Fentanyl was developed in a laboratory more than half of a century ago as a synthetic opioid drug designed to treat severe pain. Per the Journal of Pain, it is one of the most common medications used during surgical operations for pain management.
The National Institute on Drug Abuse (NIDA) publishes that it is 50 to 100 times more potent than morphine. It is available for medical use in intravenous (Sublimaze) and rapid-onset form for use in hospitals, in a transmucosal form like lozenges (Actiq) that are absorbed through the mouth often for breakthrough pain, and in patches (Duragesic), or transdermal formats, that are beneficial for chronic pain.
The demand for black market opiates has skyrocketed in recent years, and with it, the search for cheaper and easier ways to obtain these drugs. Since fentanyl is synthetic, it can be manufactured illegally in clandestine laboratories. This also makes it an ideal cutting agent for other drugs like heroin and diverted prescription painkillers, helping to stretch these products further, often without the knowledge of the person taking them.
According to CNN, much of the illegal fentanyl is manufactured in China and smuggled over into Mexico and then up through the southwestern border of the United States. The drug is also being sent through the mail; it is ordered online, often disguised as a research chemical, and delivered via the U.S. Postal Service. Illicit fentanyl is often laced into heroin or cocaine, or pressed into counterfeit prescription medication tablets. Fentanyl is a Schedule II controlled substance by the U.S. Drug Enforcement Administration (DEA) as it does have medicinal use as a pain reliever; however, it is also diverted, manufactured illegally, and a dangerous drug of abuse.
Hazards of Use
Fentanyl is a depressant drug. This means that it slows down some of the functions of the central nervous system like heart rate, respiration, and blood pressure. It lowers body temperature while blocking pain sensations, and it reduces anxiety by minimizing the body’s fight-or-flight stress reaction.
In addition to lessening feelings of intense pain, fentanyl leaves a person feeling mellow and relaxed. It can also act as a sedative, making a person sleepy and sluggish while impairing thought and memory processes.
Fentanyl is absorbed across the blood-brain barrier, quickly taking effect. One of the most dangerous potential health risks of fentanyl is a possibly life-threatening overdose, as the drug acts on many autonomic and life-sustaining functions.
Fentanyl can have many other possible side effects as well, as published by the National Library of Medicine (NLM).
- Dry mouth
- Chest pain
- Back pain
- Drowsiness
- Vision changes
- Anxiety
- Depression
- Heartburn
- Gas
- Stomach pain
- Tremors
- Hallucinations
- Cognitive difficulties
- Weight loss
- Urination issues
- Sleep difficulties
- Disturbed dreams
- Unusual thoughts
- Swelling of extremities
- Skin irritation, rash, itching, and hives
- Red face, neck, or chest
- Erectile dysfunction
- Agitation
- Disrupted menstruation
- Decreased sex drive
- Heartbeat irregularities
- Dizziness
- Muscle weakness
- Nausea and vomiting
- Constipation
Most of these side effects will wear off when a person stops taking the medication. Long-term fentanyl use, however, can lead to drug tolerance, dependence, and withdrawal symptoms. When fentanyl enters the bloodstream, it binds to opioid receptors in the brain and interacts with its chemical makeup by causing a backlog of neurotransmitters, such as dopamine. This is one of the brain’s naturally occurring chemical messengers that is involved in things like mood regulation, feelings of pleasure, movement abilities, and sleep functions. High levels of dopamine in the brain make a person feel good initially, but they also impair normal sleep, thinking, memory, and movement abilities.
Repeated interaction of fentanyl in the brain causes it to get used to the drug being present and interacting the way it does. The brain will then stop producing and absorbing dopamine the way it did before fentanyl was involved. A tolerance can form, which can mean that the regular dosage of fentanyl will no longer be effective, and a person will need to take more of the medication for it to work.
Beyond tolerance is drug dependence, wherein the brain now relies on fentanyl to be present and can no longer regulate its chemical makeup on its own without the drug. Physical dependence on fentanyl can form rather quickly, and difficult withdrawal symptoms and drug cravings can set in when fentanyl wears off.
Long-term use of fentanyl can affect the immune system, potentially making a person more prone to disease and illness. The journal the Primary Care Companion for CNS Disorders also warns that long-term and chronic use of an opioid medication may lead to an increased risk for fractures, cardiovascular events, respiratory system issues, gastrointestinal problems such as constipation, and hormonal imbalances.
Abuse of Fentanyl
The extreme euphoric high produced by fentanyl and opioid drugs make them a target for abuse. On the streets, fentanyl is referred to by many names, including:
- China White
- Apache
- China Girl
- He-Man
- Tango and Cash
- Goodfellas
- Dance Fever
- Poison
- Great Bear
- Friend
- Murder 8
- TNT
Fentanyl is often disguised as other medications in counterfeit form, or mixed in with cocaine or heroin when sold on the streets, as it can be indistinguishable from them. It may come in a white powder form on its own or be spiked on blotter paper. It can also be a desirable drug of abuse when a person is already tolerant to other opioids and may be seeking out a more intense and powerful high.
At the time of the 2016 National Survey on Drug Use and Health (NSDUH), nearly 3.5 million Americans were considered to be currently abusing prescription pain relievers, and this does not even account for illicit fentanyl abuse.
The U.S. Centers for Disease Control and Prevention (CDC) publishes that from 2013 to 2014, overdose deaths involving a synthetic opioid like fentanyl, not including methadone, spiked 80 percent, and most of these deaths are believed to have involved fentanyl that was manufactured illegally. Overdose death rates are one way that abuse of a drug like fentanyl is measured. A rise in overdose fatalities indicates an increase in abuse of the drug.
Recognizing Abuse
Fentanyl is a drug that may be abused unintentionally in combination with another drug or on its own on purpose. Abuse of fentanyl may begin with a licit and medically necessary prescription. Since fentanyl and opioid drugs are considered to be habit-forming, even using them as prescribed can lead to dependence, which can then make it difficult to stop taking the drug even when there is no longer a medical need for it.
Any time a person takes fentanyl outside of a prescribed need for it, and without a health professional’s direction, is classified as abuse. A person may go to great lengths to obtain more fentanyl after a prescription has run out, exaggerate symptoms to get more fentanyl, go to multiple doctors (called “doctor shopping”) to try and get more fentanyl, take fentanyl in between or in higher doses than prescribed, or take fentanyl in a way other than as intended.
Abuse of fentanyl may include scraping the gel off the patch and smoking or injecting it; sucking on patches; crushing and snorting, smoking, or injecting fentanyl tablets; or any other nonmedical use of the drug. A person under the influence of fentanyl often resembles someone who is intoxicated by alcohol. Their movements are often uncoordinated and sluggish; balance and reflexes are impaired; speech is slurred; and they may be drowsy or pass out.
Fentanyl also interacts with rational thought and can make it more likely for a person to act erratically and in ways that are out of character. Inhibitions are lowered, and a person is more liable to take bigger risks than normal without thinking through the consequences.
Fentanyl Addiction
Fentanyl abuse can quickly become difficult to control, and compulsive drug use is often the result of repeated fentanyl abuse. An inability to control how much and how often fentanyl is taken, and unsuccessful attempts to stop taking the drug (even when a person wants to) are symptoms of fentanyl addiction. There are additional warning signs of fentanyl addiction.
- Appetite changes and unhealthy weight loss
- Irregular sleep patterns
- Loss of interest in most activities and recreational events, even ones that were important before drug abuse began
- Changes in social circles
- Increased secrecy and social isolation
- Lack of consideration for regular obligations, which can lead to lowered work production, family troubles, and failing grades
- Unpredictable mood swings
- Unexplained packages in the mail from overseas and increased time spent online
- Memory lapses and concentration problems
- Higher rate of accidents, illness, and injuries than normal
- Financial problems
- Potential legal issues and brushes with law enforcement
- Disinterest in physical appearance and concern for personal hygiene
Someone struggling with fentanyl addiction likely spends the majority of their time consumed with thoughts of the drug—figuring out how to get it, using it, and recovering from using it. They will continue to take fentanyl even though they know it comes at a great personal cost to do so.
Typically, fentanyl addiction will lead to social, emotional, financial, physical, occupational, and interpersonal issues. It will negatively affect many facets of a person’s life as well as the lives of those close to them. The American Society of Addiction Medicine (ASAM) reports that around 2.5 million American adults battled addiction involving an opioid drug in 2016.
The Opioid Overdose Epidemic
Fentanyl is a highly potent drug that USA Today warns can be lethal in as little as 2 milligrams. It can even be absorbed through the skin on contact or breathed in through the air by accident.
In 2017, NIDA estimates there were close to 30,000 deaths from synthetic opioid drugs in the United States, the majority of which were thought to involve illicitly made fentanyl. Overdose rates involving fentanyl continue to rise partly due to the drug’s potency and partly because people don’t even realize they are taking fentanyl.
Drugs that are seized and then tested in laboratories are increasingly testing positive for fentanyl. Drug submissions containing the drug rose nearly 430 percent between 2013 and 2014, the CDC reports. The opioid overdose rate in the United States is considered an epidemic today, and fentanyl is being called the “third wave” of this crisis. Combining fentanyl with another central nervous system depressant, such as heroin, another painkiller, alcohol, or a benzodiazepine drug, can greatly increase the odds of a lethal overdose.
A fentanyl overdose is recognizable by pinpoint pupils, cold skin that may have a bluish tint to it, mental confusion, nausea and vomiting, breathing problems, weak pulse, and drowsiness or loss of consciousness. When a person overdoses on fentanyl, one of the biggest concerns is the way the drug interferes with the respiratory system, even causing a person to stop breathing altogether.
A fentanyl overdose is a medical emergency, requiring immediate medical attention and the administration of the opioid antagonist drug naloxone that can help to reverse the overdose. Due to the potency of fentanyl and the likelihood that the drug is combined with another substance, more than one dose of naloxone will often be needed to overturn the effects. A fentanyl overdose can cause a person to fall into a coma, suffer brain damage, or even die without swift medical intervention.
Withdrawal and MAT
Fentanyl can trigger significant withdrawal symptoms once a physical dependence has formed. This means that if a person tries to stop taking it after using it regularly for a length of time, they will likely suffer from symptoms that are similar to a really bad case of the flu, such as muscle aches, fever, irregular heart rate, nausea and vomiting, chills and sweats, runny nose, and watery eyes. They also may experience intense cravings for the drug and emotional distress. Anxiety, depression, irritability, agitation, restlessness, trouble thinking clearly and remembering things, concentration issues, and trouble sleeping also are common side effects of fentanyl withdrawal. These withdrawal symptoms make it hard to stop taking fentanyl since it seems easier just to keep taking it to take the edge off and keep these symptoms at bay.
It is not recommended to stop taking fentanyl suddenly because of the intensity of the withdrawal syndrome. Even when taken as directed for a medical reason, health professionals will typically set up a tapering schedule to wean the body and brain off the powerful opioid. Fentanyl may be replaced with another opioid drug (one that is longer lasting and less potent) during withdrawal to slowly rebalance the brain’s chemistry without shocking the system through Medication-Assisted Treatment (MAT).
The more significant the dependence and the longer a person has been using the drug, the more likely necessary MAT is. The presence of a co-occurring mental health or medical disorder, the combination of fentanyl with other drugs, or an unstable and stressful living environment all make MAT an optimal option for withdrawal.
Getting Help for Abuse and Addiction
Medication-Assisted Treatment addresses physical dependence on the drug, but it’s only the beginning of comprehensive treatment. Behavioral therapy, such as cognitive behavioral therapy (CBT), helps to change the way a person thinks to motivate positive changes to their actions. Fentanyl abuse may be a coping mechanism to alleviate stress, for instance, and CBT can teach people to form healthier habits. Tools for minimizing relapse and controlling cravings are also discussed during group and individual therapy sessions.
Support groups and 12-step programs can provide tips and encouragement from peers, helping to build a support system. Additional supportive measures, such as exercise programs, nutritional planning, massage therapy, and forms of creative expression, can all be helpful to the healing process during addiction treatment as well.
