Fentanyl is a synthetic opioid painkiller. It is approved by the FDA to treat severe pain, such as pain related to cancer. It is 50 to 100 times more potent than morphine and is legally available only through prescription. Pharmaceutical fentanyl is a Schedule II drug, meaning that although it is accepted for medical use in the U.S., it has a high potential for abuse and psychological/physical addiction. Some fentanyl analogs are classified as Schedule I drugs. It is available in the following forms:
- Mouth spray
- Nasal spray
- Patch placed on the skin
- Tablet dissolved between the cheek and the gums or beneath the tongue
History of Fentanyl
Fentanyl was created in Belgium by Paul Janssen in 1960. It was first approved by the FDA and used in the United States in 1968 combined with droperidol (Innovar). That same year, fentanyl citrate was produced (salt form of the drug) and began to be medically used as a general anesthetic. In the 90s, Janssen’s company, Janssen Pharmaceutica, started doing clinical trials of a fentanyl patch (brand name Duragesic) which works over 2-3 days. The trials were successful and the patch started to be used medically. The popularity of fentanyl came about for several reasons, some of those reasons were because of the speed at which the drug starts acting (5 to 15 minutes depending on the method of administration) and the fact that it is very cost-efficient to produce. Ever since then, new administration methods have been developed and fentanyl is still used medically all over the world.
Illegal Use of Fentanyl in the United States
Although fentanyl as surfaced in the media in the last decade, abuse of the drug actually started not long after it was first created. In the 70s, fentanyl started being used recreationally, either on its own or mixed with other drugs. One can get fentanyl in different ways: theft, prescription fraud, getting it illegally from a patient with a prescription, from a healthcare professional, or a pharmacist. People also illicitly manufacture fentanyl and fentanyl analogs and then deal it on the streets like any other street drug. It is sold in powder or pill form to be swallowed, smoked, snorted, or injected. However, it is sometimes mixed into heroin or cocaine. Because of its potency, it is very dangerous when a person consumes it unknowingly.
Even though legal fentanyl prescriptions decreased by almost 25% (from 6.5 million to around 5 million), the abuse of fentanyl and overdose rates related to spike dramatically. The illicit fentanyl manufacture is the chief factor in the overdose epidemic in the United States. According to a DEA Intelligence Report in January 2020, most of the illicit fentanyl found in the United States is originally from China, India, and Mexico. China is the main source of fentanyl (and other substances related to fentanyl) trafficked into the United States.
According to the CDC, fentanyl seizures increased close to 7 times from 2012 to 2014, with over 4500 seizures in 2014. Only two states reported no fentanyl seizures (Alabama and Hawaii) in 2014. The Eastern part of the United States was the most affected according to the CDC. The following states reported the most fentanyl seizures that year: Florida, New Hampshire, Pennsylvania, Ohio, Kentucky, and Massachusetts.
Fentanyl Street Names
There are many street names for fentanyl, these evolve and change depending on the location. Here are some of those street names:
- China Girl
- China Town
- China White
- Crazy One
- Dance Fever
- Dragon’s Breath
- Great Bear
- King Ivory
- Murder 8
- Tango and Cash
- Toe Tag Dope
What Does Fentanyl Look Like?
HEROIN AND FENTANYL PILLS
FENTANYL LACED PILLS
FENTANYL IN POWDER FORM
Effects of Fentanyl
There are many effects associated with fentanyl use and abuse. Note that a person using or abusing fentanyl would not necessarily get all of these symptoms, and other symptoms can present themselves, especially if someone is taking other substances at the same time.
- Constricted pupils
- Decreased energy
- Difficulty concentrating
- Difficulty walking
- Fast breathing rate
- Fast heart rate
- Increased blood pressure
- Loss of appetite
- Muscle aches
- Muscle stiffness
- Muscle weakness
- Pain in your abdomen
- Slowed breathing
- Slowed heart rate
- Slurred speech
- Trouble sleeping
- Visual hallucinations
- Weight loss
Fentanyl overdoses can happen in different ways: using illegal fentanyl (knowingly or not), taking a higher dosage than what is prescribed, taking fentanyl with other substances (including alcohol), or taking fentanyl while having some underlying medical condition. Fentanyl, like other opioids, acts on the pain receptors in the body. Those receptors also affect the respiratory system. When fentanyl overdose happens, the respiratory system starts slowing down to such a degree that the body doesn’t get enough oxygen. This can obviously be life-threatening if not addressed as quickly as possible.
Signs of Fentanyl Overdose
There are many signs that someone might be overdosing on fentanyl. There can be signs not listed here and a person could have just one or a few of these symptoms. If a fentanyl overdose is suspected, actions should be taken immediately. Listed below are some of the symptoms related to a fentanyl overdose.
- Blue/purple fingernails
- Blue/purple lips
- Choking sounds
- Clammy face
- Erratic breathing
- Extremely pale face
- Inability to speak
- Limp body
- Loss of consciousness
- Slow pulse
- Slowed breathing
- Stopped breathing
- Weak pulse
What to Do in Case of a Suspected Fentanyl Overdose?
If a fentanyl overdose is suspected, the first thing to do is to call 911 immediately so the person can get medical care as soon as possible. If you have a Naloxone kit, use it. Naloxone is the substance used to counter opioid overdose. Naloxone binds to the same receptors in the brain that opioids do, therefore countering the effects of those opioids. Within 2 to 5 minutes, you will see the effects of Naloxone. And although the person can start breathing better or feeling more awake once the drug takes effect, the person should still be monitored and treated afterward. The duration of action of Naloxone can last from 20 minutes to around 2 hours, depending on the person. Since fentanyl usually has a 30 to 90 minutes duration of action (and if mixed with other opioids, those can have effects that last even longer), the person should be fully treated by healthcare professionals since the overdose symptoms can return once the effects of Naloxone stop.
Fentanyl Overdoses in the United States
Fentanyl is one of the major factors in the overdose spike seen all over the United States. According to a DEA report on fentanyl, drug poisoning deaths due to synthetic opioids increased by 525% between 2013 and 2016 (from 3,105 to 19,413). Certain states were more affected than others. Here are the 5 states with the worse fentanyl overdose rates in 2016 according to the DEA and CDC.
|States||Fentanyl overose rate (per 100,000 people) - 2016|
|District of Columbia||19.2|
And unfortunately, fentanyl has continued to be a major problem in the country. According to a CDC report, the synthetic opioid (excluding methadone) overdose rate per 100,000 people in the United States went from 6.2 in 2016 to 9.9 in 2018, which represents a 60% increase. Those synthetic opioids were responsible for about half of all opioid-related overdoses in 2018. Fentanyl and fentanyl analogs have played a major part in those increases.
Fentanyl Abuse and Addiction
Though fentanyl is more often talked about as being a significant factor linked to overdose deaths, fentanyl has a high potential for abuse and addiction. A person can start abusing and become dependent on fentanyl in a variety of ways:
- If a person starts taking fentanyl for recreational use. Someone could start their drug use with fentanyl or use fentanyl with other drugs. For example, if someone is abusing painkillers and develops a tolerance for it, he could start abusing fentanyl as it is more potent and could develop an addiction to it over time.
- If a person has a fentanyl prescription and starts taking more than the prescribed dosage. This can lead to further physical tolerance and the need to take even more fentanyl, and thus begins the cycle of abuse and potential addiction.
- Even if someone follows the prescription to its end, the person could develop a dependence on the drug, which could lead them to buy fentanyl illegally once their prescription is over. This can sometimes happen if the person starts feeling the withdrawal symptoms once they stop taking the drug.
Signs of Fentanyl Addiction
When a person starts having a problem with any substance, there are certain signs to look for. Here are some signs to look for if one is trying to determine whether or not they have a fentanyl abuse or addiction problem.
- Being unable to stop using fentanyl even if one wishes to.
- Continuing to take fentanyl after it is no longer needed.
- Dropping responsibilities (work, family, etc.) because of fentanyl.
- Getting cravings for the drug.
- Going to multiple doctors trying to get more prescriptions for fentanyl.
- Having trouble going about one’s daily life.
- Needing more fentanyl to reach the desired effect.
- Spending a lot of time thinking about getting or taking fentanyl.
- Trying to get fentanyl illegally.
If one is trying to assess whether or not someone else has a problem with fentanyl abuse or addiction, here are some of the signs to look out for.
- Financial problems (debts, asking to borrow money)
- Frequent absences that are not explained or poorly explained
- Lack of motivation
- Mood swings
- Sleeping more than usual
- Trouble at work
- Withdrawal symptoms (physical/emotional) related to fentanyl use
How to help a loved one addicted to fentanyl
Here are some steps to take if you are dealing with a loved one addicted to fentanyl.
- Learn about fentanyl abuse and addiction. Education is a vital step to understand what fentanyl does to the person and the effects of addiction in general. It is also helpful to learn the recommended treatment plans for fentanyl addiction. Speaking to a professional such as one of our referral specialists can help you understand the treatment steps recommended for fentanyl addiction and the treatments available in your preferred area.
- Let them know in no uncertain terms that you are there to support and that they need to get help. When having a conversation concerning their fentanyl problem, make sure they are sober and in a relaxed state. If the person is under the influence or is very preoccupied with other issues, the message might not get through and might be counterproductive.
- Do not enable the behavior associated with addiction. As you support your loved one, it is essential not to let this become enabling behavior. It is important to support the person, but just as important to not support the addiction. Boundaries should be set in order to show the person that his fentanyl abuse will not be supported. This can include cutting off all financial assistance, for example. It is crucial to uphold these boundaries. The same concept applies to consequences. As you let the person know of the consequences they will face if they keep using fentanyl and don't get help, the consequences have to be met. Although it may seem unkind, you are, in fact, helping the person. The real enemy is the addiction.
- Persist in communicating with your loved one about their fentanyl problem and getting help. If you need help in this regard, you can hire a professional interventionist. Some rehabilitation facilities will provide an interventionist to help with the process. An intervention is a specific process with steps designed to make the person realize they have a problem and need treatment.
In all of this, it is important to remember that the addict is responsible for their actions. However, a lot of the destructive behaviors of the individual are related to addiction. Who they were before their addiction is who they really are. The only true help for them is to treat their addiction.
Fentanyl Abuse and Addiction Treatment
Once fentanyl abuse or addiction has been identified, it is very important to seek help as soon as possible. Because of the drug’s potency, fentanyl users run the risk of overdosing. The first step to look at in terms of treatment is detoxing. The point of detoxing is to abstain from taking fentanyl and letting the body eliminate the substance while managing the withdrawal symptoms. A great option for fentanyl detoxification is a medically supervised detox. There are many advantages to undergoing a medical detox program.
- Going away to detox is a great way to remove the triggers that can be present in the environment.
- It permits one to focus solely on getting better.
- Medical professionals will be able to manage the withdrawal symptoms (with medication if necessary).
- It will be easier to transition directly to a comprehensive drug rehabilitation program.
The withdrawal symptoms one can experience when they stop can be very unpleasant, here are some of them:
- Abdominal cramping
- Back pain
- Dilated pupils
- Excessive sweating
- Lacrimation (eyes tearing up)
- Increased blood pressure
- Joint pain
- Muscle aches
- Rapid heart rate
- Restless legs
- Runny nose
These can happen at various stages of the withdrawal. Depending on the amount of fentanyl, duration of use, and administration route, the withdrawal period can last up to around 20 days. Each case is different, which is why medical supervision is recommended. Detoxification is only the first step. The psychological aspect of addiction can be fully handled in a drug rehab facility.
Fentanyl Addiction Rehabilitation
The purpose of rehabilitation is to get the person to stop using fentanyl, give them the clarity and tools needed to face day-to-day life challenges while staying drug-free, and become a productive person when it comes to their work, their community, and their family. What one needs to achieve these goals will be different for each person. There are different types of services available for recovering addicts, including:
- Counseling services
- Educational services
- Evidence-Based treatments
- Family services
- Holistic drug treatments
- Legal services
- Medical services
- Mental health services
- Support groups
- Vocational services
Some rehabilitation facilities might offer all of these services, others might have just a few of them. Doing a professional assessment before planning rehabilitation can help one find the facility that will fulfill all their needs. For example, if a person never finished high school (because of the drugs themselves or other circumstances), they could find a rehab program that also offers GED classes or other educational services, giving them the tools needed to be productive once they complete the program.
The setting in which one goes through rehabilitation is another factor to consider. The two main settings are outpatient and inpatient rehabilitation. Whether outpatient or residential treatment is the best fit depends on several factors. An outpatient treatment will permit the person to still go about their life and fulfill their obligations (family, work, etc.) while in recovery. However, people, the environment, and some life situations can be triggering for some people and increase the chances of relapsing. A residential rehab eliminates most of those triggers and puts the person in an environment solely dedicated to recovery.
Getting the help of a certified referral service can help narrow down one's choices and find the best-suited course of rehabilitation.
Fentanyl Statistics in the United States
According to a 2018 DEA report, fentanyl is the most prevalent synthetic opioid in the United States. The drug accounted for 68% of all synthetic opioids seized. Fentanyl seizures exploded in the last 4 years. In 2014, around 65kg of powdered fentanyl was analyzed by the DEA, this quantity increased by almost 800% (584 kg) in 2017.
This fentanyl explosion in the United States was observed in many statistics. According to the DEA’s 2019 Drug Threat Assessment, the number of forensics lab reports of fentanyl went from 934 in 2013 to 56,530 in 2017, over 60 times more. Fentanyl represented the 5th most identified drug. With those reports, a big spike in fentanyl combinations was also observed. In 2017, there were 37,447 reports identifying fentanyl alone, and 27,704 reports of fentanyl identified along with another substance, heroin being the most prevalent of these substances. In 2016, there were 9,742 reports of fentanyl mixed with heroin, this number jumped to 19,192 in 2017, representing a 97% increase. Reports of fentanyl mixed with cocaine also increased significantly between 2016 and 2017 (74%).
It was also reported in the 2018 National Survey on Drug Use and Health that 269,000 people misused prescription fentanyl products (not accounting for illicit fentanyl). One out of every eight legitimate fentanyl users reported abusing fentanyl. This statistic was higher for fentanyl than it was for morphine and hydrocodone and represented about the same rate of misuse than oxycodone. This shows how easily fentanyl abuse can happen. Pain relievers have a very high rate of abuse, according to this survey, almost 10 million people reported past-year painkiller misuse. Here are the methods used to obtain those drugs.
- Around 35% reported they got it through a legitimate prescription from one doctor
- More than half reported having been given it, buying it from, or taking it from a friend or relative.
- Around 10% of people reported acquiring the fentanyl illegally (prescription from more than one physician, buying from a drug dealer or a stranger, stealing from a pharmacy, hospital, etc.).
|Fentanyl abuse||any use of fentanyl that isn't prescribed by a healthcare physician for a legitimate health problem. This can include the amount or the frequency of use, recreational use, getting several prescriptions from different doctors, etc.|
|Fentanyl analog||drugs that are chemically and/or pharmacologically similar to fentanyl.|
|Opioid||a class of drugs derived from opium (poppy plant), it also includes drugs that produce similar physiological effects than opium (such as pain relief).|
|Opioid receptors||a set of receptors in the brain that control pain signaling. When an opioid such as fentanyl is taken, the drug binds to these receptors, telling them to slow down or stop the pain signals. They are also responsible for addictive behavior, which is why opioids have a high potential for abuse.|
|Schedule I||a drug classification that means that the drug has a high potential for abuse, that it is not accepted for medical use in the U.S., and that there is a lack of accepted safety in using the drug under medical supervision. Some fentanyl analogs are Schedule II drugs.|
|Schedule II||a drug classification that means that, even though it is accepted for medical use in the U.S., the drug has a high potential for abuse and that it can lead to severe psychological or physical dependence. Fentanyl and some fentanyl analogs are Schedule II drugs.|
|Synthetic opioid||a drug made completely in a lab that is similar to opium. Fentanyl is a synthetic opioid.|