Author: Anjali Talcherkar, PhD

Fentanyl is a powerful synthetic opioid painkiller, similar to morphine but much more potent—50 to 100 times more potent.¹ It’s normally used to treat patients with severe pain or to deal with pain after surgery.

According to the Drug Enforcement Administration (DEA), fentanyl is a Schedule 2 prescription drug that has a high potential for misuse.² If you use them continually, you may experience physical dependence or addiction. Fentanyl is considered dangerous if used inappropriately and is deadlier than heroin.

Educating yourself on the dangers of fentanyl use, the potential for misuse/addiction, associated health risks, and treatment options may prevent you or a loved one from experiencing the harm associated with this drug.

What Is Fentanyl?

Like morphine, prescription fentanyl is typically used to treat patients with severe pain, especially after surgery. It is also sometimes used to treat patients with chronic pain who can’t tolerate other opioid drugs like hydrocodone or oxycontin.^1,2

Fentanyl is prescribed in the following forms:³

• Injection
• Skin patch (fentanyl patch)
• Throat lozenges (similar to cough drops)

Fentanyl is one of the most powerful forms of opioid painkillers. You need a prescription for fentanyl—however, it has also been manufactured and sold illegally on the streets. Illegal forms are unregulated and are manufactured without the important quality measures of pharmaceutical-grade fentanyl.³

Illegal fentanyl is a major contributor to recent increases in synthetic opioid overdose deaths. According to L.A. County Public Health, “Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59% of opioid-related deaths involved fentanyl, compared to 14.3% in 2010.”³

Illegally-manufactured fentanyl is sold in powder form, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into phony pills that copy other prescription opioid pills.³ It’s not always easy to know what you’re getting. Fentanyl can deceptively be mixed into other drugs, like heroin, cocaine, methamphetamine, and MDMA (ecstasy).

Historically, deaths involving illicit fentanyl have mostly occurred in the 28 states east of the Mississippi River, where the heroin market has primarily been dominated by white powder heroin.⁴

The potent combination of fentanyl mixed with heroin or other illegal drugs is dangerous. You may not even realize that the drugs you are taking contain fentanyl, which increases the chances of overdose or death.³

Potential for Misuse

Schedule II drugs, such as fentanyl, are listed as drugs with a high potential for misuse, potentially leading to severe psychological or physical dependence.² Like other strong opioid painkillers, the chemical compounds in fentanyl attach to opioid receptors in your brain, causing heightened feelings of elation and euphoria.

Over time and with continued use, your brain gets used to the fentanyl, making it hard to normalize or feel pleasure without the drug.⁵

Fentanyl side effects include:⁵

• Elation or happiness
• Drowsiness
• Nausea
• Confusion
• Constipation
• Sedation
• Breathing problems
• Coma

Because fentanyl causes induced feelings of happiness, the misuse cycle can start early. If it continues, you may experience full-blown addiction to the opiate drug, making it extremely difficult to get a handle on it. Continued use of fentanyl can lead to:^1,3,5

• Tolerance: The need to take more of the drug to achieve the same opioid effect.
• Drug dependence: Susceptibility to withdrawal if you stop using the drug.
• Addiction: Prolonged, habitual use of fentanyl leading to brain changes and adverse life consequences.

Fentanyl Overdose and Death

Fentanyl overdose occurs when the drug causes severe side effects and life-threatening symptoms. If you overdose on fentanyl, you can stop breathing. This is called hypoxia, and happens if there isn’t enough oxygen getting to your brain. Hypoxia can lead to a coma and permanent brain damage, even death.

The Centers for Disease Control and Prevention (CDC) reported, “Rates of fentanyl overdose and deaths including fentanyl and fentanyl analogs, increased over 16% from 2018 to 2019.” Since the COVID-19 pandemic, synthetic opioid overdose, including fentanyl overdose, has increased.⁴ A 98% increase in opioid deaths in western states in the last 12 months is primarily due to the large increase in illegally-produced fentanyl and availability in that area.⁴

Fentanyl misuse and overdose can be serious. Call 911 immediately if you see someone exhibiting these signs:⁶

• Their face is flushed and/or feels clammy.
• Their fingernails or lips have a purple or blue color.
• They start vomiting, gasping, or making gurgling noises.
• They are unresponsive or unable to speak.
• Their breathing or heartbeat slows or stops.

Signs and Symptoms of Fentanyl Addiction

Fentanyl misuse can lead to dependence and, in extreme cases, fentanyl addiction. If you are addicted to drugs, you continue to use them even though they cause health problems or issues at work, school, or home. Addiction is the most severe form of a substance use disorder (SUD) and can range from mild to severe.⁵

Addiction to fentanyl would be considered an opioid use disorder (OUD). The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) specifically recognizes fentanyl addiction as an OUD. If you fall into the category of fentanyl addiction, you would be clinically considered to have an opioid use disorder (at the severe end of the continuum).

The DSM-5 describes opioid use disorder as “a problematic pattern of opioid use leading to problems or distress,” with at least two of the following occurring within a 12-month period:⁷

• Taking larger amounts or taking drugs over a longer period than intended
• Persistent desire or unsuccessful efforts to cut down or control opioid use
• Spending a great deal of time obtaining or using the opioid or recovering from its effects
• Craving, or a strong desire or urge to use opioids
• Problems fulfilling obligations at work, school, or home
• Continued opioid use despite having recurring social or interpersonal problems
• Giving up or reducing activities because of opioid use
• Using opioids in physically hazardous situations
• Continued opioid use despite ongoing physical or psychological problems likely to have been caused or worsened by opioids
• Tolerance (i.e., need for increased amounts or diminished effect with continued use of the same amount)
• Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms

Fentanyl is addictive because of its strength. It’s one of the more potent forms of opioids. Even if you are taking prescription fentanyl as instructed by a doctor, you can still become dependent on it. One sign of dependency is experiencing withdrawal symptoms when you stop using the drug.

Fentanyl Withdrawal

Like other opioids, you can be dependent on a drug without being addicted, but dependence can sometimes lead to addiction. People addicted to fentanyl who stop using it can have severe withdrawal symptoms only hours after taking their last dose. These symptoms are physically uncomfortable, and many people can’t stop using fentanyl because of this reason alone.^3,5

Common fentanyl withdrawal symptoms include:³

• Restlessness
• Yawning
• Irritability or anxiety
• Runny nose or watery eyes
• Sweating or chills
• Muscle aches
• Overall weakness
• Stomach cramps
• Widened pupils
• Joint pain
• Back pain
• Leg spasms
• Fast breathing
• High blood pressure
• Increased heart rate
• Nausea
• No appetite

Fentanyl withdrawal symptoms can be hard to ward off. You may need to medically detox or get treatment to wean off. This can occur in a medical detox or supervised setting.

Treatment for Fentanyl Addiction and Abuse

Detox is the first step in fentanyl addiction treatment and can be medical (medication-assisted) or non-medical (without the use of medication). The health care professional will determine what you need to wean off fentanyl successfully. In some instances, certain medications can be used to aid in the withdrawal and detox process.⁸

Medications that have been used in treating fentanyl addiction include:^3,8

• Buprenorphine
• Methadone
• Naltrexone

Behavioral therapies for addiction to opioids like fentanyl can help you change your thoughts and behaviors around drug use, establish healthy life skills, and develop resilience.⁸

A few examples of behavioral therapies may include:³

• Cognitive-behavioral therapy (CBT): This will help you adjust your drug-use expectations and behaviors, and manage cravings, triggers, and stress
• Contingency management: This is an incentive-based system giving you “points” based on negative drug tests. You can use the points to earn items that encourage healthy living.
• Motivational interviewing: This is a patient-centered counseling style that addresses the stages of change, helping to elicit “change talk.”

Often, treatment programs will offer a variety of therapeutic tools and/or medication-assisted programs for those struggling with fentanyl addiction. Whether you need detox, treatment, medication, or a combination of all three, effective programs are tailored to your specific needs. The sudden surge in fentanyl-related deaths has caused a greater need for support.

Due to the recent rise in fentanyl overdose and deaths related to increased illegal manufacturing, the CDC has expanded the need for prevention and response.⁴ Based on fentanyl overdose and death statistics during the COVID-19 pandemic, the CDC has made the following recommendations for individuals and communities in need:⁴

• Expand the provision and use of naloxone and overdose prevention education.
• Expand access to and provision of treatment for substance use disorders.
• Intervene early with individuals at the highest risk for overdose.
• Improve detection of overdose outbreaks due to fentanyl, novel psychoactive substances, (e.g., fentanyl analogs), or other drugs to facilitate an effective response.

Fentanyl is a dangerous drug that can have severe health consequences if it is misused. Many resources are available to address your concerns. If you are struggling with a fentanyl addiction, please get help now.

Contact one of our support specialists at 800-934-1582(Who Answers?) . We are here to assist 24/7.

References

• National Institute on Drug Abuse. (n.d). Fentanyl.
• Drug Enforcement Administration. (n.d.) Drug Scheduling.
• County of Los Angeles Health Public Health. (2019). Fentanyl.
• Centers for Disease Control and Prevention. (2021). Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic.
• National Institute on Drug Abuse. (2019). What is fentanyl?
• Substance Abuse and Mental Health Services Administration. (2020). Opioid overdose.
• American Psychiatric Association. (2018). Opioid-use disorder.
• Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol (TIP 45).
• Verified.org. (2021). Verified.org. What’s Real. What’s Not.