Fentanyl Addiction: Symptoms, Risks, Effects, Treatment

Fentanyl addiction is an intense urge to use fentanyl despite the dire negative effects it has on the user’s health and overall well-being. According to the National Institute of Drug Abuse’s 2022 Substance Abuse and Mental Health Services Administration, SAMHSA research, 991,000 individuals over the age of 12 abuse fentanyl. 

Fentanyl is a highly potent synthetic opioid used medically for severe pain but has a high potential for addiction and misuse, leading to physical dependence and severe health risks.

Symptoms of fentanyl misuse include behavioral changes such as withdrawal from social activities, physical signs like drowsiness and confusion, and cognitive effects such as mental slowness and forgetfulness.

Causes of fentanyl addiction range from abusive use of prescribed painkiller opioids and genetic predisposition to environmental exposure and depression. 

Treatment for fentanyl addiction involves medication-assisted treatment (MAT), which include drugs like buprenorphine or methadone, alongside therapies like cognitive behavioral therapy to manage withdrawal symptoms and support long-term recovery.

What Is Fentanyl Addiction?

Fentanyl addiction is a prolonged use or abuse of the opioid fentanyl characterized by an insatiable craving for the drug despite its negative repercussions. It’s a mental health disorder that can wreak havoc on an individual’s life, which makes understanding and addressing fentanyl addiction a priority.

Fentanyl, a synthetic opioid pain medication, serves as a relief for those struggling with severe pain, such as post-surgery or advanced cancer patients. Its potency surpasses that of heroin by 50 times and morphine by 100 times.

This potency contributes to its effectiveness as one of the opioid analgesics to treat severe pain. Yet, this same potency also harbors a potential pitfall, paving the way to a grim addiction to fentanyl and other opioids. The pleasure derived from fentanyl use, coupled with its potency, can rapidly ensnare individuals in the cycle of addiction. 

How Addictive Is Fentanyl?

Fentanyl is highly addictive. According to the Centers for Disease Control and Prevention, CDC’s Substance Abuse and Mental Health Administrators 2022 research data, fentanyl abuse accounts for 19 percent of all substance abuse in the United States. 

Fentanyl misuse is far from an isolated occurrence. It’s a pervasive problem that continues to escalate. Statistics from the National Institution of Drug Abuse NDIC show that overdose deaths involving synthetic opioids, predominantly fentanyl, witnessed a staggering increase of over 22% from 2020 to 2021, with a reported 70,601 overdose deaths in 2021.

The pathway to fentanyl dependency usually starts with legal prescription opioid use. As tolerance develops, individuals often seek out more potent illicit opioids, including fentanyl. This transition underscores the risks of prescription opioid misuse. 

Research from drug abuse statistics NCDAS shows that more than 20 million 

Americans from the age of 12 have fentanyl addiction, and 20 percent of people with substance abuse issues use fentanyl. The COVID-19 pandemic further exacerbated the issue, leading to an acceleration of fentanyl-related overdose deaths. 

These alarming statistics mirror the devastating impact of the pandemic on substance abuse trends.

What Are Fentanyl Addiction Symptoms?

Fentanyl addiction symptoms manifest in various ways, including distinct behavioral changes, physical indications, and cognitive and psychosocial effects.

Behavioral Indicators

The destructive grip of fentanyl addiction often leads to noticeable behavioral changes. These changes can manifest in various forms, including withdrawal from family and friends, shifts in social circles, and decreased involvement in hobbies and activities that were once enjoyed. Individuals addicted to fentanyl experience mood swings, episodes of irritability, nervousness, and giddiness. 

The tendency to isolate themselves increases, and the drug user exhibits secretive behavior, indicating a possible struggle with substance abuse. These behavioral symptoms, although subtle, are critical in the early detection of fentanyl abuse.

Physical Symptoms

Fentanyl addiction is characterized by specific physical symptoms, which include:

• Extreme happiness
• Drowsiness
• Nausea
• Confusion
• Constipation

Its addiction poses immediate health risks. Pronounced sedation and significant problems with breathing may occur, even when the drug is used as prescribed. Identifying these physical symptoms is key to detecting potential fentanyl abuse and seeking timely intervention.

Cognitive And Mental Effects

The negative effects of fentanyl abuse aren’t limited to physical symptoms. It can also lead to cognitive impairments, such as mental slowness and forgetfulness, resulting in functional disabilities and a reduction in quality of life. Fentanyl addiction is associated with an increased risk for mental health issues such as anxiety and depression, further contributing to a lower quality of life. While medication-assisted treatment for addictive disorders tends to improve cognitive outcomes, cognitive performance may still be impaired when compared to non-substance users.

What Are The Symptoms Of Fentanyl Withdrawal?

The symptoms of fentanyl withdrawal include the following:

• Muscle and bone pain
• Sleep problems
• Diarrhea
• Vomiting
• Cold flashes
• Uncontrollable leg movements
• Severe cravings

Monitoring the severity of withdrawal symptoms using tools like the Short Opioid Withdrawal Scale (SOWS) can help adjust management strategies accordingly. Maintaining a calm environment, avoiding forced physical exercise, and ensuring round-the-clock availability of healthcare workers are also key elements for successful withdrawal management.

According to Shah M,’s 2023 study, ‘Opioid Withdrawal’, the treatments for fentanyl addiction include:

1. Pharmacological Management:
   • Methadone: Long-acting opioid agonist used in inpatient or outpatient settings, starting at 10 mg and adjusted based on withdrawal symptoms.
   • Buprenorphine: Partial opioid agonist given sublingually, starting at 4 to 12 mg, initiated after withdrawal symptoms appear.
2. Symptomatic Treatment:
   • Loperamide for diarrhea
   • Promethazine for nausea/vomiting
   • Ibuprofen for muscle aches
   • Clonidine to reduce blood pressure and alleviate withdrawal symptoms.
3. Behavioral Therapies: Counseling and support groups to address psychological aspects of addiction.
4. Mainstreaming Addiction Treatment (MAT) Act: Expanded prescribing authority for buprenorphine, allowing more healthcare providers to offer treatment without additional waivers.

What Are The Risk Factors Of Fentanyl Addiction?

The Risk Factors Of Fentanyl Addiction include genetic predisposition, environmental influences, and neurobiological mechanisms. These factors collectively contribute to the vulnerability and development of opioid use disorder (OUD).

• Genetic Factors: Opioid Use Disorder (OUD) is influenced by genetic factors. According to Volkow, N. D.,’s 2021 study, ‘The changing opioid crisis: development, challenges and opportunities’, for about 50% of the risk for substance use disorders (SUD). Key genes include OPRM1, linked to OUD susceptibility, and CNIH3, which regulates AMPA receptors and opioid control. Variants of the BDNF gene, especially the Val(66)Met genotype, are associated with increased drug-seeking behaviors. Other genes, such as MAOA and COMT, are involved in externalizing behaviors and reward circuitry, highlighting the complex genetics of addiction.
• Environmental and Developmental Factors: Environmental and developmental stages significantly affect OUD risk. Adolescents are particularly vulnerable to drug experimentation, with early use linked to a higher likelihood of addiction. Critical brain development during adolescence sees reward and emotion circuits maturing faster than self-regulation areas, increasing risk-taking. Adverse childhood environments, including stress and trauma, can lead to neurodevelopmental impairments that elevate addiction risk, as shown by studies linking social deprivation to delayed brain maturation and increased impulsivity.
• Neurobiological Factors: Neurobiological mechanisms are essential for understanding OUD. The brain’s reward circuitry, particularly dopamine pathways, is key to the reinforcing effects of opioids like fentanyl. Opioid use triggers dopamine release in the nucleus accumbens, reinforcing the behavior. Individuals with substance use disorders often experience dopamine hypofunction, characterized by reduced baseline dopamine release and a lower response to natural rewards, leading to tolerance. Repeated drug use also strengthens conditioned responses, making environmental cues trigger cravings and increasing relapse risk.

What Are The Effects Of Fentanyl Addiction?

The effects of fentanyl addiction include immediate health risks and long-term consequences. Immediate health risks involve increased chances of overdose, respiratory depression, and hypoxia. Long-term consequences encompass tolerance development, chronic health complications, and mental health challenges.

Immediate Health Risks

Fentanyl abuse increases the risk of an overdose. An overdose increases the chances of respiratory depression, where breathing can slow or stop, resulting in hypoxia—an inadequate oxygen supply to the body tissues.

In severe cases, fentanyl overdose can lead to:

• Unconsciousness
• Coma
• Permanent brain damage
• Death

Given the high addictive nature of fentanyl, an opioid overdose is a medical emergency that requires prompt intervention to prevent fatal outcomes.

Long-Term Consequences

While the immediate health risks of fentanyl abuse are alarming, the long-term consequences are equally devastating. Chronic fentanyl addiction can lead to:

• The development of tolerance necessitates higher doses to achieve the same effects
• Significant rise in  the risk of overdose
• A spectrum of long-term health complications
• Suppress immune functions
• Contribute to hormonal and reproductive difficulties
• Increased risk of co-occurring disorders
• Add complexity to the user’s mental health challenges 
• Complicate treatment efforts.

Untreated fentanyl addiction eventually affects various aspects of the user’s life, resulting in diminished overall physical and mental functioning. It also exposes the individual to a higher risk of diverse health issues.

What are the Treatments for Fentanyl Addiction?

The treatments for fentanyl addiction include medication-assisted treatment (MAT) and behavioral therapies. MAT combines medications like methadone, buprenorphine, and naltrexone with counseling and behavioral therapies to address the disorder.

Behavioral therapies, such as cognitive behavioral therapy, contingency management, and motivational interviewing, are particularly effective when used alongside medication. It’s important to remember that the duration of treatment with MAT is not capped and may continue indefinitely to meet the long-term recovery needs of the individual.

According to Dydyk AM’s, 2024 study named, ‘Opioid Use Disorder’ here are the treatment options for opioid use disorder (OUD) including fentanyl:

• Cognitive Behavioral Therapy (CBT):
  • Focuses on changing thought patterns to minimize drug relapses.
  • Encourages participation in self-help programs like Narcotics Anonymous.
• Psychological Support:
  • Maintenance programs that include education, motivation, and group therapy to promote self-control and restraint.
• Medication-Assisted Treatment (MAT):
  • Opioid Replacement Therapy:
    • Methadone: Oral mu-receptor agonist, reduces cravings and euphoric effects, administered in specially monitored clinics.
    • Buprenorphine: Partial mu-receptor agonist, available in various formulations, must be initiated during withdrawal to avoid precipitated withdrawal.
• Naltrexone:
  • Opioid antagonist that blocks opioid effects, used after the patient is free of physiological dependence.
• Adjunct Medications:
  • Clonidine: Alleviates withdrawal symptoms.
  • Tizanidine: Reduces anxiety and muscle pain.
  • Bupropion: Addresses anxiety symptoms.
  • Loperamide and Ondansetron: Treat diarrhea and nausea/vomiting, respectively.
• Individualized Treatment Plans:
  • Length of treatment and choice of medication should be tailored to the patient’s specific needs and circumstances, with some clinicians advocating for lifelong treatment due to relapse risks.
• Group Therapy:
  • Cost-effective and helps maintain self-control.

These approaches aim to manage withdrawal symptoms, reduce cravings, and support long-term recovery.

How Do I Respond To Fentanyl Overdose?

Responding swiftly and appropriately to a fentanyl overdose can mean the difference between life and death. First, you must recognize the symptoms of a fentanyl overdose, which include:

• Unconsciousness
• Severely reduced breathing or no breathing
• Limp or rigid body
• Choking sounds
• Tiny pupils
• Pale or bluish skin

To respond to an overdose, you should:

• Call 911 or other paramedic services
• Administer naloxone
• Maintain the person’s airway
• Lay them on their side
• Remain with them until help arrives

Naloxone, used to reverse opioid overdoses, may require multiple administrations, especially with potent opioids like fentanyl, to counteract the strong effects. Thankfully, Good Samaritan laws provide legal protection to those who assist in an overdose emergency and to the person overdosing, encouraging more bystanders to help without fear of legal repercussions.

In what ways do social and environmental factors contribute to the development and maintenance of both fentanyl addiction and lorazepam addiction?

Social and environmental factors significantly influence the development and perpetuation of fentanyl addiction and lorazepam addiction. Access to prescription medications, peer influences, socioeconomic status, trauma history, and availability of mental health support all contribute to individuals’ susceptibility to addiction. Whether obtained through prescriptions or illicit means, exposure to these drugs can be facilitated by social networks and environmental stressors.

Are there potential drug interactions or adverse effects when fentanyl is abused concurrently with cocaine?

Yes, there are potential drug interactions and adverse effects when fentanyl is abused concurrently with cocaine. Both fentanyl, a potent opioid, and cocaine, a stimulant drug, exert contrasting effects on the central nervous system, with fentanyl suppressing respiratory function and cocaine increasing heart rate and blood pressure. Concurrent use of fentanyl and cocaine, known as a “speedball,” can result in a complex interplay of physiological effects, including heightened risk of cardiovascular complications, respiratory depression, overdose, and death.

How Does Fentanyl Affect Your Vitals?

Fentanyl affects your vitals by causing a decrease in myocardial oxygen consumption and coronary blood flow. It also reduces cardiac output, heart rate, respiratory rate, and arterial oxygen tension at higher plasma concentrations. This indicates a significant impact on vital signs.