Author: Ruben Bermea, LPC

Teen fentanyl abuse can lead to tragic consequences. In 2015, 1 in 5 deaths among young adults involved opioids, including fentanyl.¹ Becoming informed about signs of fentanyl abuse can help you decide if your teen needs more support. Studies show that early intervention can be key to your child’s long-term recovery outcomes.²

In This Article:

• What Is Fentanyl and Why Is It So Dangerous?
• How Does Teen Fentanyl Abuse Develop?
• What Are the Signs of Fentanyl Overdose?
• How Do I Get Help for My Teen’s Fentanyl Misuse?

What Is Fentanyl and Why Is It So Dangerous?

Fentanyl is an opiate drug meant to relieve severe pain in the brain and nerves.³ It may be a prescribed medication or an illegally made substance.³ In prescription form, fentanyl is administered by a patch infused with the drug or in the form of a shot or lozenge.³ Prescription fentanyl is meant to treat intense acute or chronic pain, especially in post-surgical or cancer patients. It is up to 100 times more potent than morphine.³ Due to its potency and high potential for misuse, legal prescriptions for fentanyl are typically only written for short periods of time.  Fentanyl is prescribed to individuals with severe pain who are physically tolerant to other opioid pain medications.

The use of fentanyl by individuals who do not need it for extreme levels of pain has led to serious health consequences. As of 2017, more than half of all opioid-related deaths have involved fentanyl.³ Each year, more than 36,000 people die from synthetic opioids, including from fentanyl overdose.^4,5 Data show that these overdoses are most often associated with illegally manufactured fentanyl.³

Illegally made fentanyl comes in several forms, including: ³

• Powder that often resembles heroin or cocaine
• Liquid put into eye droppers and nasal sprays
• Blotter paper dosed with liquid fentanyl
• Pills that look like other prescription opioids

Opioids, such as fentanyl, are dangerous because of how easily addiction to them can develop.³ Opioids bind to opioid receptors in the brain and nervous system that activate pain reduction and produce a feeling of euphoria.⁷ This pleasure response can lead to tolerance, which is when a person needs higher doses to achieve desired results. Over time, the brain’s chemistry adapts to the drug, making it difficult for a person to feel the same degree of pleasure from anything else.³

Opioid dependence occurs when a person needs to continue taking fentanyl to avoid withdrawal symptoms. These symptoms can begin as soon as several hours after the last dose was taken.^3,7 Addiction, clinically known as a substance use disorder, occurs when a person meets certain diagnostic criteria, which include drug-seeking behavior and continued use drugs despite harmful consequences.³

In addition to the potential consequences of misusing fentanyl alone, mixing it with alcohol or other drugs can lead to dangerous outcomes, including overdose.¹

Illegal forms of the drug are often “cut with”—or combined with—other illicit and potentially dangerous substances, including methamphetamine and heroin.³ These added substances are not detectable with the naked eye. This poses a dangerous risk to individuals who are not aware of the presence of fentanyl in the drugs they are taking.³

How Does Teen Fentanyl Abuse Develop?

If your child appears to be using fentanyl, they may show signs of substance use disorder.⁶ One of the signs of a substance use disorder is when a person continues using drugs or alcohol despite negative impacts on their life.⁶

If your child has had surgery or cancer treatment and was prescribed fentanyl for pain, signs of misuse include taking the medication for longer than prescribed.¹ For example, the fentanyl patch should only be worn for a maximum of 72 hours.¹ If your child keeps the patch on for longer than recommended, this could be cause for concern. Often, teens—and adults—begin using illegally made fentanyl after becoming physically dependent on the prescription form of the medication.¹

Warning signs of fentanyl abuse include: ³

• Appearing extremely, manically happy
• Sleepiness
• Nausea
• Confusion in standard situations
• Constipation
• Difficulty breathing
• Loss of consciousness

If your child has never had their own prescription for fentanyl, they may have begun using it after becoming dependent on another opioid medication.  Another person who has access to prescription or illegal fentanyl may have been introduced fentanyl to your teen as an illegal recreational drug.

What Are the Signs of Fentanyl Overdose?

Due to its potency, fentanyl has a high risk of overdose, especially when illegally manufactured fentanyl or another substance cut with fentanyl is used. The DEA has seized illicit fentanyl pills containing as much as 5.1 milligrams of fentanyl per tablet, which is over twice the accepted lethal dose for the average adult of 2 milligrams. Of the tablets analyzed, 26% contained 2 milligrams or more of fentanyl. ⁸

A fentanyl overdose is a medical emergency.  Overdose can occur when if the individual has never used fentanyl before, has not used it for a long time, does not known they have taken fentanyl, has a low body weight, or has a low tolerance to opioids.³ Any of the following signs could indicate a fentanyl overdose: ⁹

• Inability to wake up or speak
• Slow or ceased breathing
• Limp body
• Extremely pale, clammy face
• Vomiting or gurgling noises
• Blue or purple-cast fingernails or lips

If you suspect your child may have overdosed on fentanyl, call emergency medical services immediately. Tell the operator that your child is unresponsive and exhibiting signs of a drug overdose. If directed, the operator will instruct you how to administer CPR until emergency services arrive. Tell paramedics if you suspect that fentanyl or any other opioid may be involved in the emergency so that they may administer naloxone.⁹

Naloxone is a drug used to reverse the respiratory depression caused by an overdose from opioid drugs. It comes in several forms:¹⁰

• Nasal spray
• Muscular or under-the-skin injection
• Intravenous drip

If your teen overdoses from using fentanyl, they may need more than one dose of naloxone if their breathing does not quickly return to normal.¹⁰ Nasal spray forms of naloxone are available in some states without a prescription.¹¹ Check with your local pharmacy, or consult your family doctor if a prescription is required where you live. If you choose to keep naloxone on hand, ask a pharmacist for instructions on how to use it.

Even if you keep naloxone on hand and successfully administer it to your child after an overdose, they should be seen by a medical professional as soon as possible. The effects of naloxone are short lasting—between 30 and 90 minutes—and intended to extend the window of time available to get medical attention for someone who has overdosed on opioids.

How Do I Get Help for My Teen’s Fentanyl Misuse?

If you see signs of fentanyl abuse with your teen, several treatment options are available. These include the following.

Detox

Detox, or detoxification, is when a person undergoes withdrawal from a drug while being supervised by healthcare professionals.¹² Many people experience serious withdrawal symptoms during detox from fentanyl, which is why medical supervision is often recommended.¹¹ Detox will clear fentanyl from your teen’s body, but it will not solve the underlying dependence.

Inpatient Treatment

Inpatient, or residential, treatment provides 24/7 care and supervision for your child.¹² It can take place at a hospital, clinic, or rehab center that may also provide detox assistance.¹¹

Outpatient Treatment

Outpatient care is when your teen lives in your home, their own residence, or in sober living housing but still receives medical care.¹² This option can work if your teen is willing and able to attend regular visits with care providers.¹² Outpatient care does not include overnight supervision, so this option will only work if your teen lives in a stable environment and has reliable transportation.¹¹

Medications for Fentanyl Use Disorder

Regardless of the treatment setting, your teen may benefit from medications that help with opioid addiction.¹³

During the initial withdrawal process, your teen’s treatment specialist may prescribe lofexidine. This is an FDA-approved, non-opioid medicine that reduces opioid withdrawal symptoms.¹⁴

There are also medicines, such as buprenorphine and methadone, that can help your teen stop using fentanyl by binding to the same opioid receptors.¹³ Because their connection to these receptors is weaker than the fentanyl stimulation, they may reduce drug cravings and help prevent serious withdrawal symptoms.¹³

Naltrexone is another medication that can help with fentanyl opioid addiction. This medication blocks opioid receptors. Taking naltrexone eliminates any effect opioid drugs, such as fentanyl, have on your teenager. Note that your teen can only begin naltrexone treatment after completing detoxification.¹³

Therapeutic Treatment for Teen Fentanyl Abuse

Therapy can be an effective treatment option for fentanyl misuse, either on its own or in combination with medications.¹⁵ Cognitive-behavioral therapy (CBT) is one method that can help people with substance use disorders.¹⁵ With CBT, your teen will explore how their learned behaviors and coping strategies may contribute to substance misuse.¹⁴ Once identified, they can work on changing harmful responses to negative thoughts or feelings and replace them with more helpful behaviors.¹⁵

Dialectical behavior therapy (DBT) is another form of behavioral therapy that may help with substance use disorders.¹⁶ With DBT, your teen may work to change their behaviors while receiving positive reinforcement for meeting recovery goals.¹⁶ DBT also helps your teen manage painful emotions and gain the tools they need to cope with those feelings without turning to substances for support.¹⁶

Peer Support for Fentanyl Misuse

Your teen can attend Narcotics Anonymous (NA) or another 12-step program for substance misuse at any point in their treatment journey.¹⁷ Peer support can be an important part of recovery from substance misuse, especially as it strengthens your teen’s social connections to help them stay sober.¹⁸

While a 12-step program can offer support for teen fentanyl abuse, if your child struggles with social anxiety, they may feel more comfortable in an individual therapeutic setting.¹⁸

Addressing family dynamics and substance use patterns in the home is also an important part of your teen’s recovery from fentanyl misuse.¹⁸ For that reason, 12-step programs may only be one component of your teen’s recovery from fentanyl misuse since many peer support meetings are closed to all except the individuals struggling with narcotics or other substances.¹⁸ You may have the option to include open meetings with your child or to attend Alcoholics Anonymous Family Groups (Al-Anon) meetings, which are designed to help family members of individuals with addictions of any kind to process their own experiences.

Are you concerned about your teen’s relationship with fentanyl? Do you suspect you may be dealing with teen fentanyl abuse? Help is available. Call 800-934-1582(Who Answers?) today to find the help you need.

References

1. Substance Abuse and Mental Health Services Administration. Talking With Your Teen About Opioids: Keeping Your Kids Safe.
2. Dennis, M. L., Scott, C. K., & Laudet, A. (2014). Beyond bricks and mortar: recent research on substance use disorder recovery management. Current Psychiatry Reports, 16(4),
3. National Institute on Drug Abuse. (2021). Fentanyl DrugFacts.
4. National Institute on Drug Abuse. (2020). Overdose Death Rates.
5. Mattson, C. L., Tanz, L. J., Quinn, K., Kariisa, M., Patel, P., & Davis, N. L. (2021, February 12). Trends and geographic patterns in drug and synthetic opioid overdose deaths — United States, 2013–2019. Morbidity and Mortality Weekly Report, 70, 202–207.
6. Substance Abuse and Mental Health Services Administration. (2020, April 30). Mental Health and Substance Use Disorders.
7. Le Merrer, J., Becker, J. A.; Befort, K., & Kieffer, B. L. (2009, October 1). Reward processing by the opioid system in the brain. Physiological Reviews, 89(4), 1379–1412.
8. Drug Enforcement Administration. Facts About Fentanyl.
9. Substance Abuse and Mental Health Services Administration. (2018). Opioid Overdose Toolkit.
10. Substance Abuse and Mental Health Services Administration. (2021, January 4). Medication-Assisted Treatment (MAT).
11. National Institute on Drug Abuse. (2021). Naloxone DrugFacts.
12. Substance Abuse and Mental Health Services Administration. (2019). Treatment options.
13. Lee, J. D., Nunes, E. V., Mpa, P. N., Bailey, G. L., Brigham, G. S., Cohen, A. J., Fishman, M., Ling, W., Lindblad, R., Shmueli-Blumberg, D., Stablein, D., May, J., Salazar, D., Liu, D., & Rotrosen, J. (2016, August 10). NIDA clinical trials network CTN-0051, extended-release naltrexone vs. buprenorphine for opioid treatment. Contemporary Clinical Trials, 50, 253–264.
14. Food and Drug Administration. (2018, May 16). FDA approves the first non-opioid treatment for management of opioid withdrawal symptoms in adults
15. McHugh, R.K., Hearon, B.A., & Otto, M.W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric Clinics of North America, 33(3), 511-525.
16. Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science and Clinical Practice, 4(2), 39-47.
17. Narcotics Anonymous World Services. (2021). Information about NA.
18. Center for Substance Abuse Treatment. (1999) Treatment of adolescents with substance use disorders. Treatment Improvement Protocol (TIP) Series, No. 32. Chapter 4—Twelve-Step-Based Programs.