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Fentanyl Addiction & Abuse

Fentanyl is a synthetic opioid 80 to 100 times stronger than morphine. Experts once worried about people stealing and abusing fentanyl recreationally. Now, they worry about people buying drugs tainted with fentanyl and overdosing.

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Fentanyl is a synthetic opioid that is 50 to 100 times stronger than morphine. Experts once primarily worried about people stealing and abusing fentanyl recreationally. Now, they worry about people buying drugs tainted with fentanyl and overdosing.

What Is Fentanyl?

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine.[1] It’s prescribed in brand-name medications like Actiq, Duragesic, and Sublimaze. Doctors use it to help people experiencing severe pain.

Of all types of opioids, fentanyl is the most dangerous. It’s so powerful that even a tiny dose can cause death. And many dealers are lacing their drugs with fentanyl, causing a wave of overdoses all across the United States.

Key Facts About Fentanyl

Key Facts

  • Only 1 kg of fentanyl is enough to kill 500,000 people.[2]
  • More than 150 people die every day from overdoses related to synthetic opioids like fentanyl.[3]
  • Fentanyl is commonly mixed with illicit drugs like heroin, cocaine, and methamphetamine.[3]
  • Legal fentanyl comes in patches, pills, candies, sprays, and injections. Illicit forms include nasal sprays, eye drops, paper blotters, small candies, and powder.

Different Forms of Fentanyl 

Fentanyl is a powerful prescription painkiller. People with severe pain that can’t be treated by other opioids can benefit from fentanyl-based medications. Chemists have developed patches, tablets, injections, sprays, and lozenges to help these patients. 

Brand NamePrescribed For
DuragesicThis fentanyl patch was approved by the Federal Drug Administration (FDA) in 1990 to relieve moderate to severe ongoing pain. Its effects can last up to three days. 
AbstralAbstral is taken as a quick-dissolve tablet to manage breakthrough pain or intense pain flare-ups, even when patients are treated with around-the-clock pain medications.
SublimazeThis type of fentanyl is sometimes administered alongside anesthetics. Doctors will inject it to manage pain before and after surgeries.
ActiqActiq is provided in lozenge form and administered under the tongue to relieve severe and underlying persistent pain. 
LazandaLazanda is a fentanyl nasal spray often used to treat pain in cancer patients. 

Statistics on Use & Misuse 

While fentanyl can be helpful for people in severe pain, it can be deadly when abused. Since it’s so powerful, even a tiny amount can be lethal. These statistics make the dangers clear:

  • Fentanyl is involved in more American deaths than cancer, heart disease, homicide, suicide, and other accidents.[4]
  • In the 12 months ending January 2022, 107,375 people in the United States died from overdoses. Of them, 67% involved fentanyl.[4]
  • Only 2 mg of fentanyl is enough to be lethal.[4]
  • Fentanyl is 50 times stronger than heroin.[2]
  • The DEA has confiscated pills containing twice the lethal dose of fentanyl.[2]

Dangers of Fentanyl-Laced Drugs 

Dealers add fentanyl to drugs they sell as cocaine, heroin, or prescription painkillers. The addition makes their products more powerful and addictive. And since fentanyl is so potent, they don’t need much of it to create many pills and powders to sell. 

Synthetic opioids like fentanyl are driving overdose deaths in the United States. It’s impossible to know just how many drugs are tainted. But given that deaths are rising, it’s likely that more dealers are adding fentanyl to their products every day. 

Fentanyl is commonly mixed with the following drugs:

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Addiction Potential: How Addictive Is Fentanyl?

All opioids, including fentanyl, are addictive. It’s difficult to obtain hard facts about how many people get addicted to the drug. Many people never intend to take the drug and are exposed via contaminated doses. Far too many people die due to this exposure. 

Researchers know that opioids can cause addiction via dopamine. Each dose releases this key neurotransmitter, causing euphoria and relaxation. In time, brain cells won’t produce dopamine without opioids. People feel sad, sick, and depressed without them. In time, people use fentanyl just to feel normal. 

“Fentanyl is the single deadliest drug threat our nation has ever encountered. Fentanyl is everywhere. From large metropolitan areas to rural America, no community is safe from this poison. We must take every opportunity to spread the word to prevent fentanyl-related overdose death and poisonings from claiming scores of American lives every day.”

U.S. Drug Enforcement Administration Administrator Anne Milgram[4]

Side Effects: How Fentanyl Affects the Body Over Time

Fentanyl causes side effects. People who use the drug as directed by a doctor and those who abuse the drug independently can face serious health problems. The side effects of fentanyl can vary depending on how long you use the substance. 

Short-Term Effects 

Fentanyl is a depressant drug. People feel drowsy and confused when the dose takes hold. Some people struggle to stay awake (go on the nod) while they’re intoxicated. And some people stop breathing (overdose) while using fentanyl.[5]

Other potential side effects include hallucinations, shaking, chest pain, and back pain.[5]

Long-Term Effects

Few studies on the long-term effects of fentanyl have been performed. People who use the drug via prescription rarely take it for long periods. And many people who use it illegally don’t survive the episode. 

We know that all opioids can cause dependence. People who use these drugs become physically attached to them and feel sick when their doses wear off. Opioids can also alter brain chemistry, meaning people don’t make key neurotransmitters without the drug. When this happens, people can become addicted to opioid drugs.

Side Effects of Fentanyl Use 

Short-Term EffectsLong-Term Effects
SedationDependence 
DizzinessWithdrawal symptoms 
Lack of coordinationAddiction 
Slurred speechConstipation 
ShakingInfection (if needles are used) 
Chest painHigher overdose risks 
Back pain
Overdose 

Risk Factors & Causes of Fentanyl Addiction 

Opioids like fentanyl are powerful. Anyone who abuses them could develop an addiction after repeated use. But some factors make troublesome fentanyl use more likely. 

Biological Factors

Every human has opioid receptors throughout the brain and body. The more of them you have, the stronger your response to drugs. Sometimes, additional receptors make a drug more pleasant or reinforcing. You can’t change biological factors, but if you have them, fentanyl is even more dangerous for you. 

Environmental Factors

If you live in a part of the country where many drugs are contaminated with fentanyl, you’re more likely to get introduced to it. An experience with contaminated drugs could lead to an overdose. If it doesn’t, it could spark changes leading to addiction. 

Social Factors 

Some people have peer groups that frown on addictive drugs. Others spend time with friends and family who also use drugs. The more time you spend with people who use drugs, the more likely it is that you’ll do the same. 

Psychological Factors

Most people who abuse fentanyl started with other drugs. If you have an addiction to another drug (like heroin or cocaine), you’re more likely to buy tainted drugs. Using them could lead to an addiction. 

Signs & Symptoms of Abuse: What to Look Out For 

People with a longstanding fentanyl habit can develop physical, mental, and behavioral symptoms. Spotting them could help you know when to intervene. 

Physical 

People who abuse fentanyl may seem slow, sleepy, or sedated when they’re high. If they inject the drug, they may have needle marks on their arms and legs. They may complain of chest pain, constipation, and headaches. If they experience drug withdrawal, they may have flu-like symptoms, such as severe diarrhea. 

Mental 

Life with an addiction isn’t easy. People who abuse fentanyl may seem distracted and upset between doses. They may forget what they said or did while high. They may be depressed about their inability to quit the drug.

Behavioral 

Some people who abuse drugs are open about it. They leave drugs, needles, and other paraphernalia in shared family spaces. Others hide their habits and become more secretive and withdrawn. 

Comparing Symptoms of Fentanyl Abuse

PhysicalMentalBehavioral 
Sedation Distraction Secretiveness 
Exhaustion Poor decision-making abilities Using drugs openly 
Chest pain Forgetfulness Spending time with dealers 
ConstipationDepression Stealing to get money for drugs 
Headaches
Withdrawal symptoms

Fentanyl Overdose Dangers

It’s very easy to overdose on fentanyl. Overdose deaths associated with fentanyl rose more than 38% between January 2020 and January 2021.[2]

Symptoms of a fentanyl overdose include the following:

  • Pinpoint pupils
  • Extreme drowsiness
  • Cold or clammy skin
  • Bluish tint to the fingernails, lips, or skin
  • Nausea and vomiting
  • Weak pulse and slow heart rate
  • Breathing issues
  • Lethargy
  • Reduced blood pressure

What to Do in the Event of a Fentanyl Overdose 

If you think someone is experiencing an opioid overdose, take the following steps:

  • Call 911 immediately. 
  • If the opioid reversal drug naloxone (Narcan) is available, administer it as directed. 
  • Stay with the person and try to keep them awake. 
  • Put the person on their side to keep them from choking. 
  • Stay on the phone with the 911 operator until help arrives. If you can, offer details about how much the person took, when it happened, and what other symptoms you see. 

Fentanyl Withdrawal Symptoms 

Opioids alter brain chemistry, and they keep working longer than you might think they do. If you’ve used fentanyl for long periods, you may experience withdrawal symptoms when you quit. 

Opioid withdrawal symptoms include the following:

  • Diarrhea 
  • Nausea
  • Vomiting 
  • Muscle aches 
  • Goosebumps 

Treatment for Fentanyl Addiction 

People who are addicted to opioids may struggle to quit without help. A treatment program can make a huge difference. Multiple types of treatment exist. 

Inpatient Rehab 

In an inpatient fentanyl rehab program, you’re removed from triggers that could lead to relapse. You have access to a team of treatment professionals who can provide both medication to ease withdrawal symptoms and counseling to help you understand why you use drugs. 

Quitting opioids cold turkey isn’t wise. Symptoms can be so strong that you relapse to drugs. Getting care for these symptoms is both smart and the best way to get sober. 

Medication-Assisted Treatment 

Medications can help to ease opioid withdrawal symptoms. These same medications can help reduce relapse risks, as they keep your cravings under control.

Several medications can be used to combat opioid addiction, including the following:

  • Buprenorphine: This medication latches to opioid receptors, but it doesn’t make you high. It’s designed for at-home use, so you can take your doses every day on your schedule. 
  • Methadone: This medication is stronger than buprenorphine, so it’s sometimes used to treat fentanyl addiction. You must go to a clinic to get your doses. 
  • Clonidine: This medication can ease withdrawal symptoms in some people, but it doesn’t lessen drug cravings.
  • Naltrexone: Naltrexone can block an opioid high. If you relapse to fentanyl, your dose won’t work. This could make your next craving less impactful. 

Behavioral Therapy 

While medications can relieve chemical imbalances and alleviate withdrawal symptoms and drug cravings, you will need more help. Behavioral therapy can help you dig into the reasons you used fentanyl and how you can stop.

Common behavioral therapy approaches include cognitive behavioral therapy, contingency management, and motivational interviewing. 

Researchers say people who participate in frequent behavioral therapy sessions are more likely to stay sober than those who don’t.[6]

Frequently Asked Questions About Fentanyl Addiction & Abuse

We’ve compiled some of the most frequently asked questions about fentanyl addiction and abuse

How long does fentanyl stay in your system?

A drug test can pick up fentanyl within 5 to 72 hours after your last dose. If they test your hair, the test could be positive for 90 days.

What does fentanyl look like?

Fentanyl looks like almost anything when it’s sold by a dealer. The powderf can be pressed into pills, suspended in a solution, or sold as it is.

Is fentanyl an opioid?

Yes. Fentanyl is an opioid.

How does fentanyl compare to heroin?

Fentanyl and heroin are both opioids, but fentanyl is much stronger than heroin.

How strong is fentanyl?

Fentanyl is one of the strongest opioids available. Doctors use it for severe pain for this reason.

How is fentanyl made?

Pharmaceutical-grade fentanyl is made in tightly controlled laboratories by professionals. Illicit fentanyl is made in laboratories by people who may or may not know what they’re doing.

Does Narcan work on fentanyl?

Yes. Narcan works on fentanyl, but you may need to use multiple Narcan doses to reverse an overdose.

Profile image for Dr. Alison Tarlow
Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More

Updated January 17, 2024
Resources
  1. Fentanyl drug facts. National Institute on Drug Abuse. Published June 2021. Accessed June 30, 2023.
  2. Facts about fentanyl. U.S. Drug Enforcement Administration. Accessed June 30, 2023.
  3. Fentanyl facts. Centers for Disease Control and Prevention. Published June 27, 2023. Accessed June 30, 2023.
  4. Fentanyl Awareness. U.S. Drug Enforcement Administration. Published April 29, 2022. Accessed June 30, 2023.
  5. Fentanyl. U.S. National Library of Medicine. Published May 15, 2023. Accessed June 30, 2023.
  6. Fiorentine R, Anglin M. More is better: Counseling participation and the effectiveness of outpatient drug treatment. Journal of Substance Abuse Treatment. 1996;13(4): 341-348.
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