Firstly I will be frank and honest and say that I do not condone the use of fentanyl as a recreational drug. It has found its way into fake opiate pills and this is a real worry. I have nothing against those who choose to use it or those willing to try it, my only concern is the hidden dangers behind this very potent drug.
I will re-invent the wheel by stating what I hope all opiate users know but people interested in trying them might not. A single therapeutic/analgesic dose of any opiate or opioid can can cause immediate fatal respiratory depression in people who are overly sensitive to opiates.
With fentanyl even the most tolerant of opiates users are equally at risk of this happening if they take an increased dose. The relationship between OD risk and fent dose is not linear. There is a sudden jump somewhere in the dosing for each individual. Most will never find out what that dose is until they take that knowledge with them to the grave or get urgent treatment with narcan.
If you are thinking about trying fentanyl for the first time then please ensure the following
1.Find out if you are opiate sensitive by comparing the side-effects that you encounter with other users of similar gender and body composition (i.e. muscle mass, not fat) who have taken the same dose. If you are prone to more side-effects at lower doses fentanyl is not for you
2.If you have come off opiates for a while and are getting back into things do not start with fentanyl. Make sure that you have been taking at least a minimal of 30 - 60 mg oxy per day for 1 week or equivalent
3.Know your fentanyl agonists. Although often used to heighten the effects for veterans to a newbie using agonists is not wise. Things that can enhance fent are some antibiotics, antifungals, heart rate controlling medication and grapefruit juice. Just one glass is all it takes to initiate the interaction
4.Around 3% of people taking fent will drop their heat rate below 50 beats per minute and this could lead to low blood pressure and fainting. At this stage which can be very early on it would be entirely reasonable to reverse with narcan and abort. This is a sign of serious fent sensitivity
5.Life threatening respiratory depression can occur with relatively small doses of fent if other respiratory depressants are used of which the most common are benzos and alcohol. This applies to both to those who have taken fent before and even more so in those who haven't
6.ALWAYS HAVE SEVERAL DOSES OF NARCAN AND A BUDDY WHO CAN RECOGNIZE SIGNS OF OD IF YOU TAKE FENT. The need for buddy is explained next and it is important that they aren't high as a kite as well!
7.A fent OD is a medical nightmare. The rapid mechanism of action and onset means that ODs are sudden and instant. Respiratory depression or arrest allows the build up of CO2 in the blood which in turn enhances the effect of the fentanyl. Some ODs therefore maybe to far gone for treatment with narcan alone and require oxygen supplementation i.e. call a paramedic
8.The half life of fent is almost double to triple the half life of narcan which only works fully for around 30 - 45 minutes. A repeat OD is highly likely so your buddy needs to keep an eye on you for a minimum of 3 hours
9.Very rarely treatment with narcan can cause other detrimental effects to body parts like the heart, so complaints of chest pain or tightness requires escalation to ER medical treatment
10.Do not take fent if you have a bad chest or symptomatic chronic lung problems such as asthma
11.One man/womans nodding can be anothers OD. Do not take chances. Early signs include less than 10 respirations per minute, sighing type breathing where breaths are separated by long pauses. Counting respiratory rate is fairly easy unless your buddy has taken an acid trip and lost all sense of time. Once 10 resps/minute or less has been reached CO2 retention begins and the cascade of enhancing the fent begins. Best to reverse and abort at this stage
TL;DR Fentanyl is a dangerous drug but if you really have to play pharmaceutical Russian roulette the above might help dodge a bullet.
I recommend opiate users stay very far away from fent. It might seems like a cheap alternative, but to the inexperienced it can be DEADLY!! You may think you have the correct amount measured out, or that one more knife tip will certainly get you to that next level, but in reality your about to O.D. You might not know it, or you don't care to know it, because your all high and fucked, but you gonna die, just like all the kids you hear about on the news. Next thing you know your crawling on the bathroom floor trying to catch a breath, trying not to go to sleep, panicking, wondering if you should try and get help, but you feel to good. Maybe someone will find you and phone an ambulance-- but probably not because you locked yourself in thinking you can sleep it off. Sorry mate but its all over and your just another statistic.