Understanding Fentanyl Abuse & Addiction

Fentanyl addiction and abuse is an increasingly serious problem in the United States. While not everyone may have heard of fentanyl, it has had a devastating impact on people who use it. In 2017, around 59% of opioid overdose deaths in the U.S. involved fentanyl; a massive increase from 2010 when fentanyl was involved in around 14% of opioid overdose deaths.¹ Understanding what fentanyl is, how it affects a person, and how to treat fentanyl addiction is going to be vital in combatting fentanyl abuse and addiction.

What is Fentanyl

Fentanyl is a synthetic opioid that is particularly dangerous due to the fact that it can be 80 to 100 times more potent than morphine.² Some fentanyl is manufactured for pharmaceutical use by medical professionals to manage severe pain issues such as cancer breakthrough pain and other chronic pain situations.³ Though some pharmaceutical-grade fentanyl is diverted for nonmedical misuse, fentanyl is also illegally manufactured in labs, primarily in Mexico, and sold as a street drug or combined with other illicit subtances.² On the street, fentanyl is known by such names as Apace, Great Bear, Tango and Cash, China Girl, China White, and Goodfellas.²

Due to their similarities, the drugs fentanyl and heroin are commonly compared to one another. Oftentimes, people believe they are purchasing heroin on the street, but are instead are getting fentanyl. Fentanyl is a much more potent opioid than even heroin and leads to many overdose deaths in unsuspecting heroin users.²

What is Fentanyl Used For?

Fentanyl has legitimate medical uses, primarily for controlling severe and/or chronic pain such as that associated with cancer. In its various prescription formulations, fentanyl may be labeled with such names as Actiq, Duragesic, Subsys, and Sublimaze.¹ When prescribed for pain control, fentanyl is typically administered through the skin as a patch, in a nasal spray, by injection, or as a lozenge.³ With its potential for powerfully reinforcing opioid effects, prescription forms of fentanyl are sometimes abused as people seek the euphoric high it creates.³

Oftentimes, people will steal or otherwise divert supplies of fentanyl patches and sell them on the street. Some people may attempt to remove the gel inside the patches—normally formulated for a slow, controlled transdermal release when used properly—to then be swallowed or injected. People may also freeze the patches and cut them into pieces, which are then placed under the tongue or in the cheek for oral absorption.³

Why is Fentanyl Addictive?

Fentanyl is what’s known as an opioid agonist which binds to and potently activates opioid receptors in the brain. When these opioid receptors are activated by fentanyl and other opioids, the person experiences pain relief, and in dose dependent manner, an associated sense of euphoria. The areas of the brain that are associated with reward are also activated, which reinforces the drive to continue or repeatedly use fentanyl.⁴ These rewarding neurochemical effects are what give fentanyl and other opioids a high potential for abuse, physical dependence, and addiction.

However, while fentanyl can deliver euphoric highs, it is also extremely dangerous. Synthetic opioids such as fentanyl were responsible for a 103% increase in overdose deaths between 2015 and 2016 and a 47% increase in overdose deaths in 2017. Although there are other drugs classified as synthetic opioids, fentanyl is responsible for most of the synthetic opioid deaths.³

Who is at Risk of Fentanyl Addiction?

Heroin users are among those who are most at risk of fentanyl addiction. Oftentimes, heroin mixed with fentanyl is sold on the street to unknowing heroin users. Other times, people use fentanyl as a substitute if heroin is not available.³ Fentanyl can also be mixed with cocaine—and not always with the knowledge of the person using it.⁵ So, even those who use other illicit drugs, such as cocaine, can also be at risk of the dangers of fentanyl, including eventual fentanyl addiction.

Despite its importance as an opioid painkiller used for legitimate medical purposes, prescription fentanyl is sometimes misused nonmedically, which increases the risk of fentanyl addiction. Nonmedical misuse may include:

• Taking the drug in excess of prescribed doses or dosing schedules.
• Using the drug in a manner not indicated by the prescription (e.g., extracting the patch gel to be injected).
• Using fentanyl that was prescribed for another person..
• Using fentanyl merely for the sake of obtaining a euphoric high.

Regardless of whether you purchase fentanyl on the street or have it prescribed by a doctor, there is a potential for abuse, physical dependence, and addiction. With all opioids, prolonged use may cause you to develop tolerance. Tolerance means that you have to take higher doses of the substance keep feeling the euphoria you experience the first few times you use it. As you begin to take more and more fentanyl to keep chasing this euphoria, you can develop dependence. When a person stops taking a substance they are physically dependent on, withdrawal symptoms can occur. It sets up a vicious cycle and it is easy to then slip into addiction, where you have a compulsive need to take fentanyl despite the consequences it creates when you use it.⁴

What are the Side Effects of Taking Fentanyl

Fentanyl, like all opioids, has a number of potential side effects when used. These side effects of fentanyl can range from mild to debilitating, and even deadly, in some cases.

Side effects of fentanyl abuse can include:^{1, 6}

• Euphoria.
• Dizziness.
• Confusion.
• Sedation.
• Loss of consciousness.
• Nausea.
• Vomiting.
• Constipation.
• Constricted pupils.
• Itchy skin.
• Warm skin.
• Respiratory depression, or slowed breathing.

Fentanyl abuse can easily result in dangerous respiratory depression, come, hypoxic brain injury, and overdose deaths. ¹

Fentanyl and Drinking

Mixing fentanyl with alcohol is especially dangerous. Alcohol increases some of the potentially dangerous effects of fentanyl on the body, such as a slowing of respiratory drive, which increases the risk of overdose.^{6, 7} Recent statistics show that alcohol was a factor in 11% of synthetic opioid overdoses that involved another substance.⁸

Consequences of Long-Term fentanyl use

Long-term fentanyl use can lead to:⁶

• Significant physiological opioid dependence (and withdrawal, when use stops).
• Increased likelihood of addiction, or an opioid use disorder.
• Worsened depression.
• Problems controlling impulsive behaviors.
• Chronic constipation.
• Sexual dysfunction in men.
• Menstrual issues in women.
• Diminished nutritional status and weight loss.

Signs and Symptoms of Fentanyl Addiction

Fentanyl addiction is diagnosed as what’s known as an opioid use disorder (OUD) based on the presence of several criteria.

These potential signs, symptoms, and characteristic behavioral changes used to make a diagnosis of an opioid use disorder involving fentanyl may include:

• Cravings for fentanyl.
• Tolerance, which means you need more fentanyl than before to get the same euphoric rush.
• Family and other interpersonal conflict over using fentanyl.
• Not fulfilling responsibilities at home, work, or school due to using fentanyl.
• Giving up things you used to love, such as hobbies, in order to use fentanyl.
• Using fentanyl in risky situations, such as swimming or driving.
• Continued use of fentanyl even though it makes a physical or mental issue worse.
• Using more fentanyl or using it for longer periods of time than intended.
• Spending a lot of time finding, using, and recovering from using fentanyl.
• Trying and failing to reduce or stop using.
• Experiencing signs of physical withdrawal when trying to cut back or stop using.

Fentanyl Withdrawal: Can I quit on my own?

Some people may make attempts to quit fentanyl on their own, perhaps by going “cold turkey.” Fentanyl and other opioids are powerfully addictive and their use can lead to the development of significant physical dependence; withdrawal from fentanyl and other opioids can be unnecessarily difficult without medical intervention. The supervision and support provided through professional medical detox, including certain treatment medications, can make this process much less unpleasant.

Left unmanaged, when you stop taking fentanyl, you may start to experience certain withdrawal symptoms, which could include: ^{6, 10}

• Anxiety.
• Agitation.
• Insomnia.
• Increased blood pressure and pulse rate.
• Nausea and vomiting.
• Stomach cramps.
• Diarrhea.
• Muscle aches.
• Sweating.
• Cold flashes.
• Goose flesh.
• Running nose.
• Excessive yawning.

While some of these symptoms may not sound awful in isolation, many people find opioid withdrawal extremely difficult to manage alone. Detoxing without medical intervention leads to needless suffering when other options for a medically supervised treatment are available.¹¹ In a supervised detox program, the staff will help you cope emotionally and physically with withdrawal from fentanyl. There are numerous medications that your doctor can administer to help control your symptoms of withdrawal to make your fentanyl detox as pleasant as possible.¹¹

Are You Struggling with Fentanyl Addiction?

When reading this article and looking over the potential signs and symptoms of fentanyl addiction, do you recognize any of them in yourself or a loved one? Are you looking for help, but are unsure where to start? If you answered yes to either of these questions, know that fentanyl addiction treatment has helped many recover from opioid use disorders and American Addiction Centers can help. We operate confidential helpline 24/7 staffed by a compassionate team who’s sole mission is to help you take the next step in a sober life.