Fentanyl Addiction: Symptoms, Causes, Risk, Treatment and Prevention

According to the DEA, overdose deaths involving synthetic opioids, primarily illicitly manufactured fentanyl, rose by 55.6 percent, making it the primary driver of the increase in total drug overdose deaths

The fentanyl epidemic is a major public health problem caused by this extremely powerful and habit-forming opioid drug, which has led to a sharp increase in deadly overdoses throughout the country.

Symptoms: Fentanyl addiction causes severe drowsiness, confusion, slowed breathing, and other opioid intoxication symptoms.

Causes: The high potency and addictive nature of fentanyl, coupled with factors like previous opioid use, mental health issues, and social influences, contribute to the development of fentanyl addiction.

Negative Effects: Fentanyl addiction can lead to devastating consequences like overdose, organ damage, financial ruin, strained relationships, and even death.

Treatment Options: Evidence-based treatments for fentanyl addiction include medication-assisted therapy, behavioral counseling, and comprehensive rehabilitation programs to address the physical, psychological, and social aspects of the disorder.

What is Fentanyl Addiction?

Fentanyl addiction is a serious and growing public health crisis. It is an uncontrollable urge to use and the use of fentanyl despite its negative consequences. 

According to research by Volpe DA et al, titled Uniform assessment and ranking of opioid Mu receptor binding constants for selected opioid drugs. Regul Toxicol Pharmacol. 2011;59(3):385-390. doi:10.1016/j.yrtph.2010.12.007, fentanyl is a synthetic opioid that is 50-100 times more potent than morphine. It is increasingly being illicitly manufactured and added to other drugs like heroin, cocaine, and counterfeit pills, leading to a spike in overdoses.

Fentanyl addiction works similarly to addiction to other opioids. When taken, it binds to opioid receptors in the brain, producing a powerful high and sense of relaxation. However, the potency of fentanyl means that the risk of overdose is extremely high, even with relatively small doses.

Overall, fentanyl addiction is a serious and complex issue that requires a comprehensive public health approach focused on prevention, treatment, and harm reduction. 

What are the Signs and Symptoms of Fentanyl Addiction?

Fentanyl addiction can cause symptoms like extreme drowsiness, constipation, runny nose, neglecting personal hygiene, mood swings, depression, and impaired cognitive function:

Physical Signs

• Extreme drowsiness or “nodding off”
• Constricted (pinpoint) pupils
• Slowed breathing or respiratory depression
• Nausea and vomiting
• Constipation
• Sweating, flushed skin
• Itching
• Runny nose
• Watery eyes

Behavioral Signs

• Seeking out fentanyl at all costs, including doctor shopping, forging prescriptions, or obtaining it illegally
• Using fentanyl in increasing amounts or for longer periods than intended
• Spending a lot of time obtaining, using, or recovering from using fentanyl
• Failure to fulfill major work, school, or home obligations
• Continuing to use fentanyl despite negative consequences
• Isolating from friends and family
• Loss of interest in hobbies and activities
• Neglecting personal hygiene
• Mood swings, irritability, or hostility

Psychological Signs

• Strong cravings for fentanyl
• Increased tolerance, requiring higher doses to achieve the same effect
• Withdrawal symptoms when stopping or reducing use, such as:
  • Anxiety, restlessness
  • Muscle aches
  • Insomnia
  • Diarrhea
  • Nausea and vomiting
  • Increased heart rate and blood pressure
• Depression, apathy
• Impaired cognitive function

The severity of these signs and symptoms can vary depending on the individual and the extent of their fentanyl use.

What are the Effects of Fentanyl Addiction?

The effects of fentanyl addiction encompass physical, mental and social effects, including respiratory depression, heart issues, kidney problems, legal troubles, increased risks of psychosis, negative impact on career, and many more:

Physical Effects

• Respiratory depression and risk of fatal overdose
• Cardiovascular problems like irregular heartbeat and heart attacks
• Gastrointestinal issues like severe constipation
• Increased risk of infectious diseases like HIV and hepatitis from needle use. According to reports from the Centers for Disease Control and Prevention, titled Surveillance for Viral Hepatitis – United States, (2017), Since 2010, there has been a significant surge in new cases of acute HCV in the US, primarily linked to injection drug use.
• Withdrawal symptoms like muscle aches, nausea, and diarrhea
• Increased risk of accidental injury due to impaired coordination
• Long-term organ damage, particularly to the liver and kidneys

How does fentanyl addiction impact the gastrointestinal system and lead to constipation?

Research by Yan, et al, titled The effect of opioids on gastrointestinal function in the ICU, revealed that opioids like fentanyl can delay gastric emptying, increase gastrointestinal transit time, and suppress the secretion of water and electrolytes in the intestine, thereby increasing the risk of gastrointestinal dysfunction. Here’s how fentanyl addiction severely constipates users by:

• Slowing down intestinal movement and function
• Reducing digestive fluid production
• Disrupting the gut-brain communication axis
• Causing dehydration

The combination of these effects leads to difficult, painful bowel movements and chronic constipation in those struggling with fentanyl addiction. 

Mental/Emotional Effects

• Severe cravings and compulsive drug-seeking behavior
• Heightened anxiety, depression, and mood swings
• Impaired cognitive function and decision-making abilities. According to research by Tamargo, et al, titled Cognitive Impairment Among People Who Use Heroin and Fentanyl: Findings from the Miami Adult Studies on HIV (MASH) Cohort, found that cognitive impairment was more frequent among people who used heroin and/or fentanyl compared to those who misused prescription opioids. The use of heroin/fentanyl was associated with increased odds for cognitive impairment.
• Apathy, loss of motivation, and lack of interest in previously enjoyable activities
• Increased risk of psychosis and paranoia
• Potential for long-term neurological damage

How does fentanyl affect the brain?

Fentanyl profoundly impacts the brain in the following ways:

• Triggers intense euphoria and dopamine release, reinforcing addiction
• Leads to tolerance and physical dependence over time
• Depresses respiratory centers, risking fatal overdose
• Impairs cognitive functions like memory and decision-making
• Increases risk of psychosis and long-term neurological damage

The brain’s exceptional sensitivity to fentanyl underlies its highly addictive nature and the significant challenges in treating fentanyl addiction.

Another study by Siri Carpenter, titled Cognition is central to drug addiction, found that repeated drug use, including fentanyl, can cause disruptions in the brain’s frontal cortex, which regulates cognitive activities such as decision-making, response inhibition, planning, and memory. This disruption in the frontal cortex can contribute to impaired decision-making and behavioral inhibition in drug abusers.

Social Effects

• Breakdown of relationships with family and friends
• Job loss, financial instability, and homelessness
• Legal troubles, including arrests and incarceration
• Social isolation and withdrawal from community
• Increased risk of domestic violence and other criminal activity to fund the addiction
• Negative impact on educational and career attainment
• Strain on healthcare and social services systems

The highly addictive nature of fentanyl and the severe consequences of overdose make this addiction particularly devastating across all areas of an individual’s life. 

What are the Causes of Fentanyl Addiction?

The causes of fentanyl addiction range from the potency of the drug to medical use and diversion, genetics, environmental factors, lack of information about the drug and its potential as a gateway to heroin addiction.

1. Potency and Rapid Onset

Fentanyl is an extremely potent synthetic opioid, much stronger than naturally-derived opioids like morphine. This high potency means a smaller amount of fentanyl can produce an intense, euphoric high very quickly. The rapid onset and powerful effects of fentanyl make it highly addictive, as the user’s brain becomes quickly accustomed to the drug’s effects.

2. Medical Use and Diversion

Fentanyl is commonly prescribed by doctors to treat severe, chronic pain, especially for cancer patients. However, prescription fentanyl can be diverted from legitimate medical use and sold illegally on the black market. This diverted pharmaceutical fentanyl, as well as illicitly manufactured fentanyl, is then abused by individuals who develop an addiction.

3. Gateway to Heroin Use

Some people start using fentanyl after becoming addicted to prescription opioid painkillers. As their tolerance increases, they may transition to using fentanyl to achieve a stronger high, as it is more potent than prescription opioids. The lower cost of illicit fentanyl compared to prescription opioids can also drive this transition.

According to research by Jones CM, titled Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002-2004 and 2008-2010. (2013),  young, urban injection drug users in 2008 and 2009 revealed that 86 percent had engaged in nonmedical use of opioid pain relievers before transitioning to heroin. Their introduction to nonmedical opioid use typically stemmed from three main sources: family, friends, or personal prescriptions.

4. Lack of Awareness and Misinformation

Many people are unaware of just how potent and addictive fentanyl can be, especially if they’ve only used less potent opioids. Misinformation about the perceived safety or “purity” of fentanyl, often spread on the streets or online, can lead to a false sense of security and increased use.

5. Genetic and Environmental Factors

Certain genetic predispositions can make some individuals more susceptible to developing addictive behaviors. Environmental factors like trauma, chronic stress, and negative social influences can also increase the risk of substance abuse and addiction.

6. Availability and Affordability

According to the Wisconsin Department of Health Services, the availability and affordability of fentanyl have made it an attractive option for both drug users and dealers. Illegally manufactured fentanyl is often mixed into drugs to make them more potent and less expensive to produce. This has led to fentanyl being found in various drugs, including counterfeit pills, cocaine, methamphetamine, and heroin

Understanding these concrete, grounded explanations for the causes of fentanyl addiction is crucial for developing effective prevention and treatment strategies to address this public health crisis.

What are the Risk Factors for Fentanyl Addiction 

Risk factors for fentanyl addiction include prior opioid use, social influences, mental health conditions, trauma, and lack of support.

• Prior Opioid Use
• Mental Health Disorders
• Genetic Predisposition
• Starting at a Young Age
• Social Influences
• Chronic Pain and Injury
• Socioeconomic Factors
• History of Substance Abuse
• Trauma and Adverse Life Events
• Lack of Family/Social Support

Addressing this comprehensive set of risk factors is crucial for developing effective prevention, intervention, and treatment strategies to combat the fentanyl addiction crisis.

What are the Withdrawal Symptoms of Fentanyl?

Withdrawal symptoms of fentanyl, a potent synthetic opioid, include gastrointestinal distress, fever, chills, increased heart rate, anxiety, muscle and bone pain, and diarrhea:

• Flu-like Symptoms: These may include fever, chills, sweating, runny nose, and watery eyes.
• Gastrointestinal Distress: Symptoms such as nausea, vomiting, diarrhea, and abdominal cramping are common during fentanyl withdrawal.
• Muscle and Bone Pain: Individuals may experience muscle aches, joint pain, backache, and general discomfort.
• Sleep Disturbances: Insomnia, restlessness, and difficulty falling or staying asleep are typical withdrawal symptoms.
• Mood Changes: Anxiety, irritability, agitation, and mood swings are common during fentanyl withdrawal.
• Intense Drug Cravings: Individuals may experience strong urges or cravings to use fentanyl or other opioids.
• Increased Heart Rate and Blood Pressure: Withdrawal from fentanyl can lead to elevated heart rate and blood pressure, along with palpitations.
• Dilated Pupils: Pupil dilation is a common symptom of opioid withdrawal, including fentanyl withdrawal.

What are the Treatment Options for Fentanyl Addiction?

Treatment options for fentanyl addiction include medication assisted treatments, holistic and behavioral therapies, support and counseling, and relapse prevention.

Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment (MAT) combines medications with counseling and behavioral therapies to treat substance use disorders like fentanyl addiction. MAT uses medications such as methadone, buprenorphine, or naltrexone to reduce withdrawal symptoms, cravings, and the reinforcing effects of opioids. 

According to the Illinois Criminal Justice Information Authority MAT, particularly the use of medications like methadone or buprenorphine, is considered an evidence-based practice for treating opioid use disorder (OUD), including fentanyl indicating that individuals receiving MAT have better outcomes compared to those who engage in therapy alone 

MAT has been found to reduce opioid use, decrease overdose risk, improve retention in treatment, and increase overall treatment success rates

Behavioral Therapies

Behavioral therapies are essential components of fentanyl addiction treatment, focusing on modifying thought patterns and behaviors associated with drug use. Cognitive Behavioral Therapy (CBT) helps individuals identify and change negative thought patterns, develop coping skills, and prevent relapse. 

Contingency Management (CM) provides incentives for drug-free behaviors, reinforcing positive changes and motivation. Motivational Interviewing (MI) encourages individuals to explore their ambivalence about change, build motivation, and set achievable goals. 

By addressing psychological factors contributing to addiction and promoting healthier coping mechanisms, behavioral therapies empower individuals to overcome fentanyl addiction and sustain long-term recovery.

Support Groups and Counseling

Support groups, such as Narcotics Anonymous (NA), offer peer support, shared experiences, and a sense of community, helping individuals feel understood and less isolated. Counseling sessions with trained therapists provide personalized guidance, coping strategies, and tools for addressing underlying issues contributing to addiction. 

Both avenues offer a safe space for individuals to explore their thoughts, feelings, and behaviors, promoting self-awareness, empowerment, and resilience in their journey toward recovery from fentanyl addiction.

Holistic Approaches

Holistic approaches to fentanyl addiction treatment focus on healing the whole person—body, mind, and spirit. These methods encompass various complementary therapies such as acupuncture, yoga, meditation, and art therapy. 

By addressing physical, emotional, and spiritual well-being, holistic approaches promote relaxation, stress reduction, and inner balance. Exercise and nutrition also play key roles in supporting recovery, enhancing mood, and reducing cravings.

Peer Support and Aftercare

Peer support and aftercare probide ongoing support and guidance to individuals as they navigate their recovery journey. Peer support, often facilitated through sober living homes or mutual aid groups like Narcotics Anonymous (NA), offers a sense of community, understanding, and encouragement from individuals with shared experiences. 

Aftercare services, including ongoing counseling, follow-up appointments, and support groups, help individuals maintain sobriety, address challenges, and prevent relapse. By fostering connections, accountability, and continued growth, peer support and aftercare play vital roles in sustaining long-term recovery from fentanyl addiction.

What is the Effectiveness of Peer Support in Treating Fentanyl Addiction?

Peer support has been shown to be effective in treating fentanyl addiction by providing individuals with empathy, understanding, and encouragement from others who have shared similar experiences. 

Research by K Tracy, . (2016), titled Benefits of peer support groups in the treatment of addiction. National Library of Medicine, found that peer support interventions significantly improved treatment retention rates, reduced substance use, and enhanced overall well-being among individuals recovering from opioid addiction, including fentanyl. 

This study highlights the importance of peer connections in promoting recovery and reducing the risk of relapse. Peer support offers a unique form of social support that complements traditional treatment approaches, empowering individuals to achieve and maintain sobriety.

What are the Different Forms of Fentanyl?

Fentanyl is available in various forms, including transdermal patches, oral tablets, IV injections, nasal sprays, and subcutaneous injections:

• Transdermal Patches: Fentanyl patches are designed to deliver the drug through the skin over an extended period, typically lasting 48 to 72 hours. They are commonly prescribed for chronic pain management.
• Oral Tablets and Lozenges: Fentanyl is available in oral formulations, including tablets, lozenges (often referred to as “lollipops”), and buccal films (placed inside the cheek). These forms are used for breakthrough pain in patients already receiving opioid therapy.
• Intravenous Injection: Fentanyl can be administered intravenously (IV) for rapid onset of pain relief or anesthesia induction. This form is commonly used in medical settings such as hospitals and surgical procedures.
• Nasal Spray: Fentanyl nasal spray is a prescription medication used for the management of breakthrough pain in cancer patients who are already receiving opioid therapy. It provides rapid pain relief when administered through the nostrils.
• Sublingual Tablets: Fentanyl sublingual tablets are placed under the tongue for rapid absorption into the bloodstream. They are used for the treatment of breakthrough pain in opioid-tolerant patients.
• Subcutaneous Injection: Fentanyl can also be administered subcutaneously (under the skin) for pain management, although this route of administration is less common than IV or transdermal.

It’s important to note that misuse or abuse of fentanyl, in any form, leads to severe respiratory depression, overdose, and death, if treatment isn’t available.

What are the different slang names for fentanyl?

Fentanyl is known by various slang names on the street, often used to conceal its identity or purpose. According to DEA, the slang names for fentanyl include:

• China White
• Apache
• Tango and Cash
• Dance Fever
• Goodfella
• Jackpot
• Murder 8
• TNT
• Tango
• China Girl
• Drop Dead
• Serial Killer
• Shady 80s
• Poison
• Percopop
• Shady 80s

It’s important to be aware of these slang terms, especially if you suspect someone may be using or dealing fentanyl, as misuse or abuse of the drug can have serious consequences.

What are the Law Enforcement Efforts

Here is an overview of the key law enforcement efforts and legal implications around the fentanyl crisis in the United States:

Enforcement Efforts:

• Increased interdiction at the borders to disrupt the flow of illicit fentanyl and its precursor chemicals from China and Mexico
• Targeted crackdowns on fentanyl trafficking organizations and dark web vendors
• Improved information sharing and coordination between federal, state, and local law enforcement agencies
• Implementation of task forces and strike teams dedicated to investigating and dismantling fentanyl supply chains

Drug Control Policies:

• Scheduling of fentanyl and its analogues as Schedule II controlled substances under the Controlled Substances Act
• Tougher sentencing guidelines for fentanyl-related offenses compared to other opioids
• Efforts to regulate the legitimate pharmaceutical supply of fentanyl and monitor suspicious orders
• Increased funding and resources for law enforcement, border security, and anti-trafficking initiatives

Legal Implications:

• Trafficking of fentanyl can result in lengthy federal prison sentences, often with mandatory minimums
• Possession with intent to distribute fentanyl can carry penalties of up to 20 years in prison
• Overdose deaths involving fentanyl may be prosecuted as “drug-induced homicides” with potential life sentences
• Analogues of fentanyl are treated as schedule I or II substances, even if slightly chemically modified

Role of Law Enforcement Agencies:

• Federal agencies like the DEA, ICE, and Customs and Border Protection play a leading role
• State and local police departments work in partnership on interdiction, investigations, and community outreach
• Specialized narcotics units and task forces target high-level fentanyl suppliers and distributors
• Increasing use of undercover operations, controlled deliveries, and wiretaps to disrupt trafficking networks

Legal Consequences:

• Stiff penalties aim to deter manufacturing, trafficking, and distribution of illicit fentanyl
• Significant prison sentences for fentanyl-related convictions, often with no parole
• Asset forfeiture and seizure of proceeds from fentanyl trafficking
• Collateral consequences like difficulty finding employment and housing after release from prison

The comprehensive law enforcement approach, enhanced drug control policies, and severe legal consequences reflect the gravity of the fentanyl crisis and the urgency to combat this deadly synthetic opioid.

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Frequently asked questions 

What is the difference between Fentanyl and Xanax?

Xanax (Alprazolam) and Fentanyl differ in drug class and use: Xanax treats anxiety, while Fentanyl relieves severe pain. Xanax enhances GABA for relaxation; Fentanyl binds to opioid receptors for pain relief. Xanax is a Schedule IV drug, less potent than Fentanyl, a Schedule II opioid with a high overdose risk.

What is the difference between Heroin and Fentanyl?

Heroin, derived from morphine, is an illegal Schedule I drug with no accepted medical use, commonly used recreationally. Fentanyl, a synthetic opioid, is a Schedule II drug, 50-100 times more potent than heroin, used medically for severe pain. Both can cause respiratory depression, with fentanyl posing a higher overdose risk.