Fentanyl used to be the strongest opioid medication intended for use in humans and is approximately 50 to 100 times more potent than morphine. In November 2018, the FDA approved a new opioid that is ten times stronger than fentanyl approved for use only in medically supervised environments like emergency rooms, surgical centers, and hospitals.
Fentanyl used to be extremely exclusive, prescribed only to terminally ill cancer patients. Today’s fentanyl comes from China and Mexico. Since fentanyl is completely synthetic (human-made), it can be produced cheaply, and therefore sold on the black market for less money than natural opioids like heroin.
Fentanyl is the most common added ingredient in heroin sold by dealers. Despite the massive health risk that opioid painkillers and heroin have created, fentanyl has brought about an even graver opioid epidemic; synthetic opioids that are more powerful and deadly than heroin.
The CDC (Centers for Disease Control and Prevention) reports that overdose deaths involving fentanyl rose nearly 50% from 2016 to 2017.
Where Did Fentanyl Come From?
Fentanyl was first approved over fifty years ago as a surgical anesthetic and was later approved for treating severe pain for advanced cancer patients in the late 1990s. However, the growing demand for more powerful painkillers has expanded a once limited use for the drug. Fentanyl may now be prescribed to treat patients with severe pain, for the management of pain after surgery, and to treat patients with chronic pain who are tolerant to opioids.
Fentanyl is just one of the many factors contributing to the opioid crisis in the country today, but because it is synthetic, illegal manufacturing is easy, and that presents a greater danger for heroin users who are unaware of how much fentanyl is in their heroin.
The black market production of fentanyl remains a significant concern because there is no uniformity to the strength from one batch to the next, and this is clear in multiple reports of “killer batches” of heroin in isolated areas where a spike in overdose deaths occur in a short period, especially in the northeastern regions of the country.
In addition to an additive for heroin, dealers sell fentanyl by itself for addicts seeking the most intense high available to them.
When sold on the street, fentanyl has several names, many of which sound just as deadly as the drug can be. Some common street names for fentanyl include:
- Murder 8
- Serial Killer
- China White
- Drop Dead
- Dance Fever
Fentanyl sold by street-level dealers may have the same nickname as heroin, like China White, increasing the chances that a heroin user will buy and fatally overdose on fentanyl, thinking that he or she is using heroin.
Medical formulations of fentanyl are all listed as schedule II drugs, with full acknowledgment of fentanyl’s high abuse potential and the probability of dependence upon continued use.
Fentanyl is manufactured legally in many different forms, from very short-acting for acute pain, to extended release patches that are intended to manage chronic pain over twelve hours or more.
Some efforts have been made to prevent diversion and abuse of prescribed fentanyl, but the illicit production of the drug has more than sustained the black market, negating tamper-proof efforts made by pharmaceutical companies.
Effects of Fentanyl
Fentanyl is prescribed for severe pain, and because it is so much stronger than morphine, it comes in micrograms (µG), or one-millionth of a gram, whereas most medications including the next strongest opioids measured in milligram amounts (one-thousandth of a gram). Although it is known for its analgesic qualities, a minuscule amount of fentanyl is enough to produce life-threatening effects in someone who is not tolerant to opioids.
Like all opioids, the hallmark effect of fentanyl that makes it most dangerous is respiratory depression. In overdose situations, a person’s breathing and heart rate are so depressed that they may stop breathing entirely, causing coma or death.
Whether someone is taking fentanyl for medical or non-medical reasons, it produces the same effects and presents the same risks.
Effects of clinical dosages of fentanyl can include:
- dry mouth
- depressed respiration
- constricted pupils
- reduced heart rate
- low blood pressure
- stiff or rigid muscles
As an opioid and central nervous system (CNS) depressant, one of the effects of fentanyl is respiratory depression. While it can be dangerous on its own, fentanyl is deadly when mixed with other CNS depressants including other opioid painkillers, benzodiazepines like Xanax, alcohol, or heroin. A tiny amount of fentanyl can be the difference between an enjoyable high and overdose death, even in the most experienced heroin users. The primary concern is respiratory depression and failure, which are the main symptoms of overdose.
Like most opioids, the main risk of fentanyl abuse is dependence and addiction. This risk has increased with more lenient prescribing practices that have provided non-terminal patients with powerful opioids like fentanyl for extended periods. Fentanyl, like all other opioids, causes dependence when it is used regularly for an extended time, which can be as short as a few weeks.
Withdrawal symptoms can begin within a few hours of the last dosage of fentanyl, depending on the frequency and strength of fentanyl used.
Fentanyl Abuse and Addiction
No one goes from being opioid-naive to abusing fentanyl without a few steps in between. Fentanyl is up to 100 times stronger than morphine, so someone would need to have developed a very high tolerance to opioids to be able to use fentanyl without serious risk of immediate overdose and death. Even though most heroin contains fentanyl when sold on the streets, fentanyl alone would still present the same fatal overdose risks. So, how do people become addicted to fentanyl?
The vast majority of people who are addicted to fentanyl have been prescribed the drug at some time. Although most physicians are cautious with prescribing powerful opioids like fentanyl, individuals who are addicted to the drug have most likely had prescriptions for powerful opioids in the past.
The only way for an individual to obtain a fentanyl prescription is to have documentation of a chronic pain disorder and a documented history of increasingly more potent opioid painkillers. Once prescribed, someone intent on abusing fentanyl can do so by simply taking more of the drug than indicated, or combining it with other opioids to enhance the euphoric high it produces.
The longer someone abuses fentanyl and tolerance continues to grow, the more fentanyl is needed to achieve the same effect.
When someone is addicted to fentanyl, normal amounts of the drug are not sufficient to avoid withdrawal symptoms, increasing the risk of taking too many other opioids or depressant drugs, and the potential for a fatal overdose.
Another serious concern of fentanyl abuse is the fact that normal doses of the opioid overdose antidote, naloxone, are often insufficient to reverse the drug’s effects.
In most cases of overdoses of heroin or other opioids, naloxone can reverse the effects and immediately revive a patient. However, medical workers have recently found that several doses of naloxone are necessary to reverse the overdose effects of fentanyl. The inability to reverse the deadly effects of a fentanyl overdose quickly have to lead to thousands of deaths over the last several years of the opioid epidemic in the United States.
Fentanyl Addiction Effects
Addiction to fentanyl is like addiction to any other drug. A person feels a physical and psychological need to use the drug and can lose all sense of ethics, morals, and honesty in the process of constantly seeking and using fentanyl.
Although addiction does involve a physical dependence on fentanyl, it is important to note that addiction and dependence are not the same. Dependence is a natural development when any substance is used regularly for a prolonged time. Addiction is a series of behavioral patterns and disorders, one of the most dangerous of which is drug-seeking behavior.
The following are some common signs and effects of addiction to fentanyl:
- growing tolerance and need for larger and more frequent amounts of fentanyl
- inability to cut down or stop using fentanyl
- experiencing withdrawal symptoms when not using fentanyl
- abusing fentanyl with other CNS depressant drugs like alcohol, benzodiazepines, or other opioids
- neglecting responsibilities and obligations to continue using
Fentanyl Withdrawal Symptoms
Withdrawal from opioids like fentanyl is well known for its painful and uncomfortable symptoms. For most people, fentanyl withdrawal is not life-threatening, but it is grueling. Withdrawal symptoms from fentanyl may begin within a few hours of the last dose, reach their peak between two and three days, and begin to fade around the fifth day. The exact time table for fentanyl withdrawal symptoms will vary depending on individual circumstances and abuse patterns.
Withdrawal symptoms typically start with a runny nose and frequent yawning before the development of more severe symptoms which can include:
- intense craving
- clammy skin
- abdominal pain
- muscle pain and spasms
- high blood pressure
- high fever
- increased heart rate
Although fentanyl withdrawal is not life-threatening, it is severe and painful enough for addicts to justify anything to avoid having to endure it. The attempts to “get well” can include a myriad of illegal and dangerous actions just to get fentanyl or any other opioid and avoid withdrawal.
Fentanyl Addiction Treatment
Fentanyl addiction treatment begins with detox, to remove the drugs from the system. Unlike quitting cold turkey, a medical detox can provide a full-time medical staff to administer medications that can ease severe symptoms like:
- severe anxiety
- high blood pressure
Fentanyl detox can last for several days and leave some symptoms that can linger for several weeks or months. These symptoms typically include intense cravings and anhedonia, or an inability to feel pleasure.
Some people prefer to pursue fentanyl treatment with medication-assisted treatment (MAT) using methadone or buprenorphine. These synthetic opioids address the cravings and the anhedonia, but keep a person on opioids for an extended time to last at least one year in conjunction with a sober support or recovery program.
Recovery from fentanyl addiction requires more than just a stint in a rehab facility. It requires a life-long commitment to recovery which may include some relapses, but the commitment is the most important part.
In addition to long-term support after time in rehab, an effective addiction treatment program also provides:
- coping skills to handle stress and pressure without turning to fentanyl use or abuse of other substances
- communication skills to relay needs and emotions in a productive manner
- education to recognize triggers for relapse and learning how to avoid them
- therapy to identify and address underlying issues that may have contributed to drug abuse
- nutritional classes and therapies to establish healthier lifestyle habits
- comprehensive resources and connections for sober activities and hobbies to help prevent relapse
At Vogue Recovery Centers, addiction treatment covers all of these important tools in a luxurious and comfortable setting. A treatment plan is designed around each client to address unique needs and establish a recovery path that fits the life and preferences of each person. A customized treatment plan provides the greatest chance for relapse prevention and long-term recovery.
Fentanyl is the strongest opioid that a person can take without direct medical supervision, and it is also produced in massive quantities through clandestine labs and sold on the black market. Although synthetic opioids like fentanyl have claimed thousands of lives, help is available and recovery is possible. Addiction to this dangerous drug will only get worse without intervention and treatment.
If you or someone you know is struggling with fentanyl abuse or addiction, call us now to speak with one of our experienced counselors about how we can design a life-saving treatment plan for lasting recovery.
Fentanyl addiction treatment is more than just thirty days in a rehab facility; that is only the beginning. Addiction treatment aims to provide the tools, skills, education, and support for each person to be able to remain in recovery and live an entirely drug-free life.
- NIDA “Fentanyl.” National Institute on Drug Abuse, 3 Jun. 2016
- CDC National Center for Injury Prevention and Control, Jul. 2017
- Department of Justice Drug Enforcement Administration, 21 CFR 1308, Feb.2018
- U.S.-China Economic and Security Review Commission, 1 Feb.2017
CDC Health Alert Network, 11 Jul.2018