Fentanyl Addiction and Abuse

Fentanyl is one of the strongest prescription opioids prescribed to humans. The medication was originally created to treat severe pain, especially for people who live with chronic pain and have developed a tolerance to other opioids. Fentanyl is up to 100 times more potent than morphine and 50 times more powerful than heroin, an illicit opioid drug.

Due to the drug’s potency and addictive qualities, physicians restrict fentanyl prescriptions for severe situations, such as terminal cancer patients. Fentanyl is typically prescribed to manage pain after surgery or to treat chronic pain.

When prescribed, fentanyl is administered through an injection, transdermal patch or lozenge form. However, fentanyl is also sold illegally as a powder. The powder form can be mixed in with heroin or cocaine products sold by drug dealers. This combination can lead to overdose, coma or death, especially when someone is unaware that their drug contains fentanyl.

What Is Fentanyl Used For?

Fentanyl is used for a variety of severe pain conditions. However, it is often used as a painkiller during and after surgery. It can also be used to sedate patients in intensive care. When given as an outpatient prescription, it may be used for chronic and severe pain, such as cancer-related pain.

Fentanyl is highly potent, and certain dosage forms like transdermal patches should not be used by “opioid-naive” people. This means they have not used other opioids in the past. 

People who have developed a tolerance to opioids like hydrocodone or oxycodone may be prescribed transdermal fentanyl, which is a more potent opioid. This medication is not typically prescribed to individuals who have not previously taken less powerful opioids. 

However, injectable forms of fentanyl in a hospital setting can be given to even opioid-naive people because they are closely monitored by medical staff.

Fentanyl Brand Names

Fentanyl comes in a variety of forms and has been sold under various brand names, including:

• Abstral: Sublingual tablets
• Actiq: Lozenge
• Duragesic: Patch
• Lazanda: Nasal spray
• Fentora: Effervescent tablet
• Sublimaze: Injection
• Subsys: Sublingual spray

Street Names for Fentanyl

Fentanyl has a variety of street names, including:

• Apache
• China Girl
• China Town
• Dance Fever
• Goodfellas
• Great Bear
• He-Man
• Jackpot
• King Ivory
• Murder 8
• Poison
• Tango & Cash

Fentanyl Dosage

The fentanyl dosage varies widely from person to person based on many different factors. The primary factor determining the right dose is the person’s tolerance to opioids. If someone has been taking opioids for a long time to treat pain, they will need higher doses. The same concept applies if someone is abusing fentanyl or using it illegally. The more they are taking, the more they will need to get the same effect.

The initial dose of fentanyl is generally based on the fentanyl patches, and the lowest dose is 12 to 25 micrograms per hour over 24 hours. Some people will need as high as 200 to 400 micrograms per hour over 24 hours.

Fentanyl Pills

Fentanyl is not available in pill form and does not come in a tablet or a capsule. It is only available as a liquid for injection, a patch, a lozenge or a lollipop.

Fentanyl Lollipops (Fentanyl Lozenges)

Fentanyl lollipops (Actiq) are used exclusively for patients aged 16 or older who need around-the-clock pain control for cancer pain. It should only be used in opioid-tolerant people. This means they take at least 25 micrograms of fentanyl per hour.

The purpose of the lollipop is to make the fentanyl lozenge easier to manage. If the lozenge is swallowed by mistake, it will not be as effective.

Sublingual Fentanyl

Sublingual fentanyl (Abstral) is also only approved for treating around-the-clock cancer pain. It is approved for patients who are 18 years of age and older. When taking this drug, a person should immediately remove it from the blister pack and place it under the tongue. It should not be chewed, sucked or swallowed.

Fentanyl Patches

Duragesic, previously the brand name for fentanyl patches, is one of the more commonly prescribed formulations of fentanyl outside of a hospital. Fentanyl patches are approved for use in both pediatric and adult patients. They are approved for treating chronic cancer pain but are often used for other types of pain.

Fentanyl Injection

Fentanyl injections (Sublimaze) are used almost exclusively during and after surgery instead of for cancer pain. It is used as an anesthetic for various procedures and should only ever be used in a hospital setting.

Is Fentanyl Addictive?

Fentanyl is extremely addictive. The clearest way to clarify the addictiveness of fentanyl is to consider the drug’s direct impact on the brain’s reward system.

The main job of a neurotransmitter is to communicate chemical messages in the brain by docking into receptor sites. Fentanyl relieves pain by binding to opioid receptors in the brain. In turn, this eliminates the awareness of pain. A dose of fentanyl can make a person feel relaxed and euphoric.

Fentanyl activates the brain’s reward system, causing the brain to release the feel-good chemical dopamine in larger amounts than would typically occur without the drug’s presence. The more dopamine that is released, the faster the onset of the addiction. The patient will need to keep taking more fentanyl to block the brain’s effort to correct the excess dopamine production.

Fentanyl Addiction Statistics

More than 190 people die from overdosing on synthetic (humanmade) opioids daily in the United States, many of which are due to fentanyl. Because it is much more potent than other prescription opioids, fentanyl is more likely to cause an overdose. 

The number of overdose deaths due to synthetic opioids began to increase in 2014 and rose exponentially during the COVID-19 pandemic. As of 2021, more than 70,000 synthetic opioid overdoses were reported in the United States, most of them due to fentanyl.

Fentanyl Side Effects

Side effects are common with opioids. Fentanyl has a powerful impact on the body, causing side effects that can include:

• Pinpoint pupils
• Drowsiness
• Fatigue
• Dizziness
• Excessive sweating
• Low potassium (hypokalemia)
• Peripheral edema
• Abdominal pain
• Weight loss
• Constipation
• Diarrhea
• Dehydration
• Nausea
• Vomiting

Fentanyl Withdrawal

Fentanyl has a significant addictive potential and a high likelihood of unintentional abuse. Once someone develops a tolerance to fentanyl’s narcotic properties, they will depend on it to feel normal. This leads to the person requiring more fentanyl, both in greater doses and higher frequency.

When someone needs fentanyl to feel normal, it’s known as dependence. Dependence and addiction are not the same. Someone can be dependent even if using fentanyl with a prescription. When someone is dependent on fentanyl, they will experience withdrawal symptoms if they stop taking it. These symptoms are one of the main reasons people continue using it, even if it’s harming them or their loved ones.

Withdrawal can begin anywhere between eight to 48 hours after last use, depending on the formulation of fentanyl. Longer-acting formulations will take longer for withdrawal symptoms to emerge.

Fentanyl Withdrawal Symptoms

Common fentanyl withdrawal symptoms include:

• Tearing
• Hot and cold flashes
• Excessive sweating
• Insomnia
• Muscle cramps
• Nausea
• Vomiting
• Diarrhea

How Long Does Fentanyl Stay in Your System?

Fentanyl stays in the system for varying amounts of time, depending on the formulation. Generally, a drug will take five half-lives to clear the body. Fentanyl patches have a half-life of about 34 hours, so they will stay in the system for approximately seven days.

If the urine is being tested for fentanyl, it is usually detectable for up to three days. Saliva is generally not tested for fentanyl because the test is not reliable. Like other drugs, fentanyl can also be detected in hair for up to 90 days.

Fentanyl Overdose

Fentanyl is extremely easy to overdose on because of how potent it is. Risk factors for a fentanyl overdose include being opioid-naive, not knowing the amount you are using, mixing with other drugs and intentionally taking high doses.

A fentanyl overdose will look like other opioid overdoses, with symptoms that include:

• Pale or blue skin
• Vomiting
• Slowed breathing
• Slowed heartbeat
• Coma/unconsciousness

In the event of an overdose, call 911. Fentanyl overdose is a medical emergency, and there is a high risk of death because a person can stop breathing. If you have naloxone (Narcan), an opioid antagonist, you should use it after calling 911. It will help to reverse the overdose until the ambulance arrives.

Lethal Dose of Fentanyl

The estimated lethal dose of fentanyl is 2 mg (or 2000 micrograms) for most normal-sized adults. However, a smaller person or a child is likely to have a fatal reaction at lower doses.

Fentanyl Detox

Detox is a normal process in any drug addiction treatment program. During detox, the drug leaves the body. The body then readjusts to functioning without it. Withdrawal symptoms occur during this period. For this reason, there is a high risk of relapse.

For short-acting fentanyl, withdrawal symptoms will usually start eight to 24 hours after the last dose and can last for four to 10 days. For longer-acting forms of fentanyl, symptoms can begin within 12 to 48 hours after the last dose and may last as long as 20 days.

Undergoing detox in an addiction treatment facility is effective because there are options for withdrawal support. Different medications can be prescribed to manage withdrawal symptoms, making a person more likely to successfully avoid relapse. 

Medical detox is also helpful because the support team can address other areas of a person’s life that make fentanyl appealing, such as chronic pain, mood disorders and other life stressors.

Fentanyl Addiction Treatment

There are thousands of treatment centers in the country, but not every rehab option fits each person’s needs. If you are looking for help, find a center that offers treatment for fentanyl or opioid addiction and values patient comfort. Finding a center that treats addiction to other drugs as well as co-occurring mental health disorders is also important.

The three main levels of addiction treatment include inpatient rehab, intensive outpatient programs and outpatient rehab. 

• The highest level of care is inpatient rehab, also referred to as residential. For people with severe addiction, this is the gold standard of treatment. In inpatient rehab, clients live in the facility throughout detox and treatment. In this way, the facility helps to remove relapse triggers.
• Intensive outpatient programs (IOPs) help patients transition from residential rehabilitation to independence. In an IOP, patients receive several hours of therapy each week. The aim is to address the psychological and emotional impact of addiction and ensure a successful outcome.
• Outpatient rehab is the least intensive. It allows people to continue fulfilling their obligations while attending regular treatment sessions and support meetings.

Orlando Recovery Center Drug and Alcohol Rehab has a wide range of rehabilitation programs and resources available to help treat addiction. Our mental health experts work with clients to reduce or eliminate substance use while addressing co-occurring disorders as well as physical and psychological symptoms. 

Orlando Recovery Center’s treatment resources include detoxification, inpatient and outpatient rehabilitation programs, aftercare and much more.

If you or someone you know is currently using fentanyl and needs help in Orlando, Florida, Orlando Recovery Center can help. Contact us today to speak with a representative and learn more about treatment options that suit your needs.