Fentanyl Addiction: Causes, Effects and Treatment

Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine. It is a major contributor to the ongoing opioid crisis in the United States, with data from the Centers for Disease Control and Prevention (CDC) indicating that synthetic opioids, primarily fentanyl, were involved in nearly 73% of all opioid-related overdose deaths in 2020​. 

Fentanyl addiction is often caused by the legitimate medical use of fentanyl for managing severe pain, particularly in patients with chronic pain or cancer. Over time, tolerance will develop, leading to higher doses and dependency. Additionally, illicitly manufactured fentanyl, often mixed with other drugs like heroin or cocaine, significantly increases the risk of addiction. The high potency of fentanyl makes it especially addictive, with even small amounts capable of causing dependency​.

The effects of fentanyl addiction are severe and far-reaching. Physiologically, it can cause respiratory depression, which is often fatal in overdose cases. Other physical effects include drowsiness, confusion, nausea, and constipation. Psychologically, fentanyl addiction can lead to intense cravings, anxiety, depression, and cognitive impairments. Socially, individuals will experience deteriorating relationships, job loss, and legal issues.

Treating fentanyl addiction includes medically-assisted detoxification as the first step, often using medications like buprenorphine or methadone to manage withdrawal symptoms and reduce cravings. Behavioral therapies, including cognitive-behavioral therapy (CBT) and contingency management, are crucial for addressing the psychological aspects of addiction. Additionally, support groups and long-term follow-up care play vital roles in maintaining sobriety and preventing relapse. 

What Is Fentanyl?

Fentanyl is a synthetic opioid analgesic that is classified as a Schedule II controlled substance in the United States. This classification indicates that it has a high potential for abuse and can lead to severe psychological or physical dependence, but it also has accepted medical uses. Fentanyl was first synthesized by Dr. Paul Janssen in 1960 and was introduced into medical practice in the 1960s as an intravenous anesthetic under the brand name Sublimaze. Its development marked a significant advancement in pain management, particularly for its potent analgesic properties​.

Fentanyl is widely used in the medical field for its powerful pain-relieving properties. It is often prescribed for managing severe pain, particularly in cancer patients, those with chronic pain conditions, and patients undergoing major surgeries. Fentanyl is available in various forms, including transdermal patches, lozenges, and injectable solutions, allowing for flexible administration depending on the patient’s needs​. According to the Centers for Disease Control and Prevention (CDC), fentanyl is a critical component in palliative care due to its effectiveness in alleviating severe pain​.

Illicitly manufactured fentanyl has become a major public health issue, significantly contributing to the opioid crisis. It is often mixed with other drugs like heroin and cocaine to enhance potency, often without the user’s knowledge, which dramatically increases the risk of overdose. According to an article titled “Facts About Fentanyl” published by the Drug Enforcement Administration, two milligrams of fentanyl can be lethal depending on a person’s body size, tolerance and past usage.  DEA analysis has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet.

What are the Causes of Fentanyl Addiction?

The high potency is a key cause of Fentanyl addiction. Even a small dose produces intense euphoria, which quickly leads to dependency and addiction. According to the National Institute on Drug Abuse (NIDA), fentanyl’s rapid onset and powerful effects increase the risk of addiction substantially​.

Fentanyl is often prescribed for severe pain, particularly in cancer patients and those with chronic pain conditions. Over time, patients can develop a tolerance, requiring higher doses to achieve the same pain relief. This can lead to physical dependence and, eventually, addiction. Misuse of prescribed fentanyl, such as taking higher doses than prescribed or using it without medical supervision, further increases the risk of addiction​

Fentanyl is widely available and often mixed with other substances like heroin, cocaine, and methamphetamine. The availability of illicit fentanyl on the streets has skyrocketed, making it easier for individuals to obtain and misuse the drug​. According to the National Institutes of Health’s (NIH), the number of individual pills containing fentanyl seized by law enforcement increased dramatically by 2,300 times between 2017 and 2023. In 2023, law enforcement seized 115,562,603 fentanyl pills, compared to just 49,657 pills in 2017. Additionally, the proportion of fentanyl pill seizures to the total number of fentanyl seizures more than quadrupled, with pills representing 49% of illicit fentanyl seizures in 2023, up from 10% in 2017. This increases the risk of accidental overdose and addiction because users may not be aware they are consuming fentanyl.

Economic hardship, social instability, and lack of access to proper medical care can drive individuals to misuse fentanyl and other opioids. People dealing with chronic pain or mental health issues may turn to illicit fentanyl as a means of self-medication. The stress of these socio-economic conditions can exacerbate the risk of developing substance use disorders.

What Are the Effects of Illicit Fentanyl Use?

What Are the Effects of Illicit Fentanyl Use?

Illicit fentanyl use poses a significant risk due to its high potency and the prevalence of overdose deaths. According to the National Institute on Drug Abuse (NIDA), from January 2020 to January 2021, overdose deaths involving synthetic opioids like fentanyl surged by 55.6%, indicating an accelerating epidemic. Dr. Nora Volkow, Director of NIDA, emphasizes that fentanyl’s potency makes it especially dangerous, with even tiny amounts capable of causing overdose and death. 

  1. Overdose and Death:  Illicit fentanyl is extremely potent, leading to a high risk of overdose. Even small amounts are fatal.
  2. Respiratory Depression: Fentanyl causes severe respiratory depression, which can be fatal if not treated immediately. This risk is particularly high when fentanyl is mixed with other depressants like alcohol or benzodiazepines​​.
  3. High Potency and Variability: The potency of illicit fentanyl can vary widely, increasing the risk of overdose. Users often do not know the strength of the drug they are taking, leading to accidental overdoses​​.
  4. Addiction and Dependence: Fentanyl is highly addictive, and repeated use will lead to rapid development of dependence and addiction. This leads to a cycle of increasing use and escalating risk of overdose​​.
  5. Contamination of Other Drugs: Fentanyl is often mixed with other illicit drugs like heroin, cocaine, and methamphetamine, sometimes without the user’s knowledge. This contamination increases the risk of overdose and complicates treatment efforts​.
  6. Impact on Mental Health: Chronic fentanyl use leads to severe mental health issues, including anxiety, depression, and psychosis. The drug’s impact on brain chemistry can exacerbate pre-existing mental health conditions or trigger new ones​.
  7. Community Impact: The widespread use of illicit fentanyl has a profound impact on communities, contributing to increased healthcare costs, higher crime rates, and a surge in foster care placements due to parental drug abuse.​
  8. Increased Strain on Emergency Services: Emergency medical services and public health systems are often overwhelmed by the number of fentanyl-related overdoses, leading to increased healthcare costs and strained resources

The impact of illicit fentanyl use extends beyond individual health consequences, significantly affecting entire communities. The influx of fentanyl has overwhelmed emergency services and public health systems, leading to increased healthcare costs and straining resources. Communities experience higher rates of crime, child neglect, and homelessness as a result of widespread addiction. According to a report by the Centers for Disease Control, areas heavily impacted by fentanyl see higher rates of opioid-related crimes and a surge in foster care placements due to parental drug abuse​. 

What Treatment Options are Available for Fentanyl Addiction?

The treatment of fentanyl addiction is distinct due to the drug’s high potency, rapid onset of dependence, and severe withdrawal symptoms. Effective treatment for fentanyl addiction typically involves a combination of detox, medication- assisted treatment and therapy tailored to the individual’s specific needs. Continuous monitoring and support are crucial to ensure long-term recovery and prevent relapse.

What is the Detoxification Process for Fentanyl Addiction?

The first step in treating fentanyl addiction is detoxification, which involves clearing the drug from the individual’s system. This process is critical due to the severe and potentially dangerous withdrawal symptoms associated with fentanyl use. Withdrawal from fentanyl can begin as early as a few hours after the last dose and typically peaks within one to two days, with the most intense symptoms occurring during this time. The entire detox process can last anywhere from a few days to over a week, depending on the individual’s usage history and overall health​​.

Severe Withdrawal Symptoms

Fentanyl withdrawal is particularly challenging because of the drug’s high potency and the body’s rapid development of dependence. Withdrawal symptoms can include:

  • Intense Cravings: The desire to use fentanyl again can be overwhelming, making it difficult for individuals to resist relapse without medical support.
  • Anxiety and Agitation: Withdrawal can cause severe anxiety, restlessness, and irritability, contributing to the overall discomfort and mental distress.
  • Muscle Pain and Spasms: Users often experience significant muscle aches, joint pain, and muscle spasms, which can be debilitating.
  • Gastrointestinal Distress: Symptoms such as nausea, vomiting, diarrhea, and abdominal cramps are common, leading to dehydration and further health complications.
  • Insomnia and Fatigue: Difficulty sleeping and extreme fatigue are typical, exacerbating the physical and mental challenges of detoxification.
  • Sweating and Chills: Individuals may experience profuse sweating, chills, and fluctuations in body temperature, similar to severe flu symptoms

How long does fentanyl stay in your system?

Fentanyl can be detected in urine for up to 72 hours after use, though this can vary based on the individual’s metabolism, dosage, and frequency of use. Blood tests detect fentanyl for up to 48 hours, and hair tests can detect it for up to three months​

What are the Medication-Assisted Treatments (MAT) for Fentanyl?

Medication-assisted treatment (MAT) is a cornerstone of fentanyl addiction therapy. MAT combines medications with counseling and behavioral therapies to treat substance use disorders. Common medications used in MAT for fentanyl addiction include:

  • Methadone: A long-acting opioid agonist that reduces withdrawal symptoms and cravings.
  • Buprenorphine: A partial opioid agonist that helps to diminish the effects of physical dependence on opioids, such as withdrawal symptoms and cravings, increasing safety in cases of overdose.
  • Naltrexone: An opioid antagonist that blocks the euphoric and sedative effects of opioids, helping to prevent relapse.

These medications help to stabilize brain chemistry, block the euphoric effects of opioids, and relieve physiological cravings, enabling patients to engage more fully in therapy and other forms of treatment​.

How Do Behavioral Therapies Help with Fentanyl Addiction?

Behavioral therapies are essential in treating fentanyl addiction as they address the psychological aspects of addiction. These therapies help individuals modify their attitudes and behaviors related to drug use and increase healthy life skills. Effective behavioral therapies for fentanyl addiction include:

  • Cognitive-Behavioral Therapy (CBT): Helps patients recognize and change negative thought patterns and behaviors associated with drug use, and develop coping strategies.
  • Contingency Management (CM): Provides incentives for positive behaviors such as staying drug-free.
  • Motivational Interviewing (MI): Enhances an individual’s motivation to change and engage in treatment.
  • Family Therapy: Involves family members in the treatment process to improve communication and support the recovering individual.

How Do Community and Support Systems Help with Maintaining Sobriety?

Due to the high relapse rates and potential for severe withdrawal symptoms, ongoing support through community programs and support groups is vital. Programs like Narcotics Anonymous (NA) and other peer support groups play an essential role in providing the continuous support needed to maintain long-term sobriety and prevent relapse​

What Are the Symptoms of Fentanyl Addiction?

Fentanyl symptoms are extremely uncomfortable and are the reason many people find it so difficult to stop taking fentanyl. According to the National Institute of Drug Addiciton’s article “What is Fentanyl?” published in 2021, there are medicines being developed to help with the withdrawal process for fentanyl and other opioids. The FDA has approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms. Also, the NSS-2 Bridge device is a small electrical nerve stimulator placed behind the person’s ear that is used to try to ease symptoms for up to five days during the acute withdrawal phase.

The Symptoms of Fentanyl Addiction

What are the Behavioral Signs of Fentanyl Addiction?

Fentanyl addiction manifests in various behavioral changes, including:

  • Drug-Seeking Behavior: Individuals become intensely focused on obtaining and using fentanyl, going to great lengths to acquire the drug, such as visiting multiple doctors for prescriptions or buying it illegally.
  • Neglecting Responsibilities: People addicted to fentanyl often neglect personal and professional responsibilities, such as missing work, failing to meet family obligations, or ignoring personal hygiene and health.
  • Social Withdrawal: Addicts withdraw from social activities and relationships they once valued, isolating themselves to use the drug or avoid being questioned about their behavior.
  • Changes in Mood and Behavior: Fentanyl addiction causes dramatic mood swings, irritability, and erratic behavior, making individuals more secretive or dishonest about their drug use.

What are the Physical Symptoms of Fentanyl Addiction?

Fentanyl addiction also presents distinct physical symptoms, including:

  • Respiratory Depression: Slowed or irregular breathing is one of the most dangerous symptoms and can lead to fatal overdose if not addressed promptly.
  • Drowsiness and Sedation: Users often appear excessively sleepy or sedated, impairing their ability to function normally in daily activities.
  • Constriction of Pupils: Pinpoint pupils that do not react normally to light changes are a hallmark sign of opioid use, including fentanyl.
  • Nausea and Vomiting: Frequent nausea and vomiting will occur, often leading to dehydration and further health complications.
  • Constipation: Chronic use of fentanyl frequently results in severe constipation due to its effects on the gastrointestinal system.
  • Sweating and Chills: Excessive sweating and chills, similar to flu-like symptoms, are particularly noticeable during withdrawal periods.

Can Fentanyl Overdose Be Treated?

Yes, fentanyl overdose can be treated effectively if immediate action is taken. The treatment focuses on reversing the effects of the drug and supporting the individual’s breathing and heart function until emergency medical services arrive.

What are the Symptoms of Fentanyl Overdose?

Fentanyl overdose symptoms can be severe and include:

  • Respiratory Depression: Slow, shallow, or stopped breathing.
  • Unconsciousness: Unresponsiveness or loss of consciousness.
  • Pinpoint Pupils: Extremely small pupils that do not react to light.
  • Cyanosis: Bluish tint to lips and nails due to lack of oxygen.
  • Weak Pulse: Faint or slow heartbeat.
  • Severe Drowsiness: Extreme lethargy or sudden inability to stay awake.

What Emergency Interventions are there for Fentanyl Overdose?

  1. Call Emergency Services: Immediately call 911 if a fentanyl overdose is suspected.
  2. Administer Naloxone: Naloxone (Narcan) can reverse the effects of a fentanyl overdose. It can restore normal respiration if breathing has slowed or stopped due to the overdose. Naloxone is available as an injection or nasal spray and should be administered as soon as an overdose is suspected.
  3. Provide Supportive Care: While waiting for emergency personnel, perform rescue breathing or CPR if the person is not breathing or has no pulse. Follow the emergency dispatcher’s instructions.
  4. Continuous Monitoring: After administering naloxone, continuous monitoring is crucial because multiple doses might be necessary due to fentanyl’s potency. Overdose symptoms can return as naloxone’s effects wear off.
  5. Hospital Treatment: Once stabilized, the individual should be transported to a hospital for further treatment, including additional medications, respiratory support, and monitoring for complications.

How Does Fentanyl Affect the Brain?

How Does Fentanyl Affect the Brain?

Fentanyl primarily affects the brain by interacting with the body’s opioid receptors, which are part of the brain’s reward system. These receptors are located in areas of the brain that control pain and emotions. When fentanyl binds to these receptors, it significantly increases the release of dopamine, a neurotransmitter associated with pleasure and reward. This surge in dopamine creates intense euphoria, which can lead to addiction as the brain starts craving the pleasurable effects of the drug​.

Fentanyl’s impact on the brain includes:

  • Euphoria and Relaxation: Users often feel a powerful sense of well-being and relaxation.
  • Confusion: Cognitive functions will be impaired, leading to confusion and difficulty concentrating​
  • Tolerance: Over time, the brain becomes less responsive to fentanyl, requiring higher doses to achieve the same effects, which increases the risk of overdose.
  • Cognitive Impairment: Long-term use leads to lasting cognitive impairments, such as memory loss, decreased ability to concentrate, and other mental health issues.
  • Emotional Instability: Chronic fentanyl use results in severe mood swings, anxiety, depression, and other emotional disorders.

What Treatment Options are Available for Fentanyl Addiction?

The treatment of fentanyl addiction is distinct due to the drug’s high potency, rapid onset of dependence, and severe withdrawal symptoms. Effective treatment for fentanyl addiction typically involves a combination of detox, medication- assisted treatment and therapy tailored to the individual’s specific needs. Continuous monitoring and support are crucial to ensure long-term recovery and prevent relapse.

Detoxification Process for Fentanyl Addiction

The first step in treating fentanyl addiction is detoxification, which involves clearing the drug from the individual’s system. This process is critical due to the severe and potentially dangerous withdrawal symptoms associated with fentanyl use. Withdrawal from fentanyl can begin as early as a few hours after the last dose and typically peaks within one to two days, with the most intense symptoms occurring during this time. The entire detox process can last anywhere from a few days to over a week, depending on the individual’s usage history and overall health​​.

Severe Withdrawal Symptoms

Fentanyl withdrawal is particularly challenging because of the drug’s high potency and the body’s rapid development of dependence. Withdrawal symptoms can include:

  • Intense Cravings: The desire to use fentanyl again can be overwhelming, making it difficult for individuals to resist relapse without medical support.
  • Anxiety and Agitation: Withdrawal can cause severe anxiety, restlessness, and irritability, contributing to the overall discomfort and mental distress.
  • Muscle Pain and Spasms: Users often experience significant muscle aches, joint pain, and muscle spasms, which can be debilitating.
  • Gastrointestinal Distress: Symptoms such as nausea, vomiting, diarrhea, and abdominal cramps are common, leading to dehydration and further health complications.
  • Insomnia and Fatigue: Difficulty sleeping and extreme fatigue are typical, exacerbating the physical and mental challenges of detoxification.
  • Sweating and Chills: Individuals may experience profuse sweating, chills, and fluctuations in body temperature, similar to severe flu symptoms

How long does fentanyl stay in your system?

Fentanyl can be detected in urine for up to 72 hours after use, though this can vary based on the individual’s metabolism, dosage, and frequency of use. Blood tests detect fentanyl for up to 48 hours, and hair tests can detect it for up to three months​

What are the Medication-Assisted Treatments (MAT) for Fentanyl?

Medication-assisted treatment (MAT) is a cornerstone of fentanyl addiction therapy. MAT combines medications with counseling and behavioral therapies to treat substance use disorders. Common medications used in MAT for fentanyl addiction include:

  • Methadone: A long-acting opioid agonist that reduces withdrawal symptoms and cravings.
  • Buprenorphine: A partial opioid agonist that helps to diminish the effects of physical dependence on opioids, such as withdrawal symptoms and cravings, increasing safety in cases of overdose.
  • Naltrexone: An opioid antagonist that blocks the euphoric and sedative effects of opioids, helping to prevent relapse.

These medications help to stabilize brain chemistry, block the euphoric effects of opioids, and relieve physiological cravings, enabling patients to engage more fully in therapy and other forms of treatment​.

How Do Behavioral Therapies Help with Fentanyl Addiction?

Behavioral therapies are essential in treating fentanyl addiction as they address the psychological aspects of addiction. These therapies help individuals modify their attitudes and behaviors related to drug use and increase healthy life skills. Effective behavioral therapies for fentanyl addiction include:

  • Cognitive-Behavioral Therapy (CBT): Helps patients recognize and change negative thought patterns and behaviors associated with drug use, and develop coping strategies.
  • Contingency Management (CM): Provides incentives for positive behaviors such as staying drug-free.
  • Motivational Interviewing (MI): Enhances an individual’s motivation to change and engage in treatment.
  • Family Therapy: Involves family members in the treatment process to improve communication and support the recovering individual.

How Do Community and Support Systems Help with Maintaining Sobriety?

Due to the high relapse rates and potential for severe withdrawal symptoms, ongoing support through community programs and support groups is vital. Programs like Narcotics Anonymous (NA) and other peer support groups play an essential role in providing the continuous support needed to maintain long-term sobriety and prevent relapse​

How Has the COVID-19 Pandemic Impacted Fentanyl-Related Deaths?

The COVID-19 pandemic exacerbated the opioid crisis, with a significant increase in fentanyl-related overdose deaths. Disruptions in healthcare access, increased social isolation, and economic stress contributed to higher rates of substance use and overdose during this period​.

How Long does Fentanyl Stay in Your System?

Fentanyl can be detected in urine for up to 72 hours after use, though this can vary based on the individual’s metabolism, dosage, and frequency of use. Blood tests can detect fentanyl for up to 48 hours, and hair tests can detect it for up to three months​.

Can Fentanyl Exposure be Hazardous to First Responders?

Yes, fentanyl exposure can be dangerous to first responders. Skin contact or inhalation of airborne particles can lead to accidental overdose. As a precaution, first responders often use protective equipment and carry naloxone to reverse potential overdoses​.

What Makes Fentanyl More Dangerous Than Other Opioids?

Fentanyl is 50 to 100 times more potent than morphine, making even small amounts potentially lethal. It’s high potency increases the risk of overdose, especially when users are unaware of its presence in other drugs.

Are There Any Long-Term Effects of Fentanyl Addiction?

Yes, fentanyl addiction has numerous long-term effects, including respiratory issues, cardiovascular problems, and severe cognitive impairments. According to the National Institute on Drug Abuse (NIDA), long-term opioid use changes brain structure, leading to lasting cognitive deficits and emotional instability.

The risk of developing other substance dependencies, such as Adderall addiction, also increases with long-term opioid use. Comprehensive treatment plans that address both immediate and long-term health impacts are crucial. Rehab for professionals provides tailored care that supports ongoing recovery and addresses specific needs.

The Grove Editorial Team is a dynamic group of professionals at The Grove, a leading addiction treatment center in Indianapolis, Indiana. Comprising experienced therapists, medical experts, and dedicated support staff, this team brings a wealth of knowledge and compassionate insight into the complexities of addiction and recovery. Their collective expertise shines through in each article, offering readers valuable guidance, the latest in addiction science, and inspiring stories of healing and transformation. The Grove Editorial Team is committed to educating, supporting, and empowering individuals and families on their journey toward a healthier, substance-free life.

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