Editing Fentanyl (section)

=== 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>