The opioid crisis. Over the last several years, it’s received a lot of press. Most folks are aware of drugs like heroin and morphine, but many are unaware of the most potent opioid of them all: fentanyl. What makes this drug special, and is it more dangerous than heroin?
In this post, we’ll answer this and more. Learn key facts about fentanyl that can help you spot trouble usage in others—or yourself. Find out what treatment options are available and what withdrawal is like.
What is Fentanyl?
If used only as directed, and for the duration specified by a medical professional, fentanyl can be an amazing pain reliever, especially in cases such as terminal cancer.
Due to its effectiveness in nullifying pain, prescriptions have increased in recent years. However, fentanyl is one of the most addictive prescription drugs. The only drug that comes close in sheer addictive potential is, perhaps, methamphetamine. We’ll explore how the drug changes the brain to bring about addiction later in this post.
For now, it’s enough to know that fentanyl is in a class of drugs known as opioids.
Opioids were first derived from the opium poppy, a flower. The poppy flower is one of the oldest known medicinal plants. It has long been known for its ability to lessen pain and bring about a sense of euphoria. Other drugs derived from opium include morphine, oxycodone and hydrocodone. Naturally, many illicit drugs, such as heroin, have also been derived from opium.
Compounds in the opium plant resemble certain neurotransmitters in the brain, which is how they are able to provide pain relief. Fentanyl, in particular, works on the μ-opioid receptors.
Note that fentanyl is synthetic. It’s made in a lab.
Because of this, it’s 80-100 times stronger than morphine. This makes it highly effective at relieving pain, but it’s much more addictive than organic opioids. As we’ll see, this means that it’s easier to overdose on fentanyl than to overdose on other opioids.
Indeed, since 2016, fentanyl and other synthetic opioids have been the leading cause of accidental overdose deaths in the U.S. and around the world. Two types of fentanyl exist:
- Pharmaceutical fentanyl. Pills, tablets, patches or lollies you can get from your doctor, available only by prescription. Brand names include Actiq, Sublimaze, Duragesic and Subsys.
- Illicit fentanyl. Street fentanyl that is used recreationally, usually to produce a sense of euphoria, or a high.
Pharmaceutical fentanyl is classified as a Schedule II narcotic in the U.S. Its legitimate use is as an analgesic to temporarily relieve severe pain. In the U.S, a Schedule II drug is a drug that has a high potential for abuse. Such a drug may lead to psychological or physical dependence. Other Schedule II drugs include:
As doctors wrote prescriptions for fentanyl, and as more people began using it on a regular basis, overdose deaths became more common. Consequently, doctors became more reluctant to write these scripts. As you might imagine, this left folks who were physically dependent on the drug without a way to get it. Sadly, this has resulted in a rise in the consumption of illicit forms of fentanyl.
What’s more, this type of fentanyl is often ‘cut’ with other drugs or substances. Drug dealers do this to make their supply go further. But if fentanyl is cut with another drug, such as heroin, the effect is not as strong. This results in the person having to use more of the drug than they’re used to.
The danger here is that if they then get a hold of fentanyl in its pure form, they may take too much, assuming that it’s been cut with weaker drugs or fillers. The result is often fatal.
History of fentanyl
Fentanyl was first synthesized by Paul Janssen in 1959. He synthesized the chemical while searching for substances that exhibited opioid activity. At this time, researchers were not sure why morphine worked as well as it did, as they did not yet realize that the brain contained opioid receptors. But they were very keen to find a way to synthesize a substance that would work like morphine or similar compounds such as pethidine.
Being able to synthesize morphine in a lab would free pharmaceutical companies from reliance on international suppliers of opium.
After Janssen first synthesized fentanyl, the next stage of development was fentanyl citrate, which is the salt of fentanyl and citric acid. As fentanyl citrate, the drug enjoyed widespread use as an anesthetic as early as 1968. This early version of anesthetic was marketed under the brand name Sublimaze.
Several years later, Jassen developed the Duragesic patch. This patch contained an inert gel that was infused with fentanyl. The patch proved useful in relieving extreme pain because it provided a steady dose of the drug. In fact, patches like these are on the WHO List of Essential Medications.
In 1998, a flavored fentanyl lollipop entered the market under the brand name Actiq. The drug proved useful in the administration of fentanyl to children suffering from terminal illnesses such as cancer.
With the value of hindsight, it’s easy to see how administrating a potent opioid like fentanyl via steady-dose patches or candies may not have been the best idea. After all, a steady dose can quickly create dependence. However, researchers were still working out how addiction affects the brain.
The Rising Tide of Overdose Deaths
Opioid overdose deaths are increasing year over year. How can this be when people have been warned about the dangers of recreational opioid use for years? The fact is opioid abuse doesn’t usually start on the illicit side of things. You see, many people assume that since fentanyl can be prescribed by a doctor, then it must be safe.
The drug is indeed ‘safe’ for when used as directed in that it doesn’t cause severe acute side effects, in most people. But the tests used to determine a drug’s safety and efficacy are applied over large populations, looking at large data sets.
What’s more, though fentanyl may be safe for most people when used as directed, it’s also extremely addictive, and many folks underestimate its addictive potential. Only after dependence has developed and their prescription gets cut off, do they seek illicit forms of fentanyl. Worse, some people can develop dependence on fentanyl after only a few doses.
The result is tragic.
In 2017, over 70,000 overdose deaths were documented. Of those, 47,600 were caused by opioid abuse. That’s 67 percent of all drug overdose deaths.
The U.S. states with the highest rates of death due to drug overdose in 2017 were:
- West Virginia, with 57.8 per 100,000
- Ohio, with 46.3 per 100,000
- Pennsylvania, with 44.3 per 100,000
- The District of Columbia, with 44.0 per 100,000
- Kentucky, with 37.2 per 100,000
Other states saw statistically significant increases in drug overdose deaths from 2016 to 2017, as well. These include:
- New Jersey
- New York
- North Carolina
- South Carolina
There’s no doubt that the opioid epidemic is real and spreading. As a potent synthetic opioid, fentanyl is a driving force in this tide of death.
Fentanyl Fact Sheet
In this section, we’ll touch on aspects of fentanyl that will allow you to better determine whether a loved one might be using, and to identify signs of overdose.
#1 Potency & Lethality
Fentanyl is 100 times stronger than morphine. That’s impressive enough, but some variants of fentanyl, such as carfentanil are 10,000 stronger. You read that right. Is it likely that a craving addict will be able to tell the difference between fentanyl and carfentanil? They’re both off-white powders, after all.
While a lethal dose of heroin for most people is several grams, it takes less than one gram of carfentanil to kill.
#2 Street Names
If you’re concerned that a loved one may be experimenting with fentanyl, listen for these street names. Some folks use these as code names.
- China Girl
- China White
- Dance Fever
- Murder 8
- Tang and Cash
- Great Bear
#3 Effect on the Brain
Like heroin, morphine and other opioids, fentanyl works by binding to the brain’s opioid receptors. When opioids bind to these receptors, they trigger the brain’s reward pathway. This floods the brain with dopamine, and the result is a strong rush, or euphoria.
However, the drug can have several other short term side effects, not all of which are positive, to put it mildly. These can include:
- Respiratory depression
Additionally, there are several potential cognitive side effects:
- Inability to focus
- Impaired judgment
There are several possible psychological effects as well:
- Mood swings
With each use, the user may develop dependence, which can lead to tolerance, which leads to addiction.
#4 Why It’s So Dangerous
Due to its chemical structure, fentanyl has rapid and potent effects on both the brain and the body. But even in small amounts, it can be extremely dangerous. In the worst case scenario, the drug can lead to coma and death because it depresses the breathing reflex.
As mentioned, because fentanyl is so potent, it’s very easy to become dependent on it. The brain comes to see the drug as a way to reliably trigger dopamine release. So, when dopamine levels in the brain fall, the addict feels a strong urge to use. Therefore, drug use comes to replace normal, natural and healthy dopamine-releasing activities.
#5 Symptoms of Overdose
A person who displays any of these symptoms after using fentanyl requires immediate medical attention.
- Faint pulse
- Slowed heart rate
- Loss of consciousness
- Pinpoint pupils
- Loss of coordination
- Muscle spasms
If in doubt, always call EMS.
Warning Signs of Fentanyl Addiction
From 1991 to 2011, painkiller prescriptions in the U.S. jumped from 76-million to 219-million—an increase of 288 percent. In 2013-14, 13-million of those painkiller prescriptions were for fentanyl. What’s more, deaths in women that were attributed to prescription painkiller overdose increased by more than 400 percent from 2000 to 2010.
Because fentanyl causes a dopamine flood in the brain, it chemically alters the brain over time.
This makes it easier and easier for folks to rationalize their use. After all, the drug makes them feel better. And if they’re taking a bit more this week than they did last week, that must mean that they’re in more pain now than they were then. So they need the drug. Right?
Such rationalization becomes common as addiction sets in. Tragically, it can lead to a downward spiral.
Just as susceptible individuals develop dependence on fentanyl, their prescription runs out. This leads them to seek fentanyl elsewhere, where, as mentioned, it’s cut with other substances, making it weaker. At the same time, a phenomenon known as tolerance sets in.
Tolerance occurs when the brain becomes resistant to the drug’s effects. The brain has a finite reserve of neurotransmitters like dopamine, so when you use drugs that trigger the release of those neurotransmitters, these reserves can become exhausted. To combat this, the brain becomes less receptive to the drug’s signal over time.
You have to take more of the drug to get the same old high. Combine this with the fact that street forms of fentanyl are weaker than the script version, and users can, out of sheer desperation, take massive doses. Tragically, these large doses can easily result in death.
Risk Factors for Abuse
Advances in genetic research have allowed researchers to identify genes, and gene clusters, that may leave an individual more susceptible to addiction than the general population. in addition, there are several heritable traits that can make a person more likely to develop dependence. Among these are:
- Seeking novelty
If you have a parent, brother, sister or another close relative who has struggled with substance abuse disorder, you are at increased risk of developing it yourself. In this case, your best bet may be to avoid all substances with addictive potential.
There are several environmental factors that can make you more likely to develop chemical dependence. Among these are:
- Chronic stress
- Friends who abuse drugs
- Living in poverty
Other risk factors include:
- Childhood trauma
- Ongoing trauma in adulthood
- A family history of addiction
- Access to fentanyl
- Merely being prescribed fentanyl
Again, if in doubt, it’s best to avoid this potent painkiller.
Signs & Symptoms of Addiction
In a healthy, non-addicted individual, dopamine is released as a reward for accomplishing tasks. It’s a feel good chemical, and it’s part of the brain’s reward pathway. However, when the brain begins to rely on drugs to trigger dopamine release, it’s possible to see marked changes in an individual’s behavior. As you read the following list, note that much of this centers around the affected individual becoming less and less interested in activities that once brought them satisfaction.
At the same time, they will become more obsessed with acquiring and using fentanyl.
Here are a few signs:
- Physical and psychological health problems
- Diminished performance in school or at work
- Physical harm due to impaired motor functioning
- Failed interpersonal relationships
- Inability to keep a job
- Financial problems
- Expressing a sense of hopelessness
- Suicidal thoughts or actions
In addition, there are several behavioral tells you can watch for. These include:
- Withdrawing from family and friends
- No longer participating in activities they once enjoyed
- Lying or otherwise engaging in secrecy or deception
- Engaging in risky, reckless or otherwise dangerous behaviors
Note: anyone who abuses fentanyl is in grave danger and needs professional assistance.
Without proper care, the abuse will continue to wreak havoc in all areas of the person’s life. Addiction does not resolve on its own. Indeed, it is a chronic condition that, without treatment, progresses in only one direction.
However, with proper care, a person can develop the ability to manage the compulsion to use fentanyl.
What to Expect When You Seek Treatment
Quitting fentanyl abruptly, or stopping cold turkey, is rarely life-threatening. However, it can be a truly unpleasant experience. If you’re struggling with fentanyl addiction, and you’re thinking about quitting, it’s good to know what you’re in for ahead of time.
Withdrawal is unpleasant, and withdrawal from fentanyl can even be painful. What you must keep in mind is that withdrawal symptoms don’t last forever. Withdrawal symptoms vary in severity depending on several factors, such as the amount of time you’ve been using and your typical dose. Possible withdrawal symptoms include:
- Powerful cravings for fentanyl
- Watery eyes
- Runny nose
- Excessive perspiration
- Inability to experience pleasure
- Ticks such as pacing, tapping the toes or rapid speech
- Flu-like symptoms
- Lost appetite
- Abdominal cramping
- Pain in the muscles and bones
Your best chance of getting a handle on your addiction is to visit a specialized treatment center. Such centers offer inpatient and outpatient programs to help users understand and manage their addiction. Treatment occurs over two phases, generally: detox and therapy.
Detox will purge the drug from your system and will set your brain on the path toward recovering normal neurotransmitter function. But this is usually not enough. You should also be prepared to put in hard work in therapy sessions. Therapy modalities, such as CBT, can help you identify triggers which cue you to use. Once aware of these triggers, you can make the conscious decision to acknowledge and release them.
Note, however, that addiction is a chronic condition. Detox will make the withdrawal symptoms recede, but you may still experience cravings for fentanyl down the line—sometimes quite out of the blue. Therapy arms you with the tools you will need to say no each time these feelings resurface.
If you’re trying to get addiction treatment for yourself or for someone you love, reach out to The Hills for comprehensive and caring treatment that will help patients detox and learn the skills to cope with their triggers and their addiction. You have op