Are there Fentanyl Analogs Resistant to Naloxone (Narcan)?
The Fake News About Naloxone
A number of news outlets, including this article in Newsweek, have been reporting on incidents of fentanyl analogs being resistant to Naloxone. Naloxone is used to treat a narcotic overdose in an emergency situation and blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness.
The news reports surfaced on June 28th when the Times Free Press wrote an article about a news release put out by the Georgia Bureau of Investigations (GBI). The Times wrote
The Georgia Bureau of Investigation's Crime Lab in Cleveland, Ga., has identified two new fentanyl analogues, acrylfentanyl and tetrahydrofuran fentanyl. Both those synthetic opioids had not previously been identified by the GBI Crime Lab. They both can be absorbed through the skin and are considered highly dangerous according to a Tuesday news release.
The Forsyth County Sheriff's Office submitted forensic drug evidence containing the two drugs to the crime lab in March. Acrylfentanyl had been on the GBI's watchlist for the past few months. Multiple reports in other states indicated that the opioid reversal drug, naloxone, may not be effective if someone overdosed after ingesting acrylfentanyl.
A new law went into effect in April outlawing acrylfentanyl in Georgia. Currently, tetrahydrofuran fentanyl is not covered under state law. It is unknown how the human body will react to both drugs, since they are not intended for human or veterinary use.
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The Facts About Naloxone and Fentanyl
These fentanyl analogs are not resistant to naloxone. Acrylfentanyl binds to the same receptors within the human body as fentanyl, meaning correctly administered Naloxone is effective against it. An Intelligence bulletin put out by US Customs and Border Protection put it best:
Naloxone belongs to a category of drugs known as opioid antagonists. Opioid antagonists reverse opioids’ effects by binding to the same opioid receptors in the human body as opioids. If administered quickly and at a sufficient dose, Naloxone and other opioid antagonists are effective against all opioids—including fentanyl and its analogues—regardless of their potency.
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The ONDCP added to this bulletin by stating
Acrylfentanyl is not more powerful than other fentanyls used in the illicit market. Acrylfentanyl has a morphine equivalency of about 50-100, meaning that acrylfentanyl is 50- 100 times more powerful than morphine. However, this is the same morphine equivalency as fentanyl itself and lower than that of other well-known fentanyl analogues.
Naloxone belongs to a category of drugs known as opioid antagonists, meaning they bind to the same opioid receptors as synthetic opioids but do not activate the receptors or cause any psychoactive effects. By taking the place of the opioid on the opioid receptor, antagonists reverse an opioid’s effect. If administered quickly and at a sufficient dose, naloxone and other opioid antagonists are effective against all opioids regardless of their potency.
There have been well-documented cases in which a patient who has overdosed on a synthetic opioid required several administrations of naloxone to reverse the effects of the overdose. However, this is often a function of the dose of naloxone administered as well as time elapsed since the patient took the drug.
When administered within the right amount of time, for example before brain death, heart failure, or other complication sets in, and at the right dosage level, naloxone will effectively reverse the effects of an overdose and prevent death for any opioid, acrylfentanyl included.
So now we know. Fentanyl is not resistant to naloxone. We have the facts, educate the media in your area and let them know the facts so that we can stop the false reports. If you want more information on fentanyl safety for first responders, check out my online fentanyl safety course. There are group rates for agencies that want to send multiple officers through the training. You will receive a certificate of training after completing the course.
