Why Fentanyl is so Addictive & Deadly

Nature Railroad Tracks into Stormy Clouds

In the United States, synthetic opioid drugs are the most common drugs involved in drug overdose deaths [1], with over 36,000 people dying from overdoses involving synthetic opioids in 2019 [2]. One of the most addictive and deadly synthetic opioids is a drug called fentanyl. According to a report by the National Institute on Drug Abuse, nearly 60 percent of all opioid-related deaths involved the drug in 2017, with that number likely on the rise [3].

If you suspect you or a loved one may be addicted to fentanyl, here is a brief look at why it is so addictive and deadly, plus a quick overview of treatment options for dependence and addiction.

What is Fentanyl?

Fentanyl is an extremely powerful, synthetic (manmade) opioid drug prescribed to treat severe or chronic pain. Fifty to 100 times stronger than morphine, fentanyl is classified as a Schedule II controlled substance by the Drug Enforcement Administration (DEA). This means that although fentanyl has accepted medical uses (e.g., it is often prescribed to treat severe pain among advanced cancer patients or for post-surgery pain relief), it also has a very high potential for misuse, abuse, and addiction.

When legally prescribed by a doctor, fentanyl is administered in the form of a shot, a transdermal patch, or as a cough-drop-like lozenge. Though prescription fentanyl can be illegally diverted and misused, most cases of its abuse and overdose are linked to illegally made fentanyl, according to a report by the DEA [4].

Illegal fentanyl, sold illicitly for its heroin-like effect, is typically made in clandestine labs. When made and sold illegally, it is administered in the following forms: pills; powder; placed on blotter paper to be absorbed under the tongue; put into nasal sprays and eye droppers, or mixed in with other drugs such as heroin or cocaine [5]. Street names for illegal fentanyl include Friend, Jackpot, Tango & Cash, Murder 8, Apache, Goodfellas, and Dance Fever.

Why is it so Addictive?

Fentanyl is extremely addictive for several reasons, the first being its high potency. As mentioned previously, fentanyl is 50 to 100 times more potent than morphine and 25 to 50 times more powerful than heroin. Thanks to its high potency, people can quickly become physically dependent on it, even when they are taking small amounts for a legitimate medical reason.

Another reason fentanyl is so addictive is because of the powerful effect it has on the central nervous system and brain. Similar to other opioids, fentanyl binds to the brain’s opioid receptors, causing excessive amounts of dopamine to flood the brain. While this flood of dopamine produces intense feelings of relaxation and euphoria (or a “high”), it also begins to chemically alter the brain. Over time, these neurochemical changes make it nearly impossible for fentanyl users to feel “normal” or experience pleasure without taking the drug, essentially making the brain dependent on it [6].

Finally, when a person becomes physically dependent on fentanyl, they will often experience painful withdrawal symptoms when the drug wears off. Fentanyl withdrawal symptoms include agitation, irritability, anxiety, depression, insomnia, and flu-like physical symptoms. To avoid these uncomfortable symptoms of withdrawal, many people may continue to take fentanyl after their prescription is gone or start taking more than the prescribed amount simply to avoid the negative effects of withdrawal. Unfortunately, this can lead to a serious addiction.

The Dangers of Fentanyl

Due to its high potency, it is much easier for people to accidentally overdose on fentanyl than on other drugs. In fact, fentanyl can prove deadly even in very small doses. For example, a lethal dose of morphine is considered to be over 200 milligrams, and a lethal dose of heroin is between 75 and 375 milligrams. However, a lethal dose of fentanyl is between just 2 and 3 milligrams.

Since such a small amount of fentanyl produces an intense high, it is a much cheaper option than drugs like heroin, methamphetamine, and cocaine. As a result, some drug dealers mix fentanyl with other drugs, making their products more potent for a cheaper, out-of-pocket cost.

Asian American Woman learning about fentanyl abuseHowever, mixing fentanyl with other drugs such as heroin increases the risk of overdose greatly as users are often unaware that the product they bought is laced with fentanyl. Subsequently, they may end up taking a much higher dosage of opioids than their body can handle, leading to an accidental overdose or even death [7].

Symptoms of a fentanyl overdose can occur within minutes or even seconds of taking the drug. One of the most common symptoms of a fentanyl overdose is slowed or stopped breathing. When this happens, the brain no longer receives the oxygen it needs, which can then lead to a coma, permanent brain damage, or even death. Other symptoms and side effects of a fentanyl overdose include:

  • Confusion
  • Lethargy
  • Drowsiness
  • Decreased heart rate
  • Decreased body temperature
  • Dizziness
  • Low blood pressure
  • Loss of consciousness
  • Cold, clammy skin
  • Limp body
  • Nausea and vomiting
  • Blue colored lips
  • Foaming at the mouth
  • Seizure-like activity
  • Changes in pupillary size (i.e., pinpoint pupils)

In addition to the risks of overdose, fentanyl misuse can cause cognitive defects and long-term damage to the brain, cardiovascular system, and respiratory system. Injecting it also increases a person’s risk of developing skin abscesses, collapsed veins, track marks, and scarring as well as contracting infectious diseases such as HIV/AIDS and hepatitis.

Treating Fentanyl Addiction

The first step in treating a fentanyl addiction is detoxing from the drug. Since it is such a powerful drug, it can cause severe or even life-threatening withdrawal symptoms, so it is never advisable to attempt detoxing without medical supervision and support. Thankfully, there are numerous treatment programs available that are equipped to help people safely and successfully overcome fentanyl addiction. Treatment for fentanyl addiction often includes medication as well as therapy and counseling.

If you or a loved one are suffering from fentanyl dependence or addiction, reach out for help right away. Start by talking to your doctor or call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 to talk to someone about getting help and to find treatment options in your area.


[1] NIDA. 2019, February 28. Fentanyl DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/fentanyl on 2021, March 22
[2] Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019. MMWR Morb Mortal Wkly Rep 2021;70:202–207.
[3] NIDA. 2019, February 28. Fentanyl DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/fentanyl on 2021, March 22
[4] Department of Justice, Drug Enforcement Administration, DEA Investigative Reporting, January 2015.
[5] NIDA. 2019, February 28. Fentanyl DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/fentanyl on 2021, March 22
[6] ibid.
[7] ibid.

About the Author:

Sarah Musick PhotoSarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.

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 a discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from multiple physical, emotional, 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 on March 26, 2021, on AddictionHope.com
Reviewed & Approved on March 26, 2021, by Jacquelyn Ekern, MS, LPC

About Baxter Ekern

Baxter Ekern is the Vice President of Ekern Enterprises, Inc. He contributed and helped write a major portion of Addiction Hope and is responsible for the operations of the website.