Mapping the evolution of fentanyl research: a scientometric analysis of clinical applications and abuse trends (1964–2025)

Background: Fentanyl, a potent synthetic μ-opioid agonist, has been widely used in anesthesia and analgesia since 1964; however, its misuse has escalated into a global public health crisis. Purpose: To map the evolving landscape, identify key contributors and research hotspots, and highlight emerging trends in fentanyl-related research. Methods: We collected fentanyl-related publications from three major medical databases covering the period from 1964 to 1 June 2025. Tools such as CiteSpace, VOSviewer, and Bibliometrix were used to analyze publication trends and research focus. Results: The analysis identified over 110 000 publications, with the United States and China being the top contributors. The leading institutions included the Harvard University and University of California system, while Anesthesia and Analgesia and Anesthesiology were the most influential journals. Research has evolved from clinical applications (propofol, postoperative pain) to addiction themes (opioid use disorder, xylazine), with abuse-related publications increasing by 23.1% annually post-2016. The keyword analysis revealed three clusters: anesthesia (general anesthesia), analgesia, and abuse (drug overdose). Recent studies have focused on the neurobiological mechanisms, structural modifications, and preventive strategies of fentanyl, emphasizing harm reduction (syringe services) and novel treatments (monoclonal antibodies). Conclusion: This study underscores the shift in fentanyl research from clinical efficacy to public health challenges, particularly addiction. Future research should prioritize: (1) developing safer opioid analogs with reduced abuse potential, (2) elucidating the molecular mechanisms of dependence, and (3) integrating multidisciplinary approaches such as immunotherapy and neuromodulation to address the opioid crisis. These findings provide a roadmap for policymakers and researchers to mitigate the societal effects of fentanyl.