Doctors prescribe a synthetic opioid, fentanyl for severe pain. This can include pain from cancer or severe injuries. Doctors use fentanyl because it is 50 times stronger than heroin and 100 times more potent than morphine. The problem with fentanyl, however, comes from use of the drug outside of the care of a doctor, especially the use of illegal or street versions of the drug.
Between May 2020 and April 2021, there were more than 100,000 overdose deaths, with almost two-thirds of them linked to overdoses of fentanyl or similar opioids, according to the U.S. Centers for Disease Control and Prevention (CDC). Additionally, the CDC has found that overdose death rates from synthetic opioids such as fentanyl increased by more than 16% between 2018 and 2019.
Dangers with Fentanyl
Fentanyl comes in several different forms, ranging from a liquid to a powder. Drug dealers now frequently mix Illegal or illicit fentanyl with heroin, cocaine, and methamphetamines. The person taking the drug believes they are taking one type of drug, such as cocaine, when they are ingesting an even more powerful drug. Even in very small doses, fentanyl can be deadly.
Legal fentanyl is sold as Duragesic, as patches, Aqtic, as a lozenge often called a “lollipop”, and Sublimaze, an injectable form. Common street names for fentanyl include Apache, China Girl, Goodfella, China White, TNT, Friend, and Dance Fever.
Fentanyl cannot be seen, smelled, or tasted when it is combined with other drugs. The only real way to determine if fentanyl has been added to a drug is by testing the drug with fentanyl test strips. These strips will show within five minutes if fentanyl has been added to the sample drug. However, the testing strips do not always detect other fentanyl-like drugs, such as carfentanil.
The lethality of fentanyl depends on the user’s size, tolerance, and past drug usage. Unfortunately, this only adds to the dangers of this illicit substance. And, because the production of illegal fentanyl is unregulated, the amount of the drug considered fatal also varies. Analysis conducted by the DEA revealed that counterfeit pills could contain anywhere from .02 to 5.1 milligrams of fentanyl.
A lethal dose of fentanyl is generally considered 2 milligrams. Of the pills tested by the DEA, more than 40% were found to have at least 2 milligrams of fentanyl.
Fentanyl’s Effects on the Body
Like other opioids, fentanyl binds to the opioid receptors in the brain, as well as other organs in the body. These receptors control an individual’s sensation of pain and emotions. Opioids block pain signals that the brain sends to the body. Additionally, they release dopamine in large doses. Dopamine is a neurotransmitter, or chemical messenger, that the body uses to transmit messages between cells. It plays a major role in how a person feels pleasure and impacts thinking and the ability to focus.
The large amounts of dopamine that opioids release throughout the body also make the user want to repeat the act of taking the drug.
The brain of someone who takes fentanyl will adapt over time to the presence of the drug. This effect is twofold: the person will find their ability to feel emotions diminished without the drug, and they will require larger amounts of fentanyl to feel pleasure.
Fentanyl’s other effects on the brain and body include:
- extreme happiness or euphoria
- drowsiness
- relaxation
- sedation
- nausea
- confusion
- constipation
- sedation
- problems breathing
- unconsciousness
- pain relief
- dizziness
- vomiting
- urinary retention
- pupillary constriction
Withdrawal symptoms from fentanyl can happen as quickly as 12 hours after a person’s last dose and may last for a week or even longer. Because of fentanyl’s powerful effects, it does not take long for a person to develop a tolerance, requiring them to take higher and higher doses to achieve the same results.
Dependency and Addiction to Fentanyl
To understand fentanyl’s addictiveness, it’s helpful to understand the stages that lead to addiction.
The first phase, tolerance, occurs when a person requires more frequent doses or greater amounts of a drug to achieve the same feeling as they did when they first took it.
The next phase, dependence, happens when the body’s neurons adapt to the drug and only function normally when the drug is present in the body. When the drug is not present, the person may experience a variety of physical and psychological reactions, some of which could be life-threatening.
Even if someone is taking prescription fentanyl under the care of a physician, they can quickly develop a dependence on the opioid. It is possible to be dependent without developing an addiction.
Finally, addiction occurs when a person is compelled to seek a drug despite the consequences to themselves or others. Taking the drug becomes a compulsion, causing the individual to engage in harmful behaviors to get the drug, even if they know that doing so is harmful. Addiction is a chronic disease in the same way that heart disease or diabetes is a chronic condition.
Withdrawal from Fentanyl
Someone taking fentanyl on a regular basis may experience a range of withdrawal symptoms when they stop taking the drug. This is true even for a prescription. Taking any type of fentanyl or other opioids for more than two weeks can be problematic. Withdrawal symptoms can include:
- muscle and bone pain
- problems sleeping
- diarrhea and vomiting
- cold flashes with goosebumps
- uncontrollable leg movements
- severe cravings
It is important to talk to a health care provider about the best way to stop taking prescribed opioids to avoid serious withdrawal symptoms. Depending on the type of opioid prescribed, as well as how long they have been taking it, individuals may need several weeks or longer to successfully taper off their current dosage safely.
Fentanyl withdrawal symptoms have the potential to be very uncomfortable. For this reason, many who take fentanyl, even with a prescription, may struggle to stop taking the drug.
Potential Treatments for Withdrawal
Currently, anyone undergoing withdrawal from any type of opioid, including fentanyl, should do so under the care and supervision of medical professionals.
Researchers and pharmaceutical companies continue to look for solutions to lessen the discomfort and danger of opioid withdrawal. Recently, the FDA approved a non-opioid medicine, known as lofexidine, to help reduce opioid withdrawal symptoms. Other new FDA-approved options include a prescription cognitive behavioral therapy, reSET®, which can help treat opioid use disorders when used along with other treatments, including buprenorphine and contingency management.
Signs of Fentanyl Overdose
Because it is so potent, users can very easily overdose on fentanyl. The three most common signs of a fentanyl overdose are pinpoint pupils, respiratory depression, and a decreased level of consciousness. Other signs include:
- Choking or gurgling sounds
- Limp body
- Seizure-like activity or body stiffening
- Cold or clammy skin
- Foaming at the mouth
- Lips or nails turning blue or becoming discolored
An overdose from fentanyl can happen very rapidly. Three-quarters of the people who have witnessed a fentanyl overdose said that the symptoms appeared within minutes or even seconds of the overdose occurring.
Treating Fentanyl Overdose
If you suspect someone you know is overdosing on fentanyl or any other drug, you should:
- Call 911 immediately
- Administer naloxone, if available
- Try to keep the person awake and breathing
- Lay the person on their side to prevent choking
- Stay with the person until emergency assistance arrives
Because of fentanyl’s potency, the person who is overdosing may need multiple doses of naloxone to recover. Emergency services carry naloxone with them, so make sure to call 911 right away. Naloxone is used to treat opioid overdoses because it binds to the same receptors that opioids do, preventing the drugs from taking effect.
Fentanyl Addiction Treatment
Treatment for an addiction to fentanyl typically combines medication and therapy. This is called Medication-Assisted Treatment (MAT). The value of MAT is that it considers the physical and psychological components of a person’s addiction. Of course, seeking addiction treatment in any form can help prevent or reduce the risk of overdose and increase the odds of an individual sustaining their recovery.
Medications used in MAT include:
- Buprenorphine: a medication approved by the FDA to treat opioid use disorder which binds to opioid receptors in the brain to reduce cravings and limit withdrawal symptoms
- Methadone: another opioid that can be used to limit symptoms of fentanyl withdrawal but may be addictive
- Naltrexone: blocks opioid receptors and prevents fentanyl from having an effect and is widely used in overdoses
Behavioral therapies are the other major component of addiction treatment, both in MAT and other forms of treatment. There are several types of behavioral therapy effective for addiction, but all focus on an individual’s learned behaviors and how those can be changed. While anyone can be helped by behavioral therapies, people with depression or anxiety may find them especially beneficial, as well as anyone living with issues ranging from substance abuse and eating disorders to post-traumatic stress disorder (PTSD) and ADHD.
Two of the more well-known behavioral therapy options used for addiction are cognitive behavioral therapy, or CBT, and dialectical behavioral therapy, or DBT.
CBT is commonly used to help with psychological challenges that stem from unhelpful ways of thinking and patterns of learned behavior. The primary focus of CBT is to help anyone living with a mental health challenge — including addiction — develop new and more effective ways of coping to relieve their symptoms.
Some of the most common strategies deployed during CBT help the person change their thinking and behavior patterns. Typically, this can be done by:
- Learning to recognize how distorted thinking is creating problems, then learning how to reconsider such thinking from a more realistic standpoint
- Developing a stronger understanding of how others behave and what motivates them
- Applying problem-solving skills to handle any difficult situations
- Increasing confidence in the abilities the person in recovery already possesses
- Confronting existing fears instead of avoiding them
- Preparing for interactions that may be problematic via role-playing
- Learning methods to help create a sense of calm and relaxation
The other well-known method of counseling for addiction is DBT, which is composed of several parts, including:
- Individual therapy
- Group skills training
- Phone or virtual coaching for issues that arise between sessions
Like CBT, DBT helps individuals learn beneficial life skills, such as:
- Distress tolerance: How to feel intense emotions without reacting impulsively, for example, by engaging in self-injury or substance abuse to “feel better”
- Emotion regulation: Identifying, naming, and adjusting emotions as needed
- Mindfulness: Increasing self-awareness, as well as awareness of others
- Interpersonal effectiveness: Learning to navigate conflicts that arise and ways to behave more assertively
DBT is composed of four stages, starting by dealing with self-destructive behavior, including addiction. The next stage considers a person’s quality of life by addressing their ability to regulate their emotions and interact in personal relationships. The third stage is focused on improving the individual’s self-esteem and relationships with others. Finally, in the fourth stage, DBT works to foster deeper connections in an individual’s relationships and promote more joy in their life.
Other behavioral counseling options that are less well-known but can also be highly effective in addiction treatment are contingency management and motivational interviewing.
Contingency management is a type of behavioral therapy that emphasizes rewarding positive behaviors to encourage healthier decision making. Motivational interviewing works to address the insecurity or ambivalence that may be holding individuals back from changing their behavior.
If you or a loved one are struggling with fentanyl, talk to our team for help and insights.
Aftermath Addiction Treatment Center was founded by recovering addicts to provide dual-diagnosis care. We use proven clinical and medical approaches to assist in recovery, while our treatment plans begin and end with love, empathy and direction.
