Fentanyl is linked to thousands of death a year, so why do doctors still prescribe it?

By now, you’ve probably at least heard of fentanyl, even if you’re not entirely sure what it is. The drug is linked to tens of thousands of deaths every year, including the recent high-profile deaths of the musicians Prince and Tom Petty. And while it has the potential to be abused, it can actually be obtained by a prescription.

Fentanyl is a narcotic and synthetic opioid that’s used to treat severe pain. It’s similar to morphine but is 50 to 100 times more potent, according to the National Institute on Drug Abuse. Fentanyl is prescribed under the brand names Actiq, Duragesic, and Sublimaze but can also show up on the street under names like China Girl and Apache.

Fentanyl is classified by the Food and Drug Administration as a Schedule II drug, which means it has a high potential for abuse and can lead to severe psychological or physical dependence. (Methadone and oxycodone are also Schedule II drugs.) In 2015, the Drug Enforcement Agency issued a nationwide alert about fentanyl, warning that overdoses related to the drug are happening at an “alarming rate” around the country.

But again, people can obtain a prescription for it. Fentanyl is usually available in several different forms by prescription: a patch, a lollipop, a dissolvable pill you put under your tongue, and a nasal spray, Andrew Kolodny, MD, director of Physicians for Responsible Opioid Prescribing, tells Yahoo Lifestyle. Petty’s family said in a statement on his website that the rocker was using prescription fentanyl patches to treat pain from a fractured hip when he died. According to the Mayo Clinic, these patches are often used for “severe chronic pain when around-the-clock pain relief is needed for a long period of time.” With the patch, fentanyl is administered more slowly to someone than a pill or nasal spray to minimize the overdose risk — but it doesn’t totally eliminate it, James J. Galligan, PhD, a professor of pharmacology and toxicology and director of the neuroscience program at Michigan State University, tells Yahoo Lifestyle.

Fentanyl isn’t typically a first line of defense for pain — it’s usually used to treat pain only after the patient used other opiate drugs like oxycodone and no longer has pain relief from it after building up a tolerance, Galligan says. “Fentanyl is one of the most potent narcotic medications available,” Chris Wolf, DO, a sports medicine and regenerative orthopedic specialist at Bluetail Medical Group in Chesterfield, Mo., tells Yahoo Lifestyle. “It’s typically utilized for patients who have some form of pain that we can’t treat any other way.”

Unfortunately, some doctors have become liberal with their fentanyl prescriptions, Kolodny says. Fentanyl was originally designed to be used in the operating room by anesthesiologists, taken for a few days after major surgery or a serious accident, or for end of life pain relief, he says. But some doctors are prescribing it for anyone with long-term pain, which Kolodny says is dangerous.

“If this is taken around the clock long-term, it’s more likely to hurt the patient rather than help,” Kolodny says. Fentanyl isn’t designed for long-term use in patients who aren’t terminally ill, and people need to keep taking a higher dose to get pain relief, he says.

If you’re prescribed fentanyl and you actually need it, you shouldn’t panic. Fentanyl is a “good medication for easing suffering at the end of life and when taken for a couple of days after major surgery or a serious accident,” Kolodny says. But if you’re suffering from chronic pain and you’re not terminal or post-op, you should question it, Wolf says.

It’s important to know that if you’re taking fentanyl and you need to or are ready to come off of it, you’ll need to taper off, Will Chan, MD, an assistant professor of anesthesiology at the University of Cincinnati College of Medicine, tells Yahoo Lifestyle. “If you don’t, you’ll start having withdrawal symptoms,” he says. Your doctor should have a plan for helping you to taper off of it, but if not, ask. Just don’t abruptly take yourself off of the medication or you could get so sick you’ll end up in the ER, Kolodny says.

“If used according to the doctor’s prescription and guidance, the dangers of using fentanyl are lower,” Galligan says. “However, because fentanyl is so potent, the patient must strictly follow the doctor’s orders and instructions.”