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Fentanyl Abuse, Addiction, And Treatment Options

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 1, 2019

Fentanyl is a potent opioid that comes with a high risk of overdose. Prescription grade fentanyl can be fatal in extremely small doses, and illegally produced fentanyl can be even stronger. Fentanyl abuse and addiction contribute to many fatal opioid overdoses. Fortunately, there are treatment options available for fentanyl abuse and addiction.

Fentanyl was initially prescribed to manage the pain of patients with cancer. It was useful in these situations, it was fast acting and potent, which helped to alleviate the sharp, intense, immediate pains that accompany many cancers. It also has been prescribed for treating long-term, persistent, chronic, moderate to severe pain in patients that other opioids have stopped being effective.

Fentanyl should only be used with patients who are opioid tolerant. This means that a person who has not been prescribed daily opioids for a period of time should not be prescribed fentanyl, due to significant risk of overdose. According to prescribing information by Janssen MD, the transdermal fentanyl patch, Duragesic, should only be prescribed for patients who have been taking a minimum of 60 mg of morphine daily for at least a week and should not be used on an as-needed basis.

As the opioid epidemic continues, drug traffickers have begun illegally producing fentanyl from clandestine labs in motels, kitchens, trunks of cars, and abandoned locations. This grade of fentanyl is unregulated, and determining what ingredients are contained in this drug, as well as what has been added to it (referred to as cut with) is proving to be extremely difficult and fatal.

Fentanyl overdoses are claiming the lives of many people who struggle with substance abuse. It is no longer limited to people dealing with opioid abuse and addiction. Other drugs of abuse, like cocaine and heroin, have been found to be cut with fentanyl, with devastating backlash. In an attempt to increase potency of these other substances, drug dealers have essentially created a roulette-type situation with individuals who use illicit street drugs.

In a study by the Center for Disease Control (CDC), one participant disclosed that many heroin addicts are becoming aware that fentanyl is being added to heroin. The addiction to heroin is so strong that adding fentanyl hasn’t deterred them from using. Instead, they simply do not use heroin alone, so if an overdose does occur, someone can call for help.

Thorough treatment programs are available for anyone struggling with fentanyl abuse or addiction. These programs include detox, therapy, medical care, education, vocation, and aftercare services. Taking advantage of these programs can help promote sobriety and decrease potential relapse.

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Available Forms of Fentanyl

Fentanyl is available in many forms and has a potential for abuse in every form, both illegal and prescribed.

  • Duragesic: A transdermal patch that delivers small amounts of fentanyl over time, sometimes up to three days. Some people abuse this form of fentanyl by heating, smoking, injecting, or chewing the patch.
  • Onsolis: A film that contains fentanyl that placed on the inside of the cheek to administer medication rapidly.
  • Fentora: This fentanyl medication is administered in a tablet form that is held against the inside of the cheek until dissolved.
  • Abstral: A tablet of fentanyl that dissolves under the tongue for quick pain relief.
  • Subsys: This fentanyl spray is administered under the tongue for rapid relief from pain.
  • Lazanda: A nasal spray to provide swift pain relief. This administration method is similar to a nasal spray.
  • Actiq: A lozenge, typically placed on a stick, that contains fentanyl that delivers medication when dissolved against the cheek.
  • Sublimaze: Sublimaze is reserved for hospital use during surgeries. This injectable form of fentanyl needs to be administered by an individual who is trained in anesthetics and can manage respiratory complications.

Signs Of Fentanyl Misuse, Abuse, And Addiction

Fentanyl use can quickly develop into abuse and addiction, as it is a very powerful opioid. The potential for abuse increases if the person using fentanyl is taking it in a way that is not prescribed, or if they have illegally produced fentanyl.

Recognizing the warning signs for fentanyl abuse is sometimes difficult. When managing pain, it is not uncommon for a person to appear more positive and enjoying being more active. Eventually, the person is likely to develop tolerance, which is the need to take more fentanyl to feel the same results. They may begin using higher doses or taking fentanyl more often than prescribed and run out of their medication before they are supposed to. Using fentanyl in this way can result in abuse and addiction.

Over time, fentanyl misuse and addiction become noticeable, and if a person is showing these signs, they may be abusing fentanyl:

  • confusion
  • vomiting/nausea
  • respiratory issues (decreased breathing)
  • sleeping issues (insomnia and/or sedation)
  • drowsiness
  • sweating
  • pinhole pupils
  • avoiding social situations
  • obtaining fentanyl illegally

If a person taking fentanyl has a level of drowsiness that causes them to constantly fall asleep and wake without recognizing they were sleeping, this is a sign they have ingested enough fentanyl to affect the central nervous system (CNS) and reduce its ability to function. Depressing the CNS slows heart rate, breathing and other automatic functions, which can lead to lack of oxygen throughout the body and increased risk of permanent damage.

Symptoms Of Fentanyl Abuse And Addiction

A person who is abusing fentanyl is likely to experience symptoms directly related to the amount of fentanyl they are ingesting. These symptoms include:

  • blurred vision
  • extreme euphoria
  • nausea
  • dry mouth
  • constipation
  • problems breathing
  • trouble sleeping
  • issues concentrating

Higher doses can increase the number of symptoms a person using fentanyl may experience and is very likely to make the symptoms experienced more intense.

Diagnosing Fentanyl Abuse And Addiction

Fentanyl misuse can be diagnosed as an opioid use disorder (OUD). If any of the signs or symptoms listed above are familiar, asking the following questions may help determine if an OUD diagnosis is warranted:

  • Have you changed your dose or frequency of doses without talking to your doctor?
  • Are you taking your fentanyl in the way it is not supposed to be taken? Are you snorting, smoking or injecting it?
  • Do you think you need to have better control over the amount of fentanyl you are taking?
  • Have you ever tried to stop taking fentanyl and been unable to?
  • Are you spending a lot of time trying to find fentanyl?
  • Has fentanyl had a negative effect on your responsibilities?
  • Has fentanyl caused a problem in your relationships?
  • Have you used fentanyl in dangerous situations?
  • Are you taking more fentanyl than you used to and having the same effects?
  • If you don’t take fentanyl, do you experience withdrawal?

Answering -yes- to more than one of these questions meets the criteria for an OUD. Like any other medical condition, there are options for treatment of an OUD, no matter the level of severity.

Fentanyl Misuse And Other Substances

Fentanyl has interactions with over 250 prescription medications. It is important to only take fentanyl if it has been prescribed to you, and under continued supervision of the prescribing doctor. Using fentanyl without a prescription, especially if taking other medications, may be very dangerous and even result in death.

There are currently four medications known to interact so severely with fentanyl that a person cannot take them if they are using fentanyl. These medications are:

  • amifampridine (Firdapse – under priority review for FDA approval in US)
  • mifepristone (Mifeprex, ru486)
  • naltrexone (ReVia, Vivitrol)
  • safinamide (Xadago)

Like other opioids, fentanyl should not be taken with any medication that interacts with opioid receptors, or depressants (like alcohol). Additionally, some antidepressants and benzodiazepines can have adverse reactions when taken with fentanyl.

Fentanyl Overdose

Knowing the signs and symptoms of a fentanyl overdose can help a person receive medical attention quickly. This is important because fentanyl overdoses can be deadly in a very short amount of time. Some indications that a person may be suffering from a fentanyl overdose may include the following:

  • breathing issues (shallow, restricted, lack of)
  • unable to speak or not making sense
  • strange behavior followed by losing consciousness
  • trouble moving
  • body stiffening or mimicking seizure activity
  • non-responsive (even to painful stimuli)
  • gurgling sounds or strange sounds similar to snoring
  • change in skin appearance (turning blue/gray), including nail beds and lips
  • weakened or erratic pulse
  • foaming at the mouth
  • vomiting
  • choking
  • pupils are very tiny, like pinholes

If a person at risk for a fentanyl overdose is exhibiting any of these symptoms, it is important to contact emergency medical services promptly.

Fentanyl Withdrawal

Fentanyl withdrawal can range from uncomfortable to extremely painful. It is strongly encouraged that a person who is struggling with fentanyl misuse, abuse or addiction, utilize a medically supervised detoxification program. The physical withdrawal symptoms can last several days, and with fentanyl, the intensity also significantly increases. In cases of opioid withdrawal, these supervised detox programs can use medications to help ease these withdrawal symptoms.

During detox, treatment options can be explored, and even some interventions can begin. A person may be more inclined to attend a detox program when they compare it to struggling through withdrawal from fentanyl without medical supervision, where they are more likely to experience intense symptoms, such as:

  • sweating
  • nausea
  • shaking
  • vomiting
  • aches in muscles and joints
  • cramping
  • diarrhea
  • headaches
  • restlessness
  • insomnia
  • agitation
  • anxiety
  • depression

Being able to stop taking fentanyl while avoiding some withdrawal symptoms and decreasing others may be extremely helpful in the journey to eliminate opioids and decrease the likelihood of relapse.

Treatment Program For Fentanyl (Opioid Use Disorder Treatment Facilities)

Due to federal regulations, a diagnosis of an opioid use disorder is needed to enroll in an opioid treatment facility. This can happen in a number of ways, a primary care provider, a mental health services facility, or during the intake process at an opioid treatment facility.

The steps after diagnosis are pretty straightforward. A supervised, medical detox program, followed by a multidimensional therapeutic approach to help a person struggling with opioid addiction to maintain sobriety with a solid aftercare plan to help prevent relapse. This treatment plan in always individualized and is continuously monitored and adjusted based on patient needs.

All services offered in opioid treatment facilities are required to be clearly outlined and followed to completion. This means that the program is obligated to find solutions to issues that are explored while in treatment. This is why therapeutic, medical, educational, and vocational services are offered as a part of the multidimensional treatment process.

Struggling with a fentanyl dependence, abuse, or addiction problem doesn’t have to be something to take on alone. We offer treatment services that will allow a person to stop taking fentanyl and maintain sobriety while providing an environment to explore what the next step after sobriety can be. Reach out to us today.

U.S. Food and Drug Administration (FDA) - Duragesic Prescribing Information

Centers for Disease Control and Prevention - Characteristics of Fentanyl Overdose

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