ReviewJournal of addiction medicine
Fentanyl Absorption, Distribution, Metabolism, and Excretion: Narrative Review and Clinical Significance Related to Illicitly Manufactured Fentanyl.
Review in Journal of addiction medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
57 citing papers in PubMed, 1 synthesis or guideline pooled it, 91 citations in OpenAlex.
- Evidence-based consensus guidelines for the pharmacological management of substance dependence: Recommendations from the British Association for Psychopharmacology.Journal of psychopharmacology (Oxford, England) · 2026Guideline
- Effects of TPA023B, an α2/3/5GABAPsychopharmacology · 2026Article
- New trends in the overdose epidemic: postural impact on abusers of fentanyl and xylazine and clinical and forensic implications.Forensic science, medicine, and pathology · 2026Review
- Clinical Use of Endotracheal Intubation Without Neuromuscular Blockade: The Current Stage of Knowledge.Medical science monitor : international medical journal of experimental and clinical research · 2026Review
- Acute and persistent sex-dependent disruptions of sleep-wake architecture induced by fentanyl self-administration in mice.Neuropharmacology · 2026Article
- Beyond respiratory depression: acute and delayed pulmonary responses following aerosolized fentanyl exposure.Toxicological sciences : an official journal of the Society of Toxicology · 2026Article
- Reframing Buprenorphine as a Pharmacologic Modifier of Opioid-Induced Respiratory Depression in the Fentanyl Era.Pharmaceuticals (Basel, Switzerland) · 2026Article
- "It's like scratching at the door": Experiences of outpatient buprenorphine low dose initiation among people using fentanyl.Journal of substance use and addiction treatment · 2026Article
- Implementation of low-dose buprenorphine induction at a syringe services program.Addiction science & clinical practice · 2026Article
- "You're Hoping for the Best, but Preparing for the Worst": Discussions of Starting Buprenorphine in the Context of Fentanyl Use with Clinicians and People Who Use Fentanyl.Journal of general internal medicine · 2026Article
- Preclinical abuse potential testing using behavioral economics and drug self-administration demand-curve analysis: A strategy to improve resolution of drug stratification for regulatory control.Pharmacological reviews · 2026Review
- Postmortem Redistribution of Drugs Commonly Used in Rapid Sequence Induction for Anesthesia: A Review.Journal of clinical medicine · 2026Review
- Self-Reported History of Precipitated Withdrawal: A Cross-Sectional Study of People Who Use Unregulated Opioids.Journal of addiction medicine · 2026Article
- Acute fentanyl and xylazine co-exposure uniquely increase the excitability of dopamine type 2 receptor-expressing striatal medium spiny neurons.Journal of neurophysiology · 2026Article
- Barriers to Buprenorphine Initiation in Patients Using Fentanyl.JAMA network open · 2026Article
- Fentanyl-induced cortical and cardiopulmonary damage linked to immune response functions and apoptosis-necrosis networks in a multi-omics mouse model.Frontiers in immunology · 2026Article
- Outpatient initiation of direct-to-inject buprenorphine.Drug and alcohol dependence · 2026Article
- Optimal buprenorphine exposure to treat patients with opioid use disorder in the era of fentanyl and polysubstance use.Frontiers in pharmacology · 2026Article
- Fentanyl blockade of KThe Journal of physiology · 2026Article
- Effects of Fentanyl-Adulterated Methamphetamine on Circulating Ghrelin in Rats.International journal of molecular sciences · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
objectivesThis narrative review summarizes literature on pharmaceutical fentanyl's absorption, distribution, metabolism, and excretion patterns to inform research on illicitly manufactured fentanyl (IMF).
resultsFentanyl is highly lipophilic, lending itself to rapid absorption by highly perfused tissues (including the brain) before redistributing from these tissues to muscle and fat. Fentanyl is eliminated primarily by metabolism and urinary excretion of metabolites (norfentanyl and other minor metabolites). Fentanyl has a long terminal elimination, with a documented secondary peaking phenomenon that can manifest as "fentanyl rebound." Clinical implications in overdose (respiratory depression, muscle rigidity, and "wooden chest syndrome") and opioid use disorder treatment (subjective effects, withdrawal, and buprenorphine-precipitated withdrawal) are discussed. The authors highlight research gaps derived from differences in medicinal fentanyl studies and IMF use patterns, including that medicinal fentanyl studies are largely conducted with persons who were opioid-naive, anesthetized, or had severe chronic pain and that IMF use is characterized by supratherapeutic doses and frequent and sustained administration patterns, as well as adulteration with other substances and/or fentanyl analogs.
conclusionsThis review reexamines information yielded from decades of medicinal fentanyl research and applies elements of the pharmacokinetic profile to persons with IMF exposure. In persons who use drugs, peripheral accumulation of fentanyl may be leading to prolonged exposure. More focused research on the pharmacology of fentanyl in persons using IMF is warranted.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.