Fentanyl Addiction: Symptoms and Signs of Abuse

As the National Institute on Drug Abuse (NIDA) explains, fentanyl is a generic synthetic opioid.

This means that fentanyl is a narcotic pain reliever that carries a high risk of abuse. Typically, fentanyl is used after surgery for the treatment of severe pain. The drug is the main ingredient in different branded drugs, including but not limited to Fentora, Sublimaze, and Duragesic. This manmade narcotic comes in different formats, including as a tablet, patch, spray, and lozenge. All formats are potent, addictive, and an overdose could prove fatal. In fact, fentanyl is 50-100 times more powerful than morphine (an opiate derived from the poppy plant, as is heroin).

Physical, Mental & Behavioral Signs of Fentanyl Abuse

The Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-5), is a main diagnostic tool within the mental health and addiction treatment community. Per the DSM-5, a person is considered to be suffering from a substance use disorder (note, the term addiction is no longer used) if at least two symptoms emerge within the same 12-month period. There are a total of 11 possible symptoms. The more symptoms that are present, the higher the grade of use disorder along a continuum from mild to moderate to severe.

The DSM-5 specifically recognizes opioid use disorder. A person who would be considered, in lay terms, to be experiencing fentanyl addiction would be clinically considered to have an opioid use disorder (at the severe end of the continuum). The following is a paraphrased description of the 11 symptoms associated with an opioid use disorder:

• More fentanyl is taken, or it is taken for a greater length of time than initially intended (i.e., the slippery slope from recreational narcotics use to addiction).
• The individual has the ongoing desire to stop abusing fentanyl, or at least cut down on the abuse, but is unable to do so.
• A significant portion of one’s day, energy, time, and money is used to obtain fentanyl, abuse it, or recover from its use.
• The person has urges or cravings to use fentanyl.
• As a result of the ongoing fentanyl abuse, the person is not able to adequately meet obligations at home, work, or school.
• Even though the fentanyl abuse is causing various problems, the person continues to abuse this narcotic.
• The person withdraws from or reduces participation in work, social, recreational, and other opportunities to abuse fentanyl.
• The individual continues to abuse fentanyl even when there is awareness of the dangerous situations that arise, such as while driving.
• Use of fentanyl continues, even though it is causing or exacerbating a psychological or physical problem.
• The person develops a tolerance to the drug – the natural process whereby the body demands more of a drug in order for the person to experience a high similar to that of an earlier period of use.
• Withdrawal symptoms occur when the fentanyl use stops or the familiar dosage is decreased (symptoms discussed in further detail below).

Side Effects of Fentanyl Use

The side effects associated with fentanyl can emerge, with greater severity, in individuals who abuse this drug. For this reason, it is helpful to consider some of the most common side effects, which include but are not limited to:

One of the most common side effects of fentanyl abuse is the onset of addiction (to be clinically accurate, addiction per the DSM-5, would be called an opioid use disorder). When the body continues to receive fentanyl, it naturally makes adjustments. One adjustment is to build tolerance, which then requires the person to take more fentanyl in order to achieve the desired high.

There is a great danger implicit in tolerance — as the fentanyl intake rises, so too does the risk of harmful side effects. The body wants to promote survival but once drugs are introduced, and drugs are foreign substances to the body, the system gets turned into a potential engine of personal destruction.

More Rare Side Effects

The side effects that are considered rare for individuals who use fentanyl for therapeutic purposes under the control of a doctor may be brought out by abuse of fentanyl. Some of the less common side effects include but are not limited to:

• Problems walking and balancing
• Clumsiness
• Stomach or abdominal
• Headache
• Muscle jerking or twitching
• Less responsiveness to stimuli
• Hallucinations (visual, audio, and tactile)
• Severe constipation
• Extreme sleepiness
• Abnormal thoughts
• Slowed or fast paced heartbeat
• Trembling
• Seizures

Signs of Fentanyl Overdose

When a person uses fentanyl as part of a medically supervised pain management plan, there is little risk of overdose. However, fentanyl abuse exposes a person to an ongoing risk of overdose. The most common signs of fentanyl overdose are slow breathing or acutely shallow breathing. If the following symptoms arise and persist, it may be necessary to seek medical attention:

• Shallow or slowed breathing
• Depression; feeling empty or discouraged
• Loss of strength
• Muscle stiffness
• Lack of interest in activities
• Back pain
• Diarrhea

Signs of Fentanyl Withdrawal

When a person stops using fentanyl or considerably reduces the familiar dose, withdrawal symptoms emerge. The following are some of the most common fentanyl withdrawal symptoms may include:

There is a general advisement in the addiction treatment community that an individual should not attempt to stop using narcotics suddenly. The opioid withdrawal process can be particularly uncomfortable, and suddenly stopping the use of narcotics can trigger severe withdrawal symptoms to emerge. Rehab programs that offer medication-assisted therapy will provide eligible clients with substitution therapy in the form of drugs like methadone or Suboxone (buprenorphine).

It is called substitution therapy because the person is safely transitioned to the treatment medication without fully detoxing from narcotics. Some individuals will remain on an opioid substitution therapy for months or even years. Other individuals will eventually reach full detoxification (i.e., no opioids or opiates in the body).

Behavioral Signs of Fentanyl Abuse

It is helpful to learn about behavioral symptoms of fentanyl abuse from different sources, including a person who has been down that road. Mary Grables (pseudonym) wrote an article for the informational site The Fix, about how she got into fentanyl abuse and some of the ways that she behaved as a result.

Mary’s experience sheds light on areas that may be too subtle for a research project to discover, such as chewing fentanyl patches. Her account demonstrates that many different behaviors can be expected when a person makes drug use a priority. Mary’s account reflects the great difference in thinking between a person who is in recovery versus one who is firmly in the grip of addiction. Mary encountered numerous players in the illegal prescription drug sale market, yet none of them were the villains that a media story may make people in these situations out to be. Mary’s story only highlights the need for people who are experiencing fentanyl or other drug abuse to get help.

Further, it’s not just that drugs cost money, but that people often stop being able to take care of their basic needs or keep a job. On the one hand, there’s the direct cost of fentanyl use, and on the other hand, there are all of the lost opportunity costs. The recovery process addresses each facet of drug abuse. Treatment can safely transition people to an opioid substitution therapy or guide them through a complete detox process. It can then address the root causes behind the fentanyl abuse and empower them with tools to build a drug-free future.