Fentanyl Addiction

Fentanyl is a laboratory-made (synthetic) opioid drug. It belongs to a class of drugs called narcotic (opiate) analgesics and is used to treat moderate to severe pain that cannot be controlled with non-opioid medications. However, some people misuse or abuse fentanyl and become addicted to it. Call our fentanyl helpline for help in dealing with fentanyl addiction for yourself or a loved one.

What Is Fentanyl?

Fentanyl is a synthetic opioid drug that is man-made in laboratories. It resembles the natural opioid morphine which is obtained from the opium poppy plant. Like morphine, fentanyl is used to treat moderate to severe pain that does not respond to non-opioid pain medications. However, fentanyl is 80–100 times more powerful than morphine. Fentanyl attaches to opioid receptors in the brain and changes the way pain signals are transmitted.

Because of its powerful opioid analgesic properties, fentanyl is often diverted (misused) and abused. People abuse fentanyl because it produces a short, intense high, temporary feelings of euphoria, pain relief, and relaxation. Fentanyl is available illegally on the street under various names such as China Girl, Friend, Dance Fever, Apache, China White, Jackpot, Goodfellas, Tango & Cash, and Murder 8. ^[1]

But the difference between the amount of fentanyl it takes to get high and the amount that can kill you is equivalent to just a few grains of salt. As a result, synthetic opioids (mainly fentanyl) are responsible for two-thirds of all drug overdose deaths in the US as of 2021. ^[2]

Fentanyl is cheaper to manufacture and provides a more powerful high than heroin, which is an illegal opioid drug that has no legitimate medical use. For this reason, fentanyl has become a common substitute for heroin and other prescription opioid painkillers. Even drugs sold as heroin are often contaminated with fentanyl to increase profits and potency. But because fentanyl is much more powerful than heroin and other opioids, this practice of mixing fentanyl with other drugs can put users at a high risk of a fatal opioid overdose.

The DEA has classified fentanyl as a Schedule II prescription drug. This means that while fentanyl has legitimate medical uses for controlling pain, it also has a very high risk for abuse and addiction. ^[3]

How Is Fentanyl Made?

Some prescription opioid analgesics (painkillers) are derived directly from the opium poppy plant, for example, morphine. The plant is also the source of the illegal opioid drug heroin. However, fentanyl is man-made in the laboratory and is a synthetic opioid. It does not contain natural opium. Instead, it is chemically formulated to mimic the effects of opioids in the brain.

Fentanyl is sold in the United States by prescription as a generic drug and under various brand names such as Duragesic, Actiq, Abstral, Lazanda, Fentora, Onsolis and Sublimaze. ^[4] Fentanyl comes in various dosage forms, including lozenges, dissolvable films, skin patches, and nasal sprays. ^[5]

Because of the high risk of abuse and addiction, there are strict regulations for prescribing fentanyl. The majority of fentanyl sold on the streets is not made by pharmaceutical companies. Instead, it is manufactured in illegal labs in Mexico and China and shipped from overseas for sale in the US. Unlike some other drugs, fentanyl is easy to disguise and transport, making it easier to import.

Understanding Fentanyl Addiction

Fentanyl is habit-forming and can be more addictive than other opioids because of its high potency. Taking fentanyl, even as prescribed by a healthcare professional, can lead to a psychological and physical dependence on it over time. Misusing and abusing fentanyl are associated with a very high risk of developing fentanyl addiction. Abusing fentanyl means taking it recreationally to get high. Misusing fentanyl means taking higher doses, more frequent doses, or taking it in ways other than prescribed.

One of the key features of an addiction is the development of tolerance. This means that when a person uses a drug like fentanyl, heroin, or other opioids regularly, the drug loses some of its effectiveness over time. This is called tolerance. As a result, the person must take higher doses than before to get the same effects. Taking higher doses or more frequent doses of fentanyl increases a person’s risk of developing a physical dependence on the drug.

When a person becomes physically addicted to fentanyl (or other opioids), they can experience uncomfortable withdrawal symptoms when the drug is absent from their system. Withdrawal effects can start as early as a few hours after the last dose. These symptoms can be so uncomfortable and unpleasant that they cause opioid users to dose again just to avoid them. ^[6]

Once a person is addicted to fentanyl, they experience severe drug cravings and continue abusing it despite health problems, breakdowns in relationships, and problems at work or school. Continued use over time leads to severe consequences, including health and psychosocial effects.

Why Is Fentanyl Prescribed?

Fentanyl is prescribed to people with severe or terminal illnesses that cause intractable pain. It is used only when other safer non-opioid painkillers are ineffective. Fentanyl was originally developed to help in managing severe pain in cancer patients. Because of its powerful analgesic effects, fentanyl is usually prescribed only to people who have already developed a high tolerance to other opioid painkillers.

Fentanyl is also used as a sedative in intubated patients and as pre-medication for procedures with anticipated discomfort. In addition, it is used to treat severe pain in patients with kidney failure, because unlike other painkillers, fentanyl is primarily eliminated from the body by the liver.

Safe Use of Fentanyl

As mentioned, there are legitimate uses of fentanyl. It is a safe and effective medication when used in a monitored medical setting for an isolated procedure or acute condition. However, fentanyl addiction can develop when it is used long-term. Patients who have been prescribed fentanyl should take the following precautions to avoid developing a fentanyl addiction: ^[7]

• Do not take larger doses of fentanyl than prescribed.
• Do not take more frequent doses of fentanyl than prescribed.
• Do not take fentanyl for a longer period than prescribed.
• Do not switch from one fentanyl product to another without consulting your doctor.
• Do not use fentanyl in a way other than prescribed.
• Do not eat grapefruit or drink grapefruit juice while on fentanyl, as this can affect fentanyl elimination.

Also, inform your prescribing physician about any other medications you are taking. The use of certain medications simultaneously with fentanyl can increase the risk of developing severe sedation and life-threatening breathing problems, coma, and even death.

Fentanyl can be prescribed only by physicians who have experience in treating severe pain with opioids. Every patient who receives fentanyl must be enrolled in a special program and have the prescription filled at a pharmacy that is enrolled in the program.

Doctors are aware that patients are at greater risk of abusing fentanyl if they have had problems with alcohol or drug abuse in the past or overused prescription medications before. Your healthcare provider will carefully weigh the benefits versus risks before prescribing fentanyl to you.

Accidental use of fentanyl by a child or adult who has not been prescribed this drug can be fatal due to respiratory depression (slowed or stopped breathing). Partially used fentanyl products such as skin patches may contain enough medication to be harmful. This is why it is vital that you store and dispose of fentanyl in a secure way to prevent accidental exposure of another person.

How Do People Abuse Fentanyl?

Some people abuse fentanyl for its heroin-like euphoric effects. Most cases of fentanyl-associated harm in the United States, including drug overdose deaths, are linked to fentanyl made in clandestine laboratories and sold through illegal drug markets.

Synthetic fentanyl is often sold illegally in powder form, as pills, dropped on blotting paper, or put in nasal sprays or eye droppers. Fentanyl addicts sometimes use discarded fentanyl patches that still contain a significant amount of the drug. Abusers remove the gel and place it under the tongue, inject it, or smoke it to get high.

Fentanyl is often mixed with or sold as heroin, cocaine, MDMA, or other drugs. It offers a cheap way for dealers to increase profits while still ensuring the user gets high. In many cases, drug users are unaware that the substance they are buying contains traces of fentanyl, putting them at risk of a fatal overdose.

Why Do People Abuse Fentanyl?

Fentanyl and other opioids travel through the bloodstream to the brain, where they attach to special proteins called opioid receptors, specifically mu-opioid receptors. These opioid receptors regulate many vital functions, including emotions like pleasure, reward, and pain. The activation of opioid receptors by fentanyl triggers processes in the brain that are similar to feelings of pleasure associated with activities like eating and sex. ^[8] These effects create strong incentives to continue using the drug.

Fentanyl exerts its effects by attaching to opioid receptors and increasing the levels of a natural chemical called dopamine in the brain. Dopamine is a neurotransmitter that creates feelings of euphoria. It is largely responsible for the high that fentanyl users experience. Dopamine is closely linked to addiction. The majority of addictive drugs work by causing the release of dopamine in the brain.

When someone uses a dopaminergic drug such as fentanyl, the brain creates a lasting record or memory associating fentanyl use with pleasure and positive emotions. These rewarding experiences and positive associations lead to the formation of addiction pathways in the brain that drive continued drug use. ^[9]

Once formed, these pathways cause strong drug cravings and make it challenging for a person to stop using a drug. Drugs like fentanyl also cause a physical dependence to develop, causing withdrawal symptoms when the drug is out of the system. This makes it even harder to stop using due to the uncomfortable withdrawal effects.

Adverse Effects of Fentanyl

Fentanyl is a potent synthetic opioid and its use can lead to addiction. The misuse or abuse of fentanyl can cause several side effects, many of which can be dangerous or even fatal. The most common adverse effects of fentanyl include:

• Drowsiness
• Stomach pain
• Nausea
• Weight loss
• Vision changes
• Fainting or dizziness
• Difficulty urinating
• Anxiety and depression
• Sleep disturbance
• Painful sores in the mouth (usually the cheek area where the drug is placed)

More dangerous side effects of fentanyl include changes in heartbeat, hallucinations, agitation, and seizures. Fentanyl can also cause decreased libido (sexual desire), erectile dysfunction (inability to get or keep an erection), and irregular menstruation. Allergic reactions to fentanyl may manifest with skin rash, hives, and itching and should be treated in the emergency room.

The most dangerous risk for fentanyl users is the risk of an opioid overdose. Accidental overdoses are very common in fentanyl users. As of 2021, synthetic opioids, mainly fentanyl, are responsible for the overwhelming majority of drug overdose deaths in the US. The following signs and symptoms of a fentanyl overdose warrant immediate medical attention:

• Extreme drowsiness
• Shallow, slow breathing
• Difficulty breathing or swallowing
• Dizziness, fainting, confusion
• Pallor (pale skin, blue lips or fingers)
• Loss of consciousness or unresponsiveness
• Small “pinpoint” pupils

When fentanyl is combined with other drugs, the risk to users is greatly increased. The concurrent use of fentanyl and other drugs creates a complex, multi-layered clinical picture that can make it very difficult for physicians to manage fentanyl addiction.

Fentanyl Addiction Statistics

The staggering number of opioid overdose deaths in the United States in recent years has led to more focused attention on synthetic opioids such as fentanyl. Here are some facts and figures that illustrate the scope of the opioid addiction and fentanyl addiction problem in the US: ^{[10] [11]}

• Drug overdose deaths in the US have increased by more than five-fold between 1999 and 2021.
• In 2021, there were 106,000 drug overdose deaths reported, more than any previous year.
• Of the total number of drug overdose deaths (106,000) in 2021, opioids (including prescription opioids, heroin, natural, semi-synthetic, and synthetic opioids) were responsible for more than 80,000 deaths. Synthetic opioids (mainly fentanyl) were involved in more than 70,000 drug overdose deaths in 2021.
• The U.S. Customs and Border Protection seized more than 27,000 lbs of illegal fentanyl in 2023.

Causes and Risk Factors for Fentanyl Addiction

Anyone who misuses or abuses fentanyl can develop an addiction to this powerful drug. There is no way to accurately predict the risk of developing a drug dependency on fentanyl. However, certain psychological, biologic, environmental, and genetic factors put certain people at a higher risk for addiction. ^[12]

Genetic vulnerability: Studies have shown that addiction may run in families. For example, a direct relationship has been observed between parental drug abuse and drug abuse in children. Similarly, sons and daughters of alcoholics have a 3–4 times higher risk of developing alcoholism. The mechanism by which a family history of drug or alcohol abuse confers increased genetic risk is not well understood. However, research indicates that genetics accounts for 40-60% of the risk and external environmental factors for the rest.

Physiologic vulnerability: Metabolic variations, i.e., the ability of the body to break down and excrete fentanyl, can affect the risk of abuse and addiction. There are low levels of certain enzymes, such as monoamine oxidase (MAO), in alcohol abusers. MAO plays an important role in the metabolism of neurotransmitters like dopamine. This is the brain chemical through which fentanyl exerts its effects. Therefore, alcohol abuse may cause low MAO levels which may in turn affect dopamine metabolism and increase the risk of fentanyl in people abusing this drug.

Environmental and social vulnerability: Factors such as access to drugs, peer pressure, and the presence of co-occurring psychiatric illnesses can increase the risk of fentanyl abuse and addiction. Also, psychosocial factors, such as divorce, abuse, or stress in relationships are risk factors for substance use disorders, including fentanyl and other opioid drugs. Social and cultural factors such as community drug use patterns also play a role in a person’s risk of using and becoming dependent on drugs.

Physical and mental health history: People with a medical history of severe pain due to a medical condition or injury are at risk of abusing analgesic medications like fentanyl to self-medicate. Having a mental health disorder or experiencing stress or trauma also increases a person’s risk for addiction, especially when these mental health conditions are untreated.

Fentanyl Addiction in Pregnant Women

Studies have shown that 20–30% of women fill at least one opioid prescription during pregnancy. Yet, opioid use can have many serious adverse effects on both the expectant mother and her unborn baby. ^{[13] [14]} Potential consequences of opioid abuse and addiction during pregnancy include low birth weight, small for gestational age, preterm birth, and birth defects.

Opiate use during pregnancy can also lead to a condition called neonatal abstinence syndrome (NAS) in the newborn baby. This condition occurs when a baby develops an addiction to an opioid drug that the mother has been using during her pregnancy. Babies with NAS go through withdrawal symptoms after birth when they stop receiving the drug through the mother’s circulation. Symptoms of NAS can include irritability, excessive high-pitched crying, poor sleep, increased muscle tone, skin excoriations, loose stools, tremors, sneezing, nasal stuffiness, and hyperthermia. ^[15]

Withdrawal Symptoms in Fentanyl Addicts

People with a fentanyl addiction frequently experience severe withdrawal symptoms when they stop using the drug or reduce the dose suddenly. These symptoms can begin within a few hours of last use of fentanyl. Fentanyl withdrawal symptoms commonly include:

• Muscle and bone pain
• Nausea and vomiting
• Diarrhea and loose stools
• Insomnia and restless leg syndrome
• Hot and cold flashes
• Sweating
• Severe drug cravings
• Anxiety
• Depression
• Irritability

The uncomfortable nature of withdrawal symptoms causes many people with a fentanyl addiction to take further doses of the drug. Often, fentanyl addicts develop such a high tolerance to the drug that they may not even experience any pleasurable effects and only continue to use the drug to “feel normal” and avoid withdrawal symptoms.

Luckily, effective medications and treatments are available help people who are addicted to opioids quit using these dangerous drugs. During a medically managed detox, healthcare providers can manage withdrawal symptoms. Medications such as methadone and suboxone are widely used to help people stop using fentanyl. Doctors can also prescribe other medications to reduce withdrawal symptoms and cravings, such as naltrexone and clonidine.

Fentanyl Overdose

A fentanyl overdose occurs when a person takes large enough quantities of the drug to cause life-threatening breathing problems. An overdose is a medical emergency and can be fatal. Fentanyl and other opioid drugs act on the part of the brain that regulates breathing. They cause respiratory depression (slowed or stopped breathing), which decreases the amount of oxygen reaching the brain (this is called hypoxia). Hypoxia due to a fentanyl overdose can lead to permanent brain damage, coma, and death.

In case of a known or suspected overdose, remove any visible fentanyl from the person’s mouth and call emergency services (911) immediately. If you or someone you know has been prescribed fentanyl or is abusing this drug, talk to your healthcare provider about having a rescue medication called naloxone available. Naloxone can reverse the life-threatening effects of fentanyl and other opiates in an emergency. In 2023, the U.S. Food and Drug Administration made a naloxone nasal spray available over-the-counter. Friends and family members should be aware of this medicine and when and how to use it (the person who is overdosing will not be able to use the rescue medication themselves). It can sometimes take more than one dose of naloxone to reverse fentanyl overdose symptoms and restart breathing. Call 911 after administering naloxone and stay with the person until help arrives.

Preventing Fentanyl Fatalities

Public health and safety experts recommend several ways to effectively respond to and prevent overdose deaths related to illicitly manufactured fentanyl. One of the best ways to achieve this is by expanding the use of naloxone, a safe and effective antidote to all opioid overdoses, including fentanyl.

Healthcare providers should make naloxone available to EMS first responders and law enforcement personnel, as well as to people with a fentanyl addiction who are at a high risk of overdose. Family and friends of people who are using fentanyl by prescription should also have access to naloxone in case of an accidental overdose.

People should be educated that a fentanyl overdose may require multiple doses of naloxone per event, because fentanyl is much more potent than other opioids. Any person who uses heroin or fentanyl, or knows people who do, should carry a naloxone kit and know how to use it.

Other ways to control fentanyl abuse and addiction include the rapid detection of fentanyl outbreaks with surveillance systems. The authorities should identify demographics and geographic concentrations of fentanyl use to better inform public health officials in that area. This can lead to better surveillance and fentanyl overdose prevention efforts. ^[16]

Fentanyl Addiction Treatment

Like other opioid addictions (heroin addiction, prescription pain pill addiction), fentanyl addiction is treated with a combination of medications and behavioral therapies. Medications such as suboxone (buprenorphine) and methadone, which bind to the same opioid receptors in the brain as fentanyl, are commonly used to reduce cravings and withdrawal symptoms. ^[17]

Medications are most effective when combined with psychotherapy. A range of behavioral therapies, such as cognitive-behavioral therapy (CBT), contingency management, and motivational interviewing are used to treat the psychological aspects of addiction, teach new methods of coping, build resilience, and prevent relapse.

If you or someone you know is battling fentanyl addiction, calling our hotline can help you take an important first step towards recovery. Make that call today and reclaim your life from the clutches of fentanyl addiction.

Last updated: March 19, 2024