Fentanyl Addiction: Definition, Symptoms, Side Effects, and Treatment

Fentanyl addiction is an addictive behavior to overuse fentanyl, which is a synthetic opioid that is 50 to 100 times stronger than morphine. Fentanyl is used as an instant pain reliever after surgeries, and doctors also prescribe it to cancer patients for chronic pain. Fentanyl addiction is a mental disorder that begins when an individual continuously misuses fentanyl medicine without a prescription despite knowing its negative effects on health. Fentanyl is so potent that a small overdose or short-term usage leads to fentanyl addiction and even causes death. In 2016, almost 19,000 Americans died because of a fentanyl overdose, according to research titled “Fentanyl: Receptor Pharmacology, Abuse Potential, and Implications for Treatment,” published in 2018 by the National Library of Medicine. 

The symptoms of fentanyl addiction are behavioral and physical, which include mood swings, gaining or losing weight, vomiting, change in fingernails, skin or lips color, shallow breathing, drowsiness, lack of consciousness, anxiety, depression, and withdrawal from social activities. The other symptoms of fentanyl addiction are changing friend groups and detaching themselves from family or loved ones.

The main causes of fentanyl addiction are interrelated and come from biological, social, and psychological factors. It includes environmental influences, genetic factors, mental health disorders, chronic pain, traumas, stress, drug misuse, and the availability of illicit fentanyl. 

The main side effects of fentanyl addiction are constipation, unconsciousness, drowsiness, dry mouth, confusion, chest or back pain, swelling of different body parts, hallucinations, rashes, and itching. Fentanyl addiction also causes menstrual and sexual problems. The other long-term effects are reduced libido, breathing problems, and an unstable mood.

The main treatment options for fentanyl addiction involve detoxification, support groups, cognitive behavioral therapy (CBT), aftercare and relapse prevention, and motivational interviewing. The other treatment option includes medication-assisted treatment, which consists of buprenorphine, naltrexone, and methadone.

What is Fentanyl?

Fentanyl is a synthetic opioid initially sourced from the opium poppy plant (Papaver somniferum). The opioid fentanyl, which is 50–100 times more potent than morphine, serves as a painkiller. Patients receive fentanyl as a patch, shot, or lozenge. Doctors prescribe fentanyl to patients for immediate pain relief after the surgeries. Physicians also recommended fentanyl for cancer patients to reduce chronic pain. The 5 different forms of fentanyl are table, patch, nasal spray, lozenge, and sublingual spray. Fentanyl is a strong opioid, and even a small overdose causes a fentanyl addiction. Patients must use it under the doctor’s supervision otherwise, it may lead to death. In 2013, an overdose of an illicit Xanax tablet that contains fentanyl caused 5000 deaths in San Francisco, California, according to research titled “Counterfeit Medications and Fentanyl,” published in 2016 by JAMA International Medicine.

Why is Fentanyl Addictive?

Fentanyl is addictive because it produces intense feelings of joy, happiness, and pleasure, shows a quick reaction, and is more potent than other opioids. Fentanyl overdose affects the respiratory system because of its high potency. Fentanyl is 50 to 100 times stronger than morphine and releases a huge amount of dopamine neurotransmitter, which stimulates the feeling of relief and pleasure. The dopamine encourages the patient to use fentanyl repeatedly. An accidental overdose of fentanyl can cause death within a few minutes. Fentanyl's higher dose causes severe heart problems, difficulty breathing, and unconsciousness. Other readily available illicit tablets (Xanax and Oxycodone) and powders (cocaine or heroin) commonly contain fentanyl, leading to simple addiction.

How is Fentanyl Consumed?

Fentanyl is consumed through sticks, injections, patches, tablets, lozenges, nasal sprays, and mouth sprays. Fentanyl is also available illegally in the form of powders and pills. Fentora tablets are used to treat breakthrough cancer pain, the dose is between 12.5 to 100 micrograms per hour. These distribute fentanyl in the body within 48 to 72 hours after applying to the skin. The nasal spray gives quick pain relief, and the dose is 100 - 800 mcg in one nostril. Lozenge is placed between the lower gum and cheek and is absorbed through oral mucosa. The initial dose is 200mcg over 15 minutes. Tablets called astral are dissolved under your tongue and prescribed between 100mcg and 800mcg. Sublimaze injections are given after the surgeries for instant action between 25 and 100 mcg per injection. Fentanyl should be consumed carefully because a little overdose causes huge problems.

How long does fentanyl stay in your system?

Fentanyl stays in your urine for up to 24 to 72 hours depending on the type of dose, and in blood, it stays for almost 12 hours. Fentanyl traces stay in saliva, for nearly 4 days and in hair, the traces of fentanyl stay for 90 days or longer. The metabolism, type, and frequency of dose influence the detection time. Fentanyl also has a half-life that lasts for 7 hours. Fentanyl takes 4 to 5 half-lives to eliminate from your system, which means it lasts for 35 hours in your body. 

What is Fentanyl Addiction?

Fentanyl addiction is an opioid use disorder characterized by prolonged misuse of fentanyl drugs, despite awareness of its negative consequences. Fentanyl is 50 to 100 times more synthetic opioid than morphine and is used for severe pain relief after surgeries, but its misuse leads to addiction. Fentanyl provides immediate pleasure and relief, encouraging repeated use, which can lead to addiction and even death. The death rate increased from 2628 to 5544 because of fentanyl overdose from 2012 to 2014 in the US, according to a study titled “Addressing the Fentanyl Threat to Public Health,” published in 2017 by The New England Journal of Medicine.

Fentanyl addiction prevalence increased drastically in the US in the past year. The fentanyl addiction rate is high between the ages of 25 - 44 as compared to those who are below 25 and above 65. Native Americans and African Americans experience huge cases of fentanyl addiction and fentanyl-related death, according to a study titled “New report details the deadly rise of fentanyl in the US,” published in 2023 by CNN Health.

Fentanyl addiction lies in the category of “Opioid Use Disorder” (OUD), which means the problematic behavior of misusing opioids resulting in severe impairments that lead to physical, behavioral, and psychological issues, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

What are the Signs & Symptoms of Fentanyl Addiction?

The signs and symptoms of fentanyl addiction are nausea, doctor shopping, increased tolerance, drowsiness, mood swings, anxiety and depression, irritability, overdose symptoms, and withdrawal symptoms. 

The 10 signs and symptoms of fentanyl addiction are listed below:

• Drowsiness: Fentanyl depresses the central nervous system, causes sedation and slows down brain activities. Fentanyl overuse makes you extremely drowsy and slows down your ability to perform daily tasks.

• Nausea: Fentanyl causes nausea by affecting the digestive and nervous systems, which results in discomfort of the gastrointestinal tract that becomes worse at higher doses or with long-term use.

• Doctor Shopping: Individuals consult multiple doctors to get more prescriptions, which can be interpreted as drug dependency. They try to seek additional fentanyl likely due to addiction. Doctor shopping is illegal in the US, but individuals do it on purpose to get more supplies despite knowing the consequences.

• Withdrawal from Social Activities: Fentanyl-addicted people isolate themselves from outside people and start neglecting their families and friends. They detached from all those activities they once liked. Drug dependency becomes the top priority for them, so they start avoiding their responsibilities.

• Increased Tolerance: The individuals develop a tolerance to fentanyl with its continuous use, which makes higher doses necessary for them to experience their desired effects. The high potency of fentanyl increases the risk of overdose, which leads to death.

• Mood Swings: Fentanyl releases dopamine neuroreceptors, which enhance the feeling of pleasure; this sudden change in mood causes extreme mood swings. The sudden change in mood from euphoria to a high level is unlike anything you have ever experienced. The sudden change in mood (anger and irritability) occurs as the drug level drops This creates a rift in personal relationships and negatively affects daily life routine.

• Anxiety or Depression: Fentanyl addiction has a negative effect on brain activities, which leads to anxiety and depression. As the consumption of drugs increases, the brain starts to work slowly, which leads to depression. Fentanyl disrupts brain chemistry, which results in emotional instability in an individual.

• Irritability: Irritability is the withdrawal symptom of fentanyl addiction that occurs when the individuals skip the drug dose. The person gets upset more quickly because of how drugs have changed mood and brain functioning. They also experience different cravings, discomfort, and frustration.

• Overdose Symptoms Overdose symptoms include respiratory depression, extreme sedation, lo:ss of consciousness, and pinpoint pupils. In the case of an opioid overdose, death can occur if a person is not breathing properly. 

• Withdrawal Symptoms: Withdrawal symptoms such as sweating, muscle pain, and intense cravings emerge when fentanyl use is reduced or stopped, indicating physical dependency.

What are the causes of Fentanyl Addiction?

The causes of fentanyl addiction are prescription drug misuse, availability of illicit fentanyl, genetic factors, and mental health disorders.

The 4 causes of fentanyl addiction are listed below:

• Prescription Drug Misuse: Fentanyl is more powerful than morphine and is prescribed by doctors for severe pain relief during surgeries and also prescribed to cancer patients with chronic pain. Fentanyl's quick-acting nature increases the likelihood of misuse, leading to addiction. Without doctors' advice, patients begin using fentanyl to suppress pain, which in turn leads to fentanyl and other opioid addictions. Since 2014, prescription fentanyl drug misuse has drastically caused an increase in death rates of more than 10,000, according to research titled “Drug Overdose Deaths: Facts and Figures,” published in 2024 by the National Institute on Drug Abuse. 

• Availability of illicit fentanyl: Availability of illicit fentanyl plays a crucial role in addiction and increases the risk of dependency. Fentanyl is illegally found in other painkillers like Xanax and Oxycodone and powders like cocaine and heroin. Sometimes, people are unaware of the presence of fentanyl in these pills, leading them to develop a fentanyl addiction. The availability of illicit fentanyl increases nowadays, which makes it easy for addicts to consume it.

• Genetic Factors: Individuals with an addiction history are more vulnerable to opioid drugs as compared to others. Individuals may inherit genes from their parents that negatively impact their brain functioning, specifically the DRD2 gene, which controls the dopamine neurotransmitters. The genetic change in dopamine increases the risk of substance use disorders. The genetic factors cause addiction in 40–60% of the population, according to an article titled “Understanding the genetics and neurobiological pathways behind addiction (Review),” published in 2021 by Spandidos Publications.

• Mental Health Disorder: Anxiety, depression, and Post Traumatic Stress Disorder (PTSD) are the mental disorders associated with fentanyl and other opioid addictions. Individuals with these health problems are more likely to become addicted to fentanyl because of its nature of relieving pain and giving pleasure. Individuals with anxiety and depression may feel relieved initially, but with long-term use, it causes dependency.

What are the dangerous effects of Xanax Addiction?

The dangerous effects of Xanax addiction are cognitive impairment, social isolation, financial and legal problems, coma or death, respiratory arrest, and overdose potential.

These 6 dangerous effects of Xanax addiction are listed below:

• Cognitive impairment: Xanax addiction affects the brain area associated with learning, attention, and memory. It also causes social withdrawal, lack of motivation, and difficulty in decision-making. Long-term misuse of Xanax affects verbal memories, divided attention, recent memory, and processing speed, even after discontinuation of it, according to research titled “The Residual Medium and Long-term Cognitive Effects of Benzodiazepine Use: An Updated Meta-analysis,” published in 2017 by Oxford Academics.

• Social Isolation: Xanax addiction affects the personality and relationships of an individual, and a person detaches themselves from social activities. An individual faces difficulties in communication, low self-esteem, and avoiding family and friends. Social isolation encourages the person to use drugs repeatedly because of loneliness and depression, according to research titled “Isolation, Solitude, and Social Distancing for People Who Use Drugs: An Ethnographic Perspective,” published in 2021 by ResearchGate.

• Financial and Legal Problems: Drug addiction is caused by prescription and illicit supplies that cost lots of money, which leads to financial problems. Drug consumption causes the person to feel uneasy and sick, which in turn leads to unemployment. Illicit Xanax is difficult to get, and the person may end up involved in other illegal activities.

• Overdose Potential: Xanax is taken in combination with other opioids, which increases the risk of Xanax overdose. This combination can lead to confusion, sedation, and respiratory problems. In 2023, the number of fentanyl overdoses that cause death increased up to 390 million, according to research titled “DEA Fentanyl Seizures in 2024,” published by the United States Drug Enforcement Administration. 

• Respiratory Arrest: Xanax addiction slows down breathing, which leads to respiratory arrest. The Central Nervous System (CNS) is affected by the continuous use of drugs, which ends up with life-threatening respiratory failures. 

• Coma or Death: Individuals with substance abuse end up taking high doses of Xanax and other opioids, which leads to death. Xanax addiction causes the complete shutdown of the central nervous system, and the person may go into a coma. In 2018, 5.2% of the US population died because of Xanax overdose, according to research titled “Benzodiazepines and risk of all-cause mortality in adults: cohort study,” published in 2017 by The BMJ.

How to Diagnose Fentanyl Addiction?

Fentanyl addiction is diagnosed through clinical evaluation, behavioral observation, the opioid risk tool (ORT), mental or social assessment, a blood test, and a urine test. Based on the individual's condition, the health care provider recommends the diagnosis using the 11 criteria of opioid use disorder (OUD) in the DSM-5, which categorizes the addiction as severe, mild, or moderate. Healthcare providers observe the signs, or behavioral changes, and use the screening tests called the Opioid Risk Tool (ORT) and Clinical Opiate Withdrawal Scale (COWS) to confirm the severity of addiction and then provide the treatment. Providers also run blood and urine tests to identify the amount of fentanyl present in the body, which helps them to provide the proper diagnosis.

How to Support a Loved One with Fentanyl Addiction?

To support a loved one, keep a check on them, and observe their daily activities even though they do not want to talk to you. Naloxone is a medicine that reverses the opioid action in the human body and is a very safe medicine. Naloxone is used to reduce the side effects of the fentanyl drug and is easily available without a prescription. Call the helpline without hesitation when someone is misusing the drug, and also encourage them to get proper treatment. Attending the support group meetings, checking their progress, and involving in activities with them encourages the patient to focus on treatment.

What are the treatment options for Fentanyl Addiction?

The treatment options for fentanyl addiction include medical detoxification, cognitive behavioral therapy (CBT), medication-assisted treatment (MAT), support groups, inpatient treatment, and 12-step programs.

The 6 treatment options for fentanyl addiction are listed below:

• Medical Detoxification: Medical Detoxification controls the severe withdrawal symptoms by removing the fentanyl from the body. It helps reduce the discomfort and encourages the patient to continue the treatment. The recovery occurs in 5 -10 days, depending on the severity of the addiction. Medical detoxification itself is not that effective for opioid misuse patients; without proper treatment, the person ends up with addiction again, according to research titled “Fentanyl and Other Opioid Use Disorders: Treatment and Research Needs,” published in 2023 by The American Journal of Psychiatry.

• Cognitive Behavioural Therapy: Cognitive Behaviour Therapy helps individuals overcome negative thoughts and behavior patterns. It is more effective than other therapies, and the relapse rate is low, according to a study titled “Effect of cognitive-behavioral therapy on resilience and relapse in adult patients with substance use disorder: a systematic review protocol,” published by BMJ Journal. CBT takes almost 12-16 weeks to show positive outcomes without any gap. It affects the patient’s health and slows the recovery process if they do not participate regularly. 

• Medication-Assisted Treatment (MAT): Medication-assisted treatment combines medicine like naltrexone, methadone, and buprenorphine with behavioral therapy to minimize withdrawal symptoms and cravings. It assures long-term recovery with a low risk of relapse. It takes approximately 6 -12 months to recover properly. The side effect of MAT is that it is a time-consuming procedure, so individuals might drop the sessions in between.

• Support Group: In support group therapy, patients share their experiences publicly, which helps them to feel relaxed. It increases peer support and reduces discomfort. The recovery time of support group therapy is not fixed, it takes months or years to recover completely. The primary drawback of this therapy is the challenge of regularly participating in group sessions.

• Inpatient Treatment: Inpatient treatment provides medical and therapeutic support in the rehab 24/7, its recovery time is 30-90 days. The change in environment affects the individual mental health and reduces the addiction rate. The negative outcome is the high prices of rehabs.

• 12-Step Programs: 12-step program enhances spirituality, positivity, and accountability in the patient’s recovery. It increases self-esteem, helps in personal growth, and involves the patients in peer group therapies, according to research titled “Outcomes research on twelve-step programs,” published in 2015 by the APA PsycNet. It is a long-term treatment with no fixed recovery time.

What is Fentanyl Withdrawal?

Fentanyl withdrawal occurs when an individual uses fentanyl regularly for a few weeks and then stops, which results in negative consequences. Fentanyl withdrawal affects daily activities and makes it difficult for an individual to cope without drugs. The person needs quick medication after a doctor consultation because withdrawal symptoms show immediate reaction within 12 hours. The first 2-3 days are very difficult for patients, and the chances of relapse are high during these days. Fentanyl withdrawal is measured through mean and maximum scores on the Clinical Opioid Withdrawal Scale, according to a research titled “Fentanyl withdrawal: Understanding Symptom Severity and exploring the role of body mass index on withdrawal symptoms and clearance,” published in 2022 by the National Library of Medicine.

What are Fentanyl Withdrawal Symptoms?

Some common withdrawal symptoms of fentanyl are vomiting, sweating, cravings, diarrhea, cramps, insomnia, irritability, restlessness, high blood pressure, anxiety, and breathing problems. The patients overcome these symptoms by staying hydrated, eating healthy, and consulting doctors. Medications like naltrexone, buprenorphine, and methadone help to minimize fentanyl cravings. 

How Does Fentanyl Addiction Relate to Other Opioid Addictions?

Fentanyl addiction is related to other opioids because of the same effect on mental health and behavior. Fentanyl has the same pharmacological properties as other opioids. Fentanyl binds to brain receptors and intensifies feelings of euphoria and pain relief like other opioids that cause addiction. It is a bit stronger than other opioids, which increases the risk of fentanyl addiction as compared to other opioids. Fentanyl and other opioid overdoses cause opioid use disorder, according to DSM-5. Illicit fentanyl, when combined with other opioids like heroin, oxycodone, morphine, and Xanax, increases the risk of drug dependency. 

Is fentanyl more potent than morphine?

Yes, fentanyl is 50 to 100 times more potent than morphine. Small amounts of fentanyl show strong analgesic effects, and the high potency of fentanyl contributes to its addiction which is 50 to 100 times more than morphine addiction. Fentanyl is very effective in pain management. This increases the risk of using fentanyl without a prescription, which can lead to addiction. Fentanyl binds to opioid receptors in the brain, causing an individual to use it repeatedly.

Is the risk of accidental overdose higher with fentanyl compared to heroin?

Yes, there is a higher chance of accidental fentanyl overdose because it is stronger than heroin. An enormous amount of fentanyl may result in severe respiratory depression and overdose, particularly among individuals who lack opiate tolerance. The risk of fentanyl addiction is high because of the presence of illicit fentanyl in other drugs. In 2019, fentanyl was accountable for roughly 72% of deaths caused by opioid overdoses in the United States. Both narcotics are hazardous and heroin addiction also increases the risk of opioid use disorder. 

Is fentanyl associated with a higher risk of overdose compared to methadone?

Yes, fentanyl carries a greater risk of overdose than methadone. Fentanyl's vitality along with its rapid action on the body makes it far more life-threatening. Fentanyl has been estimated to be 50 to 100 times greater in strength than morphine and slightly 30 to 50 times more effective than heroin, according to a research titled “The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies,” published in 2019 by Translational Psychiatry. Methadone has a delayed onset and a prolonged half-life, making it less toxic to use but the overuse can also cause methadone addiction. A tiny dose of fentanyl may lead to lethal respiratory depression, particularly in individuals who do not hold opiate tolerance.