What You Need To Know About Fentanyl Addiction
Fentanyl is a very potent drug that has a high addiction rate, a rapid development of tolerance, and a tough drug to detox from. A thorough understanding of its chemical behavior helps with planning a rehabilitation plan that makes recovery easy and tolerable.
As an anesthesiologist, I am trained to administer fentanyl in the preoperative environment. In fact, it’s hard to imagine a surgical procedure where fentanyl would not be used. While fentanyl is a mainstay in the operating room, its use has become too common with the patients presenting to me for substance abuse treatment. These patients need special consideration because the unique properties of fentanyl makes treatment with Suboxone very tricky. Often, I am surprised that my patients are fearful of initiating Suboxone. They are well aware that the risk for a precipitated withdrawal is very high when transitioning to Suboxone. In my practice, I developed a protocol specifically to make this process very easy and tolerable. In this blog post, I provide information about fentanyl, addiction to fentanyl, and the recovery process.
What is Fentanyl
Fentanyl is a synthetic, human-made opioid painkiller that was discovered by the chemist Paul Janssen. As with so many other pain killers, it was manufactured to improve upon morphine. In the West, fentanyl is the most widely use injectable pain medication for surgery. Outside of the operating room, it is prescribed by doctors for severe pain associated with cancer and to a lesser degree for chronic pain as a fentanyl patch. It can be given as a shot, lozenge, or skin patch.
Fentanyl attaches to opioid receptors in the brain and spinal cord and activates them. The activation of these receptors lead to pain relief, relaxation, and sometimes euphoria. Unlike morphine and oxycodone, fentanyl as a lipophilic substance. Lipophilic means that it loves fat. Since nerve cells, the brain, and cells are wrapped in a lipid (fat) layer, fentanyl crosses those barriers much faster than morphine, heroin, and other opioids. Thus, its effects occur faster than those other drugs. At the same time, fentanyl stays in the body longer and can complicate a transition to Suboxone.
Fentanyl is also one of the most potent pain medications readily used in medicine. 0.1 mg of fentanyl is equal to 10 mg of morphine. In other words, fentanyl is 100 times stronger than morphine, has a faster effect than morphine, and stays in the bodies storage (fat cells) longer than morphine.
Why Fentanyl Addiction is a Big Problem
There has been a huge increase in overdoses from illegally made and sold fentanyl in recent years. Illegal fentanyl works just like legal fentanyl. Fentanyl is a powerful drug whether it is legal or not. However, it is also being made and mixed with street drugs like heroin, cocaine, and meth. Many people don't even know they are taking fentanyl when they use these drugs. But going one step further, Carfentanil has been found in illicit drugs in the US. Carfentanil is a synthetic opioid that is 10,000 times more potent that morphine. It is often used to tranquilize elephants and has no relevant use in humans.
Some people take fentanyl on purpose to get high. But many others are accidentally using fentanyl when it is mixed into other drugs without them knowing. Misusing fentanyl this way is extremely risky. The drug is so potent that when mixed with other illegal drugs it can easily cause an overdose and death. In 2021, fentanyl was found in over 70% of nearly 110,000 overdose deaths in the U.S. It impacts people across ages and genders. Men make up most deaths involving fentanyl. Still, women and even teenagers are also overdosing and getting addicted. This is a crisis affecting everyone!
Recognizing the Symptoms of Fentanyl Addiction
It is critical to recognize the signs of addiction early on so proper treatment can begin. Addiction changes brain circuits and is influenced by genetics, life experiences, and the environment. People with an addiction can't control their drug use, even when there are bad consequences.
Symptoms of opioid addiction like fentanyl include:
· Taking more fentanyl or opioids than originally intended
· Strong desires or cravings to use fentanyl or opioids
· Not being able to complete duties for work, school, or home because of drug use
· Continuing to use fentanyl or opioids even if it harms relationships
· Needing more and more fentanyl or opioids to get the same effect (tolerance build up)
· Feeling sick when stopping use, known as withdrawal symptoms
Effects of Fentanyl Addiction
Physical signals of addiction can be: weight loss, always feeling tired, restlessness, poor hygiene and grooming. Psychological signs include: depression, confusion, hallucinations, paranoia, mood swings, and irritability. Mental illness often gets worse with addiction.
Side Effects and Risks of Fentanyl Use
Fentanyl use has many dangerous side effects:
· Slowed breathing
· Passing out
· Itching is very common
An overdose happens when side effects become life-threatening. It can lead to:
· Brain damage due to a lack of oxygen
Understanding Fentanyl Withdrawal Symptoms
People dependent on fentanyl suffer withdrawal when they stop using. Symptoms include:
· Nausea and vomiting
· Muscle and bone aches
· Chills and goosebumps
· Leg movements that can't be controlled
· Very strong drug cravings
· Mood swings
Fentanyl Addiction Treatment Program using Suboxone
Let me start by saying that if you are a heavy fentanyl user, you have to cautiously approach the transition to Suboxone (Buprenorphine/naloxone). Fortunately, it isn’t impossible but there are important considerations to take. Buprenorphine, the active ingredient in Suboxone, is an effective medication for treating opioid addiction. But it can cause sudden, painful withdrawal symptoms when starting the drug in fentanyl users. This is called “precipitated withdrawal.”
Normally, buprenorphine is started after stopping opioids for a short time, like 6-24 hours. This helps avoid precipitated withdrawal. But recent case studies found patients had severe withdrawals even after no opioid use for over 36 hours.
This is where buprenorphine microdosing comes in. Microdosing involves taking small amounts of buprenorphine during the transition period and gradually increasing the dose to prevent the precipitated withdrawal. This is such an important topic that I will write a separate blog post to provide all of the information needed to understand this process.
What Should You Do Next
First, know that addiction is not a choice or moral failure - it is a disease. Like any disease, it requires treatment. If you are struggling, reach out for help. Many resources exist, including medications to manage cravings and withdrawal. It's okay to be scared and ask for help. You are not alone in fighting this battle. Go to Google and type, “Suboxone Doctors Near Me,” I hope you find me and choose me for your journey towards recovery. But if you find another doctor, that is still a fantastic step towards getting help and finally stopping the fentanyl abuse.
Second, be aware of the extreme dangers of illegally made fentanyl and other synthetic opioids. They are so potent they can easily cause an overdose and death. You have no idea what you are really getting. There are so many adulterants used to “cut” your heroin, meth, oxycodone, or fentanyl and each can contribute to your death!
Third, be prepared to respond to overdoses. Have the medication naloxone available, as it can reverse an opioid overdose. Be prepared to administer 2 doses of naloxone for fentanyl overdoses. Quite often, one dose is not enough.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.