Fentanyl Abuse, Addiction, And Treatment Options

Fentanyl is a potent opioid with an extremely high risk of overdose. Prescription-grade fentanyl can be fatal in extremely small doses, and illegally produced fentanyl can be even more dangerous.

Fentanyl is generally prescribed for pain management in people with cancer. As a fast-acting and potent opioid, it is effective and useful in treating the intense pains associated with cancer.

Fentanyl has also been used to treat long-term, chronic pain when other opioids have stopped working effectively.

However, the drug is only recommended for use in those who are opioid-tolerant, and should never be given to individuals who have not been prescribed opioids for a period of time.

The prescribing information from JanssenMD reads that their fentanyl transdermal patch, Duragesic, is only prescribed for individuals who have been on 60 mg morphine dose for a minimum of one week, and is never to be used “as needed”.

Unfortunately, fentanyl is now being made in clandestine (or illegal) laboratories. These labs can be found in abandoned homes, motels, or even trunks of cars.

Illegally made fentanyl is unstable and its ingredients vary from batch to batch. This makes illegal fentanyl one of the most dangerous illegal substances.

Fentanyl overdoses are resulting in increasing amounts of drug overdoses. This is largely because drug traffickers have begun adding fentanyl to other drugs, like cocaine or heroin.

It is believed that this is being done to increase potency, however, the backlash is resulting in high numbers of overdose-related deaths in individuals who abuse street drugs.

It is becoming common knowledge on the streets that fentanyl is being laced in heroin, but it has not become a deterrent to those addicted to heroin.

The solution, instead, is to use heroin in larger groups, and carry Narcan (when possible), to reverse the overdose effects until medical emergency personnel can arrive.

Prescription-Grade Fentanyl

There are many different forms of fentanyl, and all of them run the risk of abuse and potential addiction:

  • Duragesic — transdermal patch
  • Onsolis — film that is placed on the inside of the cheek to administer medication rapidly
  • Fentora — tablet form that is held against the inside of the cheek
  • Abstral — tablet of fentanyl that dissolves under the tongue
  • Subsys — spray administered under the tongue
  • Lazanda — nasal spray
  • Actiq — lozenge on a stick
  • Sublimaze — injectable form, only for hospital use during surgeries, 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 is a powerful opioid and misusing fentanyl can develop into an addiction. Even taking fentanyl as prescribed can result in tolerance, dependence, and addiction.

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Warning signs of fentanyl abuse may not be easy to recognize. If a person is in extreme distress due to chronic or intense pain, alleviating that pain can make the person appear happier and make them more comfortable with activity.

Tolerance can often develop with long-term fentanyl use. The person may require higher doses of fentanyl to get the same results, and they will likely run out of their medication before their prescription can be refilled. Misusing fentanyl can result in abuse and addiction.

A person abusing fentanyl may have the following symptoms:

  • pinprick pupils
  • drowsiness
  • confusion
  • sweating
  • avoiding social situations
  • vomiting/nausea
  • decreased breathing
  • insomnia and/or sedation
  • obtaining fentanyl illegally

Nodding off, or falling asleep intermittently and waking without realizing they have been asleep, indicates that a person has taken so much fentanyl that it is affecting function on the central nervous system (CNS).

Depressing the CNS will also slow breathing and heart rate, which can increase the possibility of permanent damage to organs due to oxygen deprivation.

Symptoms Of Fentanyl Abuse And Addiction

Abusing fentanyl causes several side effects, and the intensity of these effects depends on how much fentanyl a person has taken.

Some of these symptoms are:

  • intense euphoria
  • nausea
  • dry mouth
  • trouble sleeping
  • blurred vision
  • constipation
  • problems thinking

If a person who is prescribed fentanyl is experiencing these effects, it may be an indication that they are abusing their medication.

Diagnosing Fentanyl Abuse And Addiction

Abusing fentanyl is diagnosed as an opioid use disorder (OUD).

There are many questions a doctor or professional may ask that can help determine if the fentanyl use has become problematic, and a substance abuse program may be warranted, such as:

  • Are you taking your fentanyl exactly as it is prescribed?
  • Have you changed the dosage without approval from your doctor?
  • Are you smoking, snorting, injecting, or chewing your fentanyl?
  • Are you able to stop taking your fentanyl without experiencing withdrawal?
  • Do you buy fentanyl off the streets, or from friends or family members?
  • Is taking fentanyl getting in the way of meeting responsibilities?
  • Are you taking more fentanyl than before and getting the same effects?
  • Has fentanyl been causing problems in your relationships with others?

Responding “yes” to these questions could indicate a problem. Over time, it is not unusual for a person to develop tolerance to or dependence on fentanyl. However, these changes should be monitored by a doctor or medical professional.

Mixing Fentanyl With Other Substances

Fentanyl is not recommended for use with other prescription medications. Abusing fentanyl is extremely dangerous, since it does interact with more than 250 different prescription medications.

In some cases, mixing fentanyl with other medications can be fatal.

The following four medications interact so intensely with fentanyl that a person is not allowed to take them together:

  • naltrexone (Vivitrol, ReVia)
  • safinamide (Xadago)
  • mifepristone (ru486, Mifeprex)
  • amifampridine (Firdapse, currently under priority review by FDA)

Similar to other opioids, fentanyl should not be taken with other depressants, such as benzodiazepines, alcohol, or other sedatives.

Some antidepressants also have adverse reactions when mixed with fentanyl. Speak to a doctor or pharmacist before mixing fentanyl with other medications.

Fentanyl Overdose

Being aware of the symptoms of a fentanyl overdose can help save a person’s life. Fentanyl can be deadly very quickly, and being able to intervene as soon as symptoms emerge can make a life-saving difference.

Signs of a fentanyl overdose include:

  • shallow or restricted breathing
  • pinprick pupils
  • acting bizarre then losing consciousness
  • body stiffening or mimicking seizure activity
  • gurgling sounds like snoring
  • skin turning blue/grey
  • weak pulse
  • foaming at the mouth
  • vomiting
  • choking
  • non-responsive

When a person taking fentanyl exhibits these symptoms, contact emergency medical services immediately. It may also be wise to have Narcan (naloxone) on hand, a medication used to reverse the effects of opioid overdose.

Fentanyl Withdrawal

Fentanyl withdrawal can be painful. While many of the symptoms are merely uncomfortable, some of the other symptoms are similar to extremely intense flu-like symptoms.

It is often encouraged that a person experiencing these painful withdrawal symptoms seek the assistance of a supervised detoxification program.

Medically supervised detox programs offer medications, supplements, and round-the-clock care to help ease the discomfort associated with fentanyl withdrawal.

Fentanyl withdrawal can be very intense if the person was taking large amounts of fentanyl over a long period of time.

Some of the symptoms associated with fentanyl withdrawal include:

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

A supervised detoxification program can ease, and in some cases eliminate, some withdrawal symptoms. This can help decrease the likelihood of early relapse.

While in detox, a case manager may help explore substance abuse treatment options that are designed to treat OUD, like fentanyl addiction.

Treatment Programs For Fentanyl Addiction

Treatment facilities that specialize in treating opioid use disorders are federally regulated and require a diagnosis of an OUD in order to enroll.

Vertava Health of Massachusetts offers specialized treatment for opioid use disorders. Treatment here includes medication-assisted detox which lasts up to 7 days, depending on the severity of withdrawal.

Medications we use to treat opioid withdrawal symptoms include buprenorphine (Suboxone) and naltrexone (Vivitrol). After completing detox, patients move on to Vertava Health of Massachusetts’s residential program, which lasts between 30 and 60 days.

With a full continuum of care, those in treatment for opioid addiction who complete residential treatment can move on to our partial hospitalization phase. This final phase of care is completely customizable and can last from 10 days to months or up to a year.

At Vertava Health of Massachusetts, you or your loved one will find all the tools needed to help overcome your addiction to fentanyl. For more information, contact one of our treatment specialists today.


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