Fentanyl is an opioid drug. It is a chemically synthesized relative of opiates, like morphine and heroin, which are all derived from the opium poppy. The drug mimics our brain’s own pain-regulating molecules, or endogenous opioids, which act at receptors found in the nervous system.
Opioids are a pain relieving drug but have various side effects, one of which is addiction. Fentanyl is up to 100 times more powerful than morphine and is considered a schedule II prescription drug [2, 3].
It is typically administered by a physician and injected,used in transdermal patch or given in lozenges form. Non-pharmaceutical fentanyl is sold as powder, spiked on blotter paper, mixed with or substituted for heroin, tablets, or less potent opioids.
Individuals who abuse it can swallow, snort, inject fentanyl. Its typically only prescribed to individuals if their current opioid prescription is no longer work for pain management.
How Does Fentnyl Affect the Body?
Fentanyl works similar to heroin, morphine, and other opioids by binding to the body’s opioid receptors in the brain which control pain and emotions. When fentanyl binds to these receptors, it increases dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation.
It can cause:
- Euphoria
- Drowsiness
- Nausea
- Confusion
- Constipation
- Sedation
- Tolerance
- Addiction
- Respiratory depression and arrest
- Unconsciousness
- Coma
- Death [2, 3].
Receptors that control breathing rate are also affected. High doses of opioids, especially potent ones such as fentanyl can cause breathing to stop completely, which can lead to death.
In a hospital setting, the drug can be administered via injections but in abuse situations, it is extremely easy to overdose in this way. Most abusers will look for the sublingual film that comes in time sheets (blotter sheets) to put under the tongue, the pills that are lodged between teeth and cheek, or long-lasting patches.
Abusers are also known to squeeze the liquid or gel out of the patches and smoke, ingest or place the solution under the tongue.
Actiq is sold as a lollipop that is sucked over time to release the drug and a sublingual spray for breakthrough cancer pain [3].
Because of the strength of fentanyls extraordinary strength, the drug can very quickly create a tolerance for the drug.
A dose daily in a two day period, can go from a feeling of drowsy euphoria, to no reaction to the drug. For those using the drug for pain relief, it can be difficult to keep pain under control due to the fast tolerance building effect.
Why Fentanyl Leads to Opioid Addiction
One reason How Fentanyl Addiction Has Lead to an Opioid Overdose Crisis is due to the difference between addiction and overdose. Some individuals can become addicted to the drug without ever abusing it. They can take the drug as prescribed, but be addicted on a physical level.
When a person abuses the drug, the addiction is both physical and psychological. Effects include drug use effects and withdrawal from the drug effects. Side effects of Fentanyl include nausea, drowsiness, lethargy, shortness of breath, difficulty breaking, swelling of extremities, headaches and risk of death [3].
The effects of withdrawal from Fentanyl include extreme restlessness, yawning, sweating, watery eyes, chills, muscle and bone pain, anxiety, irritability, weakness, stomach cramps, insomnia, and vomiting.
When abusing the drug the individual can lose their ability to make rational decision, and when withdrawal symptoms begin it is extremely difficult to continue the withdrawal process.
Fentanyl and pregnancy can produce drug dependence in newborns and secrete into the breastmilk if the mother is breastfeeding [10, 11]. It can also result in neonatal opioid withdrawal syndrome which signs include poor feed and irritability, diarrhea, tremor and seizures, and rigidity..
What is the Crisis All About and What is Being Done
Of the 20.5 million Americans 12 and older who have had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroine [8, 11].
23% of those who use heroin develop an opioid addiction. Drug overdoses are the leading cause of accidental deaths in the US and 52,404 lethal drug overdoses in 2015. 20,101 overdose deaths related to prescription pain relievers, while 12,900 were due to heroin in 2015.
In Cincinnati, 174 people overdose on opioids in 6 days and in Huntington, West Virginia 26 people overdosed in a four hour span [4, 6]. Fentanyl has only risen in drug of choice in the last five years, and has replaced Oxycodone so it is common to find the drug disguised as a pre-2012 Oxycodone pill.
Fentanyl is also easier to manufacture and disguise as other drugs. Many purchasers of drugs, do not realize that their opioid may be laced with Fentanyl which makes it a more dangerous behavior.
Most authorities believe that Fentanyl comes from Mexico where other illicit heroin and synthetic opioids originate, and cartels have been using chemicals sent from China for some time. Unlike heroin, synthetic opioids can be cheaply manufactured on an industrial scale and little chemical knowledge.
It costs between $3,000 to $4,000 to produce a kilo of Fentanyl, the same as to make a kilo of heroin. Heroin can sell for $60,000 or higher and go for several hundred thousand when diluted and sold by the gram. This results in a multi million profit annually for dealers.
China has made it illegal to export fentanyl but shipment leaks are growing. In the US federal agencies are continuing to draft new regulations to control the amount of painkillers being prescribed by physicians and warn patients of the drugs addictive characteristics [5, 7].
Fentanyl overdose can be reversed with an injection of naloxone, and major pharmacies, like CVS and Walgreens sell naloxone without a prescription in states that allow it, and most law enforcement carry a dose of naloxone with them at all times due to the growing crisis.
In contrast to other addictions which can take years to recovery, opioid addiction is imminently fatal, so waiting for treatment can literally be lethal. Treatment needs to be immediate and happen at all levels of care.
Research has shown that a combination of medication and psychosocial treatments is most effective for opioid use. A study from MassHealth found that patients on medication treatments like methadone or buprenorphine are 50% less likely to die [12].
In conclusion, fentanyl is a drug that is 100 times more powerful than morphine and is instantly addictive to users. Immediate treatment to overdose, education, prevention, and national policies are being identified to help reduce the Fentanyl crisis.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References:
[1] https://www.scientificamerican.com/article/why-the-pain-drug-that-killed-prince-can-be-especially-dangerous/
[2] https://www.drugabuse.gov/publications/drugfacts/fentanyl
[3] http://www.narconon.org/drug-abuse/fentanyl-effects.html
[4] http://www.cbc.ca/news/health/fentanyl-carfentanil-opioid-crisis-spreading-across-canada-1.3909986
[5] https://thinkprogress.org/americas-overdose-crisis-is-being-fueled-by-a-drug-50-times-more-potent-than-heroin-a84de27c71a3
[6] https://news.vice.com/article/americas-new-deadliest-drug-fentanyl
[7] http://health.usnews.com/health-care/articles/2016-08-25/synthetic-fentanyl-fueling-surge-in-overdose-deaths-cdc
[8] http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
[9] http://www.cnn.com/2016/05/10/health/fentanyl-new-heroin-deadlier/
[10] https://www.cdc.gov/drugoverdose/epidemic/
[11] http://www.everydayhealth.com/drugs/fentanyl
[12] http://www.health.harvard.edu/blog/fentanyl-dangers-potent-man-made-opioid-2016080510141
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Published April 20, 2017.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 20, 2017.
Published on AddictionHope.com