Actually, that’s a comparison photo of carfentanil, not fentanyl. Carfentanil is 100x stronger than fentanyl, which makes it 2x as strong as Libloather’s N-Desethyl Isotonitazene.
Carfentanil is one of the drugs used to tranq large animals, like elephants, with a relatively tiny dart fired fron am airgun.
https://en.wikipedia.org/wiki/Carfentanil
In legitimate medical use, fentanyl and its derivatives are administered in MICROgram doses.
It acts very quickly, and wears off very quickly, allowing an anesthesiologist, combat medic, or other professional to precisely manage the patient’s condition. The very small doses put less stress on kidneys than less “powerful” opiods or opiates.