Written by Leigh Morgan Updated: December 9, 2020
In 2017, fentanyl was the 250th most prescribed medication in the United States, with nearly 1.8 million prescriptions issued. In 2016, according to the National Survey on Drug Use and Health, approximately 228,000 Americans aged 12 and older — 0.1% of the population — reported misusing fentanyl within the past year. Non-medical use of fentanyl has increased in recent years, partly due to an increase in the supply of non-pharmaceutical fentanyl, which is fentanyl made in illegal drug laboratories.
Fentanyl is a powerful pain reliever that is approximately 50 to 100 times stronger than morphine. It’s typically used to control severe pain after surgery. Fentanyl is also used to relieve chronic pain in people who have developed a tolerance to other pain medications. In pediatric settings, fentanyl is only approved for use in children over the age of two, when it’s used immediately before, during, or after surgery; however, some hospitals engage in off-label use of fentanyl for children in pediatric ICUs.
Non-medical users typically misuse fentanyl because it produces feelings of extreme happiness and causes other desirable effects.
Although fentanyl is effective for relieving pain, long-term use of this substance is associated with many undesirable side effects, including respiratory depression and an increased risk of death due to unintentional overdose.
This guide explains the effects, trends, and dangers of fentanyl use, as well as an unbiased analysis of the medicinal and behavioral treatment methods for fentanyl addiction based on current research and publicly available statistics. In some cases, usage statistics are derived from general prescription opioid use, which includes morphine, hydrocodone, codeine, and tramadol.
Primary Fentanyl Dangers
Addictiveness: In one study, researchers analyzed 20 substances to determine their addictive potential. The substances analyzed include heroin, cocaine, ecstasy, cannabis, and barbiturates. After taking into account the potential for both physical harm and social harm, and the risk of dependence associated with each substance, the researchers determined that heroin has the highest addictive potential of the 20 substances studied. Like fentanyl, heroin is a powerful opioid that can help the user relax and produce feelings of euphoria. Therefore, this study demonstrates the high potential for abuse associated with fentanyl and other opioids.
Risk of overdose: In 2017, more than 28,000 Americans overdosed on synthetic opioids, such as fentanyl, according to the Centers for Disease Control and Prevention. Some of these overdose deaths occurred because fentanyl was mixed with cocaine or heroin. If fentanyl is mixed into another drug without the user’s knowledge, the risk of overdose increases.
Unintended side effects: Fentanyl can cause serious side effects, especially in chronic users and users who don’t take it as prescribed. These side effects include hallucinations, seizures, dizziness, changes in heart rate, and allergic reactions. Fentanyl can also cause respiratory depression, which makes a person’s breathing slower and less effective. Users with respiratory depression may experience shallow breathing, difficulty breathing, confusion, or fainting.
Legal risks: Due to its high potential for abuse, fentanyl is a Schedule II drug. Possessing fentanyl without a valid prescription is a criminal offense punishable by fines, court-ordered drug treatment, and/or jail time.
Fentanyl Background Information Derived From Synthetic production
Ways Used Smoked, snorted, sniffed, injected, ingested
Scientific Name Fentanyl hydrochloride/fentanyl citrate
Slang/Street Names for Fentanyl Dance Fever, China Girl, Friend, China White, Apache, Tango & Cash, Goodfellas, He-Man, King Ivory, China Town, Jackpot, Murder 8, Great Bear
How Long in Bodily System Half-life: 8-10 hours Elimination in two to three days, but up to a week in chronic users
Punitive Legal Measures: Using/Possession In the United States, fentanyl is a Schedule II controlled substance. Possessing fentanyl without a valid prescription is usually charged as a misdemeanor. Laws vary by state, but penalties may include fines, jail time, and required participation in a drug treatment program. For example, Massachusetts law classifies fentanyl as a Class A substance. Possessing a Class A substance without a valid prescription is punishable by up to two years in jail. Punitive Legal Measures: Selling/Distributing Trafficking fentanyl or possessing fentanyl with the intent to sell or distribute it are serious offenses. Potential penalties include significant fines and up to 20 years in prison. The penalties may be enhanced if an individual is convicted of selling fentanyl near a school, public park, or other government property.
DEA Drug Rating Schedule II Back to top
Signs of Abuse
Behavioral Symptoms of Fentanyl Usage and Abuse How fentanyl affects the brain The brain contains many nerve cells called opioid receptors. Fentanyl binds to these receptors, relieving pain and making the user feel happy and relaxed. One of the reasons fentanyl is so potent is because it binds tightly to the opioid receptors. As a result, very little fentanyl is needed to produce a state of euphoria. Additionally, fentanyl reaches the opioid receptors much faster than other narcotics, relaxing the user and producing an extreme sense of happiness within just a few minutes.
Behavioral signs of fentanyl usage and abuse Some fentanyl users display significant behavioral changes due to their misuse of this substance. Working adults may start calling in sick to work, showing up late, or asking to leave early. Difficulty performing work duties is another sign that an adult may be misusing fentanyl or another opioid. Parents may have difficulty performing tasks, such as attending school events and helping their children with homework. Adolescents who misuse fentanyl may start skipping school or hanging out with new friends. They may also quit participating in clubs or after-school activities. An individual who used to be financially stable might start to show signs of financial hardship. For example, someone who’s misusing fentanyl may overdraw their checking account or accumulate a large amount of debt. Some users take out loans to fund their fentanyl habits. Stealing money or asking to borrow money from friends and family may indicate that an individual needs more money to buy fentanyl. Other behavioral signs of fentanyl abuse include spending more time alone, frequent mood changes, lack of personal hygiene, sudden changes in appetite, and sleeping more or less than usual. Some people who misuse fentanyl engage in other risky behaviors, such as speeding or driving while under the influence of alcohol or drugs, making them more likely to get in trouble with the police. Physical Symptoms of Fentanyl Abuse How fentanyl affects the body In the human body, the opioid system regulates pain, body temperature, respiration, and stress response. When fentanyl binds to mu opioid receptors, it can cause respiratory depression, which is characterized by a breathing rate of eight to 10 breaths per minute. Respiratory depression can also cause reduced oxygen saturation, leaving an individual at an increased risk for heart attack and other complications associated with low oxygen levels. Fentanyl can also cause nausea, vomiting, constipation, and other undesirable physical effects. Early physical effects of fentanyl Fentanyl starts working within minutes, resulting in drowsiness, slowed heart rate, and a slower breathing rate. Some of these early physical effects of fentanyl may be dangerous, especially in individuals with a history of heart or lung problems. THIS TABLE ILLUSTRATES THE POSSIBLE SHORT-TERM PHYSICAL EFFECTS ASSOCIATED WITH FENTANYL. Short-term Physical SymptomsInitial (direct effects of drug, 30 – 60 min.)Drowsiness Slowed breathing Changes in heart rate Weakness Itching SweatingLingering (within an hour of taking the drug)Nausea Vomiting Constipation Constricted pupils SeizuresPost-Use (several hours to days after use)Fatigue Increased risk of tolerance or dependence Severe and long-term physical effects of fentanyl It only takes a small amount of fentanyl to produce severe side effects, increasing the risk of overdose for users who take more fentanyl than prescribed, or use fentanyl in a manner that’s inconsistent with the prescription instructions. For example, some people misuse fentanyl patches by tearing the patches open and removing the gel inside. Fentanyl patches are supposed to release a steady supply of the substance over several days. Users who inject, smoke, or ingest the gel receive a large dose of fentanyl all at once, increasing the risk of sudden death. In some cases, overdose occurs because users are unaware that they’re taking fentanyl. This usually occurs in one of two ways. First, fentanyl may be mixed in with heroin, cocaine, and other illicit substances. A heroin or cocaine user may not know that fentanyl has been mixed in, resulting in an unintentional overdose. Second, illegal laboratories are now producing fentanyl pills that look like anti-anxiety medications or other pain relievers. If someone takes one of these pills by mistake, an overdose can occur. The slowed breathing rate caused by fentanyl can be dangerous for some users. According to the American College of Cardiology, fentanyl is particularly risky for people with chronic obstructive pulmonary disease and other lung problems. Fentanyl may also increase the risk of complications in people who have obstructive sleep apnea, which causes multiple interruptions in breathing during sleep. People with OSA who take fentanyl may develop abnormal heart rhythms or have heart attacks due to the worsening of their breathing problems. THIS TABLE ILLUSTRATES THE POSSIBLE LONG-TERM PHYSICAL EFFECTS ASSOCIATED WITH FENTANYL. Long-term Physical SymptomsCasualHeadaches Nausea Vomiting ConstipationChronicIncluding all of the above effects for casual useWeakness FatigueWithdrawalMuscle aches Difficulty sleeping Runny nose Increased tearing Sweating Diarrhea Abdominal pain Yawning Vomiting Goose bumps Nausea Further Resources Both the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) offer in-depth information on both the symptoms and treatment of fentanyl addiction. Back to top
Rates of non-medical fentanyl usage have increased worldwide When fentanyl was first introduced, it was used mostly to anesthetize people for surgery or to supplement other forms of anesthesia. Within the past 30 years, however, pharmaceutical companies have introduced new forms of fentanyl, and have marketed fentanyl for uses other than anesthesia. For example, the introduction of an extended-release patch made fentanyl useful for treating people with chronic pain caused by cancer and other ailments. As a result, the supply of fentanyl increased, giving more people access to this substance. Although fentanyl use has certainly increased in the United States, the problem of fentanyl misuse is not a uniquely American one. According to the 2018 World Drug Report published by the United Nations Office on Drugs and Crime, fentanyl is one of the most frequently abused pharmaceutical opioids in Europe. In Central and Western Europe, many heroin users start abusing fentanyl because they’re looking for an alternative to heroin. The use of fentanyl and fentanyl derivatives is especially prevalent in Estonia, which recorded 10.6 fentanyl overdose deaths per 100,000 inhabitants in 2017. In Canada, many of the 2,066 opioid overdose deaths that occurred in the first six months of 2018 were attributed to fentanyl and fentanyl analogs. Opioid overdose deaths are more common in Ontario, British Columbia, and Alberta than in other parts of Canada. Fentanyl is also infiltrating the drug supplies of Thailand, Indonesia, India, and other Asian countries, increasing the risk of overdose in people who use heroin and cocaine. While some countries have responded by tightening their drug laws, others are attempting to prevent additional overdose deaths by implementing new policies aimed at decriminalizing the use of substances, such as kratom and cannabis. FENTANYL USAGE THROUGHOUT THE WORLD HighestSecondThirdRegions with the highest number of fentanyl usersNorth AmericaCentral Europe/Western EuropeAsiaRegions with the largest quantities of fentanyl seized in 2018North America/South AmericaEuropeAsia Sources: 2019 World Drug Report (United Nations Office on Drugs and Crime) Fentanyl Usage Demographics in the U.S. In the United States, fentanyl usage is increasing due to a significant increase in the fentanyl supply The Substance Abuse and Mental Health Services Administration reports that in 2016, approximately 0.1% of the U.S. population reported misusing Fentanyl within the prior 12-month period. More people are misusing fentanyl due to an increase in the amount of fentanyl produced by illegal laboratories in China and other Asian countries. Some of this fentanyl is trafficked over the U.S.-Mexico border, making more fentanyl available to non-medical users. In some cases, this illicit fentanyl arrives in the form of a powder and is turned into tablets or added to heroin and cocaine once it’s in the United States. In 2017, more than 2,000 kg of fentanyl were seized in North and South America; much of it was seized within the United States, particularly in towns along the Mexican border. For example, a number of seizures occurred in San Diego and Tucson, which are approximately 17 miles and 50 miles away from the border, respectively. Two cartels, the Cártel de Jalisco Nueva Generación and the Sinaloa cartel, are responsible for much of the fentanyl trafficking that takes place between Mexico and the United States. Another issue of concern in the United States is the use of fentanyl with other drugs. According to the 2018 World Drug Report, approximately 500,000 people used heroin in combination with a prescription opioid, such as fentanyl, in 2017; this is greater than the number of people who used heroin alone. As explained by Jeremy Barnett, a Credentialed Alcoholism and Substance Abuse Counselor, “Fentanyl is, at this point, almost solely associated with the increasing number of opioid-related overdoses in the United States. When people who abuse prescribed painkillers, such as Oxycodone or Percocet, look to the streets once the cost of supporting such a habit becomes unsustainable, they dramatically increase their chances of overdose, as users – and often their dealers – are oblivious to the purity of the stash.” Although fentanyl misuse continues to be a serious problem in the United States, data from the Monitoring the Future Study indicate that rates of narcotic use among adolescents decreased between 2018 and 2019. In 2018, 3.4% of 12th graders surveyed reported that they had used a narcotic other than heroin within the past 12 months; in 2019, only 2.7% of 12th graders surveyed reported that they were past-year users of narcotics other than heroin. DEMOGRAPHICS OF PRESCRIPTION NARCOTIC USAGE Past Year (2018)Lifetime8th grade (14-15 yo)No data collected No data collected10th grade (15-16 yo)No data collected No data collected12th grade (17-18 yo)6.00%5.30% Source: 2015-2018 Monitoring the Future Study: Trends in Prevalence Back to top
How to Find Help
Fentanyl affects the reward center of the brain, producing pleasurable effects and making some users crave more of the substance. Over time, users may develop a tolerance to fentanyl, causing them to take larger doses or engage in unsafe behaviors, such as removing the gel from fentanyl patches and injecting, smoking, or ingesting it. Even if a user wants to stop taking fentanyl, the withdrawal process can cause serious physical and psychological effects, making it difficult to stop. Fentanyl rehabilitation typically takes the form of a multi-step process involving an initial detoxification period and participation in group therapy or individual counseling sessions. This type of treatment gives fentanyl users much-needed support and reduces the risk of relapse. Read our fentanyl rehabilitation guide to learn more about this process. Staging an Intervention If you have a loved one who’s struggling with addiction, staging an intervention is often the first necessary step towards sobriety, but it’s important to be strategic and loving in your approach. Even the most well-meaning of interventions can have a negative effect if they aren’t handled correctly. 5 Tips for Staging an Intervention 1. Don’t Do It Alone. A professional interventionist is always the most qualified to guide a successful intervention. Also, rely on non-addict family and friends – especially those who have a close relationship with you or the addict.
2. Research Ahead of Time. It’s best to do plenty of research ahead of time to gather insight on the addiction and how it affects the addict. Also, be prepared with local resources for getting help.
3. Write Out Your Statement. During the actual intervention, emotions will likely be running high, so it’s best to have a statement of how the person’s addiction has impacted you and your relationship with him or her. These statements should be honest, yet written from a place of love – no personal attacks.
4. Offer Help. It’s important for everyone attending the intervention to offer tangible help and support as the person works through detox and rehabilitation.
5. Set Boundaries. If the person refuses to seek help and take the next steps outlined, it’s important that they understand that everyone present will end codependence and enabling behaviors.