The US has been working to tackle its opioid epidemic for decades, but in the past few years, a potent opioid drug has appeared in the country and changed the game.
Understanding the third wave of the opioid crisis (and understanding narcotics addiction in general) requires users and their loved ones to understand what fentanyl addiction is and looks like.
What Is Fentanyl?
Fentanyl is a synthetic opioid drug, around 100 times the potency of morphine – already a highly controlled substance that is only prescribed in medical instances moderate to severe pain. It was developed originally by Jansenn Pharmaceuticals in 1960 but is rarely used in medical settings due to its incredible potential for harm when abused, and its unnecessary strength in most situations.
However, starting in the 2010s, it grew in popularity in the illicit narcotics market. Because it is fully synthetic, it is cheaper and more quickly made than semi-synthetic drugs like heroin that require cultivated components such as poppies to produce. This potent powder is then used by drug cartels to cut other narcotics and stimulants – elevating their effects cheaply. According to the US Fentanyl Working Group, the cost to produce 1 kg of fentanyl is $32,000 – but this can be sold on with a current street value of $20 million.
Recognizing the Signs of Fentanyl Addiction
If you’re concerned that a loved one may be abusing opioids, you are likely worried about the potential risk of fentanyl. It’s important to note that most people who are abusing fentanyl don’t necessarily know that they are.
This drug usually appears as something that has been laced into other drugs of abuse to increase their potency, not as a substance that is sought out and taken alone.
Even so, it’s possible to spot the signs of fentanyl addiction insofar as they resemble the symptoms of narcotics addiction in general. If your loved one appears to be abusing any drugs from this family of substances, mainly if they use street suppliers, speaking to them about your concerns and options for treatment, and accessing emergency treatments like naloxone may mean the difference between life and death. Here’s what to look out for:
Symptoms of Fentanyl Abuse
Regular abuse of fentanyl can produce longer-term physical and psychological health effects that are not necessarily seen the very first time the individual uses it. With time, this powerful opioid deals serious damage both to our mental health and to our internal physiological health, causing:
- Rapid weight loss
- The development of seizures
- Long-term GI trouble
- Hypertension and cardiac disease
- Insomnia
- Migraines
- Clinical depression and anxiety
- Hallucinations and psychosis
- Cognitive decline
- Bacterial infections
- Blood-borne illness in injecting users
Mild opioid use disorder occurs when two are met and not under any kind of doubt, moderate manifestations occur when four or five are met, and the most severe forms at six or more.
Diagnosing Fentanyl Addiction
Fentanyl addiction is typically diagnosable as Opioid Use Disorder – outlined in the DSM-5 which describes individuals who continuously abuse narcotics despite knowledge of the negative consequences of their behavior. A physician evaluating an individual for fentanyl addiction will be looking to see if two or more of the following 11 criteria are met:
- The individual often takes opioids in larger amounts or for longer than they planned
- The individual wants and tries but fails to either quit or cut back on use
- Obtaining, using, and recovering from opioids takes up a great deal of time in the individual’s life
- They experience cravings
- Opioid use complicates the individual’s ability to meet major obligations
- The individual has experienced social or interpersonal issues related to their use, but continues
- Withdrawal from aspects of social, work, or home life that used to bring joy, loss of interest in hobbies
- Opioid use occurs in dangerous situations
- The individual knows that opioid abuse exacerbates a specific or recurrent physical or mental health problem of theirs
- Tolerance (effects of equivalent doses of the drug wear off over time)
- Withdrawal (either classic withdrawal syndrome symptoms, or regular use of CNS depressants to alleviate withdrawal symptoms)
Evidence of Abuse
Fentanyl is used to cut other substances and often is abused by accident. Many individuals who are taking fentanyl are doing so as they take another opioid drug, so the evidence of abusing this substance tends to resemble the evidence of taking something else (eg: heroin or prescription medication). If the person you are concerned about lives in your household, you may see physical evidence of their opiate habit without realizing it.
In addition to physical track marks and bruises which may appear on the body, depending on the mode of abuse, there may also be opioid paraphernalia around your home, including:
- Tin foil
- Hypodermic needles
- Pipes
- Small spoons, sometimes with heat discoloration
- Empty pill bottles, or pills hidden in strange places
To a lesser, but significant extent, growing evidence is showing that fentanyl is being more regularly used to cut powder cocaine supplies before they reach the US. If your loved one is using cocaine, there is a growing likelihood that they are coming into contact with fentanyl. Signs of cocaine abuse include:
- Glass surfaces
- Spoons
- Rolled-up paper or plastic straws
- Razor blades
- Needles
Signs of an Opioid High
If your loved one is regularly under the influence of opioids, including fentanyl, you’re likely to witness them in an intoxicated state from time to time. Signs of an opioid high can vary in intensity, but generally include:
- Sedated mood
- Disorientation and confusion
- Drowsiness
- Drifting in and out of consciousness, or “nodding off”
- Pinpoint pupils
- Flushed skin
- Slowed or struggling breathing
- Irregular heartbeat
- Suppressed appetite and constipation
Behavioral Signs
Addiction affects our behavior even outside of the context of a high. If your loved one is abusing opioids regularly, you are likely to see some changes in the way they act, socialize, and regulate their moods. Common behavioral signs of fentanyl addiction include:
- Constant or compulsive thoughts about using
- Mood swings, especially triggered by withdrawal after a high
- Using more frequently to stave off opioid withdrawal
- Increased isolation, avoiding social events or responsibilities to use
- Decreased libido
- Secrecy about use, often accompanied by secrecy about people and places where
- they go to use or procure the substance
- Financial trouble, relationship or housing trouble, and other negative life consequences
- Asking for explained or unexplained loans, stealing
- Failed attempts to stop using resulted in relapse
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Opioids don’t just produce a high, they affect the ways our bodies function in core ways. Fentanyl interacts with neurons in our brains responsible for managing many of our body systems, including natural sedation, wakefulness, pain relief, and regulation of various vital organ systems (including breathing, heart rate, and body temperature).
Our nervous systems don’t allow these functions to be tampered with too much long-term, and over time they will adjust the way they work to cancel out the constant presence of the drug. The new baseline will have these body systems working in overdrive – keeping things somewhat more balanced when the opioid is around, but swinging everything into a hyper-stimulated withdrawal territory when it’s gone. This is the way that physical dependence on fentanyl works – the body adjusts and begins to need it.
The primary symptom of dependence is withdrawal. When a person can’t access the drug of abuse and goes into withdrawal, they enter a state that looks like the opposite of a fentanyl high:
- Agitation and irritability
- Restlessness
- Dilated pupils
- Goosebumps
- Tremors and spasms
- Physical pain – particularly deep bone pain and muscle aches
- Fever
- Dysphoric mood
- Paranoia and anxiety
- Cramps, nausea, vomiting, and diarrhea
- Intense cravings
Treating the Symptoms of Fentanyl Abuse & Addiction
Fentanyl addiction is a complex condition with strong psychological and physiological aspects. Rehab for fentanyl addiction can be generally broken down into two fields or phases (although they often overlap in time). Upon checking into residential treatment, the first thing the team will set to work on is getting the client off of fentanyl in a process known as detox.
Detox refers to the medically-supported steps involved in helping clients cease use and eliminate fentanyl from their bodies without suffering from severe withdrawal symptoms or relapsing. Medications are sometimes prescribed that either aid in tapering off the nervous system’s dependence on opioids or managing the host of related symptoms that come with withdrawal. Residential clients benefit from 24-hour monitoring and constant access to compassionate, knowledgeable experts as well as safe and substance-free housing during this period.
In the case of fentanyl, detox can take some time to proceed safely and comfortably. Once it has begun the next step is to work with the clinic’s mental health team to start parsing out the root causes of the individual’s substance use disorder and start developing sustainable, lifelong solutions that treat the addiction from where it begins. Residential facilities like our own offer a combination of psychiatric care, such as cognitive-behavioral therapy (CBT) and dialectic-behavioral therapy (DBT) to ground these efforts, in combination with a host of alternative therapies that highlight and center whole-body healing and complementary health practices that help clients transition from opioid addiction to a state of holistic wellness that can work for them, for life.
