Fentanyl Addiction and Abuse: A Complete Guide

Last Updated: July 5, 2021

Authored by Sharon Levy, MD, MPH

Reviewed by Michael Espelin APRN

Fentanyl drug is a popular opioid analgesic used in the treatment of severe pain, and it is highly addictive. People who take it for medical reasons can quickly develop tolerance and get addicted to the drug. It can also happen with those who want to experiment with its recreational properties. In addition, Fentanyl addiction leads to severe withdrawal symptoms and can cause death. It’s important to know all the information about the drug’s dangers and addictive properties before using it.

What Is Fentanyl?

Scientists first created the medication in the 60s for the treatment of pain-related symptoms. Since then, it has been the cause of pain instead of treatment.

Fentanyl drug is a very addictive opioid analgesic. In fact, it is more potent than morphine and heroin. Additionally, it’s very effective as a painkiller with a short onset of action. As a result, many people who suffer from chronic pain (due to cancer, surgery, etc.) use it. However, when the effect of the medication wears off, patients usually go back to it. Addicts see it as the only way to cope with the reappearing pain.

The Opioid Can Be Found In Different Forms:

  • Patches
  • Films and tablets that dissolve in the mouth
  • Lollipops
  • Sprays
  • Injectable liquid

That might sound harmless, but the truth is that this opioid is very potent, and it doesn’t matter how it was used: by fentanyl patches or lollipops. What is more, its rapid onset of action contributes to its powerful properties.

Besides, the drug has a short duration of effect. Consequently, it makes people go back to it over and over again when fentanyl leaves the system and the pain and withdrawal reappear.

Fentanyl Patch

A Fentanyl patch falls into the category of narcotics. Doctors usually prescribe it when a person suffers from chronic pain, and patients can easily apply it to the skin. This patch is also known as transdermal fentanyl; it works by releasing regular doses over a given period of time.

Woman suffering abdominal pain.

The patch is usually applied once every 72 hours and comes in various dosage amounts: 12.5 micrograms/hour and 100 micrograms/hour. The dosage depends on the patient’s prior medical condition and opioid tolerance.

A fentanyl patch is used to manage severe chronic pain when a constant, non-stop treatment is needed over a more extended period. A fentanyl patch provides permanent pain relief, mitigating the patient’s situation.

Lollipop

A fentanyl lollipop is an opioid medication, also known by its brand name – Actig. Unlike the patch, it combines the opioid component and citrate to produce pain relief. The lollipop absorbs through the patient’s mouth’s mucous membrane.

The lollipops should only be used for treating breakthrough pain in cancer patients. That is a very slim category of use, highlighting that fentanyl drug should not be used for general pain management. Unfortunately, cancer patients experience pain on a daily basis, but breakthrough pain is different. It is defined as a short-term worsening of pain in patients who consistently experience persistent but stable pain. Among patients with moderate or severe pain, it is estimated to affect over 50% of patients.

This can be a last resort in many cases because the medication is 50-100 times stronger than morphine. Everyone must be cautious when beginning treatment with Actiq. If used for any other reason or more frequently, it’s considered fentanyl abuse and can cause an overdose.

Fentanyl During Labor

As mentioned above, this potent opioid was primarily used for cancer pain treatment. However, it can also be used in childbirth. According to NIDA, fentanyl during labor has shown to be an effective pain management option with fewer side effects for both the woman and the fetus. Fentanyl during labor provides good analgesic effects and considerably reduces the active phase. Therefore, its use is acceptable during the delivery.

In this research, 63% of pregnant recipients reported high levels of satisfaction with analgesia. Administration of fentanyl during labor reduced the pain intensity during the first stage of labor. As no health hazards were caused in infants after such pain management, fentanyl during labor can be considered a desirable drug for pain relief during childbirth.

Dangers Of Fentanyl

Usually, doctors prescribe the medicine to people who have some tolerance to opioids due to their highly addictive properties. Fentanyl use comes with health dangers, regardless of the reason for use. Even if a health professional prescribes it, the drug can cause addiction. One of the health risks is overdose on the opioid. As it is very potent, a relatively low dose can cause poisoning. According to data, it killed over 1000 people in the U.S. only between 2005 and 2007.

Doctors and patient in the hospital.

Because the drug is mainly used as a treatment within medical environments, the setting exposes many health specialists to the risk of addiction. Sadly enough, anesthesiologists are at a high risk of developing an addiction. It’s true especially about opioids, as they are the most common drug of abuse among anesthesiologists.

Many users without any history of abuse and without any attempt to try the recreational value of the substance reveal the addictive properties of fentanyl drug. Not surprisingly, doctors do not usually prescribe the medicine to teenagers. It is because young people might decide to experiment and use it for more than just pain relief. Therefore, make sure that medications are hidden from children and the close relatives won’t be able to abuse them in any way.

The drug can be found not only within medical settings but in the streets as well. There are different street names of the drug that are popular among users. China White and Dance Fever are only a couple of them. When one combines it with other drugs, it can be lethal.

Dealers often sell the medicine after mixing it with heroin or other drugs. Unfortunately, this mixture and all fentanyl-laced drugs can cause coma and death.

Fentanyl Abuse Signs And Symptoms

Part of what makes fentanyl patches addictive is its strength; the substance is estimated to be hundreds of times more potent than heroin. Although it can be used for medical reasons, such as pain management, it’s still essential to be able to identify signs of abuse. This information is necessary to avoid the risks. Due to its high level of toxicity, fentanyl addiction is extremely dangerous to one’s health. This means it’s essential to know the information about the symptoms of Fentanyl abuse and how they manifest psychologically, physically, and behaviorally. With appropriate action, fatal consequences can be avoided.

Young woman addicted to fentanyl.

The physical signs that someone is addicted are mostly the same as general pain pill abuse signs. Physical symptoms of painkiller addiction can also mimic the signs of prescribed use of the medication. The best way to determine if the symptoms are from addiction or common use is how frequently the symptoms are present and if they are becoming worse over time. If the medication is not meant for long-term use, persistent symptoms indicate a problem.

Physical Symptoms Of Abuse Are: 

  • Nausea and vomiting
  • Decreased heart rate
  • Shallow or slow breathing
  • General physical weakness
  • Trouble walking
  • Stiff muscles
  • Fainting
  • Shaking
  • Slurred speech
  • Difficulty staying awake and alert
  • Skin irritation and excessive scratching
  • Pinpoint pupils
  • Swollen limbs

It is important to note that the signs of fentanyl addiction are mostly the same as signs of painkiller use in general, so these symptoms alone cannot be used to diagnose addiction.

Psychological Signs of Abuse

As is the case with all opioids, the medication works by attaching to the opioid receptors in the brain. Given that the medicine targets the brain, one can expect that addiction will result in psychological changes.

The primary psychological symptoms of fentanyl addiction are the euphoria experienced directly after the drug is taken and the depression and confusion that follow; these are signs that will be present in all persons using the medicine due to its high potency.

Depressed man after quitting fentanyl.

While other psychological fentanyl addiction signs are not as common, they aren’t exactly rare either. Anxiety is often observed, as well as paranoia. If the user experienced either of these in the past, the degree of their symptoms might be elevated. Less common are hallucinations, both auditory and visual; this tends to only present after long-term use.

Behavioral Deviations

While psychological and physical symptoms can indicate fentanyl abuse when it comes to diagnosing opioid abuse disorder, behavioral deviations are given the most consideration; they are also the easiest to recognize.

Behavioral Signs Of Fentanyl Addiction Include:

  • The opioid is taken in larger amounts than prescribed or for longer than prescribed
  • Expressing a desire to stop using the medication or to cut down on it, but being unable to do so
  • Spending significant time or mental energy trying to obtain the drug
  • Frequently talking about opioids, indicating urges or cravings
  • Struggles with work, school, or home life
  • Engaging in dangerous behaviors, such as drugged driving
  • Fentanyl withdrawal symptoms present when the user stops taking the drug
  • Using the medication in non-indicated ways, such as chewing on patches to release the medicine faster

Of course, these are signs of addiction to pain medication in general. Unless one is sure the medication being used is fentanyl, all one can know from these behaviors is that the individual abuses opioids.

Fentanyl Addiction Treatment

Many rehab centers offer treatment for Fentanyl addiction. Inpatient and outpatient treatment facilities are available depending on the history of abuse and personal preferences.

The first step is detox. Depending on the history of abuse and some individual differences, that might take up to several days. Usually, physical withdrawal symptoms start around 24 hours after the last dosage and wear off a week later. In severe cases, doctors may use substitute drugs to help the patients. Methadone, Suboxone, and Naltrexone are some of them. However, remember that curing a drug addiction with another addictive drug can be dangerous.

Although there are inpatient and outpatient options, staying in a rehabilitation facility/residential treatment center is safer than getting clean at home. This is because of the medical help available. Also, if it comes with an addiction to another drug, one needs to address it in a rehab center.

After the physical detox, one should also treat all the emotional and cognitive health disturbances. Doctors also recommend behavioral therapy and individual sessions. In fact, all comorbidities must be treated. Often, doctors will prescribe benzos to help with insomnia and anxiety.

Three man at a behavioral therapy meeting.

However, many users advise that patients stay busy. It could include involvement in different activities and indulging in enjoyable hobbies. Additionally, healthy diets and vitamin supplements can be beneficial.

The drug is very potent, and cravings can last up to a year. Therefore, doctors usually provide patients with long-term help. Family therapy is also beneficial to help people restore their social and love life. Finally, many spiritual and holistic programs offer an alternative approach to addiction. They will provide the support the addict needs.

Find Rehab Center

Fentanyl is an extremely potent opioid painkiller that poses a lot of dangers. Drug abuse must not be ignored; otherwise, long-term adverse health reactions and even overdose become a significant risk. There are different rehabilitation centers, which offer addiction treatment. For opioid addiction, Methadone clinics may be an option. Recently, some treatment facilities provide much more than medical and psychological help. If the economic factor is not an issue, there are many luxury rehabs where one can stay. They offer alternative experiences that one can compare to a luxurious resort. For example, to help with detox, massages and exercises are part of that recovery process.

Also, they will develop individual programs to meet the patient’s needs. In addition, the facility might organize hiking, yoga, organic lifestyle, and meditation. A study shows that yoga decreases anxiety by 14.7%.

Detox is only one part of the recovery; extended treatment and aftercare are also crucial. If any signs of fentanyl addiction are noticed, the right help should be found. There’s no easy recovery process, and sometimes, patients can relapse. However, always remember that an addiction can be treated.

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Page Sources

  1. National Institute on Drug Abuse. Fentanyl and Other Synthetic Opioids Drug Overdose Deaths. 2018. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/fentanyl-other-synthetic-opioids-drug-overdose-deaths.
  2. Joanna Rudowska, Management of breakthrough pain due to cancer, 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687475/
  3. National Institute on Drug Abuse. Fentanyl. https://www.drugabuse.gov/drug-topics/fentanyl
  4. Integrating Yoga with Psychotherapy: A Complementary Treatment for Anxiety and Depression, Canadian Journal of Counselling and Psychotherapy, Pages 132–150, 2011. https://files.eric.ed.gov/fulltext/EJ930795.pdf
  5. Nonpharmaceutical Fentanyl-Related Deaths --- Multiple States, April 2005--March 2007. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a1.htm
  6. Ethan O. Bryson, and Jeffrey H. Silverstein, Addiction and Substance Abuse in Anesthesiology, 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766183/
  7. Nahid Jahani Shoorab, Samira Ebrahimzadeh Zagami, Kobra Mirzakhani, and Seyed Reza Mazlom, The Effect of Intravenous Fentanyl on Pain and Duration of the Active Phase of First Stage Labor, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769121/
  8. William Rayburn, AnneRathke. Patricia Leuschen, Jan Chleborad, WilliamWeidner, American Journal of Obstetrics and Gynecology, Pages 202-206. https://www.sciencedirect.com/science/article/abs/pii/0002937889902664
  9. Kuczyńska K., Grzonkowski P., Kacprzak Ł., Zawilska J. B. Abuse of fentanyl: An emerging problem to face. Forensic Science International. 2018; 289:207-214. doi: 10.1016/j.forsciint.2018.05.042. https://www.ncbi.nlm.nih.gov/pubmed/29902699
  10. Medline Plus. Fentanyl. 2019. https://medlineplus.gov/druginfo/meds/a605043.html
  11. National Institute on Drug Abuse. Fentanyl. 2019. https://www.drugabuse.gov/publications/drugfacts/fentanyl
  12. Gold M. S. et al. Fentanyl abuse and dependence: further evidence for second hand exposure hypothesis. Journal of Addictive Diseases. 2006; 25(1): 15-21. https://www.ncbi.nlm.nih.gov/pubmed/16597569.
  13. Centers For Disease Control and Prevention, Fentanyl, 2020. https://www.cdc.gov/drugoverdose/opioids/fentanyl.html
  14. Mark S Gold, Richard J Melker, Donn M Dennis, Timothy E Morey, Lakshmi K Bajpai, Raymond Pomm, Kimberly Frost-Pineda, Fentanyl abuse and dependence: further evidence for second hand exposure hypothesis, 2006. https://pubmed.ncbi.nlm.nih.gov/16597569/
  15. Centers For Disease Control and Prevention, FENTANYL : Incapacitating Agent, 2011. https://www.cdc.gov/niosh/ershdb/EmergencyResponseCard_29750022.html

Published on: March 15th, 2017

Updated on: July 5th, 2021

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.