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

Fentanyl addiction occurs when an individual has a chronic and compulsive dependence on the synthetic opioid fentanyl, marked by an inability to control or halt usage despite adverse consequences. The potent impact of fentanyl on the brain’s opioid receptors not only delivers intense pain relief but also elevates the risk of developing dependence and addiction.

The 2022 National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 991,000 individuals aged 12 or older have abused prescription fentanyl or used illegally made fentanyl (IMF) during the past year. Of the 991,000 people, 686,000 people specifically used IMF in the past year.

The side effects associated with fentanyl addiction can be categorized as short-term and long-term. Short-term effects include nausea, vomiting, blurred vision, convulsions, dizziness, fatigue, and constipation. Long-term consequences involve respiratory issues, reproductive and hormonal complications in both men and women, physical dependence, tolerance, psychological dependence, cognitive impairment, the onset of addiction, and an elevated risk of overdose.

Withdrawal from fentanyl manifests through intense cravings, muscle aches, nausea, vomiting, chills, sweating, anxiety, and irritability.

Treatment avenues for fentanyl addiction encompass detoxification, medication-assisted treatment (MAT), behavioral therapies, support groups, and aftercare and relapse prevention. These interventions address the physical, psychological, and behavioral aspects of addiction, offering a comprehensive approach to recovery.

What is Fentanyl?

Fentanyl is a synthetic opioid approved by the U.S. Food and Drug Administration (FDA) for treating severe pain, often associated with advanced cancer. According to the Centers for Disease Control and Prevention (CDC), fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. The Drug Enforcement Administration (DEA) classifies it as a Schedule II controlled substance, indicating a high potential for abuse which may lead to severe psychological or physical dependence.

what is fentanyl

What is the Definition of Fentanyl Addiction?

Fentanyl addiction is a severe and life-threatening condition characterized by a compulsive need to use fentanyl, a potent synthetic opioid, despite harmful consequences. It often leads to physical dependence, tolerance, and withdrawal symptoms.

Fentanyl’s extreme potency and the euphoria it produces greatly increase its potential for addiction. Once addicted, individuals may show behaviors typical of opioid use disorder (OUD), including uncontrollable cravings and persistent use despite negative outcomes. According to the study “Opioid Use Disorder” by Psychiatry.org, synthetic opioids such as fentanyl were implicated in about 87% of opioid-related deaths by mid-2021, highlighting the substantial risks associated with its misuse (Psychiatry.org, 2024).

What are the Symptoms of Fentanyl Addiction?

The prevalent symptoms of Fentanyl addiction include:

  • Chest pain or discomfort: Fentanyl’s impact on the central nervous system slows down breathing rates, leading to increased cardiac workload and subsequent chest pain. Additionally, fentanyl induces muscle rigidity, contributing to respiratory issues.
  • Loss of appetite: Fentanyl alters neurotransmitters regulating appetite, diminishing interest in activities like eating.
  • Mood changes: Fentanyl affects dopamine and serotonin release in the brain, leading to feelings of euphoria, relaxation, or, conversely, drowsiness and lethargy.
  • Numbness or tingling in extremities: Fentanyl, like other opioids, alters sensory processing in the central nervous system, resulting in reduced sensation in hands, feet, and lips.
  • Confusion: Opioid-induced neurotoxicity slows neural processes, causing confusion and cognitive impairment.
  • Painful or difficult urination: Fentanyl affects the autonomic nervous system and urinary tract function, leading to urinary difficulties.
  • Small (pinpoint) pupils: As the central nervous system depressant effects of fentanyl intensify, there is an excess activation of opioid receptors. This heightened stimulation leads to a more pronounced constriction of the pupils, creating the appearance of being pinpoint-sized and small.
  • Sleep disturbances: Prescription opioid dependence correlates with poor sleep quality and impairment. Research by Hartwell et al published in the journal Addictive Behaviors in 2014 showed elevated rates of both poor sleep quality and sleep impairment among individuals dependent on prescription opioids.
  • Exceeding planned usage: Loss of control over fentanyl use results in the user taking larger doses or taking the drug for longer than prescribed. 
  • Impulses or cravings: Experiencing intense urges or cravings for fentanyl signifies a psychological dependency. This urge is a compulsive need to actively pursue and use fentanyl, often propelled by the brain’s reward system irrespective of the negative effects.
  • Unsuccessful attempts to reduce usage: Despite awareness of the negative effects, overcoming the impulse to stop or reduce usage is challenging.
  • Consuming significant time, energy, and money: Addiction dominates daily life, with substantial resources dedicated to obtaining and using fentanyl.
  • Failure to fulfill responsibilities: Increasing difficulty in balancing substance use with essential tasks as the addiction progresses. The drug takes precedence over crucial commitments.

Recognizing these symptoms is essential for understanding the severity of addiction. As noted in the article “Everything you need to know about fentanyl,” medically reviewed by Alyssa Peckham, PharmD, BCPP and published on Medical News Today on March 19, 2024, effective identification and timely intervention can significantly impact the treatment outcomes for individuals suffering from fentanyl addiction.

signs of fentanyl addiction

What Are The Signs Of Fentanyl Overdose?

Symptoms of fentanyl overdose include small, constricted “pinpoint pupils,” unconsciousness or inability to wake, very slow, weak, or stopped breathing, choking or gurgling sounds, a limp body, and cold, clammy, and/or discolored skin. These signs indicate an urgent need for medical attention to prevent fatal outcomes. Immediate actions such as calling emergency services and administering naloxone, if available, are vital steps in responding to a suspected fentanyl overdose. This information is based on the findings from the Centers for Disease Control and Prevention as outlined in their document “The Facts About Fentanyl” (CDC, 2020).

What are the Causes of Fentanyl Addiction?

The causes of Fentanyl addiction are multifaceted, stemming from a combination of biological, environmental, and psychological factors. In the United States, where an estimated three million people according to ‘Opioid Addiction’ in 2023 by  Mohammadreza A. et al struggle with opioid addiction, the risks associated with Fentanyl use are significant, whether it is taken recreationally, unintentionally, or as prescribed by a medical professional.

1. Physical Dependence and Rapid Effects

The physical dependence on opioids, including Fentanyl, can manifest within weeks, with the likelihood of long-term use increasing even after a few days of opioid medication. Fentanyl’s fast-acting and potent effects, coupled with the potential lethality in a single dose, contribute to the risk of addiction.

2. Misuse and Chemical Makeup

Addiction can result from misusing Fentanyl, driven by its chemical composition and high potency. Individuals may unknowingly slip into addiction while attempting to alleviate withdrawal symptoms, finding themselves dependent on the medication without awareness.

3. Environmental Stressors

External factors, such as environmental stressors, play a pivotal role in the development of substance use disorder. Those prescribed Fentanyl for chronic pain may continue its use to cope with stressful life changes or trauma. Stressors like death in the family, poverty, unemployment, or exposure to high-risk situations increase the vulnerability to addiction.

4. Psychological Factors

The intricate connection between substance use disorder and mental illness is evident, with conditions like depression and anxiety often coexisting with addiction. Results in the Research Report by the National Institution of Drug Abuse ‘Common Comorbidities with Substance Use Disorders Research Report’ reveal that half of individuals experiencing mental illness will also encounter substance use disorder at some point. Co-occurring mental illnesses, including depression, bipolar disorder, ADHD, and personality disorders, heighten the risk of Fentanyl addiction.

5. Young Adulthood and Coping Mechanisms

Substance use typically commences in youth, coinciding with the emergence of mental illness symptoms. The transition to young adulthood, marked by significant life changes, can make this age group particularly vulnerable to substance use disorder. Academic stress, relationship pressures, and high-stress careers may drive individuals to turn to substances like Fentanyl as a coping mechanism.

6. Genetic Vulnerabilities

Genetic predispositions, when combined with environmental stressors and psychological influences, amplify the likelihood of addiction. The interplay of these factors increases the risk of developing a dependence on Fentanyl and underscores the complexity of addiction causation.

What are the Risk Factors of Fentanyl Addiction?

risk factors of fentanyl addiction

According to the United States Department of Labor’s Office of Workers’ Compensation Programs (OWCP), key risk factors for opioid addiction include opioid dosage, duration of use, and the specific formulation of the opioid prescribed.

Opioid Dose, Duration, and Formulations:

  • High Dose: Higher doses of opioids, particularly more than 100 morphine milligram equivalents (MME), significantly increase the risk of misuse and overdose, with risks over two times greater compared to lower doses. Even lower doses, such as 20-50 MME, still present substantial risks.
  • Prolonged Duration: Long-term use of opioids is associated with a significant risk of developing addiction. Physical dependence and addiction can occur in as little as a few days, with as many as one in four individuals in primary care settings struggling with opioid addiction from long-term prescriptions.
  • Extended Release and Long-Acting Formulations: These formulations carry a higher risk of overdose and death compared to immediate-release formulations due to their prolonged activity in the body.

Healthcare Conditions and Individual Characteristics:

  • Older Adults (65 years and older): This group may be more sensitive to the effects of opioids, increasing their risk of overdose.
  • Individuals with Respiratory Conditions: Those with conditions like sleep apnea, asthma, or chronic obstructive pulmonary disease are more susceptible to the respiratory depressant effects of opioids.
  • Younger Adults (18-25 years old) and Mental Health Disorders: Individuals in this age group and those with mental health disorders such as depression, anxiety, or post-traumatic stress disorder are at higher risk of opioid misuse.

Concomitant Use of Other Medications or Agents:

  • Using opioids in conjunction with other central nervous system depressants like benzodiazepines, sedatives/hypnotics, muscle relaxants, or antipsychotics can dramatically increase the risk of severe side effects such as profound sedation, respiratory depression, coma, or death.

The interaction between these risk factors often compounds the dangers associated with fentanyl use, making it critical for healthcare providers to consider these elements when prescribing and managing pain relief medications. The Office of Workers’ Compensation Programs highlights these concerns in their document, “Risk Factors for Opioid Misuse, Addiction, and Overdose,” emphasizing the need for careful management and monitoring of opioid use to prevent addiction and overdose.

What are the Treatment Options for Fentanyl Addiction?

Treating fentanyl addiction effectively requires a comprehensive approach that often involves medication-assisted treatment (MAT), behavioral therapies, and supportive care. Based on extensive research, including the studies “Prescription Opioid Addiction Treatment Study” and “Current status of opioid addiction treatment and Related Preclinical Research” by Kreek et al. (Sci. Adv., October 2019), several key components form the backbone of successful treatment strategies for opioid use disorders (OUD), including fentanyl addiction.

Medication-Assisted Treatment (MAT):

  1. Methadone: A full opioid agonist that reduces craving and withdrawal symptoms by activating the same opioid receptors as fentanyl but without producing the same high. Methadone treatment is highly regulated and typically requires daily visits to a treatment center for dosing, especially in the initial stages of treatment.
  2. Buprenorphine: A partial opioid agonist that provides a safer alternative to methadone and can be prescribed by certified physicians from office settings. Buprenorphine is less likely to produce euphoria and has a ceiling effect that lowers the risk of misuse and overdose.
  3. Naltrexone: An opioid antagonist that blocks opioid receptors and prevents fentanyl from producing euphoric effects. Naltrexone is available in a pill form or as a monthly injectable dose known as Vivitrol.

Research highlighted in Kreek et al. underscores the chronic nature of opioid addiction and the importance of long-term maintenance therapy to effectively manage this condition. The study emphasizes that fewer than 10% of individuals with opioid addiction achieve long-term abstinence without the help of MAT, which significantly improves treatment retention and outcomes.

Behavioral Therapies:

Complementing MAT with behavioral therapies is crucial for addressing the psychological aspects of addiction. Effective therapies include:

  • Cognitive Behavioral Therapy (CBT) that helps modify the patient’s drug-use expectations and behaviors, and effectively manage triggers and stress.
  • Contingency Management (CM), which uses a voucher-based system where patients earn points for negative drug tests, which can be exchanged for items that encourage healthy living.
  • Motivational Interviewing (MI), which increases an individual’s motivation to change their behavior and engage in treatment.

Supportive Care:

Support services such as case management, peer supports, and educational programs about the nature of addiction and relapse prevention strategies are vital. These services can provide the necessary support network and resources to help individuals rebuild their lives and maintain long-term recovery.

The integration of these treatment modalities provides a robust framework for treating fentanyl addiction, emphasizing the need for a personalized approach to suit the unique needs of each patient, as noted by Kreek et al. in their 2019 publication. This comprehensive approach is crucial for addressing not only the physiological aspects of dependency but also the psychological underpinnings of addiction.

How to Prevent Fentanyl Addiction?

Mitigating the risk of fentanyl addiction involves strategic steps that individuals can take to ensure responsible use and minimize the likelihood of misuse. Consider the following measures

1. Collaborate with Healthcare Professionals

Establish a partnership with your doctor to devise a pain management plan tailored to your needs. Explore non-opioid alternatives for pain relief and engage in open discussions about potential side effects and concerns. Regular follow-ups with your healthcare provider will help ensure that your pain management remains effective and safe.

2. Proper Handling of Prescription Opioids

Adhere strictly to prescribed dosages and schedules when using prescription opioids. Never exceed the recommended amounts or frequency without consulting your doctor. Keep your healthcare provider informed about any side effects or worries related to opioid use.

3. Avoid Risky Combinations

Steer clear of combining opioids with alcohol or other substances/medications, as this poses severe dangers. Particularly avoid mixing opioids with drugs that induce drowsiness, such as benzodiazepines (e.g., Xanax and Valium), muscle relaxants (e.g., Soma or Flexeril), hypnotics (e.g., Ambien or Lunesta), and other prescription opioids.

4. Responsible Disposal

Do not share or sell your prescription opioids, as this can contribute to misuse. Store these medications securely, out of reach of others, including children, family, friends, and visitors. Dispose of unused prescription opioids responsibly through community drug take-back programs, pharmacy mail-back programs, or by following guidance from the Food and Drug Administration (FDA), including safe flushing down the toilet.

How can someone tell if their drugs are laced with fentanyl?

It is nearly impossible to detect fentanyl in drugs by sight, taste, or smell. Fentanyl test strips are a practical solution for testing drugs for fentanyl contamination. These strips are inexpensive, give results within minutes, and can significantly reduce the risk of accidental overdose. However, even if the test is negative, caution should still be exercised as the strips might not detect more potent analogues like carfentanil.

Source: The Facts About Fentanyl, CDC, 2020

Can genetics influence the treatment outcomes for fentanyl addiction?

Yes, genetic factors can affect how individuals respond to opioid addiction treatments. Genetic variability influences the metabolism of medications used in treatment and can affect both the efficacy and safety of these drugs.

Source: “Current status of opioid addiction treatment and related preclinical research,” Kreek et al., Sci. Adv., October 2019

How does Fentanyl Addiction compare to a Clonazepam/ Klonopin Addiction?

Both Fentanyl and Clonazepam (brand name Klonopin) are highly addictive substances that can lead to physical and psychological dependence. While both drugs are prescribed for different medical conditions, they both act on the brain’s opioid receptors and can produce similar effects. However, Fentanyl is significantly more potent than Clonazepam and can lead to rapid development of tolerance and addiction. Additionally, Fentanyl is often obtained illegally and can be more dangerous due to its unknown potency and potential for overdose.

What role does personalized medicine play in treating opioid use disorders?

Personalized medicine in opioid addiction treatment involves tailoring medical treatment to individual characteristics, including genetic makeup. This approach helps in predicting vulnerability to opioid use disorders and in customizing treatment strategies to improve outcomes.

Source: “Current status of opioid addiction treatment and related preclinical research,” Kreek et al., Sci. Adv., October 2019

What are the differences between pharmaceutical and illicitly manufactured fentanyl?

Pharmaceutical fentanyl is a synthetic opioid prescribed by doctors to manage severe pain, especially after surgery and for patients with advanced-stage cancer. Illicitly manufactured fentanyl (IMF), however, is produced illegally and distributed through underground markets. IMF is often mixed with other drugs like heroin, cocaine, and methamphetamine to increase potency, making it extremely dangerous due to its high risk of overdose.

Source: The Facts About Fentanyl, CDC, 2020

What are the risks associated with the use of methadone in treating fentanyl addiction?

Methadone, while effective, can be risky if not properly managed. It has a high potential for overdose, especially when initiated, due to its long half-life and potent opioid effects, as detailed in “Current status of opioid addiction treatment and related preclinical research,” by Kreek et al., published in Sci. Adv., October 2019.

How effective are contingency management therapies in opioid addiction treatment?

Contingency management therapies, which reward patients for abstaining from drug use, have shown effectiveness in improving treatment outcomes by increasing retention rates and promoting abstinence, according to the Prescription Opioid Addiction Treatment Study (POATS) Review.

How does Fentanyl Addiction compare to a Cocaine Addiction?

While both Fentanyl and cocaine are highly addictive substances, there are some differences in how they affect the brain and body. Fentanyl is a synthetic opioid that has a stronger impact on the central nervous system, leading to a faster and more intense high than cocaine. This can make it even more addictive and dangerous. Additionally, fentanyl has a higher risk for overdose and can have deadly consequences. Both addictions require professional treatment and support, but it is crucial to seek help immediately if you or a loved one is struggling with a fentanyl addiction.

How does extended-release naltrexone work in preventing Fentanyl relapse?

Extended-release naltrexone works by blocking opioid receptors for about a month, which prevents fentanyl and other opioids from producing euphoric effects, thus aiding in relapse prevention. This mechanism is explained in the study “Current status of opioid addiction treatment and related preclinical research” by Kreek et al., published in Sci. Adv., October 2019.

Are there any new pharmacological treatments on the horizon for Fentanyl addiction?

Ongoing research is focused on developing new analgesic drugs with reduced abuse potential and less risk of overdose, targeting novel neurobiological mechanisms. This research direction is highlighted in “Current status of opioid addiction treatment and related preclinical research” by Kreek et al., published in Sci. Adv., October 2019.

What impact does opioid addiction have on infectious diseases?

Individuals with opioid addiction are at higher risk for infectious diseases such as HIV/AIDS and hepatitis, largely due to risky behaviors such as needle sharing.

Source: “Current status of opioid addiction treatment and related preclinical research,” Kreek et al., Sci. Adv., October 2019

How does buprenorphine-naloxone treatment support recovery in opioid addiction?

Buprenorphine-naloxone reduces withdrawal symptoms and cravings by partially activating opioid receptors, while naloxone blocks the effects of opioids at these receptors if injected, reducing abuse potential.

Source: “Current status of opioid addiction treatment and related preclinical research,” Kreek et al., Sci. Adv., October 2019

What are the challenges in accessing effective treatment for opioid addiction?

Barriers include stigma, insufficient provider education on addiction, and limited access to treatment programs, which can prevent those suffering from opioid use disorders from receiving effective care.

Source: “Current status of opioid addiction treatment and related preclinical research,” Kreek et al., Sci. Adv., October 2019

Ryan Wakim MD
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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