Fentanyl Addiction: Symptoms, Overdose, and Treatment Options

Fentanyl is a very powerful synthetic (manufactured rather than naturally occurring) opioid drug. Pharmaceutically produced fentanyl was first used in the 1960s as an anesthetic and prescription pain killer.

By 2010 it had become a widely abused prescription drug. Soon after, the illicit manufacture of fentanyl emerged and began to spread. In the years 2011 and 2012, about 2,600 overdose deaths each year were attributed to synthetic fentanyl. Then from 2013 to 2021 fentanyl overdose deaths spiked rapidly to reach more than 68,000 in 2021. Almost 97,000 deaths from fentanyl overdose are projected for the year 2024.

Fentanyl is classified as a Schedule II narcotic drug by the Drug Enforcement Administration (DEA), meaning that it has some acceptable medical uses, but it also has a high potential for abuse. In February 2018, the DEA temporarily listed certain fentanyl-related substances, as Schedule 1 drugs, the designation for the most dangerous drugs with the highest potential for abuse.

This included components used to make illicit fentanyl, known as precursors. In 2023, Congress passed a bill making this change permanent. The scheduling differences between fentanyl and fentanyl-related substances creates a distinction between the medically prescribed drug and illicitly made products.

Fentanyl is 50 times more potent than the opioid heroin and 100 times stronger than the opioid morphine. It is available as a pharmaceutical drug in patches, tablets, lozenges, injections, and sprays. Illicitly manufactured fentanyl is produced as a powder that can also be snorted or smoked.

Illicitly manufactured fentanyl is often pressed into pills. Powdered fentanyl is often mixed into other drugs such as heroin, cocaine, or methamphetamines. This is sometimes done intentionally to increase their potency, and other times it is an unintentional contaminate.

Pressed into pill form, illicit fentanyl laced products are often made to resemble Xanax, Adderall, Oxycodone, Percocet, and other legitimate prescription drugs. Fake pills are sold on the street and over the internet. In liquid form, illicit fentanyl is placed in nasal sprays and eye drops. It is sometimes placed on blotter paper to be absorbed by the mouth. Liquid fentanyl can also be injected.

Some street names for fentanyl products include Jackpot, Great Bear, Dance Fever, King Ivory, Apache, China Girl, China Town, and Blue 30s– blue colored pills with the number 30 stamped on them to make them resemble 30 mg Oxycodone pills. Rainbow Fentanyl is the name given to bright, multicolored pills that resemble candy, and thus are particularly dangerous because they can easily be mistaken for candy and ingested by children.

Recently, fake fentanyl laced pills have been found that also contain a non-opioid veterinary sedative, called xylazine. This drug is attractive to illicit pill manufacturers because it costs less and provides a longer-lasting high than when fentanyl is used alone as an adulterant in fake pills. But xylazine itself has been linked to overdose deaths, and xylazine mixed with fentanyl is especially dangerous.

In 2023, 80 million fake pills laced with fentanyl were seized by the DEA, as well as 12,000 pounds of fentanyl powder, totaling 390 million deadly doses of fentanyl. It only takes 2 milligrams of fentanyl, an amount equivalent to a few grains of table salt, to be a fatal dose.

Fentanyl Side Effects and Risks

Not only is fentanyl extremely dangerous, it’s also highly addictive. There is a high risk of physical dependence resulting in potentially severe symptoms when the drug is withdrawn. Tolerance, where larger doses are needed to get the same effect, can also easily occur, and adds to the risk for overdose.

Like other opioids, fentanyl products can provide pain relief. But they have many side effects. Short-term use of fentanyl has side effects including:

• Nausea and vomiting
• Confusion
• Low blood pressure
• Weakness
• Dizziness
• Drowsiness and sedation
• Difficulty breathing
• Long-term use of fentanyl has side effects that may include
• Dependence
• Tolerance
• Addiction
• Depression or anxiety
• Suicidal thoughts
• Damage to heart, lungs, liver, and other organs

What Effects Does Fentanyl Have on the Brain?

Because fentanyl binds to opioid receptors in the brain, it decreases pain, increases relaxation, and causes a sense of euphoria. But it also causes confusion, dizziness, and sedation. Regular use can cause injury to the brain that may be permanent and lead to vision or hearing impairment, memory loss, and difficulty in thinking and perception.

In cases of long term or excessive usage, opioid induced psychosis can occur, with symptoms that can include hallucinations and delusions.

Fentanyl Overdose Risks

Because it takes such a small amount of fentanyl to cause an overdose, it is especially risky to use this drug. Indications of fentanyl overdose include pinpoint pupils, clammy skin, blue coloration around mouth or fingertips, stupor, limpness, loss of consciousness, coma, and respiratory depression that may lead to death.

Mixing fentanyl with other opioids or stimulant drugs like cocaine or methamphetamine increases the risk for overdose. Having a chronic health disorder, such as heart or lung disease, hepatitis, HIV, or having a history of previous overdoses also increases the risk.

How to Test for Fentanyl

Fentanyl is increasingly being found in other street drugs and counterfeit pills that resemble legitimate pharmaceuticals, increasing the risk of accidental and potentially lethal fentanyl exposure. Testing strips are now available to allow drug users to test for the presence of fentanyl quickly and inexpensively. Test strips can be purchased online for about $1 each, and many harm reduction organizations offer testing strips for free.

To use a fentanyl test strip, start by dissolving a minimal amount of drug residue in clean water. Then place the testing end of the strip in the water for approximately 15 seconds. Remove the strip and lay it on a flat surface for 1 to 3 minutes. Read the test results according to instructions on the package.

Most test strips indicate the presence or absence of fentanyl by showing one or two red lines. However, this depends on the type of strip. Instructions for using the strips can usually be found on their packaging, often with pictures. You can also find videos and written information on how to use test strips online.

Signs of Fentanyl Addiction

Addiction is treatable, so recognizing signs of dependence or addiction to fentanyl is important. Signs of fentanyl addiction include symptoms seen in other opioid addictions. As outlined in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, these include

• Using more of a fentanyl product than you intended; or using it for a longer period than intended.
• Unsuccessful efforts to cut down on usage of the drug.
• Excessive time spent on obtaining, using, or recovering from effects of the drug.
• Experiencing cravings for the drug.
• Trouble maintaining work, home, or school obligations because of drug use.
• Continuing to use a fentanyl product despite realizing it is negatively impacting relationships or causing social problems.
• Not engaging in activities previously enjoyed because of drug use.
• Using a fentanyl product under physically dangerous circumstances.
• Continuing to use the drug despite knowing it is causing physical or mental problems.
• Developing tolerance to the drug.
• Having withdrawal symptoms when stopping use of the drug.

Fentanyl Withdrawal Symptoms

Once a person has developed tolerance to fentanyl and their body has adjusted to its use, more of the drug is necessary to produce the desired effect, and the person will experience uncomfortable symptoms if the drug is stopped. Withdrawal symptoms typically last up to two weeks but can last longer depending on the amount of fentanyl regularly used and how long it was used.

• Common fentanyl withdrawal symptoms include
• Nausea or vomiting
• Diarrhea
• Muscle cramping
• Profuse sweating
• Restlessness
• Irritability
• Anxiety
• Insomnia
• Increased blood pressure
• Severe cravings

Where to Find Information About Fentanyl Addiction Treatment

For those seeking treatment for addiction to fentanyl, help is available at most rehab centers that treat other opioid addictions. To find these facilities, call the Substance Abuse and Mental Health Services Administration (SAMHSA) free phone helpline at 1-866-902-6268.

A volunteer can assist you in finding a fentanyl addiction treatment center in your area. You can also use the SAMHSA findtreatment.gov website. It has a treatment locator page to help you find a facility by your zip code.

Online directory websites, such as Rehab.com, also maintain listings of treatment centers by city and state. Another option is to ask for a referral from your doctor or therapist. Or contact addiction support groups, such as Narcotics Anonymous, in your local area and ask for referrals.

What Are the Treatment Options for Addiction to Fentanyl?

Treatment for fentanyl addiction usually includes detox, inpatient rehab treatment or outpatient treatment, and aftercare. Medication-assisted treatment (MAT) is often available at both inpatient and outpatient treatment facilities.

Detox

Detox from fentanyl addiction typically uses similar medical treatments to those used for withdrawal from other opioids. This often includes long-acting opioid medications, such as buprenorphine, and methadone.

Other medications, such as clonidine and antiemetics, are used to treat the various physical symptoms of fentanyl withdrawal. Anti-anxiety medications may be used to treat the anxiety associated with withdrawal.

Holistic treatments, including massage, acupuncture, and meditation may be used to improve relaxation. Around the clock supervision may be offered during inpatient detox treatment. Counseling is often started during the detox period and then continued during follow-up treatment.

Inpatient Treatment

Inpatient treatment takes place in a hospital or clinic, or at a residential facility offering a more home-like atmosphere. It provides 24 hour care and supervision and is best for treating acute or severe addiction symptoms where medical assistance is required for safety.

Detox is often conducted as part of inpatient treatment. After detox, the patient usually moves to another part of the facility to receive additional treatment that includes education and counseling.

Outpatient Care

Outpatient care occurs in a clinic facility, at a community center, or in a practitioner’s office. MAT, including buprenorphine, methadone, or naltrexone, is offered at many outpatient facilities. Outpatient treatment can involve a partial hospitalization program (PHP), meeting in day long sessions 4 to 6 times per week, for several weeks or months; an intensive outpatient program (IOP), meeting 3 to 5 days a week and providing a total of 9 to 20 hours of treatment a week; or standard outpatient treatment (OP), typically meeting 3 to 4 hours a day for up to 4 days a week across 8 to 10 weeks.

In outpatient treatment, group counseling and education sessions are often supplemented by individual sessions as needed. 12-Step peer support group meetings are often included in the programming.

When MAT treatment is obtained as outpatient treatment, clients are sometimes required tovisit the treatment center or clinic to receive their medication. Appointments are usually scheduled several days each week for medication distribution.

In other cases, patients receive a prescription and can pick up a supply of medication from the pharmacy. Counseling appointments are usually scheduled separately and may include group and individual sessions.

Rehab Aftercare

Aftercare includes treatment that is offered after an inpatient or outpatient program has been completed. This may involve alumni meetings, 12-step meetings, and additional individual sessions, when needed. Aftercare groups provide clients an opportunity to make sober social connections and create ongoing support systems.

Treatment for fentanyl addiction, like treatment for other opioid addictions, helps people obtain healthier, more balanced, more successful lives.