Deaths from fentanyl are increasing despite availability of naloxone.

The numbers are astounding. Recent data from the CDC shows over 100,000 drug overdose deaths in 2022. Almost three quarters of those deaths, over 75,000 people — died of fentanyl and fentanyl analogue overdose.

Why?

Fentanyl causes a clinical phenomenon called Wooden Chest Syndrome (WCS), which is the combination of chest wall muscle rigidity and vocal cord closure. This process is distinct from respiratory depression seen with other opioids and uses a different set of receptors in the brain. Once these processes have begun and fentanyl binds these other non-opioid receptors, naloxone rarely works.

Fentanyl overdose requires two to fives times higher dose of naloxone than traditional opioid overdose. This can lead to life-threatening side-effects including cardiac arrhythmias, hemodynamic instability and pulmonary edema.

For a deeper scientific explanation of fentanyl mechanism and naloxone resistance to fentanyl, visit Publications.