Fentanyl Addiction and Treatment Options
Fentanyl is an extremely potent synthetic opioid drug that is commonly used to manage severe post-operative pain or chronic pain in people who are significantly tolerant to other opioids.1 Pharmaceutical-grade fentanyl is sometimes diverted from prescription supplies for non-medical use, though much of the drug encountered on the street is illicitly manufactured.2
In this article, we will provide more information about fentanyl; its different forms, including various prescription formulations and illegally made forms; the effects it has in the short and long term, withdrawal symptoms that may occur with the cutting back or stopping of use; and what options—detox, inpatient, outpatient—are available for treatment.
What is Fentanyl?
Fentanyl is a powerfully addictive drug estimated to be 50 to 100 times more potent than morphine. 1 It is a synthetic opioid drug first introduced as a pre-surgical anesthetic in the 1960s. 2 Today, it continues to be used as an anesthetic and analgesic medication under brand names such as Sublimaze and Actiq. 1,2
What is Fentanyl Used For?
An estimated 2.4 million fentanyl prescriptions were written in 2021 alone.2 It is prescribed for the management of severe pain, such as post-surgical pain, but is also used to induce and maintain anesthesia during certain medical procedures.1,2 Additional uses include managing breakthrough cancer pain in patients already using other opioid medications.2
What is the Difference Between Pharmaceutical Fentanyl and Illicit Fentanyl?
While pharmaceutical fentanyl may be administered in multiple different forms for prescription use, illicit fentanyl may be found either as a powder or pressed into pill form.3 In some cases, pharmaceutical fentanyl may be diverted from legitimate supply lines to be sold illegally for nonmedical misuse.2 Increasingly so, illicitly manufactured fentanyl has been fueling the epidemic of misuse in the United States.2
Pharmaceutical Forms of Fentanyl
Several pharmaceutical formulations of fentanyl are used in various clinical settings or prescribed for pain management. The various forms of fentanyl include injectable solutions, oral transmucosal lozenges (or troches; sometimes referred to as “fentanyl lollipops”), transdermal patches, and dissolvable sublingual or buccal tablets.3
Illicit fentanyl may be manufactured in clandestine laboratory setting.2 Unregulated manufacturing practices means that the drug may be altered or contaminated, making an already potentially lethal substance even more dangerous.
Why is Fentanyl So Dangerous?
Fentanyl is highly dangerous because of its potent opioid effects. It is estimated that fentanyl is 100 times more potent than morphine and 50 times more potent than heroin.3
Fentanyl is dangerous to use on its own, but many people use it at the same time as other drugs like heroin, cocaine, methamphetamine, or MDMA.1 Such use may take place unwittingly, as illicit fentanyl may be used as a relatively cheap substitute or adulterant for these other drugs. These covert practices of mixing or substituting with fentanyl can greatly increase a person’s risk of fatal overdose or other combined drug toxicity.1
Fentanyl and Heroin
Fentanyl has been found in heroin supplies, which can additionally increase the overdose risk to individuals who do not know they are taking the drug. Illicit fentanyl is added to other drugs like heroin to increase their potency and to cheapen production costs.7
Fentanyl is sometimes combined with drugs like heroin and made into pills that resemble prescription opioids. Those who unknowingly take it when they are using heroin run a greater risk of side effects and overdose. Using drugs, like heroin, that are mixed with fentanyl is incredibly dangerous, and the biggest risk factor is that many are unaware that the heroin is laced with fentanyl.7
Mixing Fentanyl and Illicit Stimulants
Illicit stimulants, like cocaine and crystal meth, have the potential for fentanyl contamination. Like with heroin, fentanyl may be mixed with cocaine or crystal meth, and this poses a threat to users, who may be using the drug knowingly or unknowingly. Those who sell cocaine may mix it with a synthetic opioid like fentanyl, which is risky for users, especially those who are unaware that it has been added.5
Fentanyl and crystal meth are highly potent and, when combined, amplify the risk of overdose or death.6 Illegal drug manufacturers may combine crystal meth and fentanyl together as pills because they may be easier to conceal and transport.6 This means that consumers may not be aware of what they have taken or how much, increasing their risk of overdose.
Fentanyl as a potential adulterant agent in other drugs is a major drive of risk for cocaine and crystal meth users—whether they know of the inclusion of fentanyl or not.
Mixing Fentanyl and Alcohol
While it might be overshadowed by the more immediate overdose risks of combining fentanyl with other opioids, using fentanyl at the same time as alcohol can also be very risky, as both substances slow breathing.4 Drinking alcohol with opioids such as fentanyl can result in severe respiratory depression, which can be fatal.4
Fentanyl and other synthetic opioids are the most common cause of drug overdose deaths in the United States.1 There has been a sharp increase in overdose deaths from fentanyl and other synthetic opioids in recent years—the rate of overdose deaths from synthetic opioids was 18 times higher in 2020 than in 2013.2 Overdose deaths from synthetic opioids accounted for about 82% of all opioid-related deaths in 2020.2
It is important to be aware of the symptoms of a fentanyl overdose, as they can become fatal quickly. The primary risk of a fentanyl overdose is slowed or stopped breathing, which can result in a lack of oxygen delivery to the brain, or hypoxia.1 With no medical intervention, hypoxia can have serious consequences, leading to anoxic brain injury, coma, or even death.1 Other opioid overdose symptoms to be aware of may include a stupor-like state; pinpoint pupils or late pupillary dilation; and cold, clammy, and/or blue-tinged skin (i.e., cyanosis).3
Fatal overdose from fentanyl may be reversed or prevented through the use of naloxone, an opioid receptor antagonist drug.4 If administered early enough, naloxone can work quickly to restore a normal rate of respiration to someone who has stopped breathing from an opioid overdose.4 Because of fentanyl’s potent pharmacological effects, it may require multiple doses for someone to be revived using naloxone.1 Brand names for naloxone include Narcan and Kloxxado, both of which may be administered as a nasal spray. In addition to these formulations, naloxone may also be given as an injectable solution.1
If you suspect that someone may be experiencing a fentanyl overdose, it is important to get help quickly. When available, friends, family, or other community members may administer nasal spray versions of naloxone to save someone who is overdosing. In any situation, 911 should be called. Once medical professionals have arrived, they will immediately administer naloxone to reverse the effects of the drug.1, “how can a fentanyl overdose be treated?,” pg. 6 It may also necessary to monitor someone for at least 2 hours after they have been treated with naloxone to make sure that their respiration remains steady, which may require observation in a medical setting.1, “how can a fentanyl overdose be treated?,” pg. 6
Side Effects of Fentanyl
Fentanyl use is associated with both short-term adverse effects and longer-term risks.
Short-Term Effects of Fentanyl
Some of the potential short-term adverse effects of fentanyl include:1
- Slowed breathing.
- Loss of consciousness.
Long-Term Effects of Fentanyl
Long-term effects of fentanyl can emerge over time or as you increase the frequency or amount of the drug you are taking.4 This can include the following:4
- Developing a tolerance, which is when you experience a lessened or diminished effect unless you take more of the drug.
- Physiological dependence and withdrawal, which is a feeling of physical discomfort when you are not taking the drug.
- Fentanyl use increases the risk of addiction, or what may be diagnosed by treatment professionals as an opioid use disorder.
Whether you are using fentanyl short or long term, any use of this drug can result in withdrawal symptoms when you cut back or stop use. This depends on how much you have used and how long you had been using prior to stopping fentanyl.
Withdrawal from fentanyl can lead to unpleasant physical or emotional symptoms when not managed by a medical professional.4 Comprehensive treatment for fentanyl addiction needs to address its effects on both the brain and the body, which may include detoxification, medication administration, and counseling.4
Fentanyl Withdrawal Symptoms
Fentanyl withdrawal symptoms can be extremely uncomfortable and make it difficult for people to quit.1 These symptoms can include:1
- Muscle and bone pain.
- Sleep problems.
- Diarrhea and vomiting.
- Cold flashes and goosebumps.
- Uncontrollable leg movements.
- Severe cravings for fentanyl.
Fentanyl Withdrawal Timeline
On a fentanyl withdrawal timeline, fentanyl withdrawal symptoms can set in quickly after the last time the drug was taken.1 For many people, withdrawal symptoms can begin as early as a few hours after last use.1
Fentanyl Addiction Treatment
If you or someone you know is abusing fentanyl, help is available. No single treatment is right for everyone—it must be tailored to your unique needs.8 The most effective treatment considers the various needs of the person, and can be designed to address any significant medical, mental health, and social/vocational problems.8
Drug treatment can vary in duration, intensity, setting, and other factors. For example, though treatment lengths vary for a number of reasons, some combination of residential and/or outpatient programs may consist of at least 90 days of treatment and continuing care to maintain positive outcomes.8 Keep in mind that medically assisted detox may be the just first step of treatment, and not a substitute for more comprehensive care. Many detox programs prepare people to continue with additional care, such as a residential rehab, for longer-term recovery efforts.8
In addition to inpatient/residential settings, there are several other levels of care that people may encounter on their path to recovery. These options can include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), a sober living facility, or aftercare groups. These treatment options are available to help you continue the progress you made in earlier stages of treatment, though outpatient settings also serve as a primary point of treatment for some people.
If you would like more information about fentanyl addiction treatment options available in your area, contact AAC’s helpful admissions navigators at for a free, private consultation today. They can help you to review your insurance coverage, explore paying for rehab without insurance, and find a local rehab near you.
Fentanyl Addiction and Treatment FAQs
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