Fentanyl is a synthetic opioid drug that is similar to morphine but far more potent. It is classified as a Schedule II controlled substance, and its medical uses are primarily for the management of severe pain following surgery. It can also be used to treat chronic pain in people who have developed significant tolerance to other opioid medications.
Fentanyl is typically administered through an injection, a transdermal patch, or dissolvable lozenges. The fentanyl that is sold on the street is generally sold as a powder, but it may be sold as tablets. It is often mixed with other opioids and injected, taken orally, or put on blotter paper and dissolved in the mouth. Individuals may also attempt to extract the drug from the patches and ingest it in numerous ways.
Effects of Fentanyl
Fentanyl has a similar mechanism of action to other opiates like morphine. It binds to the natural opiate receptors in the brain that are involved in the control of pain and emotional responses. When opioid drugs bind to the specific receptors, they also result in an increase in dopamine levels in the brain, and this leads to feelings of euphoria and wellbeing. The effects of fentanyl are very similar to the effects of heroin and include:
- Significant euphoria
- Drowsiness, sedation, and confusion
- Nausea, respiratory suppression, decreased heart rate, and constipation
- Impaired cognitive abilities, impaired reasoning abilities, and issues with motor coordination and reflex actions
- A comatose state and even death when taken in excessive amounts
Long-term effects of fentanyl abuse are very similar to long-term effects of morphine or heroin abuse. When taken for medical reasons under the supervision of a physician in its pure form, fentanyl will often have few significant side effects; however, abusers tend to use the drug in greater amounts and use it more frequently. They often mix it with other drugs like heroin or cocaine that can also lead to significant complications. Individuals who mix fentanyl with heroin are creating an extremely dangerous situation by combining two extremely potent opiate drugs and enhancing the effects of both drugs.
A very real potential long-term effect of fentanyl abuse is an increased risk to overdose on fentanyl due to mixing it with similar drugs like heroin, not paying attention to the amount of fentanyl being taken, or continuing to take it when under its effects. An overdose of fentanyl can result in significantly decreased respiration that can lead to brain damage and/or death. Chronic abuse of fentanyl also increases the probability that an individual will eventually ingest a counterfeit drug labeled as fentanyl or other potentially dangerous substance that can seriously harm the individual.
Chronic abuse of fentanyl can lead to problems with decision-making that can result in long-term effects due to poor choices.
This can lead to issues with self-care, failure to maintain personal hygiene, and engaging in risky behaviors like unprotected sex or needle sharing. These behaviors can lead to further complications and a risk to contract infectious diseases. Moreover, chronic abuse of fentanyl can weaken the immune system, resulting in an even higher potential to contract infectious diseases.
Abuse of fentanyl results in respiratory suppression in everyone. Over the long run, this condition can lead to an increased vulnerability for an individual to develop respiratory infections and other forms of respiratory disease. Compromise of the respiratory system can lead to chronic reduced oxygen volumes to organs like the brain, which can lead to long-term cognitive issues related to:
- Attention and concentration
- The ability to encode information in forming new memories
- The ability to coordinate intentional movements
- Impairments with reasoning, judgment, abstract thinking, and problem-solving
- Impulse control or emotional states
Individuals who inject fentanyl are placing themselves at risk for a number of blood-borne diseases and cardiovascular issues. Fentanyl abuse compromises judgment, which can lead to needle sharing that can increase this potential even further. Contraction of HIV, hepatitis, and other diseases that can affect important organs, such as the brain, heart, and liver, can result from chronic abuse of fentanyl. Chronic use of fentanyl may also result in chronic issues with hypotension that can affect an individual in the same way that respiratory suppression affects certain organs.
Tolerance and Withdrawal
Chronic abuse of fentanyl can also lead to significant issues with the development of tolerance, which results in an individual not getting the desired effects from the normal amount of the drug they have been using. When an individual develops tolerance to a drug, they often seek to use increasingly higher amounts of the drug, which can increase the potential for adverse conditions associated with abuse.
As tolerance increases, the potential to develop physical dependence on fentanyl increases. Physical dependence consists of the development of tolerance and the later appearance of a withdrawal syndrome when an individual cannot get fentanyl. While the withdrawal syndrome from opiates like fentanyl is not considered to be potentially dangerous in most cases, individuals may act out of desperation and become involved in behaviors or activities they would normally not engage in. This can further lead to an increased risk to engage in risky behaviors that can further threaten physical and mental health. Pregnant women who abuse opiate drugs run the risk of having children who are born with physical dependence on these drugs.
Chronic abuse of opiates like fentanyl often results in significant social ramifications for an individual. When an individual is chronically abusing an opiate drug, it is almost certain that they are:
- Not performing at their full potential in aspects of their employment (if they are still employed)
- Experiencing some level of distress in personal relationships
- Not fully engaging in many of their personal responsibilities, such as responsibilities to their spouse or partner, children, other family members, and friends
- Committing financial resources to obtaining fentanyl that could be better used elsewhere
- Engaging in an activity that can have serious legal ramifications
An obvious long-term effect of chronic abuse of fentanyl is the development of an opiate use disorder. By definition, this means that the individual is suffering severe stress and/or functional impairment as a result of their misuse of an opiate drug.
One of the long-term consequences of abusing any drug is the potential to also be diagnosed with another mental health disorder in addition to the substance use disorder. The American Psychiatric Association (APA) and other professional organizations use the term comorbidity to refer to the simultaneous presence of two or more disorders at the same time. Individuals with opiate use disorders have high comorbidities for other types of psychological disorders, including anxiety, depression, eating disorders, trauma- and stressor-related disorders, and numerous other disorders. It is unclear how the direction of this relationship works. Some individuals may first develop an opiate use disorder and then experience other psychological symptoms that qualify them for a psychiatric diagnosis, whereas others may have pre-existing psychiatric problems that increase the risk of abusing certain drugs.
According to APA and other sources, individuals with chronic opiate use disorders:
- Have lower levels of life achievement.
- Have lower levels of self-described life satisfaction
- Have higher rates of unemployment, divorce, and attempted suicides
- Have significantly more medical issues than individuals without substance use disorders
- Have higher rates of criminal convictions
- Die at significantly younger ages than individuals without substance use disorders even if they have years of recovery behind them
Thus, even though many individuals who abuse opiates like fentanyl consider their substance abuse an activity that contributes to their overall life satisfaction, the actual data does not support this notion. Long-term effects of abusing an opiate drug like fentanyl encroach on every area of an individual’s life and functioning in a detrimental manner.
Getting Treatment for Fentanyl Abuse
Because chronic abuse of an opiate drug like fentanyl is a serious issue and individuals who chronically abuse opiates most likely have a diagnosable opiate use disorder, the most efficient way to address the situation is for them to enroll in a comprehensive treatment program that help them understand the issues that drive their behavior and learn proactive methods to address the problem. Chronic opiate abuse does not typically resolve on its own.
These individuals will initially need a thorough assessment to identify all issues that should be addressed in the treatment program. They will often need to be involved in a medical detox or withdrawal management program to help them get through the withdrawal syndrome. They will then require a long-term treatment program that includes intensive psychotherapy, support group participation, peer and family support, medication-assisted treatment, and other forms of treatment interventions to remain abstinent and develop new skills that can help them avoid relapse.