What Is Fentanyl? Here Are Vital Answers That Can Save Lives

Information About Fentanyl Abuse, Overdose, Treatment, and Recovery

What is fentanyl? Knowing the answer might save your life or the life of a loved one. Even if you're already acquainted with fentanyl abuse or addiction, you should learn about the dangers. But you should also know that help is available. Recovery is possible.

With a single phone call, you can begin walking a more hopeful path. Caring experts in addiction can guide you toward professional treatment options that are known for helping people overcome their dependence on fentanyl and other opioids. By getting assistance, you can free yourself from the shackles of addiction and avoid the potentially lethal consequences of an accidental fentanyl overdose. Your life can be transformed in positive ways that you probably haven't even imagined yet.

So take this opportunity to learn much more about fentanyl, side effects of its use, dosage dangers, withdrawal symptoms, and treatment. Get help right away by reaching out to specialists who can direct you toward rehab providers in your area.

What Is Fentanyl?

Fentanyl is a strong, fast-acting synthetic opioid that relieves pain and can make users feel drowsy and euphoric. It was originally developed in Belgium in 1960. In the U.S., it's classified as a Schedule II prescription drug, which means it has a high potential for abuse. Fentanyl is similar to morphine, but it's up to 100 times more potent, making it one of the most powerful opioids on the market.¹

When legally prescribed, fentanyl is known by brand names like:

• Abstral
• Actiq
• Breakyl
• Duragesic
• Effontora
• Fencino
• Fentora
• Haldid
• Instanyl
• Lazanda
• Matrifen
• Mezolar
• Mylafent
• Onsolis
• Opiodur
• Osmanil
• PecFent
• Recivit
• Sublimaze
• Subsys
• Tilofyl
• Victanyl

As an illicit recreational drug, fentanyl is sold on its own or mixed with other drugs like heroin or oxycodone. Sometimes it is also unknowingly added to drugs like Ecstasy (MDMA) or counterfeit Xanax. On the street, drugs containing fentanyl have gone by names such as:

• Apache
• China Girl
• Chinatown
• China White
• Dance Fever
• Drop Dead
• Fake Oxy
• Flatline
• Friend
• Goodfella
• Great Bear
• Green Beans
• Greenies
• Jackpot
• Lethal Injection
• Lollipops
• Murder 8
• Poison
• Synthetic Heroin
• Tango and Cash
• TNT

Fentanyl has become one of the world's most abused prescription drugs, a situation which is amplified by the wide availability of illicitly manufactured fentanyl on the streets. In fact, the illicit use of fentanyl has reached crisis levels. In the U.S. alone, it's been implicated in several thousand sudden overdose deaths since the turn of this century.

What Is Fentanyl Used For?

Fentanyl's original use was as an anesthetic for surgical procedures since it is highly potent and takes effect rapidly. Later, it was discovered that, in small doses, it could be used to relieve or manage severe or chronic pain. Today, it is still sometimes used in anesthesia, along with other drugs like propofol that complement its effects. It is also frequently used to treat medical patients (including cancer patients) who are experiencing "breakthrough pain," which is severe pain that occurs despite being on other opiates or opioids like morphine or oxycodone.

In summary, the most common medical uses for fentanyl include:

• Anesthesia
• Sedation
• Post-surgical pain relief
• Emergency pain relief
• Chronic pain management
• Palliative care

When prescribed and administered by trained medical professionals, fentanyl has a wide range of safe and therapeutic uses. But when people use illicit fentanyl to get high, away from medical supervision (or in unprescribed ways), it's a completely different story. The euphoria they feel can quickly turn deadly.

How Does Fentanyl Work?

Fentanyl rapidly binds to tiny opioid receptors in a person's central nervous system. In the brain, those receptors are in regions responsible for controlling pain and emotions. The drug has a powerful effect by releasing larger-than-normal levels of dopamine, which can create intense feelings of happiness and relaxation. But the powerful effect usually only lasts for a short time—around an hour—before the body starts to eliminate the drug.

How Do People Take Fentanyl?

Pharmaceutical fentanyl comes in many different forms. So the method of use depends on the particular medical issues of each individual patient. For some surgical operations, fentanyl is injected (often in combination with other drugs) as an anesthetic or sedative. In other situations, the method of delivery can be more varied. For example, physicians may prescribe fentanyl in forms such as:

• Transdermal patches that continually release tiny amounts of the drug over time
• Tablets that dissolve under the tongue
• Strips of soluble film that dissolve in the mouth
• Lozenges that you suck on
• Nasal spray

When it comes to illicit fentanyl, drug dealers and drug abusers have come up with many resourceful (but highly dangerous) ways to use the substance. For instance, with fentanyl, patch abuse is a growing concern. Some users have discovered how to extract the drug from transdermal patches, even if the drug is suspended in gel. In some cases, users simply suck or chew on the patches or consume the gel itself. Other common methods include:

• Swallowing fentanyl-laced powder or pills
• Snorting fentanyl-laced powder or crushed pills
• Sucking on fentanyl-spiked blotter paper
• Injecting real or counterfeit heroin laced with fentanyl
• Smoking fentanyl-laced substances

Fentanyl vs. Morphine and Heroin: The Critical Differences

Although fentanyl shares many similarities with morphine and heroin, it's incredibly important to understand the differences. Here are the most essential points of contrast to remember when exploring the subject of fentanyl vs. heroin and morphine:

• Fentanyl is 30 to 50 times more potent than heroin and 50 to 100 times more potent than morphine.³
• Fentanyl is a manmade (i.e., synthetic) opioid created in laboratories. By contrast, morphine is a natural opiate obtained from the juice of opium poppy plants. Heroin is derived from morphine.
• Fentanyl and morphine are classified by the U.S. Drug Enforcement Administration (DEA) as Schedule II controlled substances. They have recognized medical uses but a high potential for abuse and addiction. Heroin, on the other hand, is a Schedule I controlled substance, which means it has a high potential for abuse without any recognized medical uses.
• Fentanyl takes effect a lot more quickly than morphine or heroin. But its effects also subside much faster, which can result in a quicker onset of withdrawal.
• On the street, illicit fentanyl is usually easier to obtain and much less expensive than heroin. In fact, on a wholesale basis, illicit fentanyl is often available at roughly 5.4 percent of what heroin costs. So drug dealers are strongly incentivized to use fentanyl as a cutting agent or filler in place of more expensive substances like heroin.⁴
• A person who overdoses on fentanyl is often a lot harder to revive than a person who overdoses on heroin.

Fatal Overdose: Why Fentanyl Can Be Extremely Dangerous

With fentanyl, toxicity is the biggest danger. The drug can be deadly in miniscule amounts. Consider this fact: For the average adult, it only takes about 2 to 3 milligrams (mg) of fentanyl to cause a fatal overdose (roughly the amount of a few grains of salt). In comparison, it takes about 30 mg of heroin to cause a lethal overdose.^{5, 6}

That's a major reason why more and more substance abusers are overdosing on fentanyl. Deaths attributed to this drug continue to rise in number. For example, in 2014, fentanyl-related overdose deaths in the U.S. totaled 5,554, which was an increase of 79 percent over 2013.⁷ And fatalities attributed to synthetic opioids (aside from methadone) rose by over 22 percent between 2020 and 2021, driven mostly by fentanyl-related overdoses.²

So, when it comes to fentanyl, dosage is critically important. But drug dealers don't usually have the kind of specialized, fine-tuned equipment that is necessary for accurately measuring the fentanyl they sell. To make matters worse, most of the fentanyl sold on the street is made in clandestine laboratories in China or Mexico. The illicit fentanyl produced by those labs tends to be less pure—but often more potent—than pharmaceutical versions of the drug. That means if you buy fentanyl or fentanyl-laced products on the black market, you can never really know what dose you're getting. It's like playing Russian roulette.

In addition, many addicts and substance abusers have no idea that they are even using fentanyl. Dishonest dealers often mix fentanyl into the heroin or cocaine they sell (or even try to pass fentanyl off as those substances) without telling their customers. But fentanyl and fentanyl derivatives have also been found in counterfeit substances being sold as oxycodone, hydrocodone, crack cocaine, crystal meth, Ecstasy, Xanax, and other drugs. The interactions between fentanyl and other substances can have serious and unpredictable consequences, including death.

Fentanyl overdose deaths are generally the result of respiratory depression. That's because certain areas of the brain that help control a person's rate of breathing also contain opioid receptors. So if you take too much fentanyl, your breathing can slow down or stop entirely. It can all happen suddenly, very shortly after taking the drug.

All methods of ingestion can produce fentanyl overdose symptoms and reactions like:

• Clammy skin
• Shallow breathing (or no breathing at all)
• Slow or inconsistent heartbeat
• Tiny, pinpoint pupils
• Inability to move or communicate
• Low blood pressure
• Cardiac arrest
• Seizures
• Unconsciousness
• Coma

Substance abusers may be at even greater risk of overdosing when they inject fentanyl. The intravenous delivery method allows the drug to reach the brain more rapidly, which can quickly lead to acute chest wall rigidity, respiratory arrest, and death. Injecting drugs like fentanyl and heroin also puts substance abusers at higher risk of contracting life-threatening heart infections.

Another growing risk to users of bootleg fentanyl and other street drugs is the sale of fentanyl derivatives with much higher potencies. For instance, carfentanil is a derivative of fentanyl that has about 10,000 times the potency of morphine. Developed as a sedative for elephants and other large animals, it was never intended for human use.^{8, 9} Like fentanyl, carfentanil is sometimes added to other illicit substances or used to make counterfeit versions of drugs like heroin, oxycodone, cocaine, or crystal meth.

It should be noted that fentanyl and fentanyl derivatives also pose a risk to law enforcement officers, community outreach workers, children of addicts, and anyone else who comes into direct contact with substance abusers. When in powder form, these drugs can be accidentally inhaled. In other forms, they can also enter the body through simple skin contact. It only takes a tiny amount to cause real harm.

Side Effects of Fentanyl

People who use fentanyl can experience a wide range of side effects. Some users experience several of them, whereas others experience only a few. To avoid potentially deadly or life-altering complications, it's crucial to have a physician monitor your use of fentanyl. Even when properly using a prescribed time-release fentanyl patch, side effects can sometimes be problematic. Some of the most common side effects include:

• Nausea
• Drowsiness
• Fatigue
• Headache
• Vomiting
• Constipation
• Swelling of extremities
• Anemia

In addition to the above side effects, others may occur. This isn't a complete list, but potential side effects of using fentanyl can also include:

• Addiction
• Dizziness
• Feeling lightheaded
• Dry mouth
• Breathing problems
• Trouble sleeping
• Nightmares
• Shaking
• Muscle spasms
• Excessive sweating
• Itching, hives, or rash
• Heart palpitations
• Confusion
• Hallucinations
• Vision problems
• Abdominal pain
• Poor appetite
• Weight loss
• Diarrhea
• Urine retention
• Depression

Fentanyl Use During Pregnancy

Using fentanyl while you're pregnant or breastfeeding generally isn't recommended. Pharmaceutical manufacturers of the drug warn that fentanyl may have the potential to harm a developing fetus or get passed on to nursing infants through breast milk. That said, the data about fentanyl's risks during pregnancy are fairly limited. In certain situations, some physicians will consider administering the smallest effective doses of the drug to pregnant mothers for short durations. But if any infants are exposed to fentanyl for extended periods of time while in the womb or close to the time of delivery, then delivering them in special units created for neonatal opioid withdrawal is usually recommended.

Who Is Vulnerable to Fentanyl Addiction?

People from all backgrounds can get addicted to fentanyl. It can affect anyone, at any level of income. In fact, well-paid physicians—anesthesiologists, to be exact—were the first to start abusing the drug. After a while, other health care workers also began experimenting with it. Employees of hospitals, nursing homes, pharmacies, and similar workplaces often have relatively easy access to opioid medications like fentanyl. Theft of the drug can be a real problem in some health care establishments.

Medical patients who receive the drug are also at risk of addiction. In many cases, a patient will receive fentanyl to help manage severe pain after a surgery. Through repeated doses, the patient's tolerance for the drug can increase very quickly, leading to physical and psychological dependence on it. The same problem frequently applies to cancer patients and others who take opiates or opioids to manage acute or chronic pain. They are often unaware that the drugs they've been prescribed can lead to addiction. They may start depending on fentanyl to feel as close to "normal" as possible.

So anybody can become dependent on fentanyl if they're exposed to repeated doses, regardless of whether they use it for medical or recreational reasons. And, in many people, addiction to fentanyl doesn't take very long to develop. It can happen after just a few weeks (or less) of repeated use. Ultimately, some of the people most at risk of becoming fentanyl addicts include:

• Recreational users of opiate and opioid street drugs
• Recreational users of other street drugs that may be laced with fentanyl
• Surgical patients in recovery
• Cancer patients with chronic pain
• Other medical patients with severe acute or chronic pain
• Anesthesiologists
• Other physicians and health care workers

How Long Does Fentanyl Stay in Your System?

This can be one of the most confusing aspects of fentanyl. Half life (i.e., the time it takes for a substance to be reduced by half of its original amount) is determined, to a great extent, by how the drug is delivered to a user's system. So, the longer the half life, the longer the drug remains detectable in your body. For some users of fentanyl, the elimination half life is only one to three hours. However, check out the typical elimination half lives when the drug is delivered in the following forms:¹⁰

• Transdermal patches—13 to 22 hours
• Buccal tablets—11 to 12 hours (for 400 to 800 mcg doses); 3 to 4 hours (for 100 to 200 mcg doses)
• Lozenges—7 hours
• Intravenous (IV)—2 to 4 hours

The human body metabolizes fentanyl pretty quickly. After 72 hours, the unchanged form of the drug is usually undetectable in urine. However, certain metabolites of the drug (such as norfentanyl) can remain detectable in urine for up to 96 hours (i.e., four days) after the last use of fentanyl.¹¹

Fentanyl Withdrawal Symptoms

Even for a user of a transdermal fentanyl patch, withdrawal can involve some uncomfortable symptoms. Regardless of the form it's taken in, people often start experiencing symptoms of fentanyl withdrawal around 12 to 30 hours after their last use of the drug.¹² However, in some cases, the onset of symptoms can happen even earlier. Some of the most common withdrawal symptoms include:

• Diarrhea
• Stomach cramps
• Anxiety
• Chills and goosebumps
• Heavy sweating
• Bone or muscle aches
• Nausea and vomiting
• Fatigue

It generally takes at least a few days before the worst symptoms subside. After the first week or two, the symptoms usually become less intense. However, many people experience a temporary resurgence of symptoms even months after stopping their use of fentanyl. Additional withdrawal symptoms that may be felt after stopping the drug include:

• Irritability
• Insomnia
• Runny nose
• Fever
• Mood swings
• Joint pain
• Poor appetite
• Faster-than-normal breathing
• Depression
• Feelings of isolation

What Are the Signs of a Fentanyl Addict?

As with almost any other addiction, a dependence on fentanyl can lead to many behaviors that erode a person's health and personal integrity. Keeping secrets may become the norm, and an addict might resort to taking illegal or unethical actions in order to secure ongoing supplies of the drug. So, beyond displaying obvious signs such as unusual mellowness, lethargy, irritability, or anxiety, fentanyl addicts may also:

• Change their appearance
• Stop caring about personal hygiene
• Lie about having certain health problems
• Lie about how many drugs they've used
• Miss work or lose their jobs
• Skip classes if enrolled in school
• Miss family events
• Obtain prescriptions for fentanyl from multiple physicians
• Rapidly change their moods
• Obsess over potential sources of the drug
• Refuse to quit using the drug
• Steal money or valuable items from friends, family, or employers
• Stop paying bills
• Shoplift and pawn stolen items
• Visit out-of-the-ordinary locations to seek illicit fentanyl
• Ignore or harm personal relationships
• Disregard other people's schedules

How to Handle a Suspected Fentanyl Overdose

First, remember that fentanyl can be fatal at miniscule doses. Death can come suddenly if an overdose victim stops breathing or has a seizure or chest pain. So it's critical that you treat the situation as a medical emergency. Call 911 right away.

Put on gloves and a mask if you'll be getting close to the victim since fentanyl can be accidentally inhaled in its powder form and absorbed through the skin in other forms. Protect yourself from any highly potent substances entering your own system. Don't handle any substances, wrappers, or drug paraphernalia unless the victim still has them in his or her mouth or on the skin. (Ensure that the victim isn't continuing to get doses of fentanyl.)

If the victim is breathing and appears to be sleeping (but won't wake up), turn him or her on the side in case vomiting occurs. (People can choke on vomit while lying on their backs.)

If the victim doesn't have a pulse or isn't breathing, perform CPR until help arrives—chest compressions only. Do not perform any direct mouth-to-mouth resuscitation since doing so may expose you to fentanyl or other toxic substances.

Do you have naloxone on hand? Have you been trained to use it? Naloxone (also known as Narcan) can reverse an opioid overdose and restore a victim's breathing. Naloxone works by blocking the victim's opiate receptors. However, in the case of fentanyl overdoses, it often takes multiple doses of naloxone to revive a victim. If you have a fentanyl addict in your life, you may want to keep a supply of naloxone where it can be quickly accessed. Just note that naloxone can be expensive. It also has a fairly short shelf life, so only buy a few doses at a time. Here's where to get it:

• Naloxone is available without a prescription in more than 40 states and throughout Canada. The list of states where you can get naloxone without a prescription continues to grow.
• In the U.S., you can purchase naloxone from popular pharmacies such as Walgreens and CVS, as well as from some online Canadian pharmacies.
• In states where a prescription is still required, you can often get a physician to legally prescribe naloxone if you know somebody who is at risk of overdosing.

Administer the naloxone as soon as possible if you have it. Or get someone else to administer it while you continue CPR (or vice versa). Depending on the form of naloxone you have, you'll either spray it into the victim's nose or inject it into his or her arm, thigh, or butt. As soon as emergency help arrives, tell them exactly what you've done up to that point and let them take over.

Fentanyl Addiction Treatment and Recovery

Recognizing an addiction is the first step toward recovery. Whether it is you or a loved one who is addicted to fentanyl, it's essential to remember that getting professional assistance is a must. Trying to stop a fentanyl habit cold turkey can be very dangerous. You need trained addiction specialists to help guide you through the process. You also need medical supervision. Look for professionals who specialize in treating addicts of opiates and opioids.

Since fentanyl is highly potent and highly habit-forming, an addict almost always needs supervised medical detox. The drug must be eliminated from the body in a controlled manner, and withdrawal symptoms need to be safely managed and minimized. Without medical supervision, those symptoms can become too severe to cope with.

Often, an addict will be slowly weaned off of fentanyl or have doses of the drug tapered down until less-potent opiates or opioids can be used in its place and tapered down further. Other medications—such as clonidine and buprenorphine—may also be prescribed to help lower the severity of withdrawal symptoms and decrease the cravings for fentanyl.

Methadone has been widely used to help treat opiate and opioid addictions. However, for fentanyl addiction, many professionals now recommend Suboxone as a safer option. Suboxone is a pharmaceutical formulation—taken orally—that consists of buprenorphine and naloxone. The buprenorphine acts a partial opioid replacement to reduce cravings, and the naloxone (included in a small amount) prevents a user from getting high or feeling the effects of the buprenorphine if he or she attempts to inject Suboxone. (When Suboxone is taken as prescribed, the naloxone in it doesn't do anything.) It's important to note that, in the U.S., physicians need a special license in order to prescribe Suboxone. Most doctors don't have the necessary license. That's one reason why methadone is still commonly used in many places.

In severe cases of opioid addiction, hospitals may be involved in treatment and recovery—especially at the initial stages. However, at least one study has suggested that it may be better for addicts to get the bulk of their treatment at specialized addiction centers, which often have lower death rates than hospitals.¹³ Addiction recovery programs and rehab centers tend to have staff that are more knowledgeable and better trained when it comes to helping people who are suffering from the special problem of opioid dependence.

Addiction treatment centers come in two main varieties: outpatient and residential. With an outpatient program, you receive treatment or therapy at a clinic or other specialized facility on an appointment-by-appointment basis, but you still live at home. Generally, outpatient programs are good for people who have plenty of support at home and addictions that aren't too severe. (You don't want to be going home each day to an environment with triggers, temptations, or unsupportive people.) The outpatient option can also be beneficial for addicts who aren't able to take a break from work, school, or family commitments. However, an outpatient program may not be right for an addict with other medical issues that may complicate his or her recovery.

Residential treatment programs provide safe and comfortable living quarters away from everyday triggers. You receive ongoing care, support, and guidance in an immersive setting designed specifically for recovery from addiction. Many residential treatment centers offer services like medical detox, professional evaluations, nutrition counseling, health and wellness coaching, and group and individual therapy sessions. They also frequently help clients find the post-treatment support they'll need after leaving their facilities.

Many resources are available for recovering addicts who've completed treatment programs. For example, ongoing support can often be found through 12-step groups such as Narcotics Anonymous. It's also worth exploring your options for individual and family counseling. Periodic therapy sessions can greatly increase your chances of staying sober. Plus, since the opioid crisis now affects nearly every town and city, many local and state governments are creating new avenues of support. Check with your state's department of health and human services to see what may be available in your area.

In some cases, recovering fentanyl addicts are prescribed small doses of Suboxone or methadone as part of the ongoing maintenance of their recovery. They may need long-term pharmaceutical assistance to help them overcome cravings without resorting to drug abuse. Eventually, they are often able to stop using replacement drugs altogether.

Find the Help You Need Right Now

Is it time to regain control of your life? With help, you can free yourself from fentanyl addiction and begin the rewarding process of becoming the person you deserve to be.