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Fentanyl – one of the drugs that has played such a prominent part in the ongoing U.S. opioid crisis – has rapidly now become a huge public health issue in its own right.

Without a doubt, the highly addictive synthetic opioid fentanyl is the main driving force behind record-breaking levels of drug overdose fatalities seen during 2020 in the U.S., and every single day, it is ruining more and more countless lives as another American family loses a loved one to fentanyl addiction.

More and more of the illicit drugs available from criminal drug dealers, such as heroin, cocaine, methamphetamine and counterfeit prescriptions, purchased either online or on U.S. street corners, are being deliberately made more potent and more dangerous by the addition of fentanyl.

We take a look at this man-made, ultra-strength opioid, how it is abused, how easily it can lead to overdose or addiction, and how the right professional treatment can successfully treat fentanyl addiction, and lead to a long-term, sustainable recovery.

What is Fentanyl?

Fentanyl is classified as a synthetic (man-made) opioid drug that is 50 times stronger than heroin, and as much as 100 times stronger than morphine.

When used medically, fentanyl, a Schedule II prescription medication, produces a euphoric state of relaxation, relieving any pain in the patient, and decreasing the perception of suffering.

However, it is illegally abused for exactly the same reasons.

Fentanyl comes in several legal forms, and people take it either:

• By injection
• As a lozenge
• As an oral tablet
• As a lollipop, or
• By applying a patch to their skin

Fentanyl: Legal Medical Use in the U.S.

Illegally Manufactured Fentanyl: Use & Abuse

Fentanyl is classified in the U.S. as a Schedule II prescription medication. It is used in the treatment of severe pain that other types of medications cannot manage successfully, or after surgery to treat post-op pain.

It is sold in the U.S. under the brand names:

• Actiq®
• Duragesic®, and
• Sublimaze®

However, fentanyl is also illegally manufactured for the illicit drug market, and is either sold by criminal drug dealers online or in the street.

Drug users take the drug either by swallowing, by smoking it, by snorting the crushed powder, or by injection. No one method is safer than any other.

Additionally, as with any illegally produced and purchased drug, drug users have little to no idea of the strength or the purity of the product.

Fentanyl Street Names:

• Apache
• China White
• Friend
• He-Man
• Percopop
• Shine

• China Girl
• Dance Fever
• Goodfellas
• Jackpot
• Poison
• Tango & Cash

• China Town
• Drop Dead
• Great Bear
• Murder 8
• Serial Killer
• TNT

Fentanyl and fentanyl analogs (chemically-similar versions) produced in illegal laboratories can be hundreds of times more potent than street heroin.

These illicit versions produce significantly more respiratory depression, making them far more dangerous to users than heroin.

“What’s really driving the surge in overdoses is this increasingly poisoned drug supply. Nearly all of this increase is fentanyl contamination in some way. Heroin is contaminated. Cocaine is contaminated. Methamphetamine is contaminated.”

– Shannon Monnat, associate professor of sociology, Syracuse University, New York

In recent years, illicit drug manufacturers have been adding fentanyl to virtually every other drug they produce for the criminal drug supply, such as cocaine, methamphetamine, ecstasy,  and counterfeit prescription drugs.

This has resulted in many people dying by drug overdose simply because they incorrectly believed their product was fentanyl-free.

Because the potency of these other drugs is not known, and they are none the wiser about the addition of fentanyl, any illicit drug use – even a reduced dose – can result in accidental overdose or death.

Fentanyl’s use as a “cutting agent” for other drugs is simply because criminal drug organizations, like Mexican drug cartels, quickly learned it was:

• Easier and cheaper to produce than most other illicit drugs, and
• Far easier to traffick successfully across national or state borders

For the criminal drug organizations, using fentanyl as a cutting agent for other drugs was seen as an instant way to radically and massively boost profits, regardless of the apparent additional loss of life.

What Causes Opioid Addiction & Why is it So Tough to Combat?

TED-Ed with Mike Davis

The full transcription of this TED-Ed video is available here.

In the 1980s and 90s, pharmaceutical companies began to market opioid painkillers aggressively, while actively downplaying their addictive potential. The number of prescriptions skyrocketed, and so did cases of addiction, beginning a crisis that continues today.

What makes opioids so addictive?

Mike Davis explains what we can do to reverse the skyrocketing rates of addiction and overdose.

Fentanyl & The Brain: How Does It Work?

Fentanyl is classed as an opioid receptor agonist, and it works by binding to the brain’s natural opioid receptors, which triggers a massive increase in dopamine levels. Normally, our own natural neurotransmitters bind to these receptors in order to control pain, regulate hormones, and keep us feeling good.

This huge increase in dopamine produces a euphoric state of relaxation, relieving any pain, and decreasing the perception of suffering.

However, because fentanyl works in a non-discriminatory way, it also affects other areas responsible for brain function, including those that control breathing, where it depresses the respiratory centers and the cough reflex.

Depression of the respiratory system is often the primary cause of death in the event of an accidental overdose.

Fentanyl Abuse: The Side Effects

Just as with any other drug, fentanyl’s side effects can vary based on a number of factors, such as:

• How long the user has been using the drug
• How tolerant they are to the drug: fentanyl abusers will have built up a level of tolerance from their long-term use, which means they require more of the drug to achieve the same effects
• The amount of the drug normally used
• The time between each use of the drug

However, one rule remains constant: The longer a person has been abusing fentanyl, the more severe the withdrawal symptoms will be.

Physical & Psychological Side Effects of Fentanyl Use

Because of fentanyl’s potency, those who use it can experience a wide range of side effects, which will vary greatly between different users. These can include:

How Long Does Fentanyl Stay in Your System?

The length of time a drug remains in a person’s body is measured by assessing the “elimination half-life” of the substance (usually referred to as the “half-life”), which is the length of time it takes for half of the drug to exit the body.

The elimination half-life of fentanyl varies depending on the method of administration.

Fentanyl usually has an elimination half-life of approximately 2 to 4 hours in adults, meaning it takes around 11-22 hours to completely leave your system.

As fentanyl breaks down in your system, it leaves behind traces called metabolites. These metabolites stay in your system far longer, meaning that a professional drug test should detect fentanyl use several days after you stop taking it.

Fentanyl Addiction in the U.S. – Facts & Stats

In 2020, the U.S. witnessed a record number of drug overdose deaths – 93,331 in total, and a rise of 30% from 2019, the largest single-year percentage increase on record since 1999.

According to the National Center for Health Statistics (NCHS), part of the U.S. Centers for Disease Control & Prevention (CDC), nearly three-quarters of these overdose deaths – 74.7% – involved opioids.

However, If you could identify one single aspect of the current situation for why drug fatalities are increasing by so much, it would have to be fentanyl – right at the heart of these tragic numbers.

For example, in 2015, man-made opioids like fentanyl were involved in only 18% of all overdose deaths; in 2020, it is now more than 60%.

However, there are other reasons, too. The record number of 2020 deaths (compared to 2019) showed increases in other substances as well:

• Cocaine – increased by 21%, and
• Psychostimulants, like methamphetamine – increased by 46%

For those who deliberately abuse fentanyl, the difference between the euphoric high they normally experience or dying from a fatal drug overdose is around a few grains of salt, as shown clearly in the graphic below:

Short & Long-Term Effects of Fentanyl Use

Just as with other drugs, both the short-term and long-term effects of fentanyl can vary based on how long a person has been using the drug.

The longer a person uses and abuses fentanyl, the more severe the consequences will be.

Fentanyl: Short-Term Effects

• Rapid / effective pain relief
• Feeling “high” / state of euphoria
• Nausea / vomiting
• Skin rash
• Slurred speech
• Respiratory depression (slower breathing)

Fentanyl: Long-Term Effects

• Confusion
• Severe constipation
• Dizziness
• Lowered blood pressure
• Drowsiness
• Sedation

Fentanyl: Long-Term Effects

• Addiction / Opioid Use Disorder (OUD)
• Structural brain changes
• Respiratory problems
• Initiate or worsen pre-existing mental health conditions, including depression
• Multiple organ system damage

• Anoxic injury (brain damage from decreased oxygen supply)
• Heart disease
• Gastroesophageal reflux (GERD)
• Development of fentanyl hypersensitivity, leading to anaphylaxis
• Personal life and relationship harm

• For pregnant women:

Low birth weight, miscarriage, and neonatal abstinence syndrome (NAS)

• For users who regularly inject: Increased risk of HIV / AIDS, hepatitis, and more

Fentanyl: The High Risk of Overdose

The use and abuse of fentanyl (either with legal prescriptions or illegally manufactured versions) carries a high risk of accidental overdose, which can prove fatal if emergency medical treatment is not sought immediately.

This risk is further exacerbated if a drug user is unaware that the illegal drug they’re using, eg. cocaine or methamphetamine, contains fentanyl.

People die from a fentanyl overdose because the drug can cause severe respiratory depression – reduced breathing or it stops altogether, leading to depleted oxygen in the body, particularly the brain, heart and lungs).

A lack of sufficient oxygen places a huge strain on the body’s vital organs. Firstly, it will stop the heart, leading to cardiac arrest, and then it will literally shut down the brain.

Without immediate medical assistance, this leads to unconsciousness, coma, and then death. After 3-5 minutes with no oxygen entering the bloodstream, brain damage begins, and is soon followed by death.

Surviving a fentanyl overdose (or any other opioid overdose) depends entirely on the body receiving enough oxygen via the respiratory system. The process of respiratory depression is not a rapid occurrence, so there is time for the necessary emergency medical intervention.

Fentanyl Overdose: The Critical Signs

• Pale, clammy skin
• Inability to speak
• Breathing difficulty, known as
  Respiratory Depression
• Vomiting / making gurgling sounds
• Slowed heart rate
• Unconsciousness

• Constricted pupils
• Lack of coordination
• Purple / bluish hue to lips and/or fingernails
• Physically limp
• Drowsiness
• Coma

What Should I Do in the Event of a Fentanyl Overdose?

• Call emergency services (Dial 911): In the event of an opioid overdose, you should call 911 without delay. Be sure to give a  clear address and/or description of your location.
• Check for signs of an opioid overdose: The visible signs of an opioid overdose have been provided above, but if the person has clear breathing problems, it is a sure sign of overdose or overmedication.
• Support the person’s breathing: “Rescue breathing” can be very effective in helping others breathe during overdose while waiting for the EMS. For adults, it involves the following steps:
  • Be sure the person’s airway is clear
  • Place one hand on the person’s chin, tilt the head back and pinch the nose closed
  • Place your mouth over the person’s mouth to make a seal and give 2 slow breaths
  • The person’s chest should rise (but not the stomach)
  • Follow up with one breath every 5 seconds
• Administer naloxone (if available): If it is available, naloxone should be administered to anyone who shows signs of opioid overdose, or when overdose is suspected. You should try to comfort the person, as the withdrawal triggered by naloxone can be unpleasant, and they need to stay calm.

Source: www.harmreductionohio.org

What is Naloxone?

Naloxone is a medicine that rapidly reverses an opioid overdose. It is an “opioid antagonist,” meaning it rapidly attaches to opioid receptors, and reverses and blocks the effects of other opioids.

Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped – one the the main reasons overdoses may become fatal.

However, naloxone has no effect on someone who does not have opioids in their system, and it should not be used as a type of treatment for opioid use disorder (OUD).

Administering Naloxone: Naloxone can be given in a number of ways, depending upon the brand – either as a nasal spray, or as an injection into the muscle, under the skin, or into the veins.

Additional information about opioid overdose response is available here: Substance Abuse and Mental Health Administration’s (SAMHSA) Opioid Overdose Prevention Toolkit.

Fentanyl Addiction: Treatment & Recovery

The majority of people who become addicted to fentanyl are normally already addicted to other opioid drugs. These are people who are typically using heroin or prescription painkillers on a regular basis.

Once these drug users start using fentanyl, the “new” addiction is simply an extension of their existing opioid use disorder (OUD).

Opioid addiction, like other substance addictions, occurs because a person has been taking these drugs for an extended period of time. However, it is possible to get addicted to both legal and illegal opioids in as little as a few weeks of regular use.

One of the criteria for any substance use disorder is the rapid emergence of withdrawal symptoms (see table below) if the user abruptly stops their drug use.

Some of these fentanyl withdrawal symptoms can be severe in nature, and can, in themselves, prompt the users to make a quick return to their original opioid use.

IMPORTANT: Detoxing from the drug by going “cold turkey” (without assistance of any kind) can be fatal if the person then relapses and takes too high a dose, or if they have a pre-existing medical condition that is severely worsened by the detox process.

Fentanyl Addiction: Common Withdrawal Symptoms

• Anxiety
• Fever / chills
• Muscle and joint pain
• Goosebumps on skin
• Elevated heart rate
• Sweating
• Fatigue
• Severe drug cravings

• Depression
• Insomnia / disrupted sleep
• Vomiting and/or diarrhea
• Restlessness
• Nausea / poor appetite
• Runny nose
• Stomach pain

Please remember, it is possible for people to fully recover from a fentanyl addiction or another opioid use disorder (OUD).

However, it is only with professional addiction treatment that any chance of success is guaranteed; this typically means going through both the detox and rehab elements of the treatment.

Drug Detox and Medication Assisted Treatment (MAT)

It is important to treat the physical side of the fentanyl addiction first, and this is done through the process of drug detox.

This should be a medically-supervised process of treating any withdrawal symptoms, and then allowing the body to naturally remove all the harmful toxins it has that have been left by the drug use.

For those addicted to fentanyl, medication assisted treatment (or MAT) is often recommended. MAT is the use of specifically designed and FDA-approved medications needed to treat ongoing opioid withdrawal symptoms.

MAT programs also include a counseling program.

Additionally, holistic treatments, such as dietary changes and exercise, can also be effective.

Drug Rehab Addiction Treatment

During drug rehabilitation, patients receive behavioral therapy to help determine and treat the root cause of their addictions. Even though there are some people who begin using opioids simply because they just want to get high, there are usually underlying issues that begin the abuse.

The National Institute on Drug Abuse (NIDA) reports that about half of all people who go to drug rehab have a co-occurring disorder or mental health condition that is driving their substance abuse.

Co-Occurring Disorder / Dual Diagnosis

Dual diagnosis treatment is available to help those who have co-occurring disorders. There are several mental health conditions that could be afflicting a person who suffers from fentanyl addiction, such as:

• Anxiety
• Depression
• Bipolar disorder
• PTSD
• Panic disorder

For many people, using opioid drugs like fentanyl becomes a way for them to “self-medicate” their mental health symptoms.

In fact, many people are not even aware that they have a mental health issue – they just know that they do not feel like they think they should.

Fortunately, dual diagnosis treatment can make a huge difference. Once the mental health issue has been addressed, the reason for their self-medication is removed. This makes it far easier for them to recover in the long-term.

Modern Recovery & Fentanyl Addiction Recovery

At Modern Recovery, we have helped many people successfully recover from opioid use disorder (OUD) – more commonly known as opioid addiction.

We have also successfully worked with many people who were once addicted to fentanyl, and some who have even survived an overdose because someone was close by to administer naloxone.

When clients come to us for treatment, the first step is always to get their withdrawal symptoms under control. Even though we do not offer drug detox at our facility, we do provide detox referrals to people who need them.

In most cases, a professional medically supervised detox means most people are ready to move on to rehab in as little as 7-10 days.

Once detox is finished, clients return to us for professional therapy; we highly recommend our Intensive Outpatient Program (IOP), which provides a high level of care, but is far more flexible than inpatient or residential rehab.

Many of our clients come from out-of-state to our facility for their fentanyl addiction treatment.  Obviously, those people need a safe, drug-free place to stay while they receive their treatment.

For all clients, but particularly those from out-of-state, we also provide a Sober Living Program, where clients can stay on site with us in exactly the environment they need – clean, comfortable housing which is both safe and secure, and, importantly, completely drug-free.

We are here 24/7 to provide you with the right professional support you need during your fentanyl addiction recovery.

If you would like to get more information about either fentanyl addiction or our intensive outpatient rehab program, please contact us today.

Fentanyl FAQs

What is fentanyl?

Fentanyl is a powerful synthetic opioid analgesic, similar to morphine but around 50 to 100 times more potent.

In its prescription form, it is used for pain relief and pain management. However, fentanyl is also manufactured illegally, and sold to drug users.

Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths.

How is illegal fentanyl manufactured and sold?

Illegal fentanyl is made in laboratories financed by large criminal drug organizations, like the Mexican drug cartels. Other manmade opioids, chemically similar to fentanyl, are also produced – these are known as fentanyl analogs.

It is sold to drug users in the following forms: as a powder, dropped on blotter paper like small candies, in eye droppers or nasal sprays, or made into pills that look like real prescription opioid tablets.

Why are fentanyl and other drug users at an increased risk of overdose?

The high potency of fentanyl greatly increases the risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains the opioid.

Additionally, Illegal fentanyl is now being mixed with other drugs, such as cocaine, heroin, methamphetamine, and MDMA. This is especially dangerous because people are often unaware that fentanyl has been added.

How does fentanyl work?

Fentanyl works by quickly binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.

What are the immediate effects of fentanyl?

Immediate effects include extreme happiness and euphoria, drowsiness, nausea, confusion, constipation, sedation, respiratory depression, and possibly unconsciousness, coma, and death.

What is naloxone?

Naloxone is an opioid overdose reversal medication that can be given to a person to reverse a fentanyl overdose. Multiple naloxone doses may be necessary because of fentanyl’s extreme potency.

What is the most effective way of treating a fentanyl addiction?

The most effective way of treating fentanyl addiction is by the combination of professional behavioral therapies and medication assisted treatment (MAT).

External Sources:

• National Institute on Drug Abuse (NIDA). Fentanyl Drug Facts. June, 2021. Available at DrugAbuse.gov.
• U.S. Centers for Disease Control & Prevention (CDC): Provisional Drug Overdose Death Counts” System. August, 2021. Available at CDC.gov.
• National Institutes of Health: How Opioids Drugs Activate Receptors. May, 2018. Available at NIH.gov.
• New Hampshire State Police: Forensic Laboratory. 2021. Available at NHSP.gov.
• U.S. National Library of Medicine: “Anoxic Encephalopathy.” July, 2021. Available at NLM.NIH.gov.
• U.S. National Library of Medicine: “Gastroesophageal Reflux (GERD).” March, 2018. Available at NLM.NIH.gov.
• American Academy of Allergy Asthma & Immunology (AAAAI): Anaphylaxis. 2021. Available at AAAAI.org.
• U.S. National Library of Medicine: “Neonatal Abstinence Syndrome.” August, 2014. Available at NLM.NIH.gov.
• Substance Abuse and Mental Health Administration (SAMHSA): Opioid Overdose Prevention Toolkit. 2018. Available at SAMHSA.gov.
• Harm Reduction Ohio: “How Much Fentanyl Will Kill You?” March, 2018. Available at HarmReductionOhio.org.
• Substance Abuse and Mental Health Administration (SAMHSA): Medication Assisted Treatment (MAT). January, 2021. Available at SAMHSA.gov.
• National Institute on Drug Abuse (NIDA). Comorbidity: Substance Use & Other Mental Disorders. June, 2021. August, 2018. Available at DrugAbuse.gov.
• National Institute of Mental Health: “Anxiety Disorders.” July, 2018. Available at NIMH.gov.
• National Institute of Mental Health: “Depression.” February, 2018. Available at NIMH.gov.
• National Institute of Mental Health: “Bipolar Disorder.” January, 2020. Available at NIMH.gov.
• National Institute of Mental Health: “Post-Traumatic Stress Disorder.” May, 2019. Available at NIMH.gov.
• National Institute of Mental Health: “Panic Disorder: When Fear Overwhelms.” 2016. Available at NIMH.gov.