What Is Fentanyl?
Fentanyl is a synthetic opioid developed for medical purposes to treat severe pain, primarily in patients with cancer, and to relieve post-surgery pain. It is classified as a Schedule II controlled substance and is only to be prescribed in specific medical situations.[1]
Fentanyl is sometimes also illicitly manufactured, and it is this type of fentanyl that is playing a large part in the opioid crisis. Illicit fentanyl is a cheaper, far more dangerous version produced in illegal labs and distributed through the drug supply, often mixed into heroin, counterfeit pills, and other substances without the user’s knowledge.[2]
As a result of its potency, just two milligrams of fentanyl can kill someone.[3] According to the CDC, fentanyl is the most widely associated drug in overdose deaths in the United States and accounted for more than 73,000 deaths in the United States in 2022.[4]
Fentanyl Addiction and Abuse
Fentanyl produces a rapid, intense euphoria by flooding the brain’s opioid receptors faster and harder than other opioids. For this reason, fentanyl has a high potential for addiction. Due to this rapid influx of opioid activity, the brain quickly accommodates and shuts down its endorphin production and downregulates its opioid receptors.[5] Once this occurs, individuals using fentanyl will need to continue using it to feel normal and will have sudden, intense withdrawal symptoms as soon as they stop using.
Many people who develop an addiction to fentanyl do not do so intentionally. Fentanyl is often present in counterfeit pills that are designed to look like prescription opioids, benzodiazepines, or stimulants, meaning that someone could be taking fentanyl while believing they are taking something else.
Others develop dependency due to regularly using other prescription opioids and then transitioning to fentanyl after they become tolerant to other drugs and need something stronger to achieve the effects they are looking for. Regardless of how a fentanyl addiction develops, it is not a moral failure, but rather a medical diagnosis that requires professional treatment.[6]
Signs of Fentanyl Abuse
Fentanyl is a very potent drug, and signs of use escalate very quickly. Common signs are as follows:
- Extreme and prolonged drowsiness, sedation, or being unable to stay awake
- Pinpoint pupils
- Slowing or shallow breathing
- Confusion and disorientation, or impaired judgment and thinking
- Nausea and vomiting
- Compulsive actions and loss of control over the use of fentanyl
- Withdrawal symptoms such as anxiety, muscle pain, sweating, and cravings that begin within hours after use is discontinued
- An increase in tolerance requiring higher frequency or larger doses to avoid withdrawal symptoms
- Withdrawal from family and friends and activities you once participated in that you enjoyed
- Continuing to use fentanyl after you are aware of the risk of overdose
If someone appears unresponsive, has slow or stopped breathing, or has blue-tinged lips or fingertips, this is a fentanyl overdose, and you should call 911 immediately. Naloxone (Narcan) should be administered immediately if available as well. Due to fentanyl’s potency, multiple doses may be needed.
What To Expect During Fentanyl Addiction Treatment
Fentanyl addiction requires more than a person’s willpower to overcome. The neurological changes to brain chemistry, in addition to the severity of withdrawal symptoms caused by fentanyl, require treatment for the physical, emotional, and social elements of the addiction at the same time.
Medication-Assisted Treatment (MAT)
MAT is the gold standard of care for fentanyl and all opioid use disorders.[7] This is stated by the Substance Abuse and Mental Health Administration (SAMHSA) and the National Institute on Drug Abuse (NIDA). The most common medications to treat fentanyl addiction are as follows:
- Buprenorphine (Suboxone): A partial opioid agonist that eases withdrawal symptoms and cravings. It can stabilize brain chemistry, reducing the risk of overdose and providing individuals with an opportunity to participate in behavioral therapies.
- Methadone: A full opioid agonist available through state-licensed opioid treatment programs. Methadone has been in public health practice for over four decades and provides an effective tool for individuals with severe fentanyl dependencies.
- Naltrexone (Vivitrol): An opioid antagonist that completely blocks the effects of opioid use. It is an effective medication for individuals who have already detoxified and stabilized.
Fentanyl and Co-Occurring Disorder Treatment
Mental health disorders, including depression, anxiety, PTSD, and bipolar disorder, are prevalent among individuals with fentanyl use disorder, and they must be treated alongside the addiction for treatment to be effective.[8] Meridian Recovery’s dual diagnosis program provides fully integrated care for co-occurring disorders, ensuring that the mental health conditions that often fuel substance use are identified and addressed as part of a comprehensive treatment plan. Treating the whole person is not a luxury in fentanyl recovery — it is a clinical necessity.
