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The Dangers of Fentanyl Misuse and How to Spot the Signs

May 20, 2022

Table of Contents

Fentanyl is a pharmaceutical agent designed for pain treatment which is often illicitly produced by clandestine means and sold by drug traffickers. 

The drug is one of several highly potent opioids whose abuse has become a major public health problem over the past decade. 

In some cases, fentanyl and its cousins are also referred to as synthetic drugs other than methadone, since they are synthesized and not derived from plants. These types of drugs are highly potent and extremely dangerous. Only a low dose is needed to activate the opioid receptor, and the drug will remain in the body for a long time.

What Is Fentanyl?

Manufactured for therapeutic reasons, fentanyl is a powerful treatment for acute and chronic pain with rapid onset of action and strong analgesic effects. This highly potent drug is 50 to 100 times more potent than morphine - which is how it works so effectively for pain alleviation.[1] 

As a pharmaceutical product, fentanyl is distributed as a patch, which allows for the slow, long-lasting release of medication through the skin. It is also sold as a lozenge, tablet, or film dissolved through the oral mucosa.

Over the last decade, fentanyl and fentanyl-like compounds have been increasingly mass-produced by the black market in numerous forms. 

Fentanyl and other similar compounds are often added to heroin, and vice versa, without the buyer’s knowledge.[2] 

These synthetic analogs are also often sold as counterfeit prescription opioids by drug dealers. Examples of highly potent synthetic opioids found on the streets include fentanyl, other fentanyl analogs like:

  • sufentanil
  • alfentanil
  • remifentanil
  • carfentanil

This list also contains novel illicitly manufactured synthetic opioids such as: 

  • acetyl fentanyl
  • butyryl fentanyl
  • beta-hydroxythiofentanyl
  • furanyl fentanyl
  • U-47700

Is Fentanyl Illegal?

When prescribed for pain treatment, and if taken as directed by your doctor, fentanyl is legal and can be a helpful medication. However, when taken recreationally or misused, it is as illegal as any other opioid, including heroin. 

As each new dangerous synthetic opioid compound appears on the streets, the Drug Enforcement Agency responds by adding it to the long list of Scheduled drugs under the Controlled Substances Act. This also involves defining the drug's parameters for therapeutic use, if any, and risk for prosecution if it is distributed by someone or ingested.

Common Ways Fentanyl Is Misused

Illicitly manufactured fentanyl is sold in the forms of a powder, dropped on blotter paper like small candies, in eye droppers or nasal sprays, or as pills that resemble real prescription opioids. 

Pharmaceutical fentanyl usually comes as a patch, lozenge, tablet, or film.

When misused, fentanyl can be ingested through a variety of mechanisms: orally, across the skin, by snorting, by injecting, or by inhaling after volatilization.[3]

Signs of Fentanyl Abuse and Side Effects

People who misuse fentanyl and other synthetic opioids can develop opioid use disorder (OUD). This means they have lost control of their use, are using the drug recklessly, and have a compulsive need to keep using it, despite all the negative consequences on their lives. 

People with OUD also experience tolerance which involves taking more of the drug to achieve the same effect. In addition to tolerance, individuals with OUD can experience severe and uncomfortable symptoms during withdrawal, which happens when someone stops using the opioid.

The physical and psychological signs of fentanyl misuse, use disorder, and withdrawal are similar to those associated with other opioids and are well described in this article

Some of the most common effects of fentanyl and other opioids include:

  • Euphoria
  • Analgesia
  • Reduced anxiety
  • Drowsiness
  • Relaxation
  • Reduced respiratory drive
  • Constipation
  • Confusion
  • Urinary retention
  • Constricted pupils
  • Nausea
  • Itching
  • Cough suppression
  • Low blood pressure
  • Fainting

Common symptoms of overdose from fentanyl and other opioids include:

  • Stupor
  • Cold and clammy skin
  • Blue skin coloration
  • Pinpoint pupils
  • Coma
  • Respiratory failure
  • Death

The Dangers of Fentanyl Abuse

As with other opioids, misuse of fentanyl, either pharmaceutical grade or illicitly manufactured, carries numerous risks. All opioids can cause euphoria. If they are taken almost daily or daily, tolerance and withdrawal come about, leading to the development of addiction or OUD

OUD often brings significant impairment in function, with frequent job loss, loss of friends and family, and financial strain.

Fentanyl misuse and misuse of other illicitly manufactured synthetic opioids carry additional risks beyond those seen with other opioids. There are a couple of reasons for this.

For one, it is extremely easy to overdose on fentanyl. 

Fentanyl and the other synthetic drugs are high potency drugs, which means they attach themselves to the opioid receptor much more readily than the other opioids. 

Despite the euphoric effect being short-lived, these compounds stay in the body for days as they are rapidly taken up by other tissues upon ingestion. 

Overdose death rates from these compounds are now the most common cause of opioid overdoses in the United States. In 2017, close to 50,000 people died of an opioid overdose, 60% of which were attributable to fentanyl or other high potency synthetic opioids other than methadone.[4] 

Moreover, illicitly manufactured synthetic opioids like fentanyl are often laced with stimulants (methamphetamine, cocaine, MDMA) and other toxic chemicals. Therefore, additional adverse but unforeseen consequences can often ensue if someone ingests them.

Getting Treatment for Fentanyl Dependence

If you or your loved one needs help with a fentanyl problem, there are solutions. The treatment for a fentanyl problem is almost the same as the treatment for an OUD. 

For OUD, counseling and support groups are of great help, but the cornerstone of treatment involves the use of medications that reduce craving and prevent relapse. This evidence-based approach is often referred to as Medications for Addiction Treatment(MAT). 

MAT involves using one of three classes of medication (namely buprenorphine-based medications like Suboxone, naltrexone, and methadone) that have been established through numerous studies to improve function and reduce overdose risk and mortality rates. 

However, certain things make fentanyl use disorder especially challenging to treat when compared with other opioids.

Illicit fentanyl is often laced with other substances, so there might be additional issues that need to be addressed such as stimulant use disorder. 

Furthermore, since fentanyl lasts in the body for days, it may be harder to initiate the two OUD treatment medications that should be started only when someone is in withdrawal - namely buprenorphine and naltrexone.[5]

Despite this challenge, Suboxone is still an excellent first-line treatment for people with a fentanyl problem. For OUD treatment, Suboxone outshines methadone from the standpoint of safety and convenience, it is easier to start than naltrexone, and it has comparable efficacy. 

Therefore, as long as someone can get started on Suboxone without difficulty, it can be an extremely useful option for people with fentanyl use disorder.   

Learn How Bicycle Health Treatment Options for Fentanyl Dependence

Bicycle Health uses Suboxone as a primary medication for dealing with opioid dependence. To learn more about the benefits and the effects of Suboxone, schedule a time to speak with one of our MAT professionals, or call us today at (844) 943-2514.


Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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1. Stanley TH. The fentanyl story. J Pain. 2014; 15(12):1215-26. doi: 10.1016/j.jpain.2014.08.010.

2. Suzuki J, El-Haddad, S. A review: Fentanyl and non-pharmaceutical fentanyls. Drug Alc Depend. 2017; 171(1): 107-116.doi:10.1016/j.drugalcdep.2016.11.033.

3. Kuczyńska K, Grzonkowski P, Kacprzak L, Zawilska JB. Abuse of fentanyl: An emerging problem to face. Forensic Sci Int. 2018;289:207-214. DOI: 10.1016/j.forsciint.2018.05.042

4. Centers for Disease Control and Prevention. 2019 Annual Surveillance Report of Drug‐Related Risks and Outcomes—United States Surveillance Special Report. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.

5. Shearer D, Young S, Fairbarin N, Brar R. Challenges with buprenorphine inducations in the context of the fentanyl overdose crisis: A case series. Drug Alcohol Rev. 2021;Online ahead of print. doi: 10.1111/dar.13394.  


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