Is fentanyl a legal drug?


fentanyl abusing woman staring out of hotel window

Fentanyl is a potent synthetic, meaning it is created in a lab. The Drug Enforcement Administration (DEA) reports that fentanyl is available in prescription form as a lozenge- often called lollipops (Actiq), as a sublingual tablet (Abstral), a sublingual spray (Subsys), a buccal tablet (Fentora), as a transdermal patch (Duragesic), or in an injectable form.

Fentanyl is regularly diverted through licit channels via pharmacy theft, fraudulent prescriptions, and diversion from patients, healthcare providers, and pharmacists. Since fentanyl is man-made, it is also made illicitly in clandestine laboratories into a powder form or pressed into counterfeit “prescription” tablets. Fentanyl may be abused by snorting, smoking, or injecting the powder. The patches may be abused by chewing or sucking on them, freezing them, or scraping the gel off to harvest it and then ingesting or injecting it.

The National Survey on Drug Use and Health (NSDUH) estimates that over 250,000 Americans abused fentanyl in 2016; however, this does not take into account illicit fentanyl, so the rate of abuse is likely much higher than that. The number of fentanyl encounters by law enforcement has risen drastically in recent years, more than doubling between 2014 and 2015, the Centers for Disease Control and Prevention (CDC) reports. This means that the amount of fentanyl on the street is increasing, and heightened availability often means more people abusing the drug.

Why is fentanyl so dangerous?


The DEA warns that fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. Since it is made in a lab and can be produced illicitly, it may be cheaper and easier to get than other opioid drugs like heroin. Fentanyl is commonly used to stretch heroin or to cut it to make it go further. A person taking heroin may have no idea that they are also taking fentanyl, which is much more potent in much lower doses, increasing the odds for a negative reaction and possible life-threatening overdose.

The New York Times publishes that overdoses involving fentanyl are up nearly 550 percent in the past three years, as over 20,000 Americans died from an overdose involving fentanyl (or a fentanyl analogue) in 2016. Around 115 people die from an opioid overdose in the United States on a daily basis, the CDC warns, and these numbers are being driven up by synthetic opioids like fentanyl.

What are the side effects of fentanyl?


As an opioid drug, fentanyl has similar effects to heroin, morphine, and other prescription narcotic pain relievers. Upon ingestion, the drug can cause intense euphoria and relaxation. Pain receptors are blocked, and dopamine floods the brain, causing drowsiness and decreased coordination and movement abilities. It also slows reduces life-sustaining autonomic functions of the central nervous system, such as respiration, heart rate, blood pressure, and body temperature. Mental confusion, trouble breathing, sedation, nausea, vomiting, muscle rigidity, constipation, itching, dry mouth, unconsciousness, coma, and death are all potential side effects of fentanyl use and abuse.

What are the risks of mixing fentanyl with other drugs?


girls trading fentanyl and other drugs

Fentanyl is an extremely dangerous drug to abuse on its own, and when combined with other drugs, the risks go up exponentially. Fentanyl may be intentionally or unintentionally combined with drugs like heroin or cocaine, other prescription opioids, benzodiazepine medications, or alcohol.

When heroin, prescription opioids or benzodiazepines, or alcohol are combined with fentanyl, the odds of fatal respiratory depression and overdose are heightened as all of these substances work to suppress the central nervous system. The combination of cocaine and fentanyl can be especially risky since these drugs have nearly opposite effects – one being a stimulant and one being a depressant. This means that the drugs may actually mask some of the effects of each other, causing a person to take a toxic overdose unknowingly.

Fentanyl-related overdoses are skyrocketing all over the United States, and quite often, multiple drugs are found in the system at the time of death. For example, the Washington Post reports that there were more than 600 overdose deaths involving fentanyl in 2016, and 115 of them involved both cocaine and heroin.

The combination of drugs can also make an overdose more difficult to reverse, especially if the first responder is not sure what drugs are involved. Due to the potency of fentanyl, one dose of the opioid antagonist often used to reverse an opioid overdose, Narcan (naloxone), may not be enough.

Mixing fentanyl with other drugs also more rapidly increases drug tolerance, dependence, and rate of addiction.

How dangerous is a fentanyl overdose, and what does it look like?


A fentanyl overdose often shuts down a person’s respiratory system, making it difficult or even impossible for them to breath. Oxygen flow is also cut off to the brain, and coma, brain damage, and death are all potential consequences of a fentanyl overdose.

Since fentanyl takes effect so rapidly, it can overwhelm a person’s system quickly, in as little as one dose. Fentanyl can also be absorbed through the skin, meaning that just coming into contact with it can put the drug into the bloodstream. Just touching fentanyl powder can be enough to cause a fatal overdose.

Immediate medical attention is required in the case of a suspected fentanyl overdose.

Possible overdose symptoms include:

  • Mental confusion
  • Shallow or labored breathing
  • Cold and clammy skin with a bluish tinge to it
  • Irregular heart rate and weak pulse
  • Involuntary movements or convulsions
  • Pinpoint pupils
  • Stupor
  • Loss of consciousness
  • Coma

What are the possible long-term health consequences of fentanyl use?


Repeated use of an opioid drug like fentanyl can lead to respiratory and lung complications and infections, including pneumonia, heart and cardiovascular problems, infections in the lining of the heart and heart valves, constipation, sleep difficulties, emotional disturbances, liver and kidney disease, sexual dysfunction and menstrual disturbances, skin abscesses, tolerance, physical dependence, and brain damage.

Perhaps one of the biggest health risks of chronic fentanyl use is addiction. Fentanyl binds to opioid receptors in the brain, interfering with normal brain chemistry levels and impacting regions of the brain responsible for emotional and pain regulation, the National Institute on Drug Abuse (NIDA) publishes.

When a person takes fentanyl several times, it can be difficult for the brain to regulate itself without the drug. Withdrawal symptoms may set in, including muscle and bone pain, insomnia, depression, anxiety, irritability, tremors, nausea and vomiting, diarrhea, restlessness, goosebumps and sweating, uncontrollable body movements, irregular heart and respiration rates, and intense cravings. A person suffering from physical dependence on fentanyl will likely have trouble feeling happy or keeping emotions regulated without the drug’s interaction. Withdrawal can be significant enough that a person will begin to struggle controlling cravings and drug use, leading to compulsive drug-seeking and using behaviors and ultimately addiction.

How addictive is fentanyl?


The American Society of Addiction Medicine (ASAM) publishes that over 2.5 million Americans battled addiction involving an opioid drug in 2015. Opioid addiction has been labeled a public health crisis in the United States.

Fentanyl may be knowingly or unknowingly abused by those struggling with opioid addiction. Individuals suffering from heroin addiction may intentionally seek out fentanyl for a bigger and more intense high. Since the drug is so potent, fentanyl is even more highly addictive than heroin and other prescription opioids. A person can very quickly develop a tolerance for opioid drugs, meaning that they will seek out bigger doses or more potent drugs to feel the desired rush of euphoria in the same way. Physical dependence is often not far behind.

Opioid dependence comes with intense cravings and difficult physical and emotional withdrawal symptoms when the drug wears off, further encouraging people to keep taking it. The more potent the drug, like fentanyl, the more significant the cravings, and withdrawal symptoms can be making it very difficult to stop taking the drug. Fentanyl is considered to be highly addictive.

What kind of support groups are there for fentanyl addiction?


Fentanyl addiction is treated through a combination of therapeutic, supportive, medical, and pharmacological methods. Medical detox is often the first step in a treatment program. It can be easier and safer to wean off the drug slowly in a controlled and medically supervised environment, often by substituting other longer-acting opioids for fentanyl and using other medications to manage cravings and withdrawal symptoms.

Behavioral therapies, counseling, and support groups are often an important aspect of a complete treatment plan. Support groups for fentanyl addiction can help to maintain sobriety, give individuals a healthy social outlet and opportunities for sober activities, and offer tools and techniques for minimizing relapse.

Narcotics Anonymous (NA) follows a 12-Step program based on peer support and a spiritual outlook on recovery. This self-help group can offer an outlet where a person in recovery can feel heard and understood. Peer mentors are often available at all times of the day and night to lend support and encouragement, and meetings are free and confidential.

What are some tips for minimizing relapse?


Completing a comprehensive addiction treatment program that is at least 90 days in length sets a strong base for a lasting recovery. Relapse prevention techniques are taught during behavioral therapies and life skills trainings. Individuals learn how to control difficult emotions, recognize potential triggers, and cope with stress. Healthy habits that are learned in treatment and then continued into recovery can help to minimize relapse as well.

Here are some tips and tools for minimizing episodes of relapse during recovery:

  • Stay busy and occupy the mind. Find hobbies to pass the time and focus positive energy.
  • Take up a creative outlet, such as writing, drawing, painting, sculpting, dancing, or playing a musical instrument. This can be a great stress reliever and healthy outlet.
  • Eat healthy and balanced meals, drink lots of water, and get plenty of sleep. Keeping a strong physical body helps with emotional strength and clarity.
  • Participate in fitness or exercise activities. Exercise can be a great way to manage stress, promote self-confidence and self-esteem, and release endorphins naturally.
  • Consider engaging in holistic endeavors, such as yoga and mindfulness meditation. Both of these alternative therapeutic techniques help to strengthen a person’s mind and body connection, teaching how to recognize and relieve stress and tension to achieve peace of mind and emotional balance.
  • Find a support group and attend meetings. Support groups can offer encouragement and tools for minimizing relapse as well as sober activities and social outlets.
  • Talk to friends and family, and reach out when needed. Be honest about cravings and feelings. Talking to loved ones can aid in keeping things under control and minimizing relapse.
  • Learn as much as possible about the disease of addiction and relapse. Know what to expect in recovery and how to prepare for eventualities that may arise.
  • Continue to attend therapy and counseling and participate in aftercare programs. Many addiction treatment programs will offer recovery support services and opportunities for alumni to meet and engage with each other.