Fentanyl: Treating Deadly Addiction

Fentanyl Problem

In 2016, synthetic opioids (primarily illegal fentanyl) surpassed prescription opioids as the most common drugs involved in overdose deaths in the United States. They accounted for 50% of all opioid-related deaths, an increase from 14% in 2010.

Fentanyl is considered to be one of the most dangerous drugs, together with Vicodin, cocaine, Adderall, and OxyContin.  It has a high potential for abuse, leading to psychological and physical dependence.

It’s important to understand the depths of fentanyl addiction, and analyze its background, how it is abused, and its health risks on human life.

Synthetic Opioids Accounted for 50% of All Opioid-Related Deaths in 2010

50%

What is Fentanyl?

Fentanyl is a synthetic opioid that’s 50 times more powerful than heroin, and 100 times more powerful than morphine. Due to its potency and addictive qualities, doctors only prescribe the drug for the most critical situations. Its most common prescriptions are related to terminal cancer and severe pain.

Addiction History of Fentanyl

The drug we know today as fentanyl was first developed in 1960 as an injectable anesthetic branded as Sublimaze. It was meant to treat medical patients with severe pain. Doctors used it on patients when pain killers couldn’t do the job. They thought that fentanyl was the ideal alternative anesthetic for operative procedures.

During the 1970s, illicit versions of fentanyl began arriving on the market. As a result, the Controlled Substances Act of 1970 declared it as a Schedule II drug due to its addictive qualities. However, the drug remained widely unknown for another two decades.

Fentanyl Abuse Today

Until recent years, doctors were still prescribing fentanyl for specific medical situations. But at the beginning of 2013, fentanyl hit the streets. Drug dealers discovered that they could add illicit fentanyl into heroin and make their product much more potent. They could easily press the white powder into illegal pain pills.

Soon, things began to get out of control. In 2013, fentanyl claimed the lives of 3,000 people. In 2017, that number rose to 30,000.

In 2016, the music superstar Prince died of a fentanyl overdose. During this time, the percent of deaths related to non-methadone synthetic opioids like fentanyl increased by more than 70%.

Today, the drug is responsible for the death of more than 65,000 people in the U.S. alone.

Common Names

There are two ways in which fentanyl can be sold legally and illegally. Pharmaceutical companies sell the legal form under different formulations. The most common include:

Lollipops

Transdermal patches

Sublingual tablets

Effervescent buccal tablets

Sublingual spray

Nasal spray

Illegal versions of fentanyl have a wide range of slang terms. The most common street names for fentanyl or fentanyl-laced heroin include:

Murder 8

TNT

Jackpot

Dance Fever

Apache

China Girl

China White

Friend

Tango

Goodfella

How Do People Abuse Fentanyl?

One of the most primitive parts of the human brain is where we seek and sense reward. This is where we experience the effects of food, fun, fluids, and reproduction. The chemical in our brain that increases when we have a rewarding experience is dopamine. Dopamine is known as the “pleasure chemical.”

For example, when you eat something that you enjoy, there’s a dopamine surge in the brain. It’s the same when people take a drug. To experience that sense of pleasure again, people often would try the same food or abuse the same drug again and again.

Fentanyl blocks pain receptors in the brain and increases the production of dopamine. The excess amounts of dopamine flood and chemically alter the brain over time. As soon as a person develops tolerance to fentanyl, they will depend on it to feel “normal” and require more of the drug to reach previous sensations.

Doctors administer fentanyl as a patch. The patch adheres to the skin. Fentanyl can also be given as an injection.

In its illegal form, fentanyl is not as distinctive. People on the streets can find it as a powder that can be melted into a liquid and injected like heroin.

Signs of Fentanyl Addiction

Some of the most common signs of addiction include:

Tolerance to the drug

Avoiding withdrawal

Preoccupation with getting the drug

Avoiding social activities to use the drug

Using fentanyl despite its negative effects

Is Fentanyl Mixed with Other Drugs?

According to the National Institute on Drug Abuse, synthetic opioids, most commonly fentanyl, are commonly mixed with a range of different substances.1

Out of 42,249 opioid-related overdose deaths in 2016, 19,413 involved synthetic opioids.

Around 17,087 involved prescription opioids. Of those, 37.4% involved synthetic opioids.

Around 15,469 of all deaths involved heroin. Of those, 37.4% involved synthetic opioids.

It’s been estimated that 10,375 overdose deaths were linked to cocaine. Of those, 40.3% involved synthetic opioids.

Roughly 10,684 overdose deaths were linked with benzodiazepines. Of those, 31% involved synthetic opioids.

In 4,812 of all overdose deaths, the main reason for the death was antidepressants. Of those, 20.8% involved synthetic opioids.

Acute Side Effects of Fentanyl Addiction

The side effects of a fentanyl addiction are similar to most other opioid addictions. The most common effects include:

Fatigue

Mental confusion

Constipation

Skin problems

Sweating

Breathing trouble

Dry mouth

Nausea

Trouble concentrating

Itching

Constricted muscles

Abnormal heart rate

Physical weakness

Serious Health Risks

Since people who are prescribed fentanyl don’t believe that fentanyl is as potent as heroin, they have higher chances of accidentally developing an addiction. The drug causes neurochemical changes in the brain, altering it over time. Due to these changes, a person might become addicted quickly and start obtaining the drug from illegal sources.

Visits to the Emergency Room

According to the National Institute on Drug Abuse, emergency department (ED) visits for opioid overdoses rose 30% in all parts of the US from July 2016 through September 2017. Out of those, 30% were men, and 24% were women. Roughly 31% were people ages 25-34, 36% were ages 35-54, and 32% were ages 55 and over.

Emergency Department Visits for Opioid Overdoses Rose 30% in the US from 2016-2017

30%

Unsuspectingly Taking Fentanyl

Fentanyl found on the streets is mixed with different substances, including heroin, antidepressants, and benzodiazepines. Abusing fentanyl that’s laced with other drugs amplifies the drug’s damaging side effects. In fact, one of the main substances responsible for drug overdose fatalities in the world is fentanyl.

Hallucinations

Another rare side effect of fentanyl addiction is hallucinations. People who are battling with addiction are at risk of experiencing auditory and visual hallucinations. This is less likely to happen if the patient receives medical help from a doctor.

Other Side Effects

Although less common, some other potential side effects of fentanyl addiction include:

  • Low blood pressure
  • Chest pain
  • Coughing up blood
  • Dyskinesia, or trouble with voluntary movement
  • Kidney damage
  • Eczema

Common Misconceptions About Fentanyl

Misconception #1: The drug is harmless and cannot cause addiction.

Whether prescribed or for non-medical reasons, repeatedly taking fentanyl increases the risk of addiction, dependence, and tolerance. In some people, mental addiction can begin upon their first use. Due to its potency, physical dependency can happen after only a few times of taking the drug.

Misconception #2: The drug is legal, and it doesn’t have any life-threatening side effects.

Just because doctors can prescribe the drug legally, it doesn’t mean that it’s not harmful or deadly. In fact, fentanyl is both addictive and dangerous, especially when people use it when it isn’t prescribed to them. In 2016, synthetic opioids were involved in nearly 50% of opioid-related deaths.

Misconception #3: All fentanyl is fentanyl.

Many people believe that all fentanyl they buy illegally is fentanyl in its pure form. However, the drug is often laced with heroin, thus increasing its potency and overdose potential. When a person buys fentanyl illegally, the pill may look like the real thing, but they can never know what it contains.

Detox and Withdrawal

As fentanyl is commonly found in a variety of street drugs, it’s one of the main substances responsible for drug overdose fatalities. Overcoming fentanyl addiction requires users to go through withdrawal before enrolling into treatment.

The challenge with people who are addicted to fentanyl is that the drug is such a potent and toxic opiate, the withdrawal symptoms are also quite severe.

Due to its short half-life of 219 minutes, addicts will start experiencing withdrawal symptoms within two or four hours after their last use. For people who were taking the drug through a patch, the withdrawal symptoms start within 24 to 36 hours of removing the patch.2

Withdrawal

There are three different stages of fentanyl withdrawal: early, peak, and long-term.

Early withdrawal

The first symptoms a patient will experience include:

Powerful cravings for the drug

Feelings of anxiety

Insomnia

Intense sweating

Muscle aches

Shaking

Hot and cold chills

Runny nose

Peak withdrawal

The peak withdrawal stage begins two to four days after the last use of the drug. It lasts for about a week.

Long-term withdrawal

During this stage, the person will start experiencing the longer-term symptoms of fentanyl withdrawal. The majority of these symptoms are psychological, but it’s not uncommon for the individual to experience physical cravings as well. The most common symptoms are:

Inability to feel pleasure

Dreams about relapse

Negative feelings of guilt, remorse, self-loathing, and low self-esteem

Pink cloud syndrome (a high-on-life feeling when a person ignores reality)

Length of Withdrawal

The length of fentanyl withdrawal is variable and depends on many factors, including:

The person’s physical and mental health

How long and how often the person abused the drug

Genetic and biological characteristics of the person

Whether the withdrawal was performed with the help of a medical team or not

Withdrawal Medications

Patients who go through withdrawal are usually given some medication that helps them get through their severe symptoms. Doctors call this an opioid replacement therapy. These replacement drugs keep drug cravings and withdrawal symptoms to a minimum. The most commonly used medications include:

Methadone (a replacement for opioid)

Buprenorphine (a replacement for opioid)

Extended-release naltrexone (a drug that blocks opioid effects)

For the majority of people, withdrawal symptoms end after seven to ten days. However, when people withdraw from fentanyl on their own, it can be fatal. When people die from fentanyl withdrawal, it’s largely due to dehydration related to vomiting and diarrhea.3

Fentanyl withdrawal symptoms are one of the principal reasons why people relapse. Proper treatment is essential to help addicts return to good mental and physical health.

Detox

Fentanyl detox is medically-assisted withdrawal. It’s also the safest and most comfortable type of withdrawal. It involves the use of medications and medical supervision by an experienced team of professionals.

During medical detox, a patient’s body is cleansed from all toxins. Patients are given replacement medication to withstand severe withdrawal symptoms. They receive smaller and smaller doses of the drug they’re addicted to in measured steps. Ultimately, the patient will be taking no medication at all.

The majority of people who died from fentanyl withdrawal tried detoxing at home. Those who consider detoxing at home should always do so under the supervision of their doctor.

Treating Fentanyl Addiction

Although fentanyl addiction can be challenging to overcome, winning this struggle is possible.

There isn’t a single type of treatment that works for everyone. Treatment will depend on each person’s unique circumstances and needs.

Step One: Detox

The first step of treatment is detox. During this stage, a medical team will eliminate the harmful substance from the body. In many cases, a replacement medication may be given before being slowly weaned off the substance.

Step Two: Rehabilitation

The second step is a rehab program. Once the patient’s body is cleansed from all toxins, a medical team of professionals will work closely with them to address the psychological effects of the addiction. There are two types of rehab: inpatient and outpatient.

Inpatient Rehab

Inpatient rehab is recommended for patients struggling with a strong physical addiction. It’s also beneficial for people who don’t live in a supportive home environment. During inpatient rehab, the patient lives at the facility while undergoing treatment.

Outpatient Rehab

Outpatient rehab is a good option for patients suffering from mild addiction. During outpatient treatment, a person continues living at their home, but they check into treatment at their allotted times for counseling and medication.

Fentanyl rehab programs usually last anywhere from 28 to 90 days. The length of stay depends on the severity of the addiction and the patient’s physical and mental needs.

Many people who are battling with fentanyl addiction may also suffer from a mental illness. This is known as a dual diagnosis or a co-occurring disorder. When a person struggles with a dual diagnosis, they must be treated for a mental health condition and a substance use disorder simultaneously.

Supportive Therapies to Treat Fentanyl Addiction

Cognitive-behavioral therapy (CBT) is one of the most effective therapies for a co-occurring disorder. With the help of CBT, patients can identify negative thought patterns that led to substance abuse and mental illness. Over time, patients will replace their negative thoughts with positive ones. CBT is a short therapy and can last anywhere from five to 20 sessions. The length of the treatment entirely depends on the seriousness of the addiction.

A patient’s treatment during a rehab program might also include:

Education about disease processes and recovery

Family therapy

12-step facilitation

Meal support and regular consultation with dietary staff

Expressive therapy (art therapy, dance therapy, outdoor recreation activities)

Step Three: Aftercare

The third step of an effective treatment program is the aftercare plan. Aftercare is a type of continued treatment that aims to improve coping skills and prevent further abuse of fentanyl. This type of continued treatment can help prevent a patient’s relapse. Examples of aftercare services include:

  • Sober-living arrangements
  • Follow-up therapy
  • Medical evaluations
  • Alumni support groups

Key Takeaways

A substance use disorder can be difficult to overcome, but recovery is possible. With the right treatment and a supportive environment, you can pursue long-term recovery.

To conclude, there are several key takeaways to keep in mind:

In 2016, synthetic opioids (primarily illegal fentanyl) became the most common drugs involved in overdose deaths int he United States, surpassing prescription opioids.

Fentanyl is commonly mixed with a range of different substances, including heroin, antidepressants, and benzodiazepines.

The side effects of a fentanyl addiction are similar to most other opioid addictions and include fatigue, nausea, and mental confusion.

People addicted to fentanyl are at risk of serious side effects, including breathing problems, coma, and overdose.

Overcoming fentanyl addiction requires users to go through withdrawal before enrolling into treatment.

Fentanyl treatment involves three stages: detox, rehabilitation, and aftercare.

This information should not replace a visit to a doctor or treatment center. If you are concerned that you might be suffering from a fentanyl addiction or a loved one, ask for professional help today.