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Fentanyl is a powerful narcotic painkiller prescribed to people with serious chronic pain or end-of-life pain, such as those in the final stages of bone cancer. This painkiller is an opioid, meaning it works like morphine, oxycodone, and hydrocodone, since it is also synthetized from the opium poppy. However, fentanyl can be up to 50-100 times more powerful than other painkillers, including morphine. It is available in several forms, such as lozenges, nasal sprays, skin patches, or intravenous fluids.
This powerful opioid medication is prescribed to individuals who need intensive pain management, when the prescribing doctor is not concerned about addiction. It is prescribed for intense, chronic pain, and in some cases, it is prescribed when other pain medications have ceased to work.
Because fentanyl is such a powerful medication, it should only be used as prescribed. However, this drug’s strength makes it a prime target for abuse.
Fentanyl use or abuse can lead to many side effects, including:
As with other opioid pain medications, fentanyl binds to the opioid receptors in the brain, which control the amount of pain the body feels. The drug can induce a sense of euphoria, relaxation, or calmness. Narcotic painkillers are highly addictive, because they flood the brain with “happy” neurotransmitters like dopamine; this triggers the reward system, leading to cravings for more of the drug.
Opiates can also lead to tolerance and dependence. Tolerance involves the body getting used to a regular dose of the drug, so it doesn’t have the same effects. Dependence is when the body needs the substance just to feel normal. Because of its potential for abuse, even though it has a medical use, the Drug Enforcement Administration has listed fentanyl as a Schedule II substance.
Because doctors prescribe fentanyl to only a small subset of their patients, it is unlikely that an individual will become addicted to fentanyl based on that prescription. However, people who suffer from addiction to painkillers from other prescriptions, such as Vicodin or Percocet, might begin to steal or illegally purchase fentanyl.
The DEA suggests that fentanyl is sometimes used as a direct substitute for heroin. People who are already struggling with opioid addiction, whether due to oxycodone or heroin, are at a high risk of becoming addicted to fentanyl. This drug is typically more potent than heroin, which can be extremely dangerous for people whose bodies are dependent on or tolerant to a specific dose. Overdose becomes much more likely.
The DEA has noted an increase in overdose deaths related to illegally made fentanyl, not diverted or illegally sold fentanyl. In 2014, fentanyl-laced heroin seizures increased; there were 942 fentanyl-laced heroin submissions to the National Forensic Laboratory Information System (NFLIS) in 2013, which increased to 3,344 in 2014. The Centers for Disease Control adds that statistics on fentanyl overdose deaths do not differentiate between illegally manufactured and diverted fentanyl, but the drug has been appearing in heroin as a way to boost heroin’s potency and effectiveness. There has been a concurrent increase in overdose deaths.
According to data gathered by the CDC, illegally made fentanyl is causing an increasing number of overdose deaths, starting in 2014. There were 52 deaths per day on average that year (19,000 people for the entire year) caused by prescription painkillers, including fentanyl, methadone, tramadol, and other potent synthetic opioids.
Because fentanyl is so potent, people who abuse this drug are likely to overdose. Symptoms of fentanyl overdose include:
Naloxone can be used to temporarily halt a fentanyl overdose, but it should not be relied on as a way to stop the overdose or detox from the drug. Naloxone has a very short half-life, and it should be used as a stopgap measure to get the individual to emergency medical care.
Medical detox is needed for fentanyl withdrawal. If a person stops taking fentanyl without an overseeing physician to prescribe medications and help with the tapering process, the person will likely suffer from severe withdrawal symptoms. Fentanyl withdrawal symptoms are like other opioid withdrawal symptoms, although because the drug is so powerful, symptoms could feel more intense. Symptoms include:
If a person attempts to detox from fentanyl on their own by going “cold turkey,” they are likely to suffer a relapse and could experience a subsequent overdose. It is very important to get professional help from a medical provider before attempting to detox from the drug.
Often, the best approach to ending an addiction to fentanyl is to enter a comprehensive rehabilitation program that provides treatment that includes medical detox and therapy. The social support and various therapies offered by these programs help clients to manage withdrawal symptoms, cravings, and triggers to use substances. As a result, clients have firm footing in sobriety and are able to resist the urge to relapse once they exit the rehab facility.