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Fentanyl Addiction: Here are the Facts

By Manjari Bansal
Learn the facts about this potentially addictive opioid.

Fentanyl is a prescription opioid used for treating severe pain. However, since it produces euphoria, it has a high potential for misuse. When misused for long periods of time, it may cause adverse and fatal health effects. Read on for vital information about this potentially addictive drug. 

Does Fentanyl Have Addictive Properties?

Fentanyl is a powerful synthetic opioid that is nearly 50 times stronger than heroin and 100 times more potent than morphine, States the Centers for Disease Control and Prevention (CDC).

“It is a schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery,” Clare Waismann, M-RAS, SUDCC II, Founder and Director of Waismann Method® and Domus Retreat in California, tells WebMD Connect to Care. “Fentanyl works by binding to opioid receptors in the brain and spinal cord, which increases feelings of pleasure and decreases feelings of pain. However, fentanyl also has a high potential for abuse and addiction. When misused, fentanyl can cause shallow breathing, dizziness, extreme drowsiness, and death.”

Fentanyl works just like other opioids and opioids are highly addictive. In fact, opioid addiction has become a national crisis in America, states the American Society of Anesthesiologists. The National Institute on Drug Abuse has reported that around 2 million Americans misuse opioids and opioid overdose causes the death of nearly 90 people every day.

“Fentanyl's addictive properties are due to its effects on the brain's reward system,” Waismann says. “When taken as prescribed, fentanyl activates the reward system and creates feelings of pleasure and euphoria. However, when misused, fentanyl can cause an abnormally large dopamine release, leading to intense cravings and compulsive drug-seeking behavior.”

“Additionally, continued use of fentanyl can cause tolerance, meaning that users will need increasingly larger doses to achieve the same effects. Withdrawal symptoms may also occur when people who misuse fentanyl try to quit. These symptoms can include anxiety, muscle aches, sweating, and diarrhea. Therefore, it is important for people who misuse fentanyl to get professional help in order to quit safely,” Waismann adds. 

What Type of Addiction Does Fentanyl Cause?

“The type of addiction caused by fentanyl is known as Substance Use Disorder (SUD),” Colleen Wenner, LMHC, LPC, MCAP, Founder & Clinical Director of New Heights Counseling & Consulting, tells WebMD Connect to Care. “SUDs are characterized by compulsive use of substances despite adverse consequences.”

According to the Mayo Clinic, substance use disorder is a complex disease that affects your brain, making it difficult for you to stop taking a substance despite harmful consequences. The risk of drug addiction varies with the type of substance. With respect to opioid painkillers, the risk of addiction is usually higher and addiction happens faster than with other substances.  

“Fentanyl addiction has distinguished qualities that set it apart from other addictions. For example, unlike most other drugs, Fentanyl doesn't produce physical dependence but creates psychological dependence. It's not due to a lack of willpower or self-control; instead, it is a result of the chemical changes in the brain where the user becomes dependent on the feeling of euphoria produced by the drug,” Wenner says. 

If you continue misusing fentanyl, you may start developing tolerance towards it. Tolerance means “your body will need higher and higher doses of the drug to achieve the same level of euphoria. Once tolerance develops, the user may be unable to stop using the drug without experiencing withdrawal symptoms, including severe depression, anxiety, and cravings,” Wenner explains.   

3. Why do brains love opioids?

When you take opioids, you experience euphoria or feelings of extreme happiness, pleasure, and relaxation. “When these drugs bind to opioid receptors, they release dopamine, a neurotransmitter associated with pleasure and reward,” Waismann says. “This dopamine flood produces euphoria and contributes to its addictive potential.”

“In addition, opioids also block pain signals from reaching the brain, providing relief from both physical and emotional pain. Over time, the brain adapts to the presence of opioids by making less dopamine. This leads to dysphoria (a state of feeling unwell) when the drug is not taken, which increases drug-seeking behavior and can lead to addiction,” Waismann adds.

As you continue taking an opioid, your brain slowly gets used to it and fails to function normally in its absence, Cleveland Clinic notes. This creates an intense craving or urges to keep using the drug, irrespective of the harmful effects. The inability to control the use of the substance despite its negative consequences is, therefore, a key characteristic of addiction.

According to the National Library of Medicine, with prolonged use, you may develop tolerance to the drug. This means you may feel the need to take increased amounts of the drug to achieve the same intensity of euphoria. This is also a sign of addiction.

Additionally, the continuous misuse of opioids may lead to psychological and physical dependence. Psychological dependence is when your thoughts, emotions, and activities are dominated by the use of drugs. Physical dependence is when your body has become accustomed to drug use to such a degree that if you reduce or stop taking the drug, you experience unpleasant withdrawal symptoms. 

Fentanyl Addiction Symptoms 

Research has shown that nearly one-third of people who use opioids to relieve pain, start misusing them, and more than 10% get addicted with prolonged use, states the Mayo Clinic. 
If someone is misusing opioids like fentanyl, it may not be easy to identify, especially in the initial stages. However, over time addiction leads to serious problems and noticeable signs and symptoms. 
According to the American Psychiatric Association (APA), opioid addiction may cause the following symptoms:

  • Taking more drugs than prescribed or more frequently
  • Inability to cut down or stop the drug use
  • Spending a lot of time obtaining, using, or recovering from the drug
  • Having a strong urge to use the drug
  • Having problems at work, school, or home
  • Losing interest in activities you used to enjoy before
  • Having issues in social and personal relationships
  • Using substances in physically dangerous situations
  • Feeling the need to use more drugs to get the desired effect (tolerance)
  • Experiencing withdrawal symptoms when the drug is not used, like chills, cramps, diarrhea, restlessness, anxiety, nausea, vomiting, sleep problems, and pain. 

How to Treat Fentanyl Addiction

There are many treatment options available for opioid addiction, however, only one in four people struggling with opioid misuse opt for specialty treatment, states the APA.

One of the most effective treatments for opioid addiction is medication assisted treatment (MAT). It is a comprehensive treatment that uses medication along with counseling and behavioral therapies. Studies have shown that MAT may help you stay in treatment, reduce opioid use, and reduce the risk of opioid overdose.

“Fentanyl addiction is a serious and potentially life-threatening condition that requires professional medical treatment,” Waismann says. “While there is no one-size-fits-all approach to recovery, successful treatment plans have some common elements. One of the most important first steps is medical detox, which can help to reduce withdrawal symptoms and manage any underlying medical issues.”

Since fentanyl is a strong opioid, “fentanyl users may need to detoxify from the drug under medical supervision, as withdrawal symptoms can be severe and challenging to get through. Medical detoxification and withdrawal management can be done with the help of professional medical staff in an inpatient setting such as a hospital. During this time, patients will be closely monitored and supported as they go through withdrawal and begin their journey to sobriety.” Waismann adds.

“After detox, it is essential to provide ongoing support and treatment for any underlying mental health conditions. This type of support can be accomplished through individual therapy, group therapy, and in some cases, with the help of medications to improve mental health disorders. In some cases, residential or outpatient treatment may also be necessary. The goal of treatment is to help the person to achieve and maintain sobriety, regain their health, and rebuild their life,” Waismann explains.

What are the short-term and long-term recovery goals? “In the short-term treatment or recovery, the goal is to physically detox somebody off of the opioids and get them to a place where they are not craving, not having withdrawals, and are stable on medication-assisted treatment,” Abid Nazeer, MD, FASAM, a Double Board-Certified Psychiatrist and Senior Medical Advisor at Symetria Recovery, tells WebMD Connect to Care. “The short-term plan is to kind of get control of their life back.”

“But it doesn't end there and there always should be a long-term recovery plan in place because, especially with fentanyl, it causes such extreme surges of dopamine, that pleasure and reward chemical in your brain where it can make it sometimes harder for people to abstain from using it. So a long-term treatment plan needs a combination, you need to make sure that you have the right support system in terms of a therapist,” Nazeer explains. 

What are the Long-Term Effects of Fentanyl?

While fentanyl can be a valuable drug for managing severe pain, it may cause several potential long-term side effects. “These effects can be both physical and psychological in nature,” Waismann says. “For example, chronic use of fentanyl can lead to respiratory depression, hypotension, and constipation. It can also lead to changes in the brain, such as tolerance and dependence.”

“In some cases, long-term fentanyl use can also lead to cognitive impairment and memory loss. Additionally, if someone is addicted to fentanyl and does not get treatment, they are at risk of suffering a fatal overdose. Furthermore, addiction can lead to financial problems, relationship problems, and job loss” Waismann explains. 

Does Narcan Work on Fentanyl?

Death due to opioid overdose can be effectively prevented if the person quickly gets the drug Narcan (Naloxone) and basic life support, states the World Health Organization (WHO).

“Narcan (naloxone) is an effective reversal agent for opioid overdoses, including those involving fentanyl,” Waismann says. “The drug must be given within a period of time to increase the chances of a successful outcome. In some cases, one dose of Narcan will not be enough to revive someone who has overdosed on opioids; multiple doses might be necessary.”

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