Fentanyl abuse is currently the driving force behind the United States’ opioid epidemic. This powerful drug is one of the most addictive opioids on the market. With a potency 50-100 times stronger than morphine, the likelihood that a user will overdose is high. Individuals who develop addictions to the drug not only suffer severe consequences in their lives, they also put themselves at a high risk of a life-threatening overdose.
Due to the debilitating withdrawal symptoms that occur when a person tries to stop using the drug, however, it is very difficult to quit this drug without outside help. Understanding the nature of the drug is essential to formulating a fentanyl addiction treatment plan and recovering from the drug’s devastating effects.
What is Fentanyl?
Fentanyl is a synthetic opioid. Opioids are a class of drugs that are derived from the opium poppy. Opium and its byproducts have been used for thousands of years for medical, religious, and recreational purposes. In the last few hundred years, scientists have managed to manufacture stronger and stronger opioids, which range from heroin to oxycodone.
Synthetic opioids like fentanyl, which share a chemical structure with other opioids but are produced in a lab using entirely artificial means, are capable of being far stronger.
Fentanyl is a legal prescription opioid analgesic. This means that, like other common addictive opioid painkillers, it is used primarily to treat severe and chronic pain. It is often given to patients in hospitals who are experiencing acute pain, either following an injury or to help with the pain associated with surgical operations. This potent painkiller is also often prescribed to individuals with chronic conditions that cause extreme pain, such as cancer.
Unfortunately, liberal prescribing practices and aggressive marketing campaigns by the pharmaceutical industry have resulted in this legal painkiller being prescribed to many people who could just as easily benefit from a weaker drug. As a result, in the last decade fentanyl prescriptions have soared.
Many people mistakenly assume that if a drug is legal, then it must be safe. This couldn’t be further from the truth when it comes to fentanyl, which not only poses a high risk of addiction but a high risk of overdose as well. Even people who take their prescriptions exactly as prescribed are likely to develop some degree of physical dependence on the drug.
Due to the drug’s euphoric effects and the fact that tolerance to these effects develops relatively quickly, even people with legitimate prescriptions are often tempted to misuse or abuse their medication. A significant percentage of people who develop opioid addictions started off using legal opioid painkillers like fentanyl.
However, not everyone begins abusing the drug using a medical prescription. Fentanyl is also a popular street drug. The vast majority currently being sold on the street is produced in illicit laboratories run by criminal organizations. Because this drug is so potent in small doses, it is easy for drug dealers and distributors to move their product around undetected.
It is also common for drug dealers to add or substitute fentanyl for other drugs, such as heroin. Adding fentanyl is a cheap way for drug dealers to increase the perceived potency of other recreational opioids.
Unfortunately, they often do not tell their buyers that the drug has been added. The result is users unwittingly expose themselves to an opioid that is many times more potent than heroin. For this reason, overdoses are common among recreational drug users, even drug users who had no intention of taking fentanyl.
How Do People Take Fentanyl?
Fentanyl is a narcotic pain reliever that comes in many different forms. Prescriptions are available via a variety of routes of administration. The most common formulations of prescription are the transdermal patch, spray, lozenges, and tablets.
These formulations have differing rates at which people experience effects, but they are all extremely powerful and addictive. All formulations of fentanyl carry a high risk of addiction and overdose.
The two most common formulations are the transdermal patch and sublingual tablets or lozenges. The patch can be placed on the skin. It is designed to deliver a steady dose of fentanyl over a 48 hours period, making it ideally suited to people suffering from chronic pain.
Sublingual formulations like the fentanyl tablet or lozenge, however, are designed to provide a quick-acting dose of the drug to treat sudden acute pain. In recent years, the fentanyl lollipop has emerged as another popular quick-acting formulation.
While quick-acting formulations of fentanyl, such as the tablet or lozenge, are the most immediately obvious choices for any would-be abuser, the patch is also widely misused. Individuals can scrape off the sticky gel-like substance on the back of their patch in order to consume it more quickly. This psychoactive gel-like substance can be injected right into the bloodstream, brewed into a tea, or dried out and smoked.
Doing so is extremely dangerous since the dosage contained on the back of a single fentanyl patch is designed to last for over 48 hours. Consuming such a high dosage of an already very potent drug can easily lead to a fatal overdose.
Illicit fentanyl often takes the form of powder. While some people specifically seek out fentanyl on the street, it is far more common for people to accidentally consume the drug that has been added to other drug products, such as heroin or cocaine.
The fentanyl additive can make drugs seem more potent, but it increases the risk, since people with no experience taking are likely to have insufficient tolerance to handle the drug — and even people who do have experience with the drug can experience an overdose if they make the slightest miscalculation in their dosage.
What Causes Fentanyl Addiction?
When fentanyl activates opioid receptors, these receptors release high quantities of dopamine in the brain. Dopamine is a neurotransmitter that is in large part responsible for the extreme feelings of pleasure and euphoria that occur during a fentanyl high. Dopamine causes pleasure because its purpose is to reinforce behaviors and make people return to them again and again. It plays an essential role in the brain’s motivation and decision-making centers.
Dopamine is naturally released during many activities, including sports, accomplishing goals, and sex. Fentanyl releases quantities of dopamine far exceeding any other activity. Each time a person uses the drug and experiences a surge in dopamine, their drug-taking behavior becomes further reinforced. In this sense, it is able to “hijacks” the brain.
Over time, the brain and body adapt to the effects of the drug. Fentanyl is a central nervous system (CNS) depressant, which means that it inhibits the activity of the brain and body. Over time, the central nervous system learns to balance the effects of opioids by increasing its activity.
As a result, the same dose of fentanyl gradually becomes less effective over time. This phenomenon, known as tolerance, means that people need to take high doses of the drug to achieve the effects to which they are accustomed. When people take higher or more frequent doses to get high, their physical dependence on the drug becomes even stronger.
Once a person has developed a physical dependence on it, they will find it difficult to stop taking the drug. When they reduce their dosage or stop taking fentanyl, they will experience withdrawal. The symptoms of fentanyl withdrawal are both physically and emotionally excruciating.
Fentanyl withdrawal is very painful and makes it difficult for a person to function. This makes it very difficult to stop using the drug. When people have a physical dependence on fentanyl, they will likely stop at nothing to avoid the miserable symptoms of opioid withdrawal.
People who are trying to avoid withdrawal will often turn to other opioids, such as heroin, which are often far cheaper and easier to obtain. For this reason, it is often helpful to recognize that fentanyl addiction is a kind of opioid addiction. Individuals who were prescribed the drug and would never normally use “street drugs” can thereby become heroin addicts. In fact, the vast majority of heroin users started off taking prescription opioids.
But is there a difference between physical dependence and addiction on fentanyl? Yes. In fact, it is crucial to understand that physical dependence and addiction are distinct phenomena. While physical dependence is, by definition, a bodily condition, addiction is a mental health disorder.
When people suffer from fentanyl addiction, they are unable to stop using it no matter how much they want to. They often often recognize the harms that the drug abuse has inflicted on their lives, but they are generally powerless to stop using it.
Physical dependence and addiction to fentanyl generally go hand in hand, but not always. Some people, for instance, do manage to withdraw successfully from the drug, at which point they no longer experience withdrawal symptoms or physical dependence.
However, people who suffer from fentanyl addiction will continue to experience cravings and obsessive thoughts about opioids. For this reason, it is common for people to relapse on opioids even after going through all the trouble of withdrawing from them. They may recognize their relapse as irrational, and they may have a strong desire to stay off of opioids, but fentanyl addiction makes them powerless to control their own decisions.
For this reason, it is crucial that people suffering from fentanyl addiction get outside help. Withdrawing from fentanyl and achieving physical abstinence is not sufficient for long term sobriety. Engaging in an addiction treatment plan and getting support from an outpatient treatment center is essential for anyone hoping to recover from this debilitating — and often fatal — addiction.
Signs and Symptoms of Fentanyl Addiction
Fentanyl addiction is a legitimate mental health condition. The clinical term for fentanyl addiction is “opioid use disorder.” The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which psychiatrists and mental health professionals use to diagnose mental health disorders, recognizes opioid use disorder. Opioid use disorder can occur on a wide range of intensities, and the symptoms of opioid use disorder vary from person to person.
For this reason, the DSM-5 lists 11 distinct symptoms of fentanyl addiction. Mental health professionals diagnose the disorder along a continuum. Individuals showing 2-3 symptoms are said to suffer from mild opioid use disorder. Those demonstrating 4-5 symptoms are said to suffer from moderate opioid use disorder, and people with more than that are considered to have severe opioid use disorder.
The eleven symptoms of opioid use disorder are:
- A person often takes opioids in larger amounts or over a longer period of time than they intend to
- A person has a persistent desire to cut down or control their opioid use, but they are often unsuccessful
- A person spends a large portion of their time in activities necessary to obtain, use, or recover from the effects of fentanyl abuse
- They experience cravings, or a strong desire to use fentanyl or other opioids
- Their regular use results in failures to fulfil role obligations at work, school, or home
- Fentanyl or opioid use continues despite the occurrence of persistent social or interpersonal problems caused by or worsened by the effects of opioids
- Important activities are given up in order to engage in the drug abuse
- Using fentanyl or other opioids in situations in which it is physically hazardous, such as driving while under the influence
- Continuing to use the drug despite knowing that one has a persistent or recurrent physical or psychological problem that is caused by or exacerbated by opioids
- Developing a tolerance, causing one to need increased quantities of opioids to achieve the desired effect
- Suffering from opioid withdrawal symptoms
However, for concerned friends and family members, looking at the official diagnostic criteria for an opioid use disorder is not sufficient. Individuals who are abusing drugs and alcohol often go to great lengths to hide their substance abuse. They may do so partly out of shame, due to the stigma that surrounds addiction, but they may also want to avoid detection so that their loved ones do not put any obstacles in between them and their next “fix.”
Since young people are not always 100% honest about their substance abuse habits, it is often a good idea to look out for common physical and behavioral symptoms of fentanyl abuse.
Obviously, individuals who have been prescribed fentanyl or another related opioid painkiller are the most obvious candidates for addiction, but anyone – even people without a chronic pain condition – can acquire the drug.
Common signs and symptoms of fentanyl addiction include:
- Unusual drowsiness
- Notable weight loss (and in some cases weight gain)
- Changes in sleep habits
- Frequent flu-like symptoms
- Lack of attention to personal hygiene and grooming
- Changes in exercise habits
- New financial difficulties
- Dealing with friends, family, classmates, or colleagues
- Isolating from friends or family
- Decreased libido
- Uncontrollable cravings
- An inability to control opioid use
- Losing jobs or failing classes
- Problems with the law
If someone in your life is exhibiting these signs, it is often a good idea to have a frank discussion with them about their substance abuse. If it becomes clear they are abusing fentanyl, help them understand that they need outside help in order to manage their addiction.
They may be in denial about wanting to quit, or they may deny having an addiction altogether, but more likely than not they have recognized the harms of fentanyl and made at least one unsuccessful attempt to quit already.
Make sure they know you are on their side and help them locate an outpatient treatment center, and chances are they will at least be open to the idea.
Part of the reason fentanyl is so difficult to quit is that once a person has developed a physical dependence on the medication, they experience opioid withdrawal symptoms when they cut down their dosage – and especially when they stop taking fentanyl completely. Opioid withdrawal is one of the most painful and arduous drug withdrawal experiences in existence, and it tends to progressively get worse over the course of the detoxification process.
People with a strong desire to stop taking fentanyl may begin this process, only to relapse midway through. No matter how strong a person’s will power is at the beginning of the process, the certain knowledge that taking another dose of fentanyl will relieve their suffering tends to weaken their resolve dramatically. For this reason, it is crucial to get outside help and support during the withdrawal process.
Common symptoms of fentanyl withdrawal include:
- Insomnia and restlessness
- Increased sweating
- Watery eyes and runny nose
- Irritability and anxiety
- Stomach cramps, nausea, and diarrhea
- Overall weakness
- Muscle, joint, and bone pain
- Widened pupils
- Increased heart rate
- High blood pressure
- Rapid breathing
- Mood problems
- Shaking, chills, ad goosebumps
- Intense cravings
Fentanyl Withdrawal Timeline
Fentanyl has a relatively short half-life, meaning it is halfway processed and eliminated from the body in 8-10 hours. For most formulations of the drug, especially quick-acting sublingual formulations, the acute withdrawal symptoms generally begin between 2 to 4 hours after a person’s last dosage.
For people taking the patch, acute withdrawal symptoms often begin somewhat later, due to the slow-release delivery system of the transdermal patch. For individuals taking the patch, withdrawal symptoms often start 24 to 36 hours after the patch has been removed.
Acute fentanyl withdrawal tends to become more intense and painful over a few days. The peak withdrawal effects generally occur after two to four days. At this point, the physical and emotional symptoms of fentanyl withdrawal are at their most severe.
During peak withdrawal, individuals are also likely to experience the strongest cravings for fentanyl — or ultimately for any opioid that can relieve their misery. It is important to understand that peak withdrawal is relatively short-lived and that it is possible to get through it.
In fact, fentanyl withdrawal generally lasts approximately one week. While symptoms rarely completely disappear after this time, most people begin to experience an abatement of withdrawal symptoms after 7 days. It is common for people to experience a few new ones sometimes as acute withdrawal becomes less severe.
Common long-term withdrawal symptoms include:
- Anhedonia (the inability to experience pleasure)
- Relapse dreams
- Negative feelings, such as remorse, guilt, self-loathing, anger, and low self-esteem
- Being on a “pink cloud”: ie, feeling excessively happy about being drug-free and ignoring the realities of one’s life
A small percentage of people experience a few symptoms of acute withdrawal for additional weeks, months, or even years after quitting opioids. This phenomenon, known as post-acute withdrawal syndrome (PAWS), is little understood. Generally, the symptoms are not as severe as those experienced in the initial days of withdrawal, but without a support system, the symptoms of PAWS can be distracting and sometimes debilitating.
These long term symptoms, while not as obviously severe as acute withdrawal symptoms, can often drive people to relapse. For this reason, getting long-term addiction treatment in an outpatient program is essential not just for acute withdrawal, but for the period of time following withdrawal as well.
Long Term Consequences of Fentanyl Addiction
People addicted to fentanyl face a wide range of long term consequences, some of which are due to the direct effects of the drug, and some of which are due to the nature of addiction itself. To begin with, addiction to any substance causes people to prioritize their substance use above all else.
Given the drug’s potency and high potential for physical dependence, this effect is especially notable for fentanyl. People addicted to it are likely to stop engaging in activities and hobbies that once gave them joy. Many tend to isolate from friends and family members so that they can engage in substance abuse. Loneliness and isolation are common consequences of opioid addiction, and moreover, loneliness is a significant factor that can motivate further substance abuse.
Over time, it is common for fentanyl addicts to stop functioning in essential areas of their lives, including school and work. At best, this can reduce their chances of achieving their ambitions, but more commonly the harms are even more severe: many people drop out of school or lose their employment entirely. Financial problems can accumulate, resulting in homelessness.
A strong desire for drugs combined with financial ruin can drive people to engage in criminal activity, such as theft, which can entrench them in legal as well as financial problems. These problems can feel insurmountable, driving people to abuse opioids as a form of escapism.
Long term fentanyl abuse also inflicts a wide range of harms on a person’s physical and mental health. Sustained fentanyl use increases the risk of anoxic injury (damage to body tissues due to significantly decreased oxygen) as well as multiple organ system damage. Physical health problems, whether related or unrelated to fentanyl abuse, tend to go untreated, putting people at significant risk.
Fentanyl addiction can also lead to the development of or worsen mental health conditions. Addiction tends to lead to moodiness and emotional problems, but long term use can cause people to develop permanent mental illnesses, including major depression and anxiety disorder.
Like many of the other consequences of fentanyl addiction, mental health disorders can cause people to engage in further substance abuse to get temporary relief from their emotional distress.
Fentanyl addiction also has a high likelihood of leading to other forms of drug abuse. In fact, the vast majority of people who abuse heroin began by using prescription opioid painkillers like fentanyl. Why do people switch to heroin? Ultimately, prescription opioids can be expensive and are often difficult to come by.
No matter how uncomfortable a person may feel about using so-called “street drugs,” once an opioid addiction has developed, few people have objections to purchasing cheap and widely available drugs that satisfy their needs.
As a result, addicts may turn to a wide variety of opioids. They may also consume other drugs alongside their opioids, such as cocaine, crack, crystal meth, or alcohol, either accidentally, as a way to “take the edge off” of withdrawal symptoms, or to “improve” the effect of opioids. This kind of polysubstance abuse increases the dangers – especially the risk of overdose.
By far the greatest risk of fentanyl abuse, in both the long and the short term, is the risk of a life threatening overdose. Between the years 1999 and 2018, over 232,000 people in the United States died as a result of a prescription opioid overdose. It is important to recognize that anyone who uses this drug puts themselves at risk of dying prematurely.
Fentanyl is extremely potent, and illicitly produced analogs such as carfentanil can be 10,000 times more potent than morphine. New users obviously face a high risk, but even people who have developed a tolerance for opioids can easily overdose if they make even the slightest miscalculation in their dosage.
How does a fentanyl overdose occur? Fentanyl is a central nervous system (CNS) depressant, meaning it inhibits the functionality of the central nervous system. The CNS is responsible for managing and coordinating all brain and bodily functions, including automatic life-sustaining processes like breathing. When a person takes a high dose of the drug that is too much for their body to handle, they can suffer from central nervous system depression.
A fentanyl overdose symptoms are:
- Low body temperature
- Respiratory depression (slowed or entirely stopped breathing)
- Stupor, loss of consciousness, or coma
- Small pupils
Due to fentanyl potency, overdosing on the drug can result in death very rapidly — often in a manner of minutes or even seconds. However, overdoses can be reversed if they are treated immediately. If a person is overdosing on this drug or any other opioid, they can be saved by being administered naloxone. Naloxone, an opioid antagonist that can be administered through a nasal spray, immediately reverses an opioid overdose.
While naloxone can save lives if it is applied in time, it is important to understand that it sends a person into immediate opioid withdrawal, which generally requires treatment. It is also common for a person to re-enter fentanyl withdrawal once naloxone wears off. For this reason, it is crucial that anyone overdosing be provided with the medical support they need.
Outpatient Fentanyl Addiction Treatment
Fentanyl addiction is a debilitating medical condition that wreaks havoc on a person’s life. No matter how much a person desires to stop using this or other opioids, if they suffer from an addiction they will be unable to stop on their own. People who narrowly escape dying after a fentanyl overdose generally return to substance abuse shortly thereafter.
Many people withdraw from fentanyl, an arduous and painful process, only to relapse some time later. A person may recognize the extreme harms that their addiction is inflicting, but no matter how much they desire to stop, they will generally find that their own personal will power is insufficient.
Getting treatment for fentanyl addiction at an outpatient treatment center is essential. The withdrawal process alone generally requires a great deal of support and supervision. Detoxing from fentanyl is far easier in a safe, trigger-free, and supportive environment. Many opioid addicts benefit from slowly tapering their opioid dosage under medical supervision.
At an outpatient treatment center, clients can also take advantage of medication-assisted treatment, which utilizes a combination of behavioral therapy and medication to mitigate the symptoms and cravings associated with opioid withdrawal.
Beyond the detox phase, however, treating the underlying addiction is crucial to preventing relapse. Research shows that individuals who engage in addiction treatment programs over a long term basis have far lower chances of relapsing.
By addressing the problems and issues that are motivating a person’s substance abuse, formulating plans to deal with common triggers, and rebuilding lives from the ground up, outpatient treatment programs ensure that individuals can not only achieve physical abstinence from fentanyl, but develop sober lives that are happy, joyous, and free.