Fentanyl has recently become a household name in America because of its role in the nation’s opioid crisis. It is the leading cause of drug overdose deaths and has been identified by the CDC as the driving factor behind the massive increase in overdose deaths.
Many people who are addicted to opioids say that they never know if their next dose will be fatal. It is impossible to know if fentanyl will be present in their next drug pick up, regardless of what type of drug they are using.
Because of this uncertainty, many people who misuse opioids now do “test doses” in hopes that they will be able to tell if the drug is laced with fentanyl. Harm reduction strategies now include distributing urine test strips to users so that they can see if the drug they consumed contained any fentanyl.
What is Fentanyl?
Fentanyl is a fully synthetic opioid drug. It is a commercially available and widely used prescription drug, but it is also manufactured illegally and sold on the illicit drug market.
Fentanyl’s deadliness lies in its ultra-high potency. Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. Even tiny amounts of it are lethal. A few grains of fentanyl may be the difference between getting high and overdosing.
The shocking thing about fentanyl addiction is that many people who use fentanyl are not even aware of it. Dealers are putting fentanyl into virtually any kind of drug, including non-opioid drugs such as cannabis and cocaine.
What is Fentanyl Used For?
Fentanyl is used for two medical purposes:
- To treat chronic, moderate-to-severe pain
- As part of general anesthetic or conscious sedation during surgery or painful medical procedures.
On the illicit market, fentanyl is used to increase profits and increase the addictiveness of drugs. Dealers are able to use tiny amounts of fentanyl powder to make fake drugs or reduce the amount of drug they put in their products.
After arriving at the hospital, many people who supposedly overdose on heroin find out that they had not actually taken heroin. Instead, what they thought was heroin was actually fentanyl and cutting agents. One study found that 73% of people who tested positive for fentanyl were not even aware that they had been using the drug.
Fentanyl also increases the addictiveness of drugs because it gives an intense high and has a very short half-life. Due to its short half-life, withdrawal symptoms begin only a couple of hours after the last use. This makes people seek out their next dose much sooner than they otherwise would.
How Does Fentanyl Work?
Opioids are drugs that come from or are similar to compounds found in the opium poppy. Like other opioids, fentanyl works by binding to opioid receptors in the brain. By doing so, they trigger abnormally high levels of the “feel-good” chemicals that form the brain’s reward system. These increased levels are responsible for the high that comes from using fentanyl.
Binding to opioid receptors (specifically the “mu” sub-type of opioid receptor) also gives fentanyl its pain-relieving effect. This receptor activity raises the pain threshold and provides an emotional detachment from pain. The sedating effect also contributes to pain relief.
What Does Fentanyl Look Like?
Illegally manufactured fentanyl comes as a white or off-white powder. However, people who purchase fentanyl on the street rarely see it in its powder form. Rather, it is hidden in other drugs (such as marijuana) or cutting agents and sold as other drugs (especially heroin). It is also pressed into tablets and sold as counterfeit pharmaceuticals, such as Oxycontin.
Different Types of Fentanyl
Fentanyl comes in a variety of pharmaceutical preparations, including delivery systems that are unique among opioids. These include:
- Fentanyl patch (transdermal)
- Fentanyl injection suspension for intravenous use
- Fentanyl sprays (for under the tongue or intranasally)
- Fentanyl oral dissolving tablets
These pharmaceutical versions of fentanyl are sometimes sold on the street after being stolen or diverted from prescriptions. However, illicit fentanyl is almost always hidden in other drugs or pressed into tablets.
Brand Names
There are many fentanyl brand names, and a number of generic pharmaceutical companies also produce fentanyl products that mirror the brand-name formulations. The following are some of the most common brand-name fentanyl products:
- Actiq
Actiq is a fentanyl preparation that comes as a transmucosal oral lozenge, meaning that it is absorbed into the bloodstream by dissolving in the mouth. The drug comes mounted on a plastic handle so that it can be removed from the mouth if the dose turns out to be too high. For this reason, Actiq is sometimes referred to as a “fentanyl lollipop.”
Actiq is intended for treating breakthrough pain in people who are using a long-acting version of fentanyl, such as Duragesic.
- Fentora
Fentora is a fentanyl preparation that comes as a tablet that dissolves in the mouth. Unlike Actiq, it does not have a handle. Fentora is intended for treating breakthrough pain.
- Duragesic
Duragesic is slow-release fentanyl preparation that comes in a transdermal patch. The patch is applied to the skin and changed every three days. It can take up to 36 hours for the drug to reach peak levels in the blood after the patch is applied for the first time. It takes around 24 to 36 hours for withdrawal symptoms appear after removing Duragesic. Duragesic provides long-acting pain relief by maintaining a constant level of the drug in the blood.
- Subsys
Subsys is a sublingual (under the tongue) fentanyl spray, used for breakthrough pain.
- Abstral
Abstral is a sublingual fentanyl dissolving tablet, also intended for breakthrough pain.
- Lazanda
Lazanda is a fentanyl nasal spray preparation for breakthrough pain.
Other Names and Street Names for Fentanyl
Because of fentanyl’s prevalence in the illicit drug market, it has developed many nicknames. These include:
- China White
- China girl
- Apache
- Dance fever
- Goodfella
- Murder 8
- TNT
- Jackpot
- Tango and Cash
- Great Bear
- He-man
Fentanyl Side Effects
Short-term side effects of fentanyl are related to the effects of the high and the withdrawal symptoms that rapidly follow. These include:
- Sedation, drowsiness
- Slowed reaction times
- Confusion, loss of touch with reality
- Breathing difficulties and suppression
- Loss of consciousness, coma
- Death
- Nausea
- Constipation
- High blood pressure, rapid heart rate
- Withdrawal symptoms (intense cravings, shakiness, cold sweats, etc.)
Long-term effects of fentanyl abuse include:
- Lack of self-care
- Drug-seeking behaviors, including crime to pay for the drugs
- Deterioration of dental health
- Infections from injection drug use (HIV, Hepatitis B or C, endocarditis)
- New onset mental health disorders
How Long Does Fentanyl Stay In Your System?
Fentanyl has an elimination half-life of 219 minutes, which is the time it takes for a healthy person to remove half of the drug from the blood. This is a short half-life, so fentanyl does not remain in the body for very long.
The length of time that fentanyl is detectable varies a great deal, depending on the individual and the particular test that the lab is using. There is considerable commercial demand for better and faster tests, so new testing procedures are being developed all the time.
Individual factors that affect the duration of fentanyl in the body include:
- Gender
- Age
- Racial background
- General Health
- Genetic and physiological make-up
- Health of the liver and kidneys
- Amount of drug used
Depending on the type of drug test, fentanyl can be detected for as long as 90 days. Common tests include:
- Blood: How long does fentanyl stay in your blood? Fentanyl is not routinely tested by blood tests. However, the drug is detectable in the blood for up to 12 hours following the last dose.
- Urine: How long does fentanyl stay in your urine? It is detectable in the urine for two to three days after the last use.
- Hair: Does fentanyl show up in a hair follicle test? Although it is often called a hair follicle test, hair drug testing does not test the follicle. Rather, it looks for the presence of the drug in the first 1.5 inches of the hair shaft. This method can detect even a single drug use for a period of about 90 days, based on average rates of hair growth.
Is Fentanyl Addictive?
Fentanyl is among the most addictive of drugs, due to two of its pharmacological properties: its ultra-high potency and its rapid clearance from the body. These properties make it lucrative for dealers to put fentanyl into their drug products. It gets people addicted faster, and it creates repeat customers who seek their drug’s potency.
How long does it take to get addicted to fentanyl? Fentanyl addiction can develop after a single use, particularly in those individuals who are predisposed to addiction by their genetics and life situation. Even without these predispositions, a single use can cause someone to seek out more of the drug after they feel fentanyl’s powerful withdrawal symptoms. These withdrawal symptoms may include intense sweating, muscle aches, shaking and chills. Things to look for when uncovering fentanyl abuse and addiction include:
- Signs of Fentanyl Addiction
Physical Signs:
Injection track marks on the body (not just the arms)
Poor dental health
Poor hygiene
Excessive weight loss
Confusion, euphoria, detachment from reality, loss of consciousness (when “high”)
Small pupils in the eyes
Behavioral Signs:
Drug-seeking behavior, potentially criminal
Intense cravings
Depression, anxiety and other mental health symptoms or disorders
Irritability
Social isolation
Negative feelings: guilt, anger, resentment, self-pity, low self-esteem, regret, self-loathing and remorse
Another concern of fentanyl addiction is the risk of overdose. According to the CDC, fentanyl is now the leading opioid associated with overdose, with 29% of overdoses involving fentanyl alone. This has made fentanyl an even more dangerous drug than that of heroin and oxycodone which previously were the substances bringing in the most overdose deaths.
At The Recovery Village Palm Beach at Baptist Health, we believe that long-lasting sobriety begins with a full continuum of care. That means our drug treatment programs are comprehensive and progressive, with each stage of treatment building on the others for a holistic and comprehensive approach to recovery.
Whether you are seeking rehab for drug addiction alone or in conjunction with a mental health disorder, The Recovery Village Palm Beach at Baptist Health can help. Contact us today for a confidential discussion with one of our representatives.
- Sources
Bouley, Jenna. “Issues with hair-follicle drug testing.” University of Richmond Journal of Law and Technology, August 13, 2018. Accessed July 16, 2019.
Centers for Disease Control and Prevention (CDC). “Drug and opioid-involved overdose deaths – United States – 2013-2017.” January 4, 2019. Accessed July 16, 2019.
Centers for Disease Control and Prevention (CDC). “Synthetic opioid overdose data.” December 19, 2018. Accessed July 16, 2019.
Drug Enforcement Administration (DEA). “Fentanyl.” (n.d.). Accessed July 16, 2019.
Food and Drug Administration (FDA). “Fentanyl citrate injection, USP.” November 2012. Accessed July 16, 2019.
Ghelardini, Carla; Di Cesare Mannelli, Lorenzo; Bianchi, Enrica. “The pharmacological basis of opioids.” Clinical Cases in Mineral and Bone Metabolism, December 2015. Accessed July 16, 2019.
Goldman, Jacqueline; Waye, Katherine; Periera, Kobe; et al. “Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: A qualitative study.” Harm Reduction Journal, January 8, 2019. Accessed July 16, 2019.
Mema, Silvina; Sage, Chloe; Popoff, Serge; et al. “Expanding harm reduction to include fentanyl urine testing: results from a pilot in rural British Columbia.” Harm Reduction Journal, April 6, 2018. Accessed July 16, 2019.
NarcoCheck. “FYL urine test (fentanyl).” 2015. Accessed July 16, 2019.
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