What to know about Fentanyl
Fentanyl is a highly potent synthetic prescription opioid available in several different formats, including fentanyl lollipops, patches, tablets and sprays. Although the drug is primarily used for treating specific types of pain associated with terminal diseases like cancer, opioids like fentanyl are highly addictive, even for users with valid prescriptions. Small amounts can cause respiratory depression, and fentanyl withdrawal can be extremely painful. Over the past two decades, opioids have been involved in 840,000 overdose deaths in the United States. Opioid overprescribing, misuse and recreational abuse have led to fatal consequences for many. The growing abuse of synthetic opioids like fentanyl, which is often used to cut other drugs, continues to cause injury and death in numerous states across the country.
What is fentanyl?
Fentanyl is a fully synthetic opioid used for pain relief. The potent opioid is 50 to 100 times more potent than morphine. Fentynal was initially approved as an anesthesia in 1968 for medical operations because of its strength, how quickly it takes effect, and the short duration of effects. The drug was later approved to treat severe pain, once fentanyl patches and oral formulations were developed. The high-strength opioid can be extremely toxic and has become a leading cause of overdose death in the United States. As little as two milligrams (about the size of two grains of salt) can be fatal to most people.
Learn more about treatment with a free consultation
If you are considering addiction treatment for yourself or someone in your life, now is the time to take action. Fentynal is an extremely potent opioid that has taken many lives, broken up families and destroyed futures. Even those who abuse other drugs unknowingly risk fentanyl overdose. Call 888-387-1531 for a free consultation. Our trained specialists will help you find the right treatment program.
What is fentanyl used for?
Fentanyl is prescribed to treat chronic breakthrough pain in cancer patients, for end of life care and as an anesthesia for certain surgeries. Cancer patients may experience sudden and severe bouts of pains that “break through” the other opioids they are already prescribed in their course of treatment. In such instances, doctors may prescribe fentanyl to provide some relief. The drug, however, should not be used to treat pain from migraines,–nor many other types of chronic pain– as safer, effective alternatives exist.
Is prescription fentanyl safe?
Fentynal and other opioids can be extremely addictive, even when prescribed by a doctor. Moreover, opioid overprescribing by medical professionals has been a huge issue that has led to addiction and overdose death in numerous patients. If you are prescribed fentanyl or another opioid, be sure that your condition truly requires the potent pain killer. According to professionals, opioids are rarely a solution to chronic pain and can cause dependence as well as tolerance in many patients. There may be other therapies that can be used for your condition. Ask your doctor if there are less dangerous, non-habit-forming alternatives available, and don’t be afraid to get a second opinion.
If you are prescribed an opioid such as fentanyl for a relevant condition, be sure to follow all use instructions carefully. Do not use the drug for longer than or to treat other issues than for which it was prescribed. Ideally, you should be taking the smallest possible dose in the smallest quantity to reduce the risk of dependence and related issues. Before taking prescribed opioids, make sure your doctor is aware of any and all other health conditions as well as medications and substances that you use. Certain opioid or fentanyl interactions with other substances can cause overdose and death. Let your doctor know if you have a personal or family history of addiction, and inform yourself about all possible side effects/risks that may compromise your wellbeing before using the drug.
Rates of fentanyl overdose
As mentioned, fentanyl is extremely dangerous and small amounts can result in overdose and death. Fentynal and other opioids have and continue to drive high overdose death tolls in the United States. 136 people die each day in opioid-related overdose deaths, a huge jump from only two decades ago. At the turn of the century, for every population of 100,000, there were 6.1 overdose deaths.
By 2017, this number tripled to 21.7 overdose deaths per 100,000. The opioid epidemic has been the leading cause of the explosion, and fentanyl specifically continues to drive overdose deaths. In fact, 2 out of 3 opioid overdose deaths in 2018 involved a synthetic opioid other than methadone. Complicating things further, illegal fentanyl is now widely sold in many cities and is often mixed with other drugs to make them appear more potent, without the knowledge of the buyer.
How fentanyl affects the brain and body
Fentanyl works by changing how the brain and central nervous system respond to pain. Like other opioids, it binds to opioid receptors located in part of the brain that controls pain and our emotions. Opioids boost levels of chemical dopamine, a neurotransmitter related to feelings of pleasure, reward and euphoria. Short- and long-term use of opioids can have many adverse effects on the brain and body, including overdose death, even in patients with valid prescriptions. One unfortunate effect is that the brain adapts to opioids like fentanyl after several uses, making it increasingly difficult to achieve feelings of pleasure without the drug. Fentynal is significantly more potent and works much faster than other extremely strong opioids like morphine. These factors make it extremely easy to develop an opioid use disorder when using fentanyl.
Short- vs long-term effects of fentanyl
- Extreme happiness
- Hot flashes
- Nausea or constipation
- Tolerance and addiction
- Slow or stopped breathing
How to recognize fentanyl overdose
Fentanyl is an extremely dangerous drug overdose. Even miniscule amounts can cause overdose and death. It is important to be able to recognize the signs of fentanyl overdose. If it is caught in time, naloxone (Narcan), can be used to reverse the effects of overdose. Signs of opioid overdose include the following:
- Pale fingers
- Pallid skin
- Blue or purplish lips
- Slowed or stopped breathing
- Slowed or stopped heartbeat
- Vomiting or gurgling sounds
- Unable to be awakened
- Inability to speak
If you or a loved one abuse opioids or are at risk of being exposed to fentanyl, you should have naloxone (Narcan) on hand at all times. Even seconds matter when an overdose occurs. Knowing what to do in the case of an overdose and how to use naloxone can be the difference between life and death. If you recognize any symptoms of overdose, immediately try to wake the person, call 911 and administer naloxone. Try yelling their name and putting pressure or rubbing on their chest plate to wake them. Administer Narcan/naloxone according to instructions. It is important that you and others have naloxone readily available. Many hospitals, pharmacies and local institutions have made the lifesaving drug available at little to no cost.
How did fentanyl become such a problem?
Our current fentanyl abuse problem is a result of the opioid epidemic, which began in the early 2000s. Opioid use in the U.S. has grown over the last two decades for several reasons. A 2001 Joint Commission on Accreditation of Healthcare Organizations decision to include pain as a vital sign when examining patients made pain treatment a larger focus for the medical community. While this decision provided some benefit for those with chronic pain, there were many unintended consequences.
Overprescribing, aggressive drug company marketing, loose restrictions and a lack of addiction education all led to a boom in prescription opioid abuse and addiction. Opioids, originally intended as a last resort painkiller, became far more widely prescribed. Drug producers began aggressive marketing campaigns towards doctors and patients to encourage the use of opioids, in addition to sharing false information about the drugs’ efficacy and potential for abuse. Like many others, Purdue is one of the companies being held responsible for its role in the opioid epidemic. The major opioid manufacturer was convicted of fraud against the U.S. government and creating a kickback scheme that supported the diversion of opioids for abuse.
Phases of the opioid epidemic
According to the CDC, the U.S. opioid epidemic occurred in three phases. In 1999, the first wave of overdose deaths associated with prescription opioids like oxycodone began. Pill mills, medical centers that sell prescriptions outside of the standards of practice for profit, were instrumental in growing the country’s opioid problem. Research looking at pain clinics in South Florida found that pill mills, fake symptoms/documentation, on-site pharmacies, liberal prescribing habits, “sponsoring” drug diversion and pain doctor/pharmacy shopping all drove opioid diversion and abuse.
Heroin and fentanyl’s role
As addiction and overdose rates exploded in the U.S., national and state governments tightened restrictions and enforcement around opioids like oxycodone. This caused the opioid problem to evolve. In response to new regulations and increased enforcement, a second wave of heroin-related overdose deaths began in 2010. Because heroin was more easily available, many with opioid addictions turned to the poppy-based drug as a cheaper alternative.
However, heroin was later replaced by an even more potent alternative. In 2013, the third and current wave of overdose deaths began, driven by synthetic opioids like fentanyl. Because of its profitability, illegal drug trades have moved into diverting, producing and trafficking fentanyl. The super strength opioid is highly addictive and easier to transport, as a small amount is extremely potent. While synthetic opioid use has grown sharply, so have overdose deaths, which have increased to an all time high.
The pandemic and the opioid epidemic
Though overdose death rates appeared to be declining from all time highs toward the end of the decade, opioid abuse during the Covid-19 pandemic reversed any progress made. Many believe that the combined effects of the coronavirus pandemic and the opioid epidemic furthered the nation’s problem with overdose death. Isolation, feelings of depression and anxiety have all increased during the pandemic, while access to addiction treatment and support resources have become more limited. This has led to self-medicating, struggles with dependency, overdose and death. Between may 2019 and 2020, an all time high of 81,000 drug overdose deaths were registered in the United States. Fentynal has been a huge contributor to the high overdose death totals, with synthetic opioid-related overdose deaths increasing by 38.4%.
Opioid sales, crime & fentanyl busts
Profits from fentanyl sales have played an important role in the rise of fentanyl abuse and consequent overdose deaths. Because fentanyl is so powerful and cheap to produce, drug dealers at international, domestic and local levels have moved toward the trafficking and sale of the opioid.
Factories in China and other countries with less strict rules around fentanyl and its precursor chemicals produce and ship it through Mexico or directly to the United States. Fentanyl may be sold on its own or used to “cut” other drugs to make them appear more powerful.
International fentanyl trafficking busts
Large-scale fentanyl busts demonstrate the opioid’s growing importance in international drug trafficking rings. According to Customs and Border Patrol (CBP), between 2018 and 2020, the amount of illicit fentanyl seized by the agency tripled and continues to climb in 2021. News outlets report that CBP seized 6,494 pounds of the synthetic opioid in the first 7 months of the 2021 fiscal year, already surpassing the 4,776 pounds seized in fiscal year 2020.
Mexico has become a distribution hub for illegally sold fentanyl precursors produced in China, India, and Mexico. According to InsightCrime.org, fentanyl is produced in Mexico for as little as $180 per kilogram and can be sold in states like Ohio or Massachusetts for $60,000 per kilogram (2,700x the price). Two major criminal organizations control distribution, although some smaller groups also traffic precursor chemicals directly from China. Additionally, fentanyl is bought and sold illegally on the dark web, furthering the difficult task of stemming the U.S: supply.
Heroin and fentanyl trafficking
While the amount of fentanyl seized by CBP in busts has increased substantially, heroin seizures have not seen the same jump. Although heroin is still highly trafficked, organized criminal groups may favor fentanyl because it is manufactured for a fraction of the price, and is close to 100-times stronger. This means the drug is both more profitable and compact than drugs like heroin. Given its high potency and the likelihood of overdose death from just a small amount, experts like Peter Reuter worry what would happen if even 50% of the global heroin market was replaced by fentynal.
Local fentanyl busts
At the local level, drug users may encounter fentanyl knowingly, or unknowingly. Some seek out the opioid, while others unintentionally use substances laced with fentanyl to increase their potency. State and local authorities continue to report large-scale fentanyl busts, seizures and overdose deaths.
Massachuesettes, Ohio and Arizona are among the many states reporting such fentanyl busts. The amount of fentanyl seized has the potential to cause thousands of overdose deaths. For instance, in one Baltimore fentanyl bust alone, 400 grams of the drug was seized, enough to kill 20,000 people. Although the U.S, state and local governments are taking steps to combat the opioid epidemic, and fentanyl in particular, the challenge remains great.
Are you or a loved one struggling with substance abuse?
If you are concerned about your loved one’s addiction, call Liberty Ranch at
Prescription fentanyl vs. street fentanyl: Is either one safe?
Fentanyl should only be used when prescribed by a doctor and following medical instructions for use. However, patients should still be extremely cautious when taking the drug as prescribed, as opioids like fentanyl have a high potential for addiction in general. Even more worrying is the overprescribing of opioids. States like Virginia have filed suit against drug companies who aggressively sold the drug to primary care doctors, lying about its uses, efficacy and dangers. Primary care doctors have also been encouraged to overprescribe the painkiller to treat non-cancer related pain for cases where it wasn’t necessary. Misprescribing and overprescribing have caused countless opioid use disorders and overdose deaths.
Fentanyl lollipops and other ways fentanyl is prescribed
Fentyanl can be prescribed in several forms which are delivered by injection, ingestion and absorption through the skin. It may be prescribed as a fentanyl lollipop lozenge (Actiq®), effervescent tablet (Fentora®), sublingual tablet (Abstral®), under-the-tongue spray (Subsys®), nasal spray (Lazanda®), skin patch (Duragesic®), or as an injection.
Fentanyl lollipops are especially talked about because they closely resemble the innocuous candy and are often sold illegally. They are generally prescribed to control extreme pain in cancer patients who have become tolerant to other opioids. Sugar and berry flavors are added to fentanyl lollipops to make them more appealing to patients. Unfortunately, unlike the candy, fentanyl lollipops are extremely potent and dangerous.
Fentynal lollipop misuse
Fentanyl lollipops are widely misused. One study found that 90% of prescriptions were off-label, meaning the condition for which it was prescribed does not meet prescribing guidelines. Like other forms of the drug, use can cause respiratory depression and other harmful effects that may result in overdose death. If one is prescribed a fentanyl lollipop, extra care should be taken to store it in a safe and secure place. Children and those who are unaware of fentanyl’s deadly effects may believe fentanyl lollipops are safe, mistaking them for candy.
Street fentanyl in weed, heroin and other drugs
Because it requires very little fentanyl to produce a high, dealers and traffickers often use it as an additive. Drug dealers may mix fentanyl with heroin, cocaine, methamphetamine, MDMA and other drugs. Fentynal in weed has even become a problem. While users believe they are taking a potent version of an intended drug, they are actually feeling the effects of fentanyl.
Even small amounts of fentanyl on its own can cause overdose. Substance users may unknowingly ingest large amounts of fentanyl when taking cocaine, marijuana, or other drugs, causing overdose. Moreover, mixing the opioid with other drugs can create toxic interactions. For instance, combining heroin and fentanyl is extremely deadly. As a result, overdose deaths involving both fentanyl and heroin in Ohio and other states have increased sharply.
Fentanyl test strips
Fentanyl test strips can be used to detect the presence of fentanyl in unregulated substances. These strips are often made available by harm reduction organizations. Because even a small amount of the opioid can cause death, fentanyl test strips can be helpful in overdose prevention. Although treatment and recovery from addiction is the best option, as many other drugs also cause overdose, those who continue to use substances should always test their supply for fentanyl prior to use.
Want to learn more about helping a loved one with addictions?
Check out our guides to learn more about dealing with substance use disorders:
- Guide for Teen Addiction
- Guide for Addiction in Adult Children
- Guide for Women and Addiction
- Guide for Dealing with an Addicted Spouse
- Guide for Adult Children of Addicts
- Guide to Parenting as an Addict
- How to Help a Drug Addict Son
- How to Let Go of a Drug Addict Son
- Sober living near me? Guide to choosing a sober living home
What does fentanyl look like?
Pure fentanyl has the appearance of a crystalline powder and is odorless. However, the prescribed opioid is available in several forms with differing appearances and instructions for use. Illegally produced and diverted fentanyl is often manipulated or mixed with other drugs, making it difficult to recognize and sometimes undetectable. Still, there are some common things to watch out for that may help you identify the powerful opioid in some cases. If you or a loved one abuses opioids or other drugs, you should know how fentanyl can look.
Actiq® Fentanyl Buccal Citrate lollipops are white lozenges on plastic lollipop sticks. Because it resembles the candy, this form of the drug is commonly referred to as a fentanyl lollipop. These and fentanyl patches are both time released forms of the opioid.
DURAGESIC® transdermal system fentanyl patches are thin, individually wrapped patches with a gel-like substance on one side that is placed directly on and absorbed through the skin. The sticky side of a fentanyl patch should not be otherwise touched, as it has the dangerous opioid on it. This time-released formula is often diverted and abused through smoking or ingestion. Misusing a fentanyl patch is especially dangerous because this form is made to be released over time. Abusers may ingest far greater amounts of the substance in shorter periods of time than intended. This can be too much for the body to handle, as even a minimal amount of the powerful opioid can lead to overdose and death.
Fentynal may be prescribed as effervescent buccal tablets (FentoraTM) or sublingual tablets (Abstral®). In this form, fentanyl looks similar to many other pills, although extreme caution should be exercised.
Prescription fentanyl is also available as nasal (Abstral®) and under-the-tongue (Subsys) sprays. Although the fentanyl in spray form may look innocuous or even similar to an inhaler, it is still quite potent and dangerous.
Fentynal can be administered as an injectable anesthesia by trained medical professionals. In this case, the fentanyl looks like a clear liquid in an injection ampule.
Fentanyl analogues are synthetic opioids that are similar to fentanyl in their chemical structure. Special testing is required to detect the presence of fentanyl analogues, which are also extremely dangerous.
Illegally produced fentanyl, or street fentanyl, is often sold as powder, on blotter paper, in eye droppers or as nasal spray. However, it may also be sold illegally in other formats. If you are wondering what street fentanyl looks like to be able to detect if a loved one is using it, you may be displeased to learn that illegally sold forms of the opioid can be visually undetectable. For instance, fentanyl is often mixed in with other drugs like cocaine, MDMA, marijuana and heroin. This is especially dangerous for substance users who may be unaware that they are ingesting fentanyl and greatly increasing their risk of overdose death. Ingesting what looks like a few grains of sand can result in death.
Recent fentanyl busts have called attention to the illegal distribution of counterfeit pills containing the harmful opioid. Street fentanyl may be mixed into counterfeit pills like oxycodone. Some busts have also turned up blue, round pills with M30 imprinted on them. In other cases, pills containing the opioid look exactly like legitimate medications, making it virtually impossible to detect the presence of fentanyl visually. For this reason, the illegal purchase of medication should be avoided.
Fentynal in the system and fentanyl withdrawal
The fast acting opioid is known for its high potency and addictive properties, but how long does fentanyl stay in your system and what is withdrawal like? Although the “high” feeling is only felt for a few hours, the opioid remains in a person’s system for far longer. Fentanyl tests can be used to detect its presence even after the drug’s effects have worn off.
How long does fentanyl stay in your system?
Fentanyl use can be detected through urine, saliva, blood and hair follicle tests. Using a urine test, fentanyl and its metabolites can be found in a person’s system for approximately 2 to 4 days following use. However, one study found that for people with opioid use disorders, the drug may remain present in urine for 7 or more days. Blood tests can usually detect fentanyl and its metabolites for up to 48 hours after use. In terms of saliva tests, an analysis found the screening tool to be unreliable, so it’s use is not recommended. If you are wondering how long fentanyl stays in your system according to hair follicle tests, you should know that these tests are commonly able to detect opioids for up to three months following last use. Hair follicle tests may also be used to detect the presence of drugs including opioids, marijuana, cocaine, ecstasy, methamphetamines, amphetamines and PCP. However, detection time frames for all tests depend on several individual factors that impact how long fentanyl stays in a person’s system.
Factors that affect how long fentanyl stays in your system include:
- Dosage of the drug taken
- Frequency of use
- The individual’s metabolism, liver and renal functions
- Body weight, fat and height
- Thickness of the person’s skin
- Food intake
- Use of other drugs
- Urine PH
Those wondering how long fentanyl stays in the system should also be aware of what happens to the body as the drug leaves a person’s system. This process is called fentanyl withdrawal, and it can be quite painful. When a person discontinues the use of fentanyl or other opioids, they may experience the following symptoms:
- Cold flashes
- Diarrhea and vomiting
- Sleep problems
- Cramps and abdominal pain
- Uncontrollable leg movements
- Extreme cravings
- Rapid heart rate
- High blood pressure
How quickly do fentanyl withdrawal symptoms appear?
The onset of fentanyl withdrawal symptoms tends to be rapid. Symptoms may be felt as early as a few hours after a person’s last dose of the opioid. For others, fentanyl withdrawal symptoms can take up to 30 hours to appear. Symptoms can be extremely painful and uncomfortable, making it challenging to discontinue use. Without proper professional support, many people end up using the drug again to make these severe symptoms go away.
How long does fentanyl withdrawal last?
Fentanyl withdrawal symptoms generally last for around 10 days. But it can take several months before a person starts to feel “completely normal”. In some cases, as with dry drunk syndrome, individuals can experience opioid withdrawal symptoms later. This is called Post-Acute Withdrawal Syndrome (PAWS).
Managing fentanyl withdrawal
If you or a loved one is addicted to an opioid such as fentanyl, it may be tempting to attempt the “cold turkey method”. However, opioid withdrawal can be dangerous. According to the ASAM, trying to stop using opioids without professional support can lead to even stronger cravings, increasing the chances of relapse.
Before detoxing, those with substance use disorders should seek advice from medical or addiction treatment specialists. Professionals may prescribe medications or use certain treatments to ease the symptoms experienced during opioid withdrawal. Additionally, addiction and medical professionals can provide counseling throughout the fentanyl withdrawal process.
What to do if you or a loved one struggles with opioid addiction
Addiction is extremely difficult, not only for the person struggling with a substance use disorder, but also for their loved ones. Family, friends and significant others all experience the consequences of substance abuse. If you have a child struggling with substance abuse, you have likely suffered the emotional, mental and financial costs of addiction. The growing use of fentanyl as a cutting agent makes substance abuse even more concerning, as many people unknowingly consume the dangerous opioid and overdose.
Learn how to recognize signs of opioid addiction
Dependence on opioids like fentanyl can cause a number of problems in a person’s life. If you are worried about your own opioid use or a loved one, be aware of the following signs of opioid use disorders:
- Inability to stop or cut down on opioid use despite the desire to do so
- Needing larger amounts of a drug to achieve the desired effect
- Strong cravings
- Problems at school or work
- Issues with families, friends and relationships
- Problems with money
- Frequent, unexplained sickness
- Legal issues related to one’s substance abuse
If you or a loved one is experiencing some or all of these symptoms, it may be time to get help. Fentynal abuse is especially risky and those using illicit opioids face a higher risk of overdose. Speak to qualified addiction specialists to learn more about the options available for you or your loved one.
Educate yourself about opioid addiction, recovery and safety
As a loved one, it is extremely important to understand addiction, recovery and substance abuse safety. Family support groups and treatment facilities like Liberty Ranch Rehabilitation Center can provide helpful information on how to support your loved one without enabling their addiction. Proper planning and safety are also key. While you cannot force your loved one to stop using drugs, you can help prevent overdose.
Because the risk of fentanyl overdose is extremely high, certain harm reduction methods can reduce the likelihood of overdose and death. While ideally your loved one seeks treatment for addiction, if they choose not to, fentanyl test strips can help detect the presence of the powerful opioid in other drugs. Additionally, having naloxone on hand and knowing what to do in case of overdose can save a life.
Find out about treatment options for opioid use disorders
Because addiction is a complex, chronic disease involving the brain and the body, it requires treatment, like any other disease. For many, attending drug rehab can be key in learning to manage their addiction and develop healthy ways of coping with issues. Inpatient programs and intensive outpatient programs help individuals and their families recover from addiction and alcoholism.
Talk to your loved one about treatment
If your loved one suffers from a substance use disorder, given the rates of fentanyl overdose deaths, you may be especially worried for their well-being. Although in most cases you cannot force them into treatment, you can still discuss your concerns about your loved one’s opioid abuse and provide them with information on treatment options.
15 tips for talking to your loved one about opioid dependence treatment
Treatment can be a lifesaving option for many. Here are some tips for talking to your loved one about treatment.
- Prepare in advance, don’t just “wing it”. If others are going to be part of the discussion, involve them in the planning process.
- Define what you would like out of the conversation beforehand and write things down to keep yourself on track.
- Find and contact accredited treatment facilities so that you can have treatment options available.
- Contact an intervention expert if you need additional support.
- When you approach your loved one, make sure they are not under the influence of any substances and that there is ample time available for the conversation.
- Let them know how much you love them, how concerned you are for them and the ways in which their addiction has impacted you.
- Tell your loved ones about your fears related to fentanyl and overdose death, but avoid lecturing and belittling.
- Be clear about the outcome that you want. If you want your loved one to go to treatment, tell them.
- Don’t blame or shame your loved one, and try to use “I” statements.
- Be willing to recognize your own role in the situation if you have enabled their addiction.
- Expect that your loved one may become angry or defensive during the conversation.
- Remain clear, loving and respectful.
- Have a conversation, and let your loved one have voice in the discussion.
- Be prepared to move quickly. If your loved one agrees to attend treatment, it is best to get them into a program as quickly as possible before changing their mind or cravings set in.
- Remember, if you don’t achieve the objective you hoped for, that is okay. The idea is to at least open communication.
Get your own support
Addiction takes a toll on families as a whole. If your loved one abuses opioids like fentanyl, it can be extremely scary and stressful. Join a peer support group like Families Anonymous or Nar-anon that can provide you with support and insight on addiction. These groups are safe spaces to share, process feelings and seek guidance.