Fentanyl is a highly potent synthetic opioid analgesic that is typically prescribed for the treatment of severe pain, such as that experienced following surgery or during palliative care. As a member of the narcotic analgesics class, fentanyl works by altering the brain’s perception of pain, primarily through its effects on dopamine levels—a neurotransmitter associated with pleasure and reward (National Institute on Drug Abuse [NIDA], 2021).
Forms and Pharmacology of Fentanyl
Fentanyl is available in several prescription forms, including oral tablets, lozenges, lollipops, nasal sprays, transdermal patches, and injectable solutions (Volkow, 2022). It is estimated to be 50 to 100 times more potent than morphine and significantly more potent than meperidine. The drug’s high lipid solubility allows it to rapidly cross the blood-brain barrier, leading to quick onset of effects (Centers for Disease Control and Prevention [CDC], 2020).
Its therapeutic index (TI)—a measure of a drug’s safety—is approximately four times that of morphine and more than 50 times that of meperidine, indicating that fentanyl can be effective at very small doses, but also highly dangerous when misused.
Risk and Signs of Fentanyl Addiction
Despite its therapeutic benefits, fentanyl carries a high risk of addiction. Many patients underestimate the addictive potential of opioid pain relievers like fentanyl, assuming they are safer than illicit drugs such as heroin. However, the same neurochemical mechanisms that relieve pain can also lead to psychological and physical dependence (NIDA, 2021).
Addiction typically begins with tolerance: individuals require higher doses to achieve the same euphoric effect. Over time, this can result in compulsive drug-seeking behavior, including illegal procurement of fentanyl after exhausting legitimate prescriptions.
Common signs of fentanyl misuse include:
- Respiratory depression (slowed breathing)
- Drowsiness and sedation
- Euphoria and a sense of calm
- Headaches and dizziness
- Blurred vision
- Constipation, nausea, and vomiting
- Seizures
- Itching and confusion
Those without an established opioid tolerance are at particularly high risk for overdose. Illicit fentanyl, often mixed with other substances such as heroin or cocaine, has caused a sharp increase in unintentional poisonings and fatalities (CDC, 2020).
Critical Facts About Fentanyl
- Overdose Deaths: Nearly half of all opioid-related overdose deaths involve fentanyl. Synthetic opioids have surpassed prescription opioids as the most common substances implicated in these fatalities (NIDA, 2021).
- Potency and Lethality: Just two milligrams of fentanyl—an amount equivalent to a few grains of salt—can be fatal. Emergency responders are also at risk if they inhale or come into skin contact with the drug (DEA, 2021).
- Illicit Manufacturing: Although pharmaceutical-grade fentanyl is legally prescribed, much of the drug implicated in overdose deaths is illicitly manufactured, particularly in clandestine labs in China and Mexico (Volkow, 2022).
- Availability: Fentanyl is a Schedule II controlled substance and is available under brand names such as Actiq®, Duragesic®, and Sublimaze®.
- Treatment with Naloxone: Overdoses can be reversed with naloxone (Narcan), an opioid antagonist that must be administered quickly to be effective (CDC, 2020).
- Addiction Treatment: Recovery is possible through a combination of medication-assisted treatment (MAT) and behavioral therapies.
- Drug Enforcement Trends: In 2020, the Drug Enforcement Administration (DEA) reported a 214% increase in methamphetamine seizures and a 59% increase in fentanyl seizures compared to the previous year (DEA, 2021).
- Carfentanil: Similar compounds like carfentanil are even more potent and dangerous, with minimal exposure potentially leading to death.
- Historical Context: Fentanyl was synthesized in 1960 for use in surgical procedures. Unlike other opioids, it does not require harvesting of the poppy plant and can be synthesized inexpensively in laboratories.
Treatment and Withdrawal
Abrupt cessation of fentanyl, also known as quitting “cold turkey,” can be physically and emotionally taxing, though rarely life-threatening. Symptoms of withdrawal may include irritability, chills, restlessness, sweating, and severe discomfort. Despite its non-lethal withdrawal profile, the risk of relapse remains high, especially without professional support (NIDA, 2021).
Specialized inpatient and outpatient addiction treatment programs offer medical supervision during detoxification and can significantly reduce the likelihood of relapse. Medications such as buprenorphine or methadone, combined with counseling, have proven effective in treating opioid use disorders.
Conclusion
Fentanyl represents a major public health concern in the United States due to its potency, availability, and the rapid escalation of addiction it can cause. The synthetic nature of the drug also makes it easy to produce and distribute illegally. With appropriate treatment, recovery from fentanyl addiction is achievable. Public education, access to treatment, and harm-reduction strategies like naloxone distribution remain essential tools in combating the ongoing opioid crisis.
New Dimensions Can Help!
If you know an adult or an adolescent who is struggling with substance abuse, New Dimensions can help. Early intervention can prevent irreversible damage to one’s physical and mental health. New Dimensions provides outpatient programs for adolescents and adults with substance abuse and mental health issues. To learn more about our services, including Psychological Testing, Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and Interventions for Substance Abuse, contact us at 800-685-9796 or visit our website at www.nddtreatment.com.
References
- Centers for Disease Control and Prevention. (2020). Synthetic opioids drug overdose deaths. Retrieved from https://www.cdc.gov
- Drug Enforcement Administration. (2021). DEA releases 2020 National Drug Threat Assessment. Retrieved from https://www.dea.gov
- National Institute on Drug Abuse. (2021). Fentanyl drug facts. Retrieved from https://nida.nih.gov
- Volkow, N. D. (2022). Illicit fentanyl driving rise in opioid overdose deaths. National Institute on Drug Abuse. Retrieved from https://nida.nih.gov/news-events