Fentanyl is a laboratory-made (synthetic) opioid drug. It belongs to a class of drugs called narcotic (opiate) analgesics. Call our helpline for help in dealing with fentanyl addiction for you or a loved one.

Fentanyl Hotlines

There are a range of resources available for those struggling with fentanyl addiction. In addition to the National Drug Helpline, hotlines are available from SAMHSA and NCADD.

Service Provider Contact Number Opening Hours
National Drug Helpline 1-844-289-0879 24/7
SAMHSA 1-800-662-HELP(4357) 24/7
NCADD 1-800-NCA-CALL(622-2255) Not specified

What is Fentanyl?

Like morphine, fentanyl is used to treat patients with severe pain. However, fentanyl is 50-100 times more powerful than morphine. A dose of 100 mcg fentanyl can produce pain control equivalent to 10 mg of morphine. 1

The Drug Enforcement Administration (DEA) considers fentanyl dangerous and habit-forming. Therefore, they have classified fentanyl as a Schedule II prescription drug based on its high potential for abuse and addiction (physical and psychological dependence). 2

Fentanyl is available in the United States by prescription under various brand names, such as Duragesic, Actiq, and Sublimaze. 3Fentanyl comes in various forms, including lozenge (Actiq), sublingual tablet (Abstral), patch (Duragesic), nasal spray (Lazanda), film (Onsolis), and buccal tablet (Fentora). 4Because of its low molecular weight and fat solubility, fentanyl is ideal for delivery via the transdermal route. 5

Because of its powerful opioid analgesic properties, fentanyl is often diverted for abuse. 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.

Illegal fentanyl in the United States comes mainly from clandestine laboratories in Mexico. Sometimes, fentanyl is added to heroin to increase heroin’s potency. Users purchase what they think is highly potent heroin, not knowing that it contains fentanyl, which often results in overdose deaths.

Understanding Fentanyl Addiction

Fentanyl is a habit-forming drug. It can be more addictive than other opioids because of its high potency. Even a person who takes fentanyl by prescription from a doctor can develop a dependence on it. When someone misuses fentanyl (uses more than prescribed) or abuses fentanyl (uses it to get high), it can lead to fentanyl addiction.

Fentanyl addiction is characterized by tolerance and withdrawal. Tolerance is the need to take higher and higher doses of fentanyl to achieve the same euphoric effects. Withdrawal is the presence of distressing symptoms in the absence of fentanyl. 6

Fentanyl addiction is a severe form of substance use disorder. It is characterized by a compulsive need to use fentanyl despite harmful consequences. When someone is addicted to fentanyl, they continue abusing it despite health problems, breakdown in relationships, and problems at work or school.

Why is Fentanyl Prescribed?

Fentanyl is prescribed by doctors to cancer patients to treat uncontrollable pain (episodes of pain that occur despite round-the-clock pain medications). It is only prescribed to adults who are on regularly scheduled doses of another opiate pain medication. In patients who are not on other narcotic medications, fentanyl can cause serious breathing problems, even death.

Fentanyl is also used as a sedative in intubated patients and as pre-medication for procedures with anticipated discomfort. Clinicians sometimes use fentanyl in patients who have become tolerant to opiates. It is also used to treat severe pain in patients with kidney failure because fentanyl is primarily eliminated from the body by the liver.

Fentanyl is not used to treat short-term pain, for example, migraine pain, pain from injuries, or pain following medical or dental procedures.

Safe Use of Fentanyl

There are many legitimate uses of fentanyl. It is a safe and effective medication when used in a monitored medical setting. However, fentanyl can be habit-forming if not used according to the prescribing physician’s instructions, especially with prolonged use. 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 eat grapefruit or drink grapefruit juice while on fentanyl as this can affect fentanyl elimination.

Also, patients should inform their prescribing physician about any other medications they are taking. The use of certain medications simultaneously with fentanyl can increase the risk of developing life-threatening breathing problems, sedation, and coma.

Fentanyl should be prescribed only by physicians who have experience in treating cancer 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 should be aware that patients are at greater risk of abusing fentanyl if they have had problems with alcohol, used street drugs, or overused prescription medications in the past.

The accidental use of fentanyl by a child or adult who has not been prescribed this drug can cause serious harm including death. Partially used fentanyl products may contain enough medication to be harmful. For this reason, fentanyl should be kept safely out of reach of children. Partially used lozenges should be disposed of carefully according to the manufacturer’s instructions. If a person has accidentally used fentanyl, the medication should be removed from the mouth and emergency medical services called.

Why Do People Abuse Fentanyl?

Drug addicts abuse fentanyl for its heroin-like euphoric effects. 8Fentanyl abusers obtain the drug from legitimate medical supplies. Also, drug dealers supply illicitly manufactured fentanyl to addicts. 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.

Fentanyl is often mixed with or sold as heroin. Fentanyl is also mixed with other illicit drugs such as cocaine, MDMA, and amphetamine – with or without the user’s knowledge – to increase the euphoric effects. This is done because fentanyl is a powerful drug and it takes very little fentanyl to produce a high. Therefore, adding fentanyl to other illegal drugs is a cheap way to make them more potent. However, this is risky because the users don’t realize they are using drugs containing fentanyl as a cheap, but dangerous additive. This puts them at risk of overdose, and in case of overdose, it becomes difficult to know which drug is causing the overdose.

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. Synthetic fentanyl is often sold illegally as a powder, dropped on blotting paper, or put in nasal sprays or eye droppers. Illicitly manufactured fentanyl is sometimes made into pills.

How Does Fentanyl Affect the Human Brain?

Fentanyl and other opioids travel through the bloodstream to the brain where they attach to special proteins called opioid receptors, specifically mu-opioid receptors in the case of fentanyl. Opioid receptors regulate many vital functions, including emotions like pleasure, reward, and pain. The activation of opioid receptors by fentanyl, therefore, triggers processes in the brain that are similar to feelings of pleasure associated with activities like eating and sex. 9

Fentanyl exerts its effects by increasing the levels of dopamine in the brain. Dopamine is a neurotransmitter (chemical) that creates a feeling of wellbeing (euphoria), induces a state of relaxation, and relieves pain. With repeated fentanyl abuse, the brain creates a lasting record or memory that associates fentanyl use with these good feelings and the circumstances in which they occur. These conditioned associations often lead to drug cravings when the person encounters the same people, places, and things that were previously associated with fentanyl abuse. Conditioned associations drive fentanyl abusers to seek out more of the drug despite the many negative consequences of fentanyl addiction.

With continued use of fentanyl or exposure to escalating doses, the brain becomes used to the presence of large amounts of dopamine, so much so that it can only function normally when fentanyl is present in the system. As a result, two important things happen – tolerance and withdrawal – which are the characteristic features of fentanyl addiction.

Adverse Effects of Fentanyl

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

  • Drowsiness
  • Stomach pain
  • Heartburn
  • Weight loss
  • Vision changes
  • Difficulty urinating
  • Anxiety and depression
  • Unusual dreams or thinking
  • Delirium
  • Sleep disturbance
  • Uncontrolled shaking of the body
  • Redness of the face, neck, or upper chest
  • Back pain
  • Chest pain
  • Swelling of the hands, feet, ankles, and lower legs
  • Painful sores in the mouth (cheek area where the drug is placed)

Also, more dangerous side effects of fentanyl include changes in heartbeat, hallucinations, agitation, and seizures. Fentanyl may cause decreased libido (sexual desire), erectile dysfunction (inability to get or keep an erection), and irregular menstruation. It can also cause hives, itching, and rash.

If a person is using fentanyl, whether by prescription or illegally, the presence of the following signs and symptoms warrants immediate medical attention:

  • Extreme drowsiness
  • Shallow, slow breathing
  • Difficulty breathing or swallowing
  • Dizziness, fainting, confusion

It is worth noting that alcohol and some other drugs like cocaine and heroin can act synergistically and worsen the side effects of fentanyl. The concurrent use of fentanyl and other drugs creates a complex, multi-layered clinical picture that makes it difficult for physicians to manage fentanyl addiction.

Fentanyl Addiction Statistics

The rising number of opioid overdose deaths in the United States has led to more focused attention on synthetic opioids like fentanyl. Here are some facts and figures that illustrate the scope of the fentanyl addiction problem in the US: 10

  • From 2010 to 2015, annual opioid overdose deaths increased by 57% with a notable rise in overdose deaths attributed to synthetic opioids like fentanyl.
  • Synthetic opioid overdose deaths (fentanyl, tramadol, Demerol) increased by 219% between 2010 and 2015.
  • Drug submissions that tested positive for illicitly manufactured fentanyl increased by 196% from 2014 to 2015.
  • Overdoses associated with fentanyl have risen sharply despite a fall in prescription rates.
  • In 2018, more than 31,000 people died from overdoses involving synthetic opioids such as fentanyl.

Causes and Risk Factors for Fentanyl Addiction

There is no way to accurately predict a drug dependency like fentanyl addiction. However, there are some common characteristics among individuals who end up struggling with substance use disorders like fentanyl abuse. 11

Genetic vulnerability: Studies have shown that drug addiction can run in families. For example, a direct relationship has been observed between parental drug abuse and drug abuse in the offspring. 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 abuse confers increased genetic risk is not well understood.

Physiologic vulnerability: Differences in the neurochemical system can influence a person’s risk of developing substance use disorders like fentanyl addiction. Meaning different people have different responsiveness to drugs. For instance, metabolic variations, i.e., the ability of the body to break down and excrete fentanyl, can increase the risk of abuse and addiction. Certain enzymes, such as monoamine oxidase (MAO), are low in alcohol abusers. MAO plays an important role in the metabolism of neurotransmitters like dopamine, which is the chemical through which fentanyl exerts its effects.

Psychosocial vulnerability: Factors like access to drugs, peer pressure, and the presence of co-occurring psychiatric illnesses, can all increase the risk of fentanyl abuse. Also, familial factors, such as dealing with divorce, abuse, or stressful relationships are risk factors for substance use disorders. Social and cultural factors such as community drug use patterns also play a role. For instance, a person who hangs out with people who abuse fentanyl is at high risk of abusing fentanyl themselves.

Personality traits: Certain personality types have been linked to alcoholism and drug abuse, such as aggressiveness, antisocial behavior, rejection of parental authority, and risk-taking behaviors. Also, past or current abuse of other drugs is a risk factor for fentanyl abuse and addiction.

Medical history: People with a medical history of severe pain due to a medical condition or injury are at risk of seeking out a potent analgesic like fentanyl to self-medicate. Also, individuals with untreated psychiatric disorders are at risk of fentanyl addiction.

Signs and Symptoms of Fentanyl Abuse

When a person is abusing fentanyl or has developed an addiction to it, several physical, psychological, and behavioral changes occur. These changes can alert loved ones to the presence of chemical dependency. Some of the signs and symptoms of fentanyl addiction include:

Physical symptoms: Slowed breathing, drowsiness, fatigue, swollen hands and feet, dizziness, diarrhea, vomiting.

Mental symptoms: Confusion, disorientation, inability to concentrate, anxiety, depression.

Behavioral symptoms: Taking more fentanyl than intended, secretive or deceptive behavior, unusual or erratic behavior, taking unnecessary risks under the influence of fentanyl, social isolation, avoiding participation in previously enjoyable activities, fixation on obtaining fentanyl, cravings for fentanyl, continued abuse of fentanyl despite negative effects on health, relationships, work, and finances.

Fentanyl Addiction in Pregnant Women

Various studies have shown that 20-30% of women fill at least one opioid prescription during pregnancy. This high opioid prescription rate is worrisome because the fetal safety of opioids during pregnancy is not completely understood. The reason being clinical trials do not typically include pregnant women for ethical reasons. 12

Nonetheless,numerous studies have shown evidence of adverse effects on fetal development as a result of exposure to opioids during pregnancy. 13 This includes the use of opioids for medical indications as well as opioid dependency such as fentanyl addiction. Some of the potential consequences of opioid addiction during pregnancy that have been studied include low birth weight, small for gestational age, preterm birth, and birth defects. 14

Opiate use during pregnancy can lead to a condition known as neonatal abstinence syndrome (NAS) in the newborn baby. This is a serious condition that occurs in babies who are exposed to opioid drugs like heroin, prescription pain pills, or fentanyl during the pregnancy through maternal drug abuse. NAS is characterized by irritability, excessive 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 can have severe withdrawal symptoms when they stop using the drug. The symptoms can begin within a few hours of the last time fentanyl is taken. Fentanyl withdrawal symptoms include:

  • Muscle and bone pain
  • Vomiting and diarrhea
  • Sleep disturbances
  • Cold flashes and goosebumps
  • Uncontrolled movements of the legs
  • Severe cravings for fentanyl

Withdrawal from fentanyl can be extremely uncomfortable due to the presence of these symptoms. This is one of the reasons fentanyl addicts are unable to quit abusing the drug. For this reason, professional rehab care is recommended to safely come off opioid drugs like fentanyl.

The FDA has approved a non-opioid medication called lofexidine to help with the withdrawal process from fentanyl and other opioids. Lofexidine works by reducing withdrawal symptoms. Also, a device called the NSS-2 Bridge is available to help with managing fentanyl withdrawal. The device is placed at the back of the person’s ear, from where it generates small electrical pulses to stimulate the nerves. It is effective in easing fentanyl withdrawal symptoms for a maximum of 5 days during the phase when the withdrawal symptoms are the most severe. Also, the FDA has cleared a mobile application called reSET to help manage opioid use disorders, including fentanyl addiction. The app provides cognitive behavioral therapy and is used in conjunction with other therapies like contingency management and buprenorphine medication management.

Fentanyl Overdose

Fentanyl overdose occurs when a person takes enough of the drug to cause serious life-threatening symptoms. It is a medical emergency. A fentanyl overdose can lead to slowed or stopped breathing, which decreases the amount of oxygen reaching the brain (a condition known as hypoxia). Hypoxia as a result of fentanyl overdose can lead to permanent brain damage, coma, and death.

In case of overdose, the fentanyl should be removed from the person’s mouth and emergency services (911) contacted. People who have been prescribed fentanyl or those who are known to be abusing the drug may be told to always keep the rescue medication naloxone on hand. Naloxone can reverse the life-threatening effects of fentanyl and other opiates. Friends and family members should be made aware of this and taught how to use naloxone since the person who is overdosing will not be able to use the rescue medication themselves. It may take more than one dose of naloxone to reverse fentanyl overdose symptoms.

Friends and family members should also be educated on recognizing the signs and symptoms of a fentanyl overdose. The common symptoms of an overdose include:

  • Extreme drowsiness
  • Dizziness
  • Confusion
  • Shallow breathing, slow breathing, or stopped breathing
  • Pinpoint pupils

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 people with fentanyl addiction who are at high risk of overdose. Family and friends of people who are using fentanyl by prescription should also have access to naloxone in case of accidental overdose.

People should be educated that fentanyl overdose may require multiple doses of naloxone per event because fentanyl is much more potent than other opioids. Any person who uses heroin and/or fentanyl or knows people that 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 the 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, prescription pain pills), fentanyl addiction is treated with medications and behavioral therapies. Medications like buprenorphine and methadone, which bind to the same opioid receptors in the brain as fentanyl, are used to reduce cravings and withdrawal symptoms. 17 Another medicine, naltrexone, is used to block opioid receptors and reverse the effects of fentanyl.Also, a variety of behavioral therapies, such as cognitive-behavioral therapy, contingency management, and motivational interviewing are used to modify expectations and behaviors and manage triggers in people with a fentanyl addiction.

Last updated: August 26, 2020

References

  1. Ramos-Matos CF, Bistas KG, Lopez-Ojeda W. Fentanyl. [Updated 2020 Apr 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459275/
  2. Drug Scheduling. Drug Enforcement Administration. Available online. Accessed August 21, 2020. https://www.dea.gov/drug-scheduling
  3. Fentanyl. National Institute on Drug Abuse. Available online. Accessed August 21, 2020. https://www.drugabuse.gov/drug-topics/fentanyl
  4. Fentanyl. U.S. National Library of Medicine. Available online. Accessed August 21, 2020. https://medlineplus.gov/druginfo/meds/a605043.html
  5. Taylor KP, Goyal A. Fentanyl Transdermal. [Updated 2020 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555968/
  6. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13-20. doi:10.1151/spp021113 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/
  7. Kharasch ED, Whittington D, Hoffer C. Influence of hepatic and intestinal cytochrome P4503A activity on the acute disposition and effects of oral transmucosal fentanyl citrate. Anesthesiology. 2004;101(3):729-737. doi:10.1097/00000542-200409000-00022 https://pubmed.ncbi.nlm.nih.gov/15329598/
  8. Opioid Overdose. Fentanyl. Centers for Disease Control and Prevention. Available online. Accessed August 21, 2020. https://www.cdc.gov/drugoverdose/opioids/fentanyl.html
  9. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13-20. doi:10.1151/spp021113 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/
  10. Prescription Behavior Surveillance System. Issue Brief. Available online. Accessed August 21, 2020. https://www.cdc.gov/drugoverdose/pdf/pbss/PBSS-Report-072017.pdf
  11. Webster LR. Risk Factors for Opioid-Use Disorder and Overdose. Anesth Analg. 2017;125(5):1741-1748. doi:10.1213/ANE.0000000000002496 https://pubmed.ncbi.nlm.nih.gov/29049118/
  12. Yazdy MM, Desai RJ, Brogly SB. Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. J Pediatr Genet. 2015;4(2):56-70. doi:10.1055/s-0035-1556740
  13. Broussard CS, Rasmussen SA, Reefhuis J, et al. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol. 2011;204(4):. doi:10.1016/j.ajog.2010.12.039 https://pubmed.ncbi.nlm.nih.gov/21345403/
  14. Yazdy MM, Desai RJ, Brogly SB. Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. J Pediatr Genet. 2015;4(2):56-70. doi:10.1055/s-0035-1556740
  15. Stover MW, Davis JM. Opioids in pregnancy and neonatal abstinence syndrome. Semin Perinatol. 2015;39(7):561-565. doi:10.1053/j.semperi.2015.08.013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628571/
  16. Prescription Behavior Surveillance System. Issue Brief. Available online. Accessed August 21, 2020. https://www.cdc.gov/drugoverdose/pdf/pbss/PBSS-Report-072017.pdf
  17. Weiss RD, Rao V. The Prescription Opioid Addiction Treatment Study: What have we learned. Drug Alcohol Depend. 2017;173 Suppl 1(Suppl 1):S48-S54. doi:10.1016/j.drugalcdep.2016.12.001