we can learn from a tiny Baltic country's two-decade Fentanyl crisis | website = Vice | url = https://www.vice.com/en/article/estonia-fentanyl-crisis-what-says-about-us/ | access-date = 31 January 2021 | archive-date = 8 March 2021 | archive-url = https://web.archive.org/web/20210308162515/https://www.vice.com/en/article/k7ea93/estonia-fentanyl-crisis-what-says-about-us | url-status = live }}</ref>

A 2018 report by ''[[The Guardian]]'' indicated that many major drug suppliers on the [[dark web]] have voluntarily banned the trafficking of fentanyl.<ref>{{cite news |vauthors=Townsend M |date=1 December 2018 |title=Dark web dealers voluntarily ban deadly fentanyl |newspaper=[[The Guardian]] |url=https://www.theguardian.com/society/2018/dec/01/dark-web-dealers-voluntary-ban-deadly-fentanyl |access-date=3 December 2018 |archive-date=2 December 2018 |archive-url=https://web.archive.org/web/20181202232730/https://www.theguardian.com/society/2018/dec/01/dark-web-dealers-voluntary-ban-deadly-fentanyl |url-status=live }}</ref>

The fentanyl epidemic has erupted in a highly acrimonious dispute between the U.S. and Mexican governments. While U.S. officials blame the flood of fentanyl crossing the border primarily on Mexican crime groups, then-President [[Andrés Manuel López Obrador]] insisted that the main source of this synthetic drug is [[Asia]]. He stated that the crisis of a lack of family values in the United States drives people to use the drug.<ref>{{cite news |title=As fentanyl crisis grows, U.S.-Mexico divide deepens |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/world/2023/04/29/mexico-us-fentanyl/ |access-date=1 May 2023 |archive-date=29 April 2023 |archive-url=https://web.archive.org/web/20230429142455/https://www.washingtonpost.com/world/2023/04/29/mexico-us-fentanyl/ |url-status=live }}</ref>

=== Recreational use ===
[[Substance abuse|Illicit use]] of pharmaceutical fentanyl and its analogues first appeared in the mid-1970s in the medical community and continues in the present. More than 12 different analogues of fentanyl, all unapproved and [[clandestine chemistry|clandestinely]] produced, have been identified in the U.S. drug traffic. In February 2018, the U.S. Drug Enforcement Administration indicated that illicit fentanyl analogs have no medically valid use, and thus applied a "Schedule I" classification to them.<ref>{{cite magazine |vauthors=Ducharme J |date=3 December 2018 |title=China has promised to crack down on Fentanyl. Here's what that could mean for overdose deaths in the U.S. |magazine=[[Time (magazine)|Time]] |url=https://time.com/5469231/china-fentanyl-controlled-substance/ |access-date=6 December 2018 |archive-date=6 December 2018 |archive-url=https://web.archive.org/web/20181206031948/http://time.com/5469231/china-fentanyl-controlled-substance/ |url-status=live }}</ref>

Fentanyl analogues may be hundreds of times more potent than heroin. Fentanyl is used orally, smoked, snorted, or injected. Fentanyl is sometimes sold as heroin or [[oxycodone]], which can lead to overdose. Many fentanyl overdoses are initially classified as heroin overdoses.<ref name="pmid16909503">{{cite journal | vauthors = Boddiger D | title = Fentanyl-laced street drugs "kill hundreds" | journal = Lancet | volume = 368 | issue = 9535 | pages = 569–570 | date = August 2006 | pmid = 16909503 | doi = 10.1016/S0140-6736(06)69181-2 | s2cid = 39788629 | doi-access = free | title-link = doi }}</ref> Recreational use is not particularly widespread in the EU except for Tallinn, Estonia, where it has largely replaced heroin. [[Estonia]] has the highest rate of [[3-methylfentanyl]] overdose deaths in the EU, due to its high rate of recreational use.<ref>{{cite news |title=Synthetic drug fentanyl causes overdose boom in Estonia |date=30 March 2012 |website=[[BBC News Online]] |url=https://www.bbc.co.uk/news/world-europe-17524945 |access-date=21 June 2018 |archive-url=https://web.archive.org/web/20180728214747/https://www.bbc.co.uk/news/world-europe-17524945 |archive-date=28 July 2018 |url-status=live }}</ref>

Fentanyl is sometimes sold on the black market in the form of transdermal fentanyl patches such as [[Duragesic]], diverted from legitimate medical supplies. The gel from inside the patches is sometimes ingested or injected.<ref name=DEA2015 />

Another form of fentanyl that has appeared on the streets is the Actiq lollipop formulation. The pharmacy retail price ranges from US$15 to US$50 per unit based on the strength of the lozenge, with the black market cost ranging from US$5 to US$25, depending on the dose.<ref name="trib2">"{{cite web | vauthors = Mims B |date = 11 November 2004 |title = Painkiller is topic of inquiry |newspaper = [[The Salt Lake Tribune]] |url = http://opioids.com/fentanyl/actiq.html |archive-url = https://web.archive.org/web/20071224161858/http://opioids.com/fentanyl/actiq.html |archive-date=2007-12-24}}</ref> The attorneys general of Connecticut and Pennsylvania have launched investigations into its diversion from the legitimate pharmaceutical market, including Cephalon's "sales and promotional practices for Provigil, Actiq and Gabitril."<ref name="trib2" />

Non-medical use of fentanyl by individuals without opioid tolerance can be very dangerous and has resulted in numerous deaths.<ref name=DEA2015>{{cite web |title=Fentanyl |date=March 2015 |publisher=U.S. [[Drug Enforcement Administration]] |url=http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf |access-date=2 June 2016 |archive-url=https://web.archive.org/web/20160611072817/http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf |archive-date=11 June 2016 |url-status=live }}</ref> Even those with opiate tolerances are at high risk for overdoses. Like all opioids, the effects of fentanyl can be reversed with [[naloxone]], or other opiate antagonists. Naloxone is increasingly available to the public. Long-acting or sustained-release opioids may require repeat dosage. Illicitly synthesized fentanyl powder has also appeared on the United States market. Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately, and often the resulting mixture may be far too strong and, therefore, very dangerous.<ref>{{cite journal | vauthors = Mars SG, Rosenblum D, Ciccarone D | title = Illicit fentanyls in the opioid street market: desired or imposed? | journal = Addiction | volume = 114 | issue = 5 | pages = 774–780 | date = May 2019 | pmid = 30512204 | pmc = 6548693 | doi = 10.1111/add.14474 }}</ref>

Some heroin dealers mix fentanyl powder with heroin to increase potency or compensate for low-quality heroin. In 2006, illegally manufactured, non-pharmaceutical fentanyl often mixed with [[cocaine]] or [[heroin]] caused an outbreak of overdose deaths in the United States and [[Canada]], heavily concentrated in the cities of [[Dayton, Ohio|Dayton]], Ohio; [[Chicago, Illinois|Chicago]], Illinois; [[Detroit, Michigan|Detroit]], Michigan; and [[Philadelphia, Pennsylvania|Philadelphia]], Pennsylvania.<ref>{{cite journal | title = Nonpharmaceutical fentanyl-related deaths—multiple states, April 2005 – March 2007 | journal = MMWR Morb Mortal Wkly Rep | volume = 57 | issue = 29 | pages = 793–796 | date = July 2008 | pmid = 18650786 | url = https://www.cdc.gov/mmwr/PDF/wk/mm5729.pdf | author1 = Centers for Disease Control Prevention (CDC) | access-date = 2 December 2022 | archive-date = 2 December 2022 | archive-url = https://web.archive.org/web/20221202101157/https://www.cdc.gov/mmwr/PDF/wk/mm5729.pdf | url-status = live }}</ref>

=== Enforcement ===
{{Further|Anti-fentanyl legislation in the United States|United States sanctions against China#Sanctions on producers of fentanyl precursors|China and the opioid epidemic in the United States}}
[[Image:deafentanyl.jpg|thumb|Fentanyl powder (23% fentanyl) seized by police in [[Ohio]], United States<ref>{{cite web |title=DEA Microgram Bulletin |date=June 2006 |publisher=U.S. [[Drug Enforcement Administration]] |department=Office of Forensic Sciences |place=Washington, DC |url=http://www.usdoj.gov/dea/programs/forensicsci/microgram/mg0606/mg0606.html |access-date=22 June 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090721101918/http://www.usdoj.gov/dea/programs/forensicsci/microgram/mg0606/mg0606.html|archive-date=21 July 2009}}</ref>]]

The fentanyl supply chain in Mexico consists of a vast and elusive network, potentially involving hundreds of players. U.S. and Mexican anti-narcotics officials acknowledge that the exact number is unknown. Some brokers operate as specialists within major cartels, while others act independently. However, the majority remain unknown to authorities and operate below the radar. A major challenge in disrupting this trade lies in the global chemical industry. Many of the compounds used to manufacture fentanyl have legitimate industrial applications, classifying them as dual-use chemicals. These substances are often unregulated or only lightly controlled in key countries such as the United States, Mexico, and China. This regulatory gap enables brokers to evade detection, seamlessly navigating between the legal chemical trade and the illicit drug market to acquire the necessary precursors.<ref>{{Cite web|url=https://www.reuters.com/investigates/special-report/drugs-fentanyl-brokers/|title=The shadowy 'brokers' helping Mexico's cartels smuggle fentanyl chemicals from China|website=[[Reuters]] }}</ref>

Several large quantities of illicitly produced fentanyl have been seized by U.S. law enforcement agencies. In November{{nbsp}}2016, the DEA uncovered an operation making counterfeit oxycodone and [[Alprazolam|Xanax]] from a home in [[Cottonwood Heights, Utah|Cottonwood Heights]], Utah. They found about 70,000{{nbsp}}pills in the appearance of oxycodone and more than 25,000 in the appearance of Xanax. The DEA reported that millions of pills could have been distributed from this location over the course of time. The accused owned a [[tablet press]] and ordered fentanyl in powder form from China.<ref>{{cite news | vauthors = Tanner C |date=2016 |title=Thousands of fentanyl pills confiscated in Utah drug raid |newspaper=[[The Salt Lake Tribune]] |url=http://www.sltrib.com/news/4623595-155/thousands-of-fentanyl-pills-confiscated-in |access-date=23 November 2016 |url-status=live |archive-url=https://web.archive.org/web/20161124094546/http://www.sltrib.com/news/4623595-155/thousands-of-fentanyl-pills-confiscated-in |archive-date=24 November 2016 }}</ref><ref>{{cite web |title=Cottonwood Heights drug bust one of the largest in Utah history |date=22 November 2016 |website=Fox 13 |url=http://fox13now.com/2016/11/22/dea-investigating-drug-operation-near-cottonwood-heights-school/ |url-status=live |access-date=23 November 2016 |archive-url=https://web.archive.org/web/20161123142646/http://fox13now.com/2016/11/22/dea-investigating-drug-operation-near-cottonwood-heights-school/ |archive-date=23 November 2016}}</ref> A seizure of a record amount of fentanyl occurred on 2 February 2019, by [[U.S. Customs and Border Protection]] in [[Nogales, Arizona|Nogales]], Arizona. The {{convert|254|lbs|kg}} of fentanyl, which was estimated to be worth US$3.5M, was concealed in a compartment under a false floor of a truck transporting cucumbers.<ref>{{cite news |title=U.S. border officers make largest-ever fentanyl bust: 254{{nbsp}}pounds hidden under cucumbers |date=31 January 2019 |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/world/national-security/us-border-officials-announce-largest-ever-fentanyl-seizure/2019/01/31/a43eeb62-258c-11e9-90cd-dedb0c92dc17_story.html |access-date=8 June 2020 |archive-date=8 June 2020 |archive-url=https://web.archive.org/web/20200608203341/https://www.washingtonpost.com/world/national-security/us-border-officials-announce-largest-ever-fentanyl-seizure/2019/01/31/a43eeb62-258c-11e9-90cd-dedb0c92dc17_story.html |url-status=live }}</ref> The "China White" form of fentanyl refers to any of a number of clandestinely produced analogues, especially [[α-Methylfentanyl|α-methylfentanyl]] (AMF).<ref name="deadiversion.usdoj.gov"/> One US Department of Justice publication lists "China White" as a synonym for a number of fentanyl analogues, including 3-methylfentanyl and α-methylfentanyl,<ref>{{cite journal | vauthors = Kram TC, Cooper DA, Allen AC | title = Behind the identification of China White | journal = Analytical Chemistry | volume = 53 | issue = 12 | pages = 1379A–1386A | date = October 1981 | pmid = 7294353 | doi = 10.1021/ac00235a003 }}</ref> which today are classified as [[Schedule I drug]]s in the United States.<ref name="deadiversion.usdoj.gov">{{cite web |title = List of Schedule I Drugs |publisher = U.S. Department of Justice |url = http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched1.htm |archive-url = https://web.archive.org/web/20100109203853/http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched1.htm |archive-date = 9 January 2010 }}</ref> Part of the motivation for AMF is that, despite the extra difficulty from a synthetic standpoint, the resultant drug is more resistant to metabolic degradation. This results in a drug with an increased duration.<ref name="pmid4420811">{{cite journal | vauthors = Van Bever WF, Niemegeers CJ, Janssen PA | title = Synthetic analgesics. Synthesis and pharmacology of the diastereoisomers of N-(3-methyl-1-(2-phenylethyl)-4-piperidyl)-N-phenylpropanamide and N-(3-methyl-1-(1-methyl-2-phenylethyl)-4-piperidyl)-N-phenylpropanamide | journal = Journal of Medicinal Chemistry | volume = 17 | issue = 10 | pages = 1047–1051 | date = October 1974 | pmid = 4420811 | doi = 10.1021/jm00256a003 }}</ref>

In June 2013, the United States [[Centers for Disease Control and Prevention]] (CDC) issued a health advisory<ref>{{cite web |title=Recommendations for Laboratory Testing for Acetyl Fentanyl and Patient Evaluation and Treatment for Overdose with Synthetic Opioids | author = CDC Health Alert Network |date=20 June 2013 |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |url=http://emergency.cdc.gov/HAN/han00350.asp |access-date=20 June 2013 |archive-url=https://web.archive.org/web/20130624113939/http://emergency.cdc.gov/HAN/han00350.asp |archive-date=24 June 2013 |url-status=dead }}</ref> to emergency departments alerting to 14 overdose deaths among intravenous drug users in Rhode Island associated with [[acetylfentanyl]], a synthetic opioid analog of fentanyl that has never been licensed for medical use. In a separate study conducted by the CDC, 82% of fentanyl overdose deaths involved illegally manufactured fentanyl, while only 4% were suspected to originate from a prescription.<ref>{{cite report |title=Characteristics of Fentanyl overdose — Massachusetts, 2014–2016 |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |date=14 April 2017}}</ref>

Beginning in 2015, Canada has seen several fentanyl overdoses. Authorities suspected that the drug was being imported from Asia to the western coast by organized crime groups in powder form and being pressed into pseudo-OxyContin tablets.<ref>{{cite web |title = Lethal fentanyl profiting gangs in Western Canada while deaths climb |date = 6 August 2015 |website = CTV News |url = https://www.ctvnews.ca/canada/lethal-fentanyl-profiting-gangs-in-western-canada-while-deaths-climb-1.2505470 |vauthors = Burgmann T |access-date = 16 July 2022 |archive-date = 17 July 2022 |archive-url = https://web.archive.org/web/20220717024447/https://www.ctvnews.ca/canada/lethal-fentanyl-profiting-gangs-in-western-canada-while-deaths-climb-1.2505470 |url-status = live }}</ref> Traces of the drug have also been found in other recreational drugs, including cocaine, [[MDMA]], and heroin. The drug has been implicated in the deaths of people from all walks of life—from homeless individuals to professionals—including teens and young parents.<ref>{{cite web |title = Fentanyl doesn't discriminate, killing the homeless and young professionals |date = 22 August 2015 |newspaper = [[Edmonton Journal]] |url = https://edmontonjournal.com/news/local-news/fentanyl-doesnt-discriminate-killing-the-homeless-and-young-professionals |archive-url = https://web.archive.org/web/20161220132537/http://edmontonjournal.com/news/local-news/fentanyl-doesnt-discriminate-killing-the-homeless-and-young-professionals |archive-date = 20 December 2016}}</ref> Because of the rising deaths across the country, especially in [[British Columbia]] where 1,716{{nbsp}}deaths were reported in 2020 and 1,782 from January to October{{nbsp}}2021,<ref>{{cite news |vauthors=Mangione K, Hasegawa R |date=9 December 2021 |title=2021 is now B.C.'s deadliest year in the opioid crisis, with 2{{nbsp}}months of data left to collect |website=[[CTV News]] |url=https://bc.ctvnews.ca/2021-is-now-b-c-s-deadliest-year-in-the-opioid-crisis-with-2-months-of-data-left-to-collect-1.5700104 |access-date=25 December 2021 |archive-date=25 December 2021 |archive-url=https://web.archive.org/web/20211225152051/https://bc.ctvnews.ca/2021-is-now-b-c-s-deadliest-year-in-the-opioid-crisis-with-2-months-of-data-left-to-collect-1.5700104 |url-status=live }}</ref> [[Health Canada]] is putting a rush on a review of the prescription-only status of [[naloxone]] in an effort to combat overdoses of the drug.<ref>{{cite news |title=Winnipeg Naloxone-distribution program could prevent fentanyl deaths |website=[[CBC News]] |url=http://www.cbc.ca/news/canada/manitoba/winnipeg-naloxone-distribution-program-could-prevent-fentanyl-deaths-1.3197131 |access-date=16 January 2018 |url-status=live |archive-url=https://web.archive.org/web/20180531104801/http://www.cbc.ca/news/canada/manitoba/winnipeg-naloxone-distribution-program-could-prevent-fentanyl-deaths-1.3197131 |archive-date=31 May 2018 }}</ref> In 2018, [[Global News]] reported allegations that [[Canada–China relations|diplomatic tensions]] between Canada and China hindered cooperation to seize imports, with Beijing being accused of inaction.<ref>{{cite news |vauthors=Cooper S, Bell S, Russell A |date=1 December 2018 |title=China won't stop flood of fentanyl into Canada, sources say |department=National |newspaper=[[Global News]] |place=Canada |url=https://globalnews.ca/news/4658188/fentanyl-china-canada-diplomatic-tensions/ |access-date=21 July 2021 |archive-date=13 June 2021 |archive-url=https://web.archive.org/web/20210613085610/https://globalnews.ca/news/4658188/fentanyl-china-canada-diplomatic-tensions/ |url-status=live }}</ref>

Fentanyl has been discovered for sale in illicit markets in Australia in 2017<ref>{{cite news | vauthors = Bonini T |date=13 October 2017 |title=Could fentanyl be Australia's next deadly drug epidemic? |website=ABC News (Australia) |url=http://www.abc.net.au/news/2017-10-13/could-fentanyl-be-australias-next-deadly-drug-epidemic/9048530 |access-date=6 April 2018 |archive-url=https://web.archive.org/web/20180508164151/http://www.abc.net.au/news/2017-10-13/could-fentanyl-be-australias-next-deadly-drug-epidemic/9048530 |archive-date=8 May 2018 |url-status=live }}</ref> and in New Zealand in 2018.<ref>{{cite web |title=Fentanyl found at New Zealand festival |date=20 March 2018 |website=KnowYourStuffNZ |url=https://knowyourstuff.nz/2018/03/20/fentanyl-found-at-new-zealand-festival/ |access-date=6 April 2018 |url-status=live |archive-url=https://web.archive.org/web/20180407115814/https://knowyourstuff.nz/2018/03/20/fentanyl-found-at-new-zealand-festival/ |archive-date=7 April 2018 |author1=Knowyourstuffnz }}</ref> In response, New Zealand experts called for wider availability of naloxone.<ref>{{cite news | vauthors = Buchanan J |date=27 March 2018 |title=NZ's 'deadly' indifference to drug overdose antidote |website=HealthCentral NZ |url=http://healthcentral.nz/opinion-julian-buchanan-nzs-deadly-indifference-to-drug-overdose-antidote/ |access-date=6 April 2018 |url-status=live |archive-url=https://web.archive.org/web/20180407054328/http://healthcentral.nz/opinion-julian-buchanan-nzs-deadly-indifference-to-drug-overdose-antidote/ |archive-date=7 April 2018 }}</ref>

In May 2019, China regulated the entire class of fentanyl-type drugs and two fentanyl precursors. Nevertheless, it remains the principal origin of fentanyl in the United States: Mexican cartels source fentanyl [[Precursor (chemistry)|precursors]] from Chinese suppliers such as [[Yuancheng Group]], which are finished in Mexico and smuggled to the United States.<ref>{{cite news |vauthors=Feng E |date=17 November 2020 |title='We Are Shipping To The U.S.': Inside China's Online Synthetic Drug Networks |work=[[NPR]] |url=https://www.npr.org/2020/11/17/916890880/we-are-shipping-to-the-u-s-china-s-fentanyl-sellers-find-new-routes-to-drug-user |access-date=1 October 2022 |archive-date=1 October 2022 |archive-url=https://web.archive.org/web/20221001144517/https://www.npr.org/2020/11/17/916890880/we-are-shipping-to-the-u-s-china-s-fentanyl-sellers-find-new-routes-to-drug-user |url-status=live }}</ref><ref name="brookings-3-22">{{cite web |vauthors=Felbab-Brown V |date=23 March 2022 |title=China and synthetic drugs control: Fentanyl, methamphetamines, and precursors |url=https://www.brookings.edu/research/china-and-synthetic-drugs-control-fentanyl-methamphetamines-and-precursors/ |access-date=23 September 2022 |website=Brookings |archive-date=23 September 2022 |archive-url=https://web.archive.org/web/20220923083453/https://www.brookings.edu/research/china-and-synthetic-drugs-control-fentanyl-methamphetamines-and-precursors/ |url-status=live }}</ref><ref name="dea-2020">{{cite web |date=January 2020 |title=Fentanyl Flow to the United States |url=https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-008-20%20Fentanyl%20Flow%20in%20the%20United%20States_0.pdf |access-date=4 October 2022 |website=U.S. [[Drug Enforcement Administration]] |archive-date=30 September 2022 |archive-url=https://web.archive.org/web/20220930135741/https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-008-20%20Fentanyl%20Flow%20in%20the%20United%20States_0.pdf |url-status=live }}</ref> Following the [[2022 visit by Nancy Pelosi to Taiwan]], China halted cooperation with the United States on combatting drug trafficking.<ref>{{cite web |vauthors=Lo K |date=29 September 2022 |title=White House confirms China has stopped cooperating on anti-drug measures |url=https://www.scmp.com/news/china/diplomacy/article/3194183/white-house-confirms-china-has-stopped-cooperating-anti-drug |access-date=1 October 2022 |website=[[South China Morning Post]] |archive-date=1 October 2022 |archive-url=https://web.archive.org/web/20221001071714/https://www.scmp.com/news/china/diplomacy/article/3194183/white-house-confirms-china-has-stopped-cooperating-anti-drug |url-status=live }}</ref> Bilateral talks on fentanyl later resumed in San Francisco in 2024 when then U.S. President Joe Biden and Chinese President Xi Jinping met. In the past several months before February 2025, China had also began scheduling fentanyl precursors that are internationally banned, aligning with efforts to restrict the flow of chemicals used in fentanyl production as well as the drug itself. These actions are intended to strengthen efforts to curb drug trafficking and disrupt the supply chain more effectively. In February 2025, US president Trump imposed a 10% [[Second Trump tariffs|tariff]] on Chinese imports, claiming the move as a way "to pressure China into taking action on fentanyl" but experts have expressed concern that these tariffs could reverse the progress made under the Biden administration and weaken the international cooperation necessary to combat global drug trafficking.<ref>{{Cite web | vauthors = Ortiz E |date=4 March 2025 |title=Trump says tariffs were enacted to curb fentanyl, but U.S. overdose deaths are already declining |url=https://www.nbcnewyork.com/news/national-international/trump-says-tariffs-to-curb-fentanyl-but-us-overdose-deaths-declining/6173140/?os=io....sxj9oul9no_journeys=true&ref=app |access-date=10 March 2025 | work = NBC New | location = New York |language=en-US}}</ref><ref>{{Cite news | vauthors = Hawkins A |date=4 February 2025 |title=Is the China-US fentanyl pipeline really responsible for the US opioid crisis? |url=https://www.theguardian.com/society/2024/nov/26/is-the-china-us-fentanyl-pipeline-really-responsible-for-the-us-opioid-crisis |access-date=10 March 2025 |work=The Guardian |language=en-GB |issn=0261-3077}}</ref><ref>{{Cite news | vauthors = Green HH |date=8 March 2025 |title=Trump policies could fuel illicit drug trade despite vow to curb fentanyl |url=https://www.theguardian.com/us-news/2025/mar/08/trump-policies-drug-trade-fentanyl |access-date=10 March 2025 |work=The Guardian |language=en-GB |issn=0261-3077}}</ref>

India has also emerged as a source of fentanyl and fentanyl precursors,<ref name="dea-2020" /> where Mexican cartels have already developed networks for the import of synthetic drugs. It is possible that fentanyl and precursor production may disperse to other countries, such as [[Nigeria]], [[South Africa]], [[Indonesia]], [[Myanmar]], and the [[Netherlands]].<ref name="brookings-3-22" />

In 2020, the [[Myanmar military]] and police confiscated 990 gallons of "methyl fentanyl"{{sic}}, as well as [[Precursor (chemistry)|precursors]] for the illicit synthesis of the drug. According to the [[United Nations Office on Drugs and Crime]], the [[Shan State]] of Myanmar has been identified as a major source for fentanyl derivatives. In 2021, the agency reported a further drop in opium poppy cultivation in Burma, as the region's synthetic drug market continues to expand and diversify.<ref>{{cite web |vauthors = Beech H, Nang S |date = 19 May 2020 |title = Raids reveal massive fentanyl production in Myanmar |newspaper = [[The New York Times]] |url = https://www.nytimes.com/2020/05/19/world/asia/myanmar-drug-raid-fentanyl.html |access-date = 2 May 2021 |archive-date = 8 June 2021 |archive-url = https://web.archive.org/web/20210608052805/https://www.nytimes.com/2020/05/19/world/asia/myanmar-drug-raid-fentanyl.html |url-status = live }}</ref><ref>{{cite report | title = UNODC report: Opium production drops again in Myanmar as the synthetic drug market expands | website = [[UNODC]] (Myanmar) | url = https://www.unodc.org/southeastasiaandpacific/en/2021/02/myanmar-opium-survey-report-launch/story.html | access-date = 2 May 2021 | archive-date = 4 March 2021 | archive-url = https://web.archive.org/web/20210304124958/https://www.unodc.org/southeastasiaandpacific/en/2021/02/myanmar-opium-survey-report-launch/story.html | url-status = live }}</ref>

In 2023, a California police union director was charged with importing synthetic opioids, including fentanyl and [[tapentadol]] disguised as [[chocolate]]. U.S. law enforcement had been slow in their response to the fentanyl crisis, according to the Washington Post. The response by the federal government to the fentanyl crisis had also faltered, according to the press release. Overdose deaths by fentanyl and other illegally imported opioids were surging since 2019 and are presently a major cause of death in all U.S. states.<ref>{{cite web | url = https://www.cnn.com/2023/03/30/us/california-police-union-executive-drug-scheme-opioids/index.html | title = A California police union director is being charged with importing opioids, including fentanyl, disguised as chocolate and wedding favors | archive-url = https://web.archive.org/web/20230402201933/https://www.cnn.com/2023/03/30/us/california-police-union-executive-drug-scheme-opioids/index.html | archive-date=2 April 2023 | work = CNN | date = 31 March 2023 | access-date = 2 April 2023 }}</ref><ref>{{cite news | url = https://www.washingtonpost.com/investigations/interactive/2022/dea-fentanyl-failure/ | title = Cause of death: Washington faltered as fentanyl gripped America | archive-url = https://web.archive.org/web/20230325131141/https://www.washingtonpost.com/investigations/interactive/2022/dea-fentanyl-failure/ | archive-date=25 March 2023 | newspaper = [[The Washington Post]] | access-date = 2 April 2023 }}</ref>

According to the national archives and the [[Drug Enforcement Administration|DEA]], direct fentanyl shipments from China have stopped since 2022.<ref>{{cite web |date=10 May 2022 |title=DEA zeroes in on China as fentanyl deaths soar – CBS News |url=https://www.cbsnews.com/news/fentanyl-china-mexico-drug-enforcement-administration/ |access-date=15 November 2023 |website=CBS News |archive-date=15 November 2023 |archive-url=https://web.archive.org/web/20231115231610/https://www.cbsnews.com/news/fentanyl-china-mexico-drug-enforcement-administration/ |url-status=live }}</ref><ref>{{cite web |title=DHS Investigation Leads to Indictments Against China-Based Companies and Employees for Fentanyl Trafficking {{!}} Homeland Security |url=https://www.dhs.gov/news/2023/10/03/dhs-investigation-leads-indictments-against-china-based-companies-and-employees |access-date=15 November 2023 |website=U.S. Department of Homeland Security|archive-date=15 November 2023 |archive-url=https://web.archive.org/web/20231115231610/https://www.dhs.gov/news/2023/10/03/dhs-investigation-leads-indictments-against-china-based-companies-and-employees |url-status=live }}</ref> The majority of illicit fentanyl and analogues now entering the U.S. from Mexico are final products in form of "tablets" and adulterated heroin from previously synthesized fentanyl. From the sophistication of full [[chemical synthesis|fentanyl synthesis]] and acute toxicity in laboratory environments, 'clandestine' labs in Mexico relate to making an illicit dosage form from available fentanyl rather than the synthesis itself. Based on further research by investigators, fentanyl and analogues are likely synthesized in labs that have the appearance of a legal entity, or are diverted from pharmaceutical laboratories.<ref>{{cite web | url = https://www.reuters.com/article/us-usa-trump-opioid-indictments-idUKKBN1CM22B | title = U.S. indicts major Chinese traffickers and three Americans for selling fentanyl online | archive-url = https://web.archive.org/web/20230405070000/https://www.reuters.com/article/us-usa-trump-opioid-indictments-idUKKBN1CM22B | archive-date=5 April 2023 | date = 17 October 2017 | work = Reuters | access-date = 4 April 2023 }}</ref><ref>{{cite web | url = https://trone.house.gov/2023/01/08/chinas-role-in-illicit-fentanyl-running-rampant-on-us-streets/ | title = China's Role in Illicit Fentanyl Running Rampant on US Streets | archive-url = https://web.archive.org/web/20230216071828/https://trone.house.gov/2023/01/08/chinas-role-in-illicit-fentanyl-running-rampant-on-us-streets/ | archive-date=16 February 2023 | work = trone.house.gov | date = 8 January 2023 | access-date = 4 April 2023 }}</ref><ref>{{cite web | url = https://www.wilsoncenter.org/article/briefing-senate-foreign-relations-committee-countering-illicit-fentanyl-trafficking-hearing | title = Briefing on the Senate Foreign Relations Committee Countering Illicit Fentanyl Trafficking Hearing | archive-url = https://web.archive.org/web/20230405062732/https://www.wilsoncenter.org/article/briefing-senate-foreign-relations-committee-countering-illicit-fentanyl-trafficking-hearing | archive-date=5 April 2023 | work = Wilson Center | access-date = 4 April 2023 }}</ref>

Recent investigations and convictions of members of the [[Sinaloa drug cartel]] by federal agencies made a clear connection between illegal arms trafficking from the U.S. to Mexico and the smuggling of fentanyl into the U.S. Mexico had repeatedly made official complaints since illegal guns are easily purchased for example in Arizona and as far north as Wisconsin and even Alaska, according to U.S. intelligence sources, and transported onto Mexican territory through a chain of American brokers and couriers often financed by those drug cartels that also engage in money laundering. Therefore, the lack of arms controls in the U.S. has directly contributed to the U.S. opioid overdose crisis.<ref>{{cite web | url = https://www.atf.gov/news/pr/convicted-felon-arrested-attempting-trade-fentanyl-four-firearms | title = Felon Arrested for Attempting To Trade Fentanyl for Four Firearms | date = 6 September 2023 | work = ATF.gov | access-date = 16 December 2023 }}</ref><ref>{{cite web | url = https://home.treasury.gov/news/press-releases/jy1523 | title = Treasury Sanctions Individuals Linked to CJNG's Arms Trafficking, Fuel Theft, and Money Laundering | work = home.treasury.gov | access-date = 16 December 2023 }}</ref><ref>{{cite web | url = https://www.cbsnews.com/news/mexican-drug-cartels-american-weapons-smuggled-across-border/ | title = Mexican drug cartels pay Americans to smuggle weapons across the border, intelligence documents show | work = CBS News | date = 18 September 2023 | access-date = 16 December 2023 }}</ref> 
 	
The [[opioid epidemic in the United States]] is largely fueled by drugs smuggled from Mexico; approximately 98% of fentanyl entering the U.S. comes from Mexico.<ref>{{Cite web | vauthors = Devlin K, Ma Y |date=4 March 2025 |title=How does fentanyl get into the US? |url=https://www.bbc.com/news/articles/cvg93nn1e6go |access-date=4 March 2025 |website=[[BBC News]] |language=en-GB}}</ref> In January 2025, President Trump said that [[2025 United States trade war with Canada and Mexico|tariffs on Mexico]] were intended to reduce the U.S. trade deficit and force the country to secure its border with the U.S. against fentanyl smuggling and [[illegal immigration into the United States|illegal immigration]].<ref>{{Cite news | vauthors = Kaye D |date=1 February 2025 |title=Here's What to Know About Trump's Tariffs |url=https://www.nytimes.com/2025/02/01/business/trump-tariffs-canada-mexico-china.html |url-status=live |archive-url=https://web.archive.org/web/20250203162720/https://www.nytimes.com/2025/02/01/business/trump-tariffs-canada-mexico-china.html |archive-date=3 February 2025 |access-date=2 February 2025 |work=[[The New York Times]] |language=en-US |issn=0362-4331}}</ref>

=== Brand names ===
Brand names include Sublimaze,<ref name="urlDrugs@FDA: FDA Approved Drug Products">{{cite web |title=Fentanyl |publisher=U.S. [[Food and Drug Administration]] (FDA) |url=http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&SearchTerm=fentanyl&SearchType=BasicSearch |url-status=live |access-date=4 September 2013 |archive-url=https://web.archive.org/web/20130313061008/http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&SearchTerm=fentanyl&SearchType=BasicSearch |archive-date=13 March 2013}}</ref> Actiq, Durogesic, Duragesic, Fentora, Matrifen, Haldid, Onsolis,<ref>{{cite web |title=Introducing Onsolis |website=Onsolis.com |url=http://www.onsolis.com |url-status=live |access-date=28 July 2010 |archive-url=https://web.archive.org/web/20100722034245/http://www.onsolis.com/ |archive-date=22 July 2010}}</ref> Instanyl,<ref>{{cite report |title=Instanyl |publisher=[[European Medicines Agency]] |url=http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/000959/WC500033142.pdf |url-status=live |access-date=28 July 2010 |archive-url=https://web.archive.org/web/20120520054824/http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/000959/WC500033142.pdf |archive-date=20 May 2012}}</ref> Abstral,<ref>{{cite web |title=Abstral |url=http://newdrugreview.com/index.php/analgesic-drugs/abstral-fentanyl |url-status=dead |access-date=7 January 2011 |archive-url=https://web.archive.org/web/20110714180154/http://newdrugreview.com/index.php/analgesic-drugs/abstral-fentanyl|archive-date=14 July 2011}}</ref> Lazanda<ref>{{cite web |title=Lazanda (fentanyl nasal spray) CII |publisher=Lazanda.com |url=http://www.lazanda.com/ |url-status=live |access-date=14 May 2012 |archive-url=https://web.archive.org/web/20120425063819/http://www.lazanda.com/ |archive-date=25 April 2012}}</ref> and others.<ref name="urlFentanyl - Drugs.com">{{cite web |title=Fentanyl |website=Drugs.com |url=https://www.drugs.com/international/fentanyl.html |url-status=live |access-date=23 January 2018 |archive-url=https://web.archive.org/web/20180616103343/https://www.drugs.com/international/fentanyl.html |archive-date=16 June 2018}}</ref>

=== Economics ===
[[File:3205 FK Mac FentanylCitrate 5ml-020322vf.jpg|thumb|Fentanyl citrate injection, USP]]

In the United States, the 800 mcg tablet was 6.75 times more expensive as of 2020 than the lozenge.<ref>{{cite web|title=Fentanyl Buccal|url=https://www.goodrx.com/fentanyl-buccal?dosage=800mcg&form=buccal-tablet&label_override=fentanyl+buccal&quantity=1|access-date=27 May 2020|archive-date=31 July 2020|archive-url=https://web.archive.org/web/20200731044214/https://www.goodrx.com/fentanyl-buccal?dosage=800mcg&form=buccal-tablet&label_override=fentanyl+buccal&quantity=1|url-status=live}}</ref><ref>{{cite web |title=Fentanyl Citrate Generic Actiq |url=https://www.goodrx.com/fentanyl-citrate?dosage=800mcg&form=lozenge&label_override=fentanyl+citrate&quantity=1 |website=GoodRx |access-date=27 May 2020 |archive-date=31 July 2020 |archive-url=https://web.archive.org/web/20200731065535/https://www.goodrx.com/fentanyl-citrate?dosage=800mcg&form=lozenge&label_override=fentanyl+citrate&quantity=1 |url-status=live }}</ref> As of 2023, the average cost for an injectable fentanyl solution (50&nbsp;mcg/mL) is around [[USD|US]]$17 for a supply of 20 milliliters, depending on the pharmacy.<ref>{{cite web |title=Fentanyl Prices, Coupons, Copay & Patient Assistance |url=https://www.drugs.com/price-guide/fentanyl |website=Drugs.com |access-date=26 January 2023 |archive-date=26 January 2023 |archive-url=https://web.archive.org/web/20230126185041/https://www.drugs.com/price-guide/fentanyl |url-status=live }}</ref> In a 2020 report by the [[Australian Institute of Criminology]], a 100-microgram transdermal patch was valued from between [[AUD|AU]]$75 and AU$450 on illicit markets.<ref>{{cite web |vauthors=Broadhurst R, Ball M, Trivedi H |title=Fentanyl availability on darknet markets |url=https://www.aic.gov.au/sites/default/files/2020-05/ti590_fentanyl_availability_on_darknet_markets.pdf |access-date=26 January 2023 |page=1 |date=February 2020 |archive-date=26 January 2023 |archive-url=https://web.archive.org/web/20230126185041/https://www.aic.gov.au/sites/default/files/2020-05/ti590_fentanyl_availability_on_darknet_markets.pdf |url-status=live }}</ref> Furthermore, in another 2020 study, the average price per gram of non-pharmaceutical fentanyl on various [[cryptomarket]]s was US$1,470.40 for offerings of less than five grams; the average for offers over five grams was US$139.50. In addition, on [[Dream Market|DreamMarket]] furanfentanyl (Fu-F), the most common analog on said market, the average price per gram was US$243.10 for retail listings and US$26.50 per gram for wholesale listings.<ref>{{cite journal | vauthors = Lamy FR, Daniulaityte R, Barratt MJ, Lokala U, Sheth A, Carlson RG | title = Listed for sale: Analyzing data on fentanyl, fentanyl analogs and other novel synthetic opioids on one cryptomarket | journal = Drug and Alcohol Dependence | volume = 213 | page = 108115 | date = June 2020 | pmid = 32585419 | pmc = 7736148 | doi = 10.1016/j.drugalcdep.2020.108115 }}</ref>

=== Storage and disposal ===
The fentanyl patch is one of a few medications that may be especially harmful, and in some cases fatal, with just one dose, if misused by a child.<ref>{{cite journal |author=Office of the Commissioner |date=26 January 2022 |title=Accidental Exposures to Fentanyl Patches Continue to Be Deadly to Children |url=https://www.fda.gov/consumers/consumer-updates/accidental-exposures-fentanyl-patches-continue-be-deadly-children |journal=FDA |access-date=12 April 2022 |archive-date=12 April 2022 |archive-url=https://web.archive.org/web/20220412190113/https://www.fda.gov/consumers/consumer-updates/accidental-exposures-fentanyl-patches-continue-be-deadly-children |url-status=live }}</ref><ref name="fda-disp">{{cite web|url=https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know|title=Disposal of Unused Medicines: What You Should Know|date=1 February 2019|publisher=U.S. [[Food and Drug Administration]] (FDA)|access-date=2 September 2019|archive-date=2 September 2019|archive-url=https://web.archive.org/web/20190902064935/https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know|url-status=live}}</ref> Experts have advised that any unused fentanyl patches be kept in a secure location out of children's sight and reach, such as a locked cabinet.

In [[British Columbia]], [[Canada]], where there are environmental concerns about toilet flushing or garbage disposal, [[pharmacists]] recommend that unused patches be sealed in a [[child-proof]] container that is then returned to a [[pharmacy]].<ref name="bcpharm">{{cite web|url=https://www.bcpharmacists.org/fentanyl-patches|title=Safe Disposal of Fentanyl Patches|date=2019|publisher=College of Pharmacists of British Columbia|access-date=2 September 2019|archive-date=2 September 2019|archive-url=https://web.archive.org/web/20190902144426/https://www.bcpharmacists.org/fentanyl-patches|url-status=live}}</ref> In the United States where patches cannot always be returned through a medication take-back program, [[Flush toilet|flushing]] is recommended for fentanyl patches, because it is the fastest and surest way to remove them from the home to prevent ingestion by children, pets or others not intended to use them.<ref name="fda-disp" /><ref name="fda-flush">{{cite web|url=https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-flush-potentially-dangerous-medicine#FlushList|title=Drug Disposal: Flush Potentially Dangerous Medicine (Flush list)|date=19 December 2018|publisher=U.S. [[Food and Drug Administration]] (FDA)|access-date=2 September 2019|archive-date=4 September 2019|archive-url=https://web.archive.org/web/20190904234712/https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-flush-potentially-dangerous-medicine#FlushList|url-status=live}}</ref>

=== Governmental usage ===
In August 2018, Nebraska became the first American state to use fentanyl to [[capital punishment|execute]] a prisoner.<ref name="BBC News_2018">{{cite news |title=Nebraska first to use fentanyl in execution |date=14 August 2018 |website=[[BBC News]] |url=https://www.bbc.com/news/world-us-canada-45185687 |access-date=15 August 2018 |archive-date=15 August 2018 |archive-url=https://web.archive.org/web/20180815025008/https://www.bbc.com/news/world-us-canada-45185687 |url-status=live }}</ref><ref>{{cite news |title=Nebraska becomes first state to use fentanyl in execution |date=14 August 2018 |website=[[NBC News]] |url=https://www.nbcnews.com/storyline/lethal-injection/nebraska-set-become-first-state-use-fentanyl-execution-n900576 |access-date=15 August 2018 |archive-date=14 August 2018 |archive-url=https://web.archive.org/web/20180814234427/https://www.nbcnews.com/storyline/lethal-injection/nebraska-set-become-first-state-use-fentanyl-execution-n900576 |url-status=live }}</ref><ref name="National Public Radio">{{cite news |title=Nebraska carries out 1st execution using Fentanyl in U.S. |website=[[National Public Radio]] |url=https://www.npr.org/2018/08/14/638250649/nebraska-prepares-to-carry-out-first-execution-using-fentanyl |access-date=15 August 2018 |archive-date=14 August 2018 |archive-url=https://web.archive.org/web/20180814235530/https://www.npr.org/2018/08/14/638250649/nebraska-prepares-to-carry-out-first-execution-using-fentanyl |url-status=live }}</ref> [[Execution of Carey Dean Moore|Carey Dean Moore]], at the time one of the longest-serving [[Capital punishment in the United States|death row]] [[Prisoner|inmates]] in the United States,<ref>{{cite news |title=Nebraska will make history in its execution of a death row inmate |date=14 August 2018 |magazine=[[Newsweek]] |url=https://www.newsweek.com/carey-dean-moore-nebraska-fentanyl-lethal-injection-death-row-execution-1071741 |access-date=15 August 2018 |archive-date=14 August 2018 |archive-url=https://web.archive.org/web/20180814232910/https://www.newsweek.com/carey-dean-moore-nebraska-fentanyl-lethal-injection-death-row-execution-1071741 |url-status=live }}</ref> was executed at the [[Nebraska State Penitentiary]]. Moore received a [[lethal injection]], administered as an [[Drug injection|intravenous]] series of four drugs that included fentanyl citrate, to inhibit breathing and render the subject unconscious. The other drugs included [[diazepam]] as a tranquilizer, [[Cisatracurium besilate|cisatracurium besylate]] as a muscle relaxant, and [[Potassium chloride (medical use)|potassium chloride]] to stop the heart.<ref name="The New York Times_2018">{{cite news |title=Fentanyl used to execute Nebraska inmate, in a first for U.S. |date=14 August 2018 |newspaper=[[The New York Times]] |url=https://www.nytimes.com/2018/08/14/us/carey-dean-moore-nebraska-execution-fentanyl.html |url-access=subscription |url-status=live |access-date=15 August 2018 |archive-url=https://web.archive.org/web/20180814182425/https://www.nytimes.com/2018/08/14/us/carey-dean-moore-nebraska-execution-fentanyl.html |archive-date=14 August 2018}}</ref><ref name="Nebraska executes inmate using powerful opioid fentanyl_2018">{{cite news |title=Nebraska executes inmate using powerful opioid fentanyl |date=14 August 2018 |department=PBS NewsHour |publisher=[[Public Broadcasting System]] |url=https://www.pbs.org/newshour/nation/nebraska-executes-inmate-using-powerful-opioid-fentanyl |access-date=15 August 2018 |archive-date=15 August 2018 |archive-url=https://web.archive.org/web/20180815013302/https://www.pbs.org/newshour/nation/nebraska-executes-inmate-using-powerful-opioid-fentanyl |url-status=live }}</ref> The use of fentanyl in execution caused concern among death penalty experts because it was part of a previously untested [[Lethal injection#Drugs|drug cocktail]].<ref name="BBC News_2018"/><ref name="National Public Radio"/> The execution was also protested by [[Anti-Death Penalty Movement in the United States|anti-death penalty]] advocates at the prison during the execution and later at the [[Nebraska State Capitol]].<ref name="The New York Times_2018"/><ref name="Nebraska executes inmate using powerful opioid fentanyl_2018"/>

Russian [[Spetsnaz]] security forces are [[Moscow hostage crisis chemical agent|suspected to have used]] a fentanyl analogue, or derivative (suspected to be carfentanil and remifentanil),<ref>{{cite journal | vauthors = Riches JR, Read RW, Black RM, Cooper NJ, Timperley CM | title = Analysis of clothing and urine from Moscow theatre siege casualties reveals carfentanil and remifentanil use | journal = Journal of Analytical Toxicology | volume = 36 | issue = 9 | pages = 647–656 | date = 2012 | pmid = 23002178 | doi = 10.1093/jat/bks078 | doi-access = free | title-link = doi }}</ref> to rapidly incapacitate people in the [[Moscow theater hostage crisis]] in 2002. The siege was ended, but many hostages died from the gas after their health was severely taxed during the days long siege.<ref>{{cite news |date=27 October 2002 |title=Gas 'killed Moscow hostages' |url=http://news.bbc.co.uk/2/hi/europe/2365383.stm |access-date=7 April 2023 |archive-date=31 July 2017 |archive-url=https://web.archive.org/web/20170731010211/http://news.bbc.co.uk/2/hi/europe/2365383.stm |url-status=live }}</ref><ref name="gas">{{cite news |url=https://pqasb.pqarchiver.com/washingtonpost/access/224294031.html?dids=224294031:224294031&FMT=ABS&FMTS=ABS:FT&fmac=&date=Oct+28%2C+2002&author=Susan+B.+Glasser+and+Peter+Baker&desc=Gas+in+Raid+Killed+115+Hostages |title=115 Hostages in Moscow Killed by Gas |newspaper=The Washington Post |date=27 October 2002 |archive-url=https://web.archive.org/web/20070313010058/https://pqasb.pqarchiver.com/washingtonpost/access/224294031.html?dids=224294031:224294031&FMT=ABS&FMTS=ABS:FT&fmac=&date=Oct+28%2C+2002&author=Susan+B.+Glasser+and+Peter+Baker&desc=Gas+in+Raid+Killed+115+Hostages |archive-date=13 March 2007 }}</ref> The Russian Health Minister later stated that the gas was based on fentanyl,<ref>{{cite news |title=Russia names Moscow siege gas |date=31 October 2002 |publisher=[[BBC News]] |url=http://news.bbc.co.uk/2/hi/europe/2377563.stm |access-date=18 May 2018 |url-status=live |archive-url=https://web.archive.org/web/20180619064228/http://news.bbc.co.uk/2/hi/europe/2377563.stm |archive-date=19 June 2018 }}</ref> but the exact chemical agent has not been clearly identified.<ref>{{cite web | url=https://www.history.com/news/opioid-chemical-weapons-moscow-theater-hostage-crisis | title=How Opioids Were Used as Weapons During the Moscow Theater Hostage Crisis | date=5 October 2023 | access-date=15 November 2023 | archive-date=15 November 2023 | archive-url=https://web.archive.org/web/20231115230951/https://www.history.com/news/opioid-chemical-weapons-moscow-theater-hostage-crisis | url-status=live }}</ref>

=== Recalls ===
In February{{nbsp}}2004, a leading fentanyl supplier, Janssen Pharmaceutica Products recalled one lot, and later, additional lots of fentanyl (brand name: Duragesic) patches because of seal breaches that might have allowed the medication to leak from the patch. A series of class{{nbsp}}II recalls was initiated in March{{nbsp}}2004, and in February{{nbsp}}2008, the [[ALZA Corporation]] recalled their 25{{nbsp}}μg/h Duragesic patches due to a concern that small cuts in the gel reservoir could result in accidental exposure of patients or health care providers to the fentanyl gel.<ref name="recall">{{cite web |title=Pricara recalls 25{{nbsp}}mcg/hr Duragesic (Fentanyl transdermal system) c{{nbsp}}II pain patches |date=12 February 2008 |publisher=U.S. [[Food and Drug Administration]] (FDA) |url=https://www.fda.gov/oc/po/firmrecalls/pricara02_08.html |url-status=live |access-date=10 May 2008 |archive-url=https://web.archive.org/web/20080513124253/https://www.fda.gov/oc/po/firmrecalls/pricara02_08.html |archive-date=13 May 2008}}</ref> In April 2023, [[Teva Pharmaceuticals]] USA recalled 13 lots of their Fentanyl Buccal Tablets CII due to missing safety information sheets on how to properly administer their product. The corporation issued a consumer recall report<ref>{{cite web | title = Teva Issues Voluntary Nationwide Recall of Specific Lots of FENTANYL Buccal Tablets CII to the Consumer Level | work = Teva Pharmaceuticals USA, Inc. | date = 27 April 2023 | url = https://www.tevausa.com/globalassets/us-files---global/fentanyl-citrate-recall-04-2023-_consumer-letter-27-apr-2023.pdf }}</ref> and stressed the importance of safety in the use and administration of opioid therapeutics.<ref>{{cite web |work=Office of Regulatory Affairs |date=28 April 2023 |title=Teva Initiates Voluntary Nationwide Recall of Specific Lots of FENTANYL Buccal Tablets CII Due to a Labeling Error |url=https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/teva-initiates-voluntary-nationwide-recall-specific-lots-fentanyl-buccal-tablets-cii-due-labeling |access-date=15 November 2023 |publisher=U.S. Food and Drug Administration |archive-date=15 November 2023 |archive-url=https://web.archive.org/web/20231115231609/https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/teva-initiates-voluntary-nationwide-recall-specific-lots-fentanyl-buccal-tablets-cii-due-labeling |url-status=live }}</ref>