man holding needle sitting outside looks away from camera

Fentanyl is a man-made (synthetic) opioid drug. The drug has a rapid onset and is extremely potent, far more potent than many other of the opiate drugs like morphine.

Fentanyl’s primary medical use is for the control of chronic pain or postsurgical pain, particularly for people who have developed tolerance to other opiate medications. It can be used in different formats, such as a patch that is placed on the skin and releases the drug slowly into the system, in pill form, and even as a lollipop for children who suffer from chronic pain related to diseases like cancer. Some of the brand names for fentanyl products include Duragesic, Actiq, and Sublimaze.

This drug is an extremely dangerous drug when abused. The United States Drug Enforcement Administration classifies it in the Schedule II controlled substances category, which is the highest level of control for drugs that are available with a prescription from a physician.

Fentanyl has received coverage in the media as a result of an increase in overdose deaths associated with opiate drugs and its role in overdoses among intravenous drug abusers. Abusers may commonly mix fentanyl products with heroin, or illicit drug dealers may mix fentanyl with heroin in an attempt to produce a more potent product. This can be a very dangerous practice because the potency of fentanyl is so high that very small amounts can be fatal even in individuals who have developed tolerance to other opiates.

Formal Signs of an Opiate Use Disorder as a Result of Fentanyl Abuse

The American Psychiatric Association (APA) lists the criteria used to formally diagnose substance use disorders and addictive behaviors. While only a trained clinician can make a formal diagnosis of an opiate use disorder, generalities associated with the formal diagnostic criteria are symptoms that an individual may recognize in someone with a suspected problem with fentanyl abuse. The formal diagnostic criteria are not presented here, but the behaviors that are covered by the diagnostic criteria to formally diagnose someone with an opiate use disorder include the following:

  • Frequent use of the drug for nonmedical reasons
  • Use of the drug that leads to significant distress or impairment in functioning
  • Significant problems controlling use of fentanyl
  • Giving up important recreational, social, or occupational activities as a result of use of the drug
  • Significant problems at work, at home, or in other areas as a result of use of the drug
  • Use of the drug that results in being unable to fulfill important role obligations, such as obligations at work, at home, or in other important areas of life
  • Significant cravings for the drug
  • Tolerance to the drug
  • Withdrawal symptoms when use of the drug is stopped or reduced

There are 11 formal diagnostic criteria that can be used by clinicians to diagnose an opiate use disorder. A formal diagnosis is made when the person displays at least two of these 11 diagnostic criteria within a 12-month period. The severity of the person’s opiate use disorder is determined by the number of diagnostic criteria they meet. People who only satisfy two or three diagnostic criteria would be diagnosed with a mild opiate use disorder (previously referred to as substance abuse). Individuals who have met the diagnostic criteria for four or five symptoms would be diagnosed with a moderate opiate use disorder, whereas those having six or more of the symptoms would be diagnosed with a severe opiate use disorder. Most individuals who meet the diagnostic criteria for moderate or severe opiate use disorders would be classified under the older system as having a substance dependence issue (addiction).

Clinicians are trained to understand how the diagnostic criteria apply to the types of situations that occur with substance use disorders and how to determine if an individual meets them. Some of the more specific manifestations of the behaviors that occur under the realm of the diagnostic criteria that might suggest a person has a problem with abusing fentanyl can include the following:

  • The person engages in doctor shopping in an attempt to get multiple prescriptions for fentanyl products.
  • A person with a prescription for fentanyl frequently uses up the drug before it should have been used up according to its prescribed instructions.
  • Individuals with fentanyl patches attempt to extract the drug from the patch and take it in oral form or inject it.
  • Individuals without a prescription for fentanyl are found to have prescription bottles for fentanyl pills, discarded fentanyl patches, and other drug paraphernalia that is associated with the use of fentanyl, such as syringes.
  • The person spends a significant amount of time and/or money attempting to illicitly get fentanyl products.
  • A person who uses fentanyl in conjunction with other drugs, such as heroin, would obviously be suspected of fentanyl abuse.
  • Symptoms of fentanyl intoxication are present, such as pinpoint pupils, problems with motor coordination, slurred speech, lethargy, and even confusion or frequent issues with consciousness.
  • Track marks as a result of injecting drugs should arouse suspicion.
  • A person suspected of abusing fentanyl may often display periods of cold or flulike symptoms as a result of withdrawal.
  • The person may become very reactive (irritable or angry) when someone mentions they may have a problem with drug abuse.
  • A person suspected of fentanyl abuse may uncharacteristically lie or engage in uncharacteristic behaviors, such as selling items, stealing, or other illicit activities (most likely in an effort to purchase more of the drug).
  • Some of the above symptoms may be present in conjunction with significant weight loss and/or significant health issues.
  • Some of the above signs may be present in conjunction with intense mood swings that vacillate from depression or anxiety to periods of happiness or serenity.
  • Legal problems associated with the use or possession of drugs like fentanyl are obvious signs that there may be an abuse issue.

Treatment Issues

Troubled teenager during meeting with his psychologist

Individuals with opiate use disorders are often unwilling to enroll in a treatment program unless there is some very potent external motivating factor, such as getting caught up in the legal system, the threat of loss of a job or relationship, or being forced into treatment. It should be noted that individuals who are coerced into treatment for substance use disorders have the same overall rates of success in recovery as those who voluntarily enter treatment. Thus, using coercion to get someone into treatment may be beneficial. At some point in treatment, the person must make the connection between their behavior (drug abuse) and the distress and dysfunction they are experiencing. This is where professional treatment providers, family members, and concerned peers can help the person.

Treatment should always consist of:

  • An initial assessment to identify areas to address in treatment
  • Initial placement in a medical detox program that utilizes opiate replacement medications like Suboxone or methadone
  • Treatment of any co-occurring psychiatric/psychological conditions
  • Continued use of medications when needed
  • Personal acceptance of accountability for behavior and a willingness to undergo random drug screenings in the initial stages of recovery
  • The use of psychotherapy for substance abuse to understand the substance abuse problem, develop positive coping skills, engage in a program of relapse prevention, and develop other needed skills to engage in positive recovery
  • Participation in social support groups, such as Narcotics Anonymous or other types of groups that are run by and primarily consist of other individuals in recovery
  • Family support and participation
  • Long-term involvement in treatment that extends far beyond simply getting through the withdrawal management process