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Fentanyl Addiction: Signs, Symptoms & Medications

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Jan 10, 2024 • 7 cited sources

Fentanyl addiction often ends in fatal overdose. Most people begin by misusing prescription painkillers, and the pills they buy on the street are often laced with fentanyl. Some people seek out fentanyl for the intense high it brings, but it’s incredibly easy to overdose on this drug.

Fentanyl is a drug with two lives. In one life, it’s a powerful pain medication used in medical settings to help people struggling with overwhelming pain. In another, it’s an intoxicating substance dealers add to their products to increase their profits.

Fentanyl is versatile, and it’s available as pills, powders and liquids. Any or all of them could be inside the drugs you buy from a dealer. And since fentanyl is so much more powerful than other drugs (including heroin), a dose that seems right to you could be strong enough to kill you.

Drug addiction isn’t new. For decades, people have struggled with the chemical and emotional changes substance misuse can cause. But fentanyl is responsible for a new wave of overdose deaths in people who never planned to take this drug. 

Anyone who buys drugs from dealers — even once — should know what fentanyl is and how it works. 

4 Key Facts About Fentanyl

  • Fentanyl is a synthetic opioid that is much stronger than other drugs in its class. Fentanyl is about 100 times stronger than morphine. An amount of fentanyl that is so small it can fit on a pencil tip can be lethal.[1]
  • Among fentanyl-laced pills that are tested by officials, 6 in 10 contain a deadly dose of the drug.[1]
  • The drug overdose category currently growing at the fastest pace is one experts call “synthetic opioids other than methadone,” which includes fentanyl.[2]
  • More than 150 people die every day due to overdoses of synthetic opioids like fentanyl.[3]
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Why Is Fentanyl Dangerous?

All opioids share some hazards and characteristics. But fentanyl’s strength, speed and power make it one of the most unpredictable and dangerous medications in its class. It’s almost impossible to detect too, as it’s odorless, colorless and tasteless.[3] 

Understanding its risks could help you see why buying drugs from dealers is so risky.

Short-Term & Long-Term Side Effects of Fentanyl

Short-Term Side Effects

Fentanyl is a potent central nervous system depressant, capable of delivering changes in minutes. 

People intoxicated by fentanyl often have these symptoms:

  • Sedation
  • Slurred speech
  • Nodding head
  • Lack of coordination
  • Slow breathing 

Fentanyl doses wear off, and when they do, people may only remember the euphoria the drug delivered. Memory gaps of several hours are common in people who use fentanyl. 

Long-Term Side Effects

Many people misuse fentanyl repeatedly even if they aren’t specifically seeking fentanyl out, since fentanyl is commonly mixed into other street drugs. But people who develop a fentanyl addiction may develop the following health issues:

  • Chronic constipation due to fentanyl’s slowdown of gut function
  • Infected injection spots from dirty needles
  • Weight loss
  • Sexually transmitted disease
  • Hepatitis C 

Withdrawal Symptoms

Fentanyl is powerful, and its changes linger when the doses wear off. Brain cells shocked into releasing chemicals with fentanyl may malfunction when the drug is gone. 

Common fentanyl withdrawal symptoms include the following:

  • Nausea
  • Stomach cramps
  • Cold sweats
  • Goosebumps
  • Runny nose
  • Watery eyes
  • Diarrhea
  • Headache
  • Dehydration

Long episodes of vomiting and diarrhea can lead to dehydration, which can harm vital organs like the kidneys. Withdrawal stress can also stress the heart, leading to cardiac events like heart attack. A withdrawal episode can be life-threatening. 

Overdose Symptoms

Fentanyl is a central nervous system depressant, causing deep relaxation and sedation. At even tiny amounts, fentanyl can slow or even stop breathing or heart rates. This is a medical emergency, and without treatment, people can die due to an overdose.

A fentanyl overdose causes the following symptoms:

  • Cool, clammy skin
  • Pale or blue-tinged lips and fingernails
  • Slow, shallow breathing
  • Gagging or choking sounds
  • Severe sedation or unconsciousness

A person experiencing a fentanyl overdose won’t respond to shakes, slaps or verbal cues. Someone like this can be revived with the medication naloxone.

Naloxone kicks opioids off receptors, but it’s sometimes not strong enough for fentanyl. Researchers say more than 80% of people experiencing a fentanyl overdose need two naloxone doses, while most people using other opioids only need one.[4] 

If a person who has overdosed on fentanyl responds to the second dose of naloxone, they still need emergency help. Naloxone wears off quickly, meaning the opioid overdose could return, and this is more common with fentanyl due to its strength.

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How Is Fentanyl Fueling the Opioid Epidemic?

Illicit drugs contaminated with fentanyl are spreading throughout the United States, and many people are dying due to overdoses. An experienced drug user may buy two tablets that look like Vicodin and think that dose is safe, but if the pills contain fentanyl, that dose is much too large. 

Researchers say drug overdose deaths quadrupled between 1999 and 2015. Between May 2020 and April 2021, more than 100,000 Americans died due to drug overdose — and of them, 64% were caused by fentanyl and its analogs.[5] 

Politicians say most of America’s fentanyl is manufactured in China and brought into the country by drug cartels.[6] Dealers can cite the following reasons for mixing fentanyl into their drugs:[7]

  • It’s addictive. Customers will come back for more because the drug does so much damage.
  • It’s powerful. A tiny amount can mimic the action of a larger dose of other opioids. 
  • It increases profit margins. Instead of stealing or buying legitimate pills, dealers can spike products with a tiny amount of drug mixed into inexpensive fillers.
  • It’s tiny and easy to smuggle. Bringing thousands of pills across the border is hard. Hiding a tiny amount of powder is not. 

Some people seek out fentanyl directly and develop addictions to this powerful drug. But it’s far more common for people to develop an addiction to something else and get exposed to fentanyl inadvertently. 

What Does Fentanyl Misuse Look Like?

People with substance misuse problems come from all walks of life. It’s impossible to pick people who misuse fentanyl out of a crowd and definitively diagnose their problems. But people with fentanyl problems do tend to share characteristics. 

Behavioral changes associated with fentanyl misuse include the following:

  • Secretiveness
  • Financial issues
  • New friends 
  • Unexplained work or school absences
  • Defensiveness when asked about drugs

Physical changes associated with fentanyl misuse include the following:

  • Weight loss
  • Unkempt appearance
  • Frequent sedation 
  • Unexplained constipation 
  • Frequent overdoses or withdrawal episodes 

Is It Time to Get Help?

Substance misuse stigma is very real. People struggling with opioids like fentanyl often worry about what others will think about them or say to them when they try to quit. But if you answer “yes” to these questions, it might be time to put worries aside and get help:

  1. Have I tried to quit using opioids and failed?
  2. Am I afraid of opioid withdrawal symptoms?
  3. Is my work or schoolwork suffering because of drug use?
  4. Have I used drugs in dangerous situations (like while driving or caring for children)?
  5. Have people told me they’re worried about my drug use?
  6. Have I spent money I can’t spare on fentanyl?
  7. Have I overdosed on fentanyl in the past?
  8. Have I experienced a drug-related health problem (like an infection)?
  9. Am I worried about what will happen if I keep using fentanyl?
  10. Do drug cravings seem overwhelming to me?

MAT for Fentanyl Misuse

Medication for Addiction Treatment (MAT) involves using prescriptions like Suboxone (buprenorphine/naloxone). The buprenorphine in these medications latches to receptors once used by Suboxone, and it can ease withdrawal symptoms. With Suboxone, you can get sober without experiencing life-threatening dehydration.

Suboxone can also help to ease cravings, making it an ideal treatment for long-term use. MAT therapies do not cause intoxication, so you won’t feel high or out of sorts while using them. But they can help you navigate challenges without returning to drug misuse. 

Bicycle Health uses telemedicine to administer MAT. Meet with a doctor via a secure connection on your phone or computer. You’ll then discuss your fentanyl misuse, any other substance misuse, and recovery plans. You’ll get a prescription for Suboxone that you can fill at your local pharmacy. 

There isn’t a time limit to this treatment. Stay enrolled in MAT as long as it’s helpful for you. Many people remain on Suboxone for years, and some people take it for the rest of their lives. 

Contact Bicycle Health to find out if this treatment is right for you, and enroll in care to help you get better.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. DEA Laboratory Testing Reveals that 6 out of 10 Fentanyl-Laced Fake Prescription Pills Now Contain a Potentially Lethal Dose of Fentanyl. U.S. Department of Justice. Accessed April 2023.
  2. Drug Overdoses. National Safety Council. Accessed April 2023.
  3. Fentanyl Facts. Centers for Disease Control and Prevention. February 2022. Accessed April 2023.
  4. Higher Doses of Naloxone Are Needed in the Synthetic Opioid Era. Substance Abuse Treatment, Prevention and Policy February 2019. Accessed April 2023.
  5. What Is Fentanyl and Why Is It Behind the Deadly Surge in U.S. Drug Overdoses? University of Massachusetts. May 2022. Accessed April 2023.
  6. China's Role in Illicit Fentanyl Running Rampant on U.S. Streets. Congressman David Trone. January 2023. Accessed April 2023.
  7. If Fentanyl Is So Deadly, Why Do Drug Dealers Use It to Lace Illicit Drugs? ABC News. February 2023. Accessed April 2023.

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