Fentanyl Use and Abuse
Fentanyl is a synthetic opioid drug prescribed to treat severe pain. It is extremely potent and highly addictive, and abusing it can lead to problems with health, relationships, and employment.
What Is Fentanyl?
Fentanyl (Actiq, Duragesic, and Sublimaze), 1 is a synthetic opioid painkiller designed to treat severe pain. It is also prescribed to manage pain after surgery and to control chronic pain in those who have developed physical tolerance to other prescription painkillers. 1 Even though it is chemically similar to morphine , it is 50 to 100 times stronger. 1
Fentanyl was first used in the 1960s as an intravenous anesthetic. Today, it is commonly used as an anesthetic during heart surgeries and is indicated for use in patients with compromised cardiac functioning, as it does not depress heart rate to the extent that many other similar opioids do.2 It is also effective in controlling "breakthrough pain" in cancer patients who are already taking prescription opioids for chronic pain.2
Like other opioids, such as OxyContin, Percocet , Vicodin, and morphine, fentanyl increases dopamine in the reward center in the brain and produces an intense euphoria.1 These pleasurable feelings act as positive reinforcement to continue using.
On the street market, heroin is sometimes laced with fentanyl in an effort to boost the potency of the often impure, illicit opiate. Both fentanyl that is sold illegally and fentanyl-laced heroin are known by such street names as:
- China White.
- China Girl.
- Murder 8.
- Dance Fever. 1
Watch Dr. Sanjay Gupta of CNN talk about fentanyl.
Methods of Use
Prescription injection or patch. When a doctor prescribes fentanyl, the drug is usually taken by injection or through a transdermal patch that adheres to the skin, releasing the drug over a period of time.1
Lozenges. Sometimes fentanyl is prescribed in the form of lozenges.1
Snorted, swallowed, or injected on the street. When it is abused as a street drug, it can be snorted, swallowed, injected, or absorbed in the mouth after being placed on a piece of blotter paper.1
Users will also remove fentanyl gel from transdermal patches and take it orally or intravenously.2 When intended time-release mechanisms are bypassed in this manner, the drug can produce a very immediate, powerful effect, and places users at extreme risk of overdose.
Risks of Street Use
When fentanyl is obtained on the street, the user has no way of knowing how much fentanyl he or she is taking or if the fentanyl is pure. Sometimes it is mixed with other drugs, such as heroin .
One of the greatest concerns with getting fentanyl on the street is its potency. It is much more potent than heroin and morphine, and fentanyl that is taken in unknown doses can easily result in overdose and death.
Fentanyl, like all opioids, is dangerous and addictive if taken inappropriately. Fentanyl misuse or abuse can not only lead to addiction, but can also result in an accidental overdose, leading to respiratory depression and death. Users who are unaware of fentanyl's high potency are particularly susceptible to experiencing an accidental overdose.
Whether the drug was taken for pain control or recreational use, however, the person will typically experience short-term effects, such as: 1
Fentanyl produces many side effects. These effects can result from both licit and illicit use of the drug.
After a person uses fentanyl, he or she may experience: 1,3
- Urinary retention.
- Stomach pains.
Rash or hives.
Hypotension (low blood pressure).
If you are prescribed fentanyl and experience any serious adverse effects, contact your physician immediately.
Though the long-term effects of fentanyl use require more research, some possible consequences include:
Increased risk of HIV, hepatitis, and other infectious diseases from shared needles. 4
Oxygen deficiency, which can lead to brain damage. 5
Deterioration of the brain's white matter, impacting behavior regulation, stress response, and decision-making skills. 5
Excessive work or school absences.
Relationship or family problems.
Legal problems, such as driving under the influence or theft.
Over time, regular use of fentanyl can also lead to tolerance and dependence. Users who have developed tolerance require higher doses to achieve desired effects. Physical dependence occurs as the body adapts to the presence of the drug. People who have developed dependence are likely to experience unpleasant withdrawal symptoms while detoxing .
These withdrawal symptoms may include: 4
Bone and muscle pain.
"Goose bumps" from cold flashes.
Involuntary leg movements.
Signs and Symptoms of Addiction
Addiction can develop rapidly when fentanyl is consistently misused. A person can be considered to have an addiction to an opioid drug such as fentanyl when he or she exhibits at least 2 of the following symptoms within a 12-month period: 6
Taking more fentanyl than he or she planned on taking
Having difficulty cutting back or stopping the use of fentanyl
Spending a significant amount of time thinking about fentanyl, acquiring it, using it, and recovering from its effects
Having cravings for fentanyl
Failing to carry out major life roles in areas such as work, school, or home because of fentanyl use
Continuing to use fentanyl despite experiencing negative social consequences as a result of use
Giving up or reducing involvement in previously important activities due to fentanyl use
Using fentanyl in dangerous situations, such as while driving
Continuing to use fentanyl even though it causes or aggravates a psychological or physical issue
Developing tolerance, and requiring increased doses to achieve the desired effects
Experiencing withdrawal symptoms with cessation of use
Addiction impacts a person's employment, family relationships, and health. As the addiction progresses, a person may engage in various illegal activities to obtain the drug, which can include theft and assault. Those with access to prescription medications may steal fentanyl or prescription pads from work.
Many people abusing fentanyl do not understand that it is much more potent than heroin and other opioids. High doses can cause respiratory depression, coma, and death.1 The Drug Enforcement Administration (DEA) reports that fentanyl is lethal even in low doses.7
Overdose risk is especially high when the drug is combed with street heroin. Depending on availability, some heroin addicts will substitute fentanyl for heroin, but due to fentanyl's high potency, they frequently overdose.2 If an overdose occurs, commonly seen symptoms include: 3
Shallow breathing or stopped breathing.
Loss of consciousness.
Cyanotic (bluish) appearance to lips, fingers, toes.
Unreactive, constricted pupils (pinpoint pupils).
If an overdose is suspected, call 911 or visit an emergency room for immediate intervention and treatment.
Rates of abuse. According to the 2015 National Survey on Drug Use and Health, almost 300,000 people aged 12 and older (0.1% of the population) reported misusing fentanyl in the past year. 10
Overdose deaths. From 2013 to 2014, there was a 115% increase in fentanyl deaths in Florida (from 185 to 397) and a 526% increase in Ohio (from 84 to 526). 11
Illegal confiscations. The rate of law enforcement confiscations of fentanyl in illegal laboratories increased sevenfold from 2012 to 2014, with a total of 4,585 confiscations in 2014. 8
Emergency room visits. Non-pharmaceutical use of fentanyl accounted for more than 20,000 emergency department visits in 2011. 2
Synthetic opioid deaths. Synthetic opioids other than methadone were responsible for about 5,500 overdose deaths in 2014. 8
Prescription painkiller misuse. In 2015, an estimated 3.8 million people aged 12 or older currently misused prescription pain relievers, or about 1.4% of the population aged 12 or older.9
It is believed that the increase in overdoses and fatalities associated with fentanyl use are due to the increased availability of the illegal form of the drug and not so much from the use of the prescription form on fentanyl.8
Find Treatment for Fentanyl Addiction
If you believe that you or your loved one has a problem with fentanyl addiction, help is available in a variety of settings. Call 1-888-319-2606Who Answers? today to speak with a treatment referral specialist who can help you find the best treatment program options.
. National Institute on Drug Abuse (2016). DrugFacts: Fentanyl .
. Drug Enforcement Administration (2015). Drug Fact Sheets: Fentanyl .
. U.S. National Library of Medicine. (2016). Medline Plus: Fentanyl .
. National Institute on Drug Abuse, (2016). Commonly Abused Drugs Charts .
. National Institute on Drug Abuse. (2014). What are the possible consequences of opioid use and abuse?
 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC.
 Drug Enforcement Administration (2015). DEA Issues Nationwide Alert on Fentanyl as a Threat to Health and Public Safety .
. Centers for Disease Control (2016). Injury Prevention and Control: Opioid Overdose: Fentanyl .
. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
. Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables . Substance Abuse and Mental Health Services Administration, Rockville, MD.
. Centers for Disease Control and Prevention. Increases in Fentanyl-Related Overdose Death - Florida and Ohio, 2013-2015 . Morbidity and Mortality Weekly Report (MMWR) August 26, 2016 65(33): 844-849.