Fentanyl Addiction

What is Fentanyl Addiction?

Fentanyl addiction is a dependency on the drug despite its harmful effects, often leading individuals to lose control over their intake. Medically, fentanyl is used as a synthetic opioid for pain management, particularly in cancer patients. However, it is also illicitly manufactured and abused.

Fentanyl operates by binding to opioid receptors in the brain, producing intense sensations of euphoria and pain relief. With repeated use, the brain’s sensitivity to other stimuli diminishes, resulting in aggressive and compulsive drug-seeking behavior. This cycle of dependency can lead to significant physical, emotional, and social consequences, making fentanyl addiction a critical public health issue.

Fentanyl Types

1. Pharmaceutical Fentanyl: Pharmaceutical version, administered under prescription by a medical professional, to manage severe pain, particularly in cancer patients.
2. Illicitly Manufactured Fentanyl: Manufactured in unregulated labs; it is often sold on the streets. It is usually mixed with other drugs, increasing the risk of overdose and making it highly dangerous.

Both forms are incredibly potent and, therefore, extremely addictive and dangerous.

Fentanyl is also available in various formulations, including: 

• Transdermal patches
• Lozenges or Lollipops
• Injectable solutions
• Powders
• Nasal sprays

What is Fentanyl used for?

Fentanyl is primarily prescribed to manage severe pain that cannot be adequately treated with other pain medications. Medical prescriptions of fentanyl are commonly given for:

• Severe cancer pain
• Pain management post-surgery
• Chronic pain in opioid-tolerant patients

Additionally, fentanyl is used to treat various conditions, including:

• Complex regional pain syndrome
• Postherpetic neuralgia (pain after having shingles)
• Severe arthritis
• Arachnoiditis (inflammation of the spinal cord)

While fentanyl has high efficacy in pain management, its potency prescribes cautious management to avoid misuse and dependence.

How do people use Fentanyl?

Fentanyl can be used both legally and illegally. 

When prescribed legally, it is most commonly administered in the following forms:

• Transdermal patches on the skin
• Lozenges or lollipops that may be slowly dissolved
• Injectable solutions utilized within the environment of a hospital

Illegally, fentanyl is often misused in several ways, including:

• Smoking or snorting it in powdered form
• Snorting liquid forms through nasal sprays
• Injecting the liquid form
• Swallowing pills pressed with fentanyl
• Placing liquid drops onto blotter paper and dissolving it under the tongue.

Mixing fentanyl with other substances, such as heroin or cocaine, significantly increases the risk of overdose, often without the users’ knowledge of fentanyl’s presence. 

Fentanyl Abuse Statistics

The rise in fentanyl abuse has been alarming, marked by a significant increase in both supply and the number of fentanyl-related deaths. 

Law enforcement seizures of illicit fentanyl have reached unprecedented levels, particularly in the form of pills. From 2017 to 2023, the number of fentanyl pills seized surged dramatically, with 115.6 million pills confiscated in 2023, compared to just 49,657 in 2017—an increase of approximately 2,300 percent. 

Tablets now account for roughly half of all fentanyl seizures, representing 49% of total seizures compared to only 10% in 2017. 

Additionally, seizures of fentanyl powder have also risen during this period, further underscoring the escalating crisis of fentanyl abuse.

According to the CDC:

• Illicit fentanyl accounts for 52.7% of all overdose fatalities in the United States.
• SAMHSA estimated that 991,000 individuals aged over 12 years abused fentanyl in 2022.
• More than 2 million Americans experience opioid use disorder, with 20% of those suffering from substance use disorder attributed to opioid addiction.

These statistics highlight fentanyl as one of the deadliest and most pervasive drugs fueling the current opioid crisis.

Symptoms and Causes

What are the signs & symptoms of Fentanyl addiction?

Fentanyl addiction is generally referred to as opioid use disorder, which, according to the DSM-5, may be manifested by at least two of the following over 12 months:

1. Strong cravings to use fentanyl.
2. When the intake of fentanyl is beyond the intended or prescribed duration.
3. Difficulty controlling use or cutting down.
4. Inability to meet obligations at work, school, or home due to fentanyl use.
5. Spending excessive time obtaining, using, or recovering from fentanyl.
6. Continued use despite harmful consequences.
7. Use in hazardous activities: driving.
8. Social isolation in order to use drugs.
9. Continued use despite physical, emotional, or psychological harm.
10. When not using fentanyl, a person may experience withdrawal symptoms.
11. Tolerance is developed – the need for larger doses to produce the same effect.

Identifying these signs is necessary at an early stage for intervention and seeking help.

Behavioral Changes

• Neglect of duties whether at home, work, or school
• Isolation from family and friends
• Secretive behavior or lying about drug use
• Risk-taking (Driving Under The Influence)
• Compulsive drug-seeking behavior

Physical Symptoms

• Increased tolerance – requires higher doses
• Withdrawal symptoms when not using the drug fentanyl
• Disturbances in sleep
• Respiratory problems, such as shallow breathing
• Drowsiness or sedation
• Sudden weight loss or loss of appetite

Cognitive Symptoms

• Confusion or memory problems
• Poor concentration, decision-making
• Slowed reaction times
• Impaired judgment

Psychological Signs

• Anxiety and depression
• Mood swings or irritability
• Intense desires to use fentanyl
• Shame or guilt about using drugs

How strong is Fentanyl?

Fentanyl is an extremely potent synthetic opioid, estimated to be about 100 times more powerful than morphine and approximately 50 times more potent than heroin. While this high potency makes fentanyl an effective option for pain management in medical settings, it also poses significant dangers in non-medical environments, where the risk of overdose and addiction increases dramatically. The small difference in dosage required for therapeutic effects versus lethal outcomes underscores the need for caution when using fentanyl.

How much Fentanyl is too much?

Even a small amount of fentanyl can be lethal. A dose as low as 2 milligrams can be deadly, depending on factors such as an individual’s size, tolerance, and previous opioid use. Additionally, counterfeit pills may contain varying amounts of fentanyl, with some potentially having up to 5.1 milligrams, which is more than double the lethal dosage. This kind of disparity significantly increases the risks associated with the illicit use of fentanyl, making it particularly dangerous. Users may unknowingly consume a dose that exceeds their tolerance, leading to fatal overdoses.

What causes Fentanyl addiction?

Several factors contribute to fentanyl addiction:

1. Biological Factors: Genetic predisposition and chemical imbalances in the brain can significantly influence an individual’s susceptibility to addiction.
2. Psychosocial Factors: The presence of mental health disorders, such as major depression, anxiety, or trauma, can increase the likelihood of substance use as a coping mechanism.
3. Environmental Stressors: Chronic stress, poverty, trauma, or exposure to drug use in one’s environment can trigger substance use.
4. Prescription Drug Abuse: Misusing fentanyl, whether by taking higher doses than prescribed, mixing it with alcohol or other drugs, or using it in ways not directed by a healthcare professional—can lead to the rapid development of dependence.

Additionally, the speed with which fentanyl acts makes it a danger, even for those who do not have a history of addiction. Recreational users or individuals who unknowingly consume fentanyl mixed with other drugs face significant overdose risks.

What is the main cause of Fentanyl addiction?

The primary cause of fentanyl addiction is its extreme potency. Fentanyl acts on the brain’s opioid receptors with overwhelming strength, producing an intensely euphoric high. This powerful effect makes it highly addictive.

Additionally, even when used as prescribed, long-term use can lead to physical dependence. Individuals may experience withdrawal symptoms if they stop taking fentanyl, further perpetuating the cycle of addiction as they may continue to use the drug to avoid these unpleasant effects.

What are the effects of Fentanyl abuse?

Fentanyl works by binding to opioid receptors in the brain, altering the body’s perception and response to pain. The effects of fentanyl abuse can be categorized into short-term and long-term effects.

Short-Term Effects

The immediate short-term effects of fentanyl abuse can include:

• Euphoria
• Relaxation
• Pain relief
• Drowsiness
• Nausea

However, most of these short-term effects are always accompanied by the following dangerous side effects:

• Dizziness
• Confusion
• Constipation
• Respiratory depression: unusually slow or arrested breathing

Long-Term Effects

Prolonged use of fentanyl can lead to serious and lasting effects on both the body and mind. Over time, individuals may experience:

• Chronic respiratory issues
• Cognitive impairments including memory disturbance
• Hormonal disturbances of libido and sterility
• Infection risk (with intravenous use)
• Gastrointestinal problems like chronic constipation

In addition to these physical effects, fentanyl abuse can significantly impact daily life. It can cause stress in relationships, impair job performance, and create a dependency cycle that is difficult to escape. Addiction often leads to neglect of personal responsibilities, financial difficulties, and social isolation from family and friends. Recognizing these long-term effects is crucial for understanding the broader impact of fentanyl addiction.

What makes a person addicted to Fentanyl?

Fentanyl makes people addicted partly because of its great potency and fast action. Even those who took this substance as an active principle of a prescription can develop an addiction, having withdrawal afterward in case of stopping the intake of the substance.

Fentanyl Withdrawal

Fentanyl withdrawal symptoms can be extremely painful and uncomfortable, encompassing both physical and psychological distress. Symptoms may begin as early as 12 hours after the last dose and typically peak within 24 to 48 hours, potentially lasting for a week or longer in some cases.

Common withdrawal symptoms include the following:

• Bone and muscle aches
• Sleep Disturbances
• Nausea and vomiting
• Intense cravings
• Cold flashes with goosebumps
• Irritability and depression

The initial days of withdrawal can be particularly intense, with waves of discomfort and irritability common. Symptoms can become severe enough that professional treatment is often necessary to help individuals manage withdrawal and reduce the risk of relapse. Seeking medical assistance during this period is crucial for a safe and supportive recovery process.

Fentanyl Overdose

A fentanyl overdose is a life-threatening emergency that requires immediate medical attention. This powerful synthetic opioid can depress breathing to the point where oxygen cannot reach the brain, leading to hypoxia. Hypoxia can result in serious consequences, including brain damage, coma, and even death.

Symptoms of a Fentanyl Overdose may appear within seconds or minutes after use and include:

• Blue-colored lips or skin
• Shallow or slow breathing
• Gurgling sounds
• Confusion or disorientation
• Chest Pain
• Seizures or muscle rigidity
• Loss of consciousness

If you suspect someone is overdosing on fentanyl, you need to immediately call emergency services. Naloxone, an opioid antagonist, can temporarily reverse the effects of the overdose, but medical help is essential for recovery and to address any underlying issues.

Diagnosis and Tests

How is Fentanyl addiction diagnosed?

Diagnosis of fentanyl addiction is generally carried out by a healthcare professional after conducting an in-depth assessment. Diagnostic tools often used include:

• Physical Examination: Examining the patient for physical signs of opioid use, such as track marks or withdrawal symptoms.
• Medical History: To review prescription use and previous use of substances.
• Behavioral Assessment: This will hint at changes in behavior, mood, and daily functioning.
• Criteria for DSM-5: The criteria for diagnosing opioid use disorder, based on the Diagnostic and Statistical Manual of Mental Disorders, are increased tolerance, withdrawal symptoms, and several efforts to stop the use despite harmful consequences.

Obtaining a formal diagnosis is crucial, as timely intervention significantly increases the chances of successful recovery from fentanyl addiction.

Treatment

What are treatments for Fentanyl addiction?

Fentanyl addiction, like other opioid use disorders, is treated through a combination of medications and behavioral therapies.

Medication-Assisted Treatment (MAT):

• Methadone: It is a full opioid agonist that reduces the desire for opioids and withdrawal symptoms.
• Buprenorphine: It is the partial opioid agonist used for maintenance therapy of withdrawal and reduces abuse potential.
• Naltrexone: It works as an opioid antagonist by blocking the reinforcing effects of fentanyl and hence prevents relapse.

Behavioral Therapies:

• Cognitive Behavioral Therapy (CBT): It helps the individual to know and identify triggers and modify certain behaviors to develop healthier coping.
• Contingency Management: Trying to reward participants for staying sober, that is, through negative drug tests.
• Motivational Interviewing (MI): This is helpful to people in making them resolve ambivalence toward recovery and embracing change.

Treatment Programs:

After medical detoxification, patients will normally enter one of the following treatment programs:

• Outpatient Program (OP): Flexibility in treatment while staying at home and visiting regular therapy sessions.
• Intensive Outpatient Program (IOP): A level of care that is more intensive when compared to outpatient; it includes increased hours of therapy.
• Partial Hospitalization Program (PHP): Day programs in which a patient is given intense treatment yet allowed to return home at night.
• Sober Living Homes: Sober living homes provide a safe and structured environment in which residents can thrive to support the process of long-term sobriety through peers and accountability.

These programs continue to support these individuals over time as they work their way through long-term sobriety.

Prevention

How can I prevent Fentanyl addiction?

You can prevent fentanyl addiction with responsible opioid use. In instances where one is prescribed fentanyl for pain, consideration of the following should be put in place:

• Always do exactly as your healthcare professional has instructed you.
• Never take more than the prescribed dose or for a longer time than prescribed.
• Fentanyl should not be taken together with alcohol or other sedative drugs.
• If the fentanyl is not used, get rid of it properly to avoid misuse.

Treatment via therapy, support groups, and recovery programs may minimize the risk of addiction associated with misuse or relapse in vulnerable individuals.

Outlook / Prognosis

Is there a cure for Fentanyl addiction?

While there is no such thing as a one-time cure for fentanyl addiction, it is considerably manageable through medication taken together with psychotherapy and long-term support. It is a continuous period of recovery because medical, psychological, and behavioral interventions must be carried out in the course of the process. People with good support can regain control over their lives, remain sober, and live fulfilling lives without fentanyl.

Living With

How do I help someone I love who is suffering from Fentanyl addiction?

Supporting a loved one through addiction to fentanyl is not easy; but your involvement is important to their recovery. Here’s how you can help:

• Educate yourself: Understand fentanyl addiction and the associated risks as a means of offering support to a loved one.
• Be compassionate: Addiction is a disease, not a moral failing. Approach your loved one without judgment but with empathy.
• Encourage treatment: Offer to help them find professional treatment. Be prepared to provide support during this process.
• Set boundaries: While being supportive is important, clear boundaries should be drawn, ones that will not serve to enable addictive behaviors.
• Take care of yourself: It may be an emotionally draining job to support one through the recovery process. Make sure you have a support system for yourself.

By encouraging treatment and always being there to support, you might be making all the difference on their road to complete recovery.