Fentanyl is a potent synthetic opioid that can cause severe harm when misused. It is a prescription drug for pain relief; however, it can be produced and distributed illegally and has a high potential for misuse and addiction.¹ Prescription fentanyl can also be misused by the person it’s prescribed to, or a person who uses someone else’s prescription.

When made illegally, fentanyl is often combined with other harmful substances, which makes it riskier to use because people don’t realize which substances they’re taking. This can lead to a potentially fatal overdose.^{1, 5}

If you or someone you care about uses fentanyl or other substances that might contain fentanyl, it’s important to understand the effects of fentanyl, fentanyl overdose symptoms and treatment, and where to get help for fentanyl addiction.

What Is Fentanyl?

Fentanyl is a powerful synthetic (manmade) opioid drug similar to morphine (a naturally occurring opioid), but between 50 and 100 times more potent.^{1, 2} It is a Schedule II controlled substance, which means that it has a recognized medical use but a high potential for misuse and psychological and physical dependence.^{3, 4}

When prescribed by a physician and taken under medical guidance, fentanyl is often used to treat severe pain due to surgery or cancer.^{1, 5} Legally made fentanyl comes in the form of fentanyl patches or lozenges known by names such as Actiq, FentoraTM, and Duragesic.⁶

When fentanyl is used illegally, it may be taken on its own or mixed with other substances.¹ People may use it as a nasal spray or powder, or as a counterfeit pill form that can resemble prescription opioids.⁴ Using illegal fentanyl can be dangerous and lead to fentanyl overdose because products often contain lethal amounts of fentanyl.⁴

Illicit fentanyl is sometimes mixed with drugs like cocaine, methamphetamine, or MDMA, because it’s cheap and only takes a small quantity to produce a high.¹ This can make it especially dangerous to use street substances because you can never be certain about what substance you’re taking or its potency.¹ It only takes a small amount to cause harm or death because it is so potent in very small amounts.¹

Street names for fentanyl include:²

Apace.
China Girl.
China Town.
China White.
Dance Fever.
Goodfellas.
Great Bear.
He-Man.
Poison.
Tango & Cash.

What Are Fentanyl Analogues?

Fentanyl analogues are substances that are chemically similar to fentanyl.⁷ They can be dangerous because their exact potency levels aren’t always known. The potency of illicitly made analogues hasn’t been measured in humans.⁷

Fentanyl analogues include acetylfentanyl, furanylfentanyl, and carfentanil.⁷ It can be difficult to detect these substances because they require specialized toxicology tests.⁷ Carfentanil is the most potent analogue found in the U.S. and is thought to be 10,000 times more potent than morphine.⁷

What Is Fentanyl Addiction?

Fentanyl is a highly addictive substance due to its potency.¹ Medical professionals diagnose fentanyl addiction as an opioid use disorder (OUD), which means that a person compulsively uses fentanyl despite knowledge of the negative consequences.¹

Fentanyl can quickly cause dependence, meaning that a person needs the substance to avoid feeling uncomfortable withdrawal symptoms, which can fuel the cycle of addiction.¹ People can be dependent on fentanyl and not addicted; however, dependence can lead to addiction.¹

Like other opioids, fentanyl produces its effects by attaching to opioid receptors in the brain.¹ These receptors play a role in controlling pain and emotion.¹ When people chronically use fentanyl, their brains adapt to the presence of the substance, and they might be unable to feel pleasure without it.¹

Fentanyl’s effects might feel pleasurable and cause people to want to keep using it. However, other effects may be uncomfortable. Fentanyl side effects can include:¹

Extreme happiness.
Drowsiness.
Nausea.
Confusion.
Constipation.
Sedation.
Breathing problems.
Loss of consciousness.

Signs of Fentanyl Addiction

Only a medical professional can provide a formal diagnosis for a substance use disorder (SUD) or OUD, but it can be useful to know the common signs of addiction to help decide when to seek help. The criteria for OUD outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), include:⁸

Using fentanyl in higher amounts or for a longer time than originally intended.
Being unable to cut down or stop fentanyl use even if you want to.
Spending a lot of time obtaining, using, and recovering from the effects of fentanyl.
Cravings, or strong physical or psychological urges to use fentanyl.
Being unable to fulfill obligations at home, work, or school due to fentanyl use.
Continues to use opioids despite experiencing social or interpersonal problems that occur due to fentanyl use.
Giving up important activities or hobbies to use fentanyl.
Using fentanyl in situations where it is physically hazardous to do so.
Continuing to use fentanyl despite knowing that you have a physical or psychological problem that is probably due to its use.
Tolerance, or needing to use more fentanyl to experience previous effects.
Develop withdrawal symptoms when you stop using fentanyl.

Statistics on Fentanyl Addiction

Fentanyl misuse and addiction can cause harm and lead to potentially fatal consequences. In the US, most of the cases of fentanyl overdose and death are due to illegally made fentanyl.⁵

According to the 2020 National Survey on Drug Use and Health, 356,000 people aged 12 and older misused prescription fentanyl drug products in the past year. This does not include people who abused illicitly made fentanyl or fentanyl mixed with other substances; these numbers are not reported.⁹
The Centers for Disease Control and Prevention (CDC) reports that deaths due to synthetic opioids like fentanyl are on the rise, with an overdose rate in 2019 that was 12 times higher than in 2013.⁵
More than 36,000 people died from synthetic opioid overdose in 2019.⁵
Deaths involving synthetic opioids, mainly fentanyl, kept rising in 2020, with 56,516 overdose deaths reported.¹⁰

Fentanyl Withdrawal

When someone who is dependent on fentanyl suddenly cuts down or stops using it, they can experience fentanyl withdrawal.¹ Withdrawal symptoms can be very uncomfortable and unpleasant, and people may find them difficult to tolerate, which is why having support during withdrawal or fentanyl detox can be helpful.¹ Withdrawal is also one of the criteria for OUD.⁸

Fentanyl symptoms of withdrawal can be severe and develop within a few hours of last use.¹ Fentanyl can be long-acting (such as in controlled release medications) or short-acting. Symptoms typically develop 8 to 48 hours after last use and usually last 4 to 20 days depending on the form used.^{11, 12}

Common fentanyl withdrawal symptoms can include:^{1, 12}

Nausea.
Vomiting
Diarrhea.
Anxiety.
Muscle and bone pain.
Sleep problems.
Hot and cold flashes.
Uncontrollable leg movements.
Severe cravings.

Fentanyl Overdose

Fentanyl is an extremely dangerous opioid that can cause overdose and death, even if used in small amounts.¹³ A fentanyl overdose can occur when it produces serious adverse effects and life-threatening symptoms.¹

One of the main risks of overdose on fentanyl is hypoxia, a condition that occurs when a person’s breathing stops and their brain doesn’t receive enough oxygen, which can lead to coma and death.¹

Common fentanyl overdose symptoms include:¹³

Small, pinpoint pupils.
Loss of consciousness.
Slow, weak, or stopped breathing.
Choking or gurgling sounds
Limp body.
Cold, clammy, or blue skin.

If you suspect that someone has overdosed on fentanyl, you should:¹³

Call 911 right away.
Administer naloxone, if possible, which helps reverse an overdose.
Keep the person awake and breathing.
Place them on their side to prevent choking.
Stay with the person until emergency personnel arrives. Never leave a person alone if you suspect they have overdosed.

Risk Factors for Fentanyl Overdose

If you use illicit substances, there is always a potential for overdose. The CDC says that you can’t know for sure if drugs have been laced with fentanyl without using a fentanyl testing strip.¹³ Thus, using other drugs may also put you at higher risk for overdose. Risk factors for a fentanyl overdose can include:^{15, 16}

Using high doses of fentanyl.
Using a long-acting form of fentanyl, like fentanyl patches.
Being 18 to 25 years old, or older than 65.
Having a respiratory condition, like asthma.
Having a mental health condition like depression or posttraumatic stress disorder (PTSD).
Having a history of alcohol or drug abuse.
Using other substances, including certain medications, alcohol, or other illicit drugs, along with fentanyl.
Co-occurring medical conditions like sleep apnea or reduced liver or kidney function.

How Can Fentanyl Overdose Be Treated?

You should call 911 right away if you suspect that someone has suffered a fentanyl overdose.¹³ Emergency medical personnel can provide naloxone, an opioid agonist medication, which blocks the effects of opioids and rapidly reverses an overdose.¹⁷ However, it needs to be administered right away to be effective.^{1, 17} Some states require a prescription, but some allow people to purchase naloxone from a pharmacist without a prescription.^{1, 18}

Naloxone is available as a nasal spray or autoinjector, both of which can be administered by friends and family, and as an injectable, which requires formal training to administer.¹ Regardless of the form, people should receive training on how to administer naloxone.^{1, 18} People who receive naloxone should get immediate medical attention and be monitored for at least 2 hours after administration to ensure they keep breathing.¹

American Addiction Centers maintains a strong partnership with a large group of insurance companies at our addiction treatment facilities. Start the journey to recovery and find out instantly if your insurance provider may be able to cover all or part of the cost of rehab and associated therapies.

Fentanyl Addiction Treatment

People struggling with fentanyl addiction can benefit from addiction treatment.¹ Treatment may help you stop the cycle of substance misuse and start the path to recovery. There is no one-size-fits-all approach to treatment. It should be personalized and modified to your medical, psychological, social, vocational, and legal needs, as well as your age, gender, ethnicity, and culture.¹⁹

Treatment can take place at different levels of intensity and in a variety of settings, including outpatient rehab, where you live at home and travel to a treatment center on a regular basis, or inpatient rehab, where you live onsite and receive 24/7 care and monitoring.

Regardless of the setting, you may receive a combination of behavioral therapies and medication to treat fentanyl addiction and help prevent relapse.¹ Common medications used in treating fentanyl addiction include:^{1, 20, 21}

Methadone, an opioid receptor agonist, binds to the same receptors in the brain as opioids do. It prevents cravings and withdrawal symptoms.
Buprenorphine, a partial opioid receptor agonist that only partially binds to opioid receptors. It eases cravings and withdrawal symptoms.
Naltrexone, an opioid receptor antagonist, blocks the euphoric effects of opioids if you use them. It can help reduce cravings.
Buprenorphine/naloxone combination, a combination medication commonly sold as Suboxone. It blocks opioid receptors, prevents fentanyl’s effects, reduces cravings, and minimizes withdrawal symptoms.
Lofexidine, a nonopioid medication known as an adrenergic receptor agonist. It alleviates withdrawal symptoms.

Common behavioral therapies include:¹

Cognitive behavioral therapy, or CBT, which helps you make changes to drug-using behaviors and helps you learn ways to deal with stress and cravings.
Contingency management, which provides vouchers for tangible goods in exchange for healthy, positive behaviors and/or negative drug tests.
Motivational interviewing, which is designed to help address your ambivalence about quitting fentanyl and increase your motivation to make positive life changes.

Fentanyl Addiction: Signs, Effects, Overdose, & Treatment