fentanyl addiction and treatment
Introduction to Fentanyl
Tom Petty. Prince. Mac Miller. These music artists have made headlines over the last five years due to the growing impact of fentanyl abuse. Almost unheard of 30 years ago, fentanyl has rapidly become one of the most abused prescription drugs on the market. From 2010–2017, fentanyl-related deaths increased by 45%.1 In 2019 alone, federal health authorities counted over 37,000 fentanyl overdose deaths, and they say that the opioid crisis has gotten worse during the coronavirus pandemic. Teens and young adults (ages sixteen to thirty) are most at risk for prescription drug misuse, overdose, and death.2
What is Fentanyl?
As a synthetic opioid pain reliever, fentanyl treats pain in cancer patients and those with severe pain who have built up a tolerance to other opioids. For reference, fentanyl is fifty to one hundred times more potent than morphine.3 It’s prescribed as a shot, skin patch, or lozenge.
Brand Names
Fentanyl’s brand names include:
- Fentora
- Actiq
- Duragesic
- Sublimaze
- Abstral
- Onsolis
We will use the both “fentanyl” and “Fentora” to refer to this synthetic opioid. Legal forms of fentanyl can also resemble a tablet, spray, or lollipop. Illicitly manufactured fentanyl (IMF) often hides in mixtures with other drugs like heroin or cocaine. In its purest form, it resembles a powder or tablet.4
Common Street Names
- Apache
- Dance Fever
- Friend
- Goodfellas
- Jackpot
- Murder 8
- Tango & Cash
- China Town
Fentanyl’s Drug Class and Schedule
Fentanyl is considered a Schedule II drug in the U.S., a class of drugs considered dangerous by the Drug Enforcement Administration (DEA) due to a high chance of abuse and dependence. Other examples of Schedule II drugs include Vicodin, cocaine, OxyContin, Adderall, Ritalin, and meth. These synthetic opioids have become the primary source of drug overdose deaths in the U.S., with fentanyl overdose topping the list of offenders.
History of Fentanyl
Unfortunately, fentanyl deaths increased from 2011–2018, likely in tandem with a growth in drug trafficking from Transnational Criminal Organizations (TCO) in China, Mexico, Canada, and the Caribbean.4 According to a DEA report, a single kilogram of fentanyl can transform into $1.5 million for traffickers and prove deadly for up to 500,000 people.5
Fentanyl was first created in 1959 and began circulating as an anesthetic during the 1960s. Initially applied intravenously; doctors eventually developed a fentanyl patch applied to the patient’s skin.6 In recent years, fentanyl prescriptions decreased from 6.5 million in 2015 to 4 million in 2018.7 Fewer prescriptions are one way healthcare practitioners are trying to address the growing opioid abuse problem in the United States.
Since the 1990s, legal fentanyl has become a black market item. Around that time, opioid prescriptions began to increase, and with them came a boom in opioid abuse. The second wave of abuse hit the U.S. around 2010, and the third wave in 2013 proved especially deadly.8
Deaths and Other Costs of Fentanyl
How Overdose Happens
One kilogram may not sound like much, but therein lies its deadly nature—it doesn’t take much to ingest a lethal dose of Fentora. Unlike approved pharmaceutical forms of the medication, like the fentanyl patch, illegally manufactured Fentora (IMF) isn’t regulated, so you may not know exactly how much you are getting. Additionally, IMFs are often unknowingly combined with other drugs. Even if an overdose doesn’t occur, fentanyl is highly addictive.
Rising Overdose Deaths
Opioid related overdose deaths were four times higher in 2018 than in 1999, and nearly 68% of drug overdose deaths in 2017 were related to opioids.8 The 2017 numbers include increases across demographics like age, race, and region, showing that Fentora does not discriminate.
In just two years, from 2016 to 2017, synthetic opioid overdoses rose by 45.2%, plus another 10% between 2017 and 2018.9, 10 As mentioned earlier, even wealthy celebrities are not immune. Rapper Mac Miller, singer-songwriter Tom Petty, and pop artist Prince all died from accidental fentanyl overdoses.
Fentanyl Side Effects
Fentora provides a high similar to that of heroin and morphine. Chemically, it hitches onto opioid receptors in the brain that manage pain and emotions.11 Short-term fentanyl side effects include:
- Drowsiness
- Euphoria
- Confusion
- Nausea
- Breathing problems
- Unconsciousness
When Fentora repeatedly enters the body, the brain rewires, needing more of the drug to feel pleasure. Eventually, the brain is triggered to crave the drug by unrelated things it associates with the high.
Fentanyl Overdose
When a lethal dose of fentanyl is accidentally or intentionally ingested, pupils will become tiny, and cold, sweaty skin will turn a bluish tint. If left untreated, breathing will slow to a dangerous rate (a condition called hypoxia), and there is an increased risk of coma, brain damage, and death. Call 911 immediately if you notice any fentanyl side effects. A medicine called Naloxone can treat a Fentora overdose if it’s given right away. If you have a friend or loved one who you suspect has an opioid use disorder, you may be eligible to receive a personal prescription of Naloxone to keep on hand.
Fentanyl Withdrawal
Fentanyl withdrawal symptoms are very unpleasant and can contribute to a hesitancy to seek treatment. Symptoms include:
- Muscle and bone aches
- Disrupted sleep
- Cold flashes
- Leg twitches
- Intense cravings
- Vomiting
- Diarrhea
Most, if not all, people with an opioid use disorder need help with recovery from the addiction.
Signs and Symptoms of Fentanyl Addiction
Substance use disorders can begin as dependence and develop into an addiction. Common signs of an opioid use disorder are usually related to changes in behavior. There may be signs of fentanyl side effects, such as elation, drowsiness, or nausea. If fentanyl withdrawal symptoms occur, they will have difficulty sleeping, keeping food down, and managing their physical pain. Fentora addiction also presents compulsive and erratic behaviors. A common side effect of substance use disorders is compulsively seeking the drug, even when issues arise personally or professionally.
Fentanyl Addiction Treatment
According to the National Institute on Drug Abuse, opioid addiction is very treatable, but it’s a multi-step process. The goal of treatment is to stop drug use, help maintain a drug-free life, and improve relationships and careers.
Medically Assisted Detox
Most recovery plans begin with a medically assisted detox. This treatment is only the first step in the recovery journey, and detox without ongoing supports and therapies usually results in relapse. Most detox programs incorporate medicines to help ease withdrawal symptoms, which can make behavioral treatment more comfortable. Several medications have proven to treat symptoms of Fentora addiction effectively. These medications include:
- Lofexidine
- Buprenorphine
- Methadone
- Naltrexone
Additionally, a small electrical nerve stimulator called the NSS-2 Bridge can reduce withdrawal symptoms when secured behind the ear.
Treatment Programs
After detox, inpatient rehabilitation programs are beneficial to ongoing recovery success. These programs typically take place at licensed residential treatment facilities with around-the-clock care and therapy. Inpatient treatment lasts between one to three months, after which you can opt to transition into a therapeutic community (six to twelve months) or recovery housing. Outpatient treatment is another viable option, and involves intensive therapeutic sessions at a hospital several days a week. An FDA approved mobile app is also available. It’s called reSET, and it provides cognitive behavioral therapy (CBT) in tandem with outpatient treatment. CBT helps manage stress, change personal outlook, and overcome negative thought patterns.
Other effective behavioral treatments can address both the addiction and any underlying mental health issues. Besides CBT, different approaches include Contingency Management, which uses a point-based system to encourage healthy choices, and Motivational Interviewing, which deals with any mixed feelings about change. Ultimately, the most effective recovery plan includes lifetime community and family support.
Resources
- https://www.drugabuse.gov/publications/drugfacts/fentanyl
- https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction/
- https://www.drugabuse.gov/drug-topics/fentanyl
- https://www.dea.gov/sites/default/files/2020-06/Fentanyl-2020_0.pdf
- https://www.dea.gov/drug-scheduling
- https://www.dea.gov/factsheets/fentanyl
- https://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf
- https://www.cdc.gov/drugoverdose/epidemic/index.html
- https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm
- https://www.cdc.gov/drugoverdose/opioids/fentanyl.html
- https://medlineplus.gov/druginfo/meds/a605043.html
