Fentanyl Use – Identifying Signs of Abuse and Addiction

Last Updated: December 18, 2019

Authored by Sharon Levy, MD, MPH

There are certain medications that everyone associates with abuse and addiction — Xanax and Oxycodone are just two examples. But Fentanyl is not a name society at large connects to misuse; in fact, many have never even heard of the drug. Despite this, Fentanyl addiction is becoming widespread, even contributing to the high-profile overdose deaths of Tom Petty and Prince.
Part of what makes Fentanyl addictive is its strength; the drug is estimated to be about 80 times as potent as morphine and hundreds of times more potent than heroin. Although it can be used for medical reasons, such as pain management, it is still essential to be able to identify signs of Fentanyl abuse.

Typical Fentanyl Use Symptoms

Fentanyl abuse can arise from being prescribed the drug, taking illegal drugs cut with Fentanyl, or purchasing Fentanyl without a prescription. Its use has been linked to the continued rise in Fentanyl overdose deaths throughout the United States. Due to its high level of toxicity, any use of this drug has the potential to be deadly, making it vital that the signs of abuse be spotted as soon as possible.
So, what are some typical Fentanyl addiction symptoms to look for?

  • Extreme euphoria followed by depression and confusion
  • Anxiety
  • Paranoia
  • Decreased heart rate
  • Shallow or slow breathing
  • General physical weakness
  • Trouble walking
  • Stiff muscles
  • Dizziness
  • Fainting
  • Shaking
  • Slurred speech
  • Difficulty staying awake and alert
  • Nausea and vomiting
  • Skin irritation and excessive scratching
  • Pinpoint pupils
  • Loss of appetite
  • Struggles with sleep
  • Swollen limbs
  • Hallucinations, either auditory or visual
  • Severe and chronic gastrointestinal problems
  • Frequent illness due to lowered immunity
  • Seizures

There are also behavioral symptoms to watch for. It is important to note that the signs of Fentanyl addiction are mostly the same as signs of pain pill use in general, so these symptoms alone cannot be used to diagnose addiction to Fentanyl.

Psychological Signs of Fentanyl Abuse


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

The primary psychological signs of Fentanyl addiction are the euphoria experienced directly after the drug is taken and the depression and confusion that follows; these are signs that will be present in all persons using the drug due to its high potency. Fentanyl is a short-acting drug; its effects begin within minutes and only last a few hours. This contributes to the extreme high and then sudden drop as the drug wears off.

Physical Symptoms of Fentanyl Consumption

The physical signs that someone is addicted to Fentanyl are mostly the same as the signs of general pain pill abuse. Physical signs of painkillers addiction can also mimic the signs of prescribed use of the medication. The best way to determine if the symptoms are from addiction or standard use is how frequently the symptoms are present and if they are becoming worse over time. With Fentanyl, the medication is not meant for long-term use, so persistent symptoms indicate a problem.
Some physical symptoms are only observable by the user or are at least easy to keep hidden. This includes decreased heart rate, stiff muscles, nausea, gastrointestinal issues, and sleep difficulties. More noticeable symptoms are shallow or slow breathing—this can be heard as well as seen in the movements of the chest—general physical weakness, trouble walking, fainting, shaking, and slurred speech. Loved ones may also notice the user struggling to stay awake or being awake but unalert frequently. Pinpoint pupils and loss of appetite are also direct physical symptoms of use. Depending on how the user is administering the medication, there may be skin irritation present, resulting in scratching.

Behavioral Deviations of the Fentanyl Addict

A woman struggles to deal with her addiction.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:

  • Fentanyl 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 Fentanyl
  • Frequently talking about Fentanyl or other 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 medication 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 is abusing opioids.

Fentanyl Abuse Is Extremely Dangerous

Due to its high level of toxicity, Fentanyl addiction is extremely dangerous. This means it is essential to know the signs of Fentanyl abuse and how they manifest psychologically, physically, and behaviorally. With appropriate action, fatal consequences can be avoided.

Page Sources

  1. https://www.cdc.gov/niosh/ershdb/EmergencyResponseCard_29750022.html

Published on: May 3rd, 2017

Updated on: December 18th, 2019

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.


Leave a comment