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Fentanyl Addiction

Written by Thomas Christiansen

& Medically Reviewed by Dr. Andrew Proulx, MD

Medically Reviewed

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This article was reviewed by a medical professional to guarantee the delivery of accurate and up-to- date information. View our research policy.

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Last Updated - 07/14/2023

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Updated 07/14/2023

Key Takeaways

  • Many people who consume fentanyl don’t mean to
  • Fentanyl’s characteristics of ultra-high potency and short half-life make it a difficult drug to withdraw from
  • Many people with addiction have a co-occurring mental health disorder, and may not even be aware of it
  • Fear of withdrawal is a major barrier to sobriety for many people
  • Medical detox is a safe and comfortable way to get off fentanyl without having to endure the harsh withdrawal effects
  • Simply the absence of drug use is not recovery, because it does nothing to address the underlying causes of the addiction
  • Residential rehab following medical detox is the mainstay of treatment for those who are ready to break free from fentanyl addiction

Fentanyl addiction is a deadly substance use disorder. Find out what makes fentanyl so deadly and what treatment options are available to people ready for recovery.

Fentanyl is a familiar word to most Americans because of its notoriety as a deadly drug. It is a synthetic opioid drug with an ultra-high potency. Perhaps the most bizarre aspect about fentanyl addiction is that many people who consume fentanyl may not intend to because it’s often cut with other drugs. Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. Even tiny amounts of it are lethal.

How addictive is fentanyl? Fentanyl’s ultra-high potency makes it among the most addictive drugs. Fentanyl is cleared from the body rapidly, meaning that withdrawal symptoms come on fast and intensely, not long after the last dose. This quality makes the drug even more addictive because users will seek the next dose soon after their last dose to stop the withdrawal, thus establishing the addiction cycle early on. Sometimes dealers use fentanyl to increase the addictiveness of their products.

How Is Fentanyl Abused?

Fentanyl is added to many other drugs, including cannabis. The idea is that dealers can make their product more addictive and people return to buy their product, drawn by the more potent high they get from the added fentanyl.

Fentanyl comes in a variety of forms, all of which have a high abuse potential:

  • Fentanyl patch: commercially available as a slow-release skin patch. A fentanyl patch high is obtained by smoking it.
  • Fentanyl powder: non-pharmaceutical, manufactured illegally, usually in China or Mexico.
  • Fentanyl pills: made illegally by pressing the powder into pills; often disguised as other opioids such as Oxycontin.
  • Fentanyl injection suspension: pharmaceutical, for intravenous use.
  • Fentanyl spray: nasal and sublingual (under the tongue) sprays are commercially available pharmaceuticals.

Signs of Fentanyl Abuse

Physical Signs

Physical symptoms of fentanyl abuse can depend on how long individuals have been using the drug and how much their addiction has removed them from normal life function. Some of these symptoms include:

  • 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

As a psychoactive drug, fentanyl changes the brain chemistry of the people who use it. As such, it is not surprising that it has significant effects on the psychology and behavior of people who use the drug, especially those who take it frequently or at high doses. The behaviors that are typical of any other substance addiction can also appear:

  • Drug-seeking behavior, potentially criminal
  • Intense cravings
  • Depressionanxiety 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

Fentanyl Withdrawal Symptoms

Because of fentanyl’s short half-life, acute withdrawal symptoms usually begin within two to four hours after the last use. This timeframe can be longer for people who were using the fentanyl patch (on their skin, as opposed to smoking it) because it is a slow-release delivery system. Regarding patches, withdrawal symptoms usually start within 24 to 36 hours after removing the patch. Peak withdrawal effects are usually seen two to four days after the last use of the drug, and symptoms usually last until about a week after the last use.

During the acute withdrawal phase, typical symptoms are: 

  • Intense cravings
  • Anxiety
  • Intense sweating
  • Insomnia
  • Muscle aches
  • Runny nose
  • Shaking, chills or goosebumps

After the acute withdrawal period, long-term symptoms may emerge. These are primarily psychological, although physical cravings can develop. Typical psychological symptoms include:

  • Relapse dreams
  • Anhedonia (inability to experience pleasure)
  • The “pink cloud” syndrome (excessively happy feelings, ignoring the reality of life)
  • Negative feelings typical of addiction: guilt, remorse, self-loathing, low self-esteem and anger

These symptoms are an especially potent cause of relapse and are precisely the reason that proper rehab treatment is necessary for most individuals for a return to good mental and physical health.

Fentanyl Overdose

What happens during a fentanyl overdose? Fentanyl overdose death is caused by the effect of the opioid on the brain’s breathing control center. As the amount of drug within the system increases, it eventually reaches a point where the brain stops telling the lungs to breathe and the individual stops breathing. Brain death and then death quickly follow.

Fentanyl overdose symptoms include:

  • Respiratory depression (a breathing rate less than 12 per minute)
  • Low body temperature
  • Stupor, loss of consciousness, coma
  • Small pupils

Side Effects of Fentanyl Abuse

Fentanyl side effects (including fentanyl powder side effects) can be related to short-term effects of use (especially the high followed by withdrawal), or long-term effects not only of the drug itself but also of addiction in general.

Short-Term Side Effects

Short-term side effects of fentanyl are related to the effects of the high and withdrawal:

  • 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

Side Effects of Long-Term Abuse

Long-term effects of fentanyl abuse include:

  • Lack of self-care
  • Drug-seeking behaviors, including crime
  • Deterioration of dental health
  • Infections from injection drug use (HIV, hepatitis B or C, endocarditis)
  • New-onset mental health disorders

Effects of Polysubstance Abuse

Fentanyl is often a part of polysubstance abuse because it is frequently added to other drugs, often without the knowledge of the people using the drugs. Heroin mixed with fentanyl, marijuana laced with fentanyl and other fentanyl-laced street drugs are commonly abused.

People who take non-opioid drugs (such as cannabis or cocaine) laced with fentanyl could be at especially high risk for overdose because they do not have opioid tolerance and are therefore susceptible to overdosing at much lower doses.

Causes of Fentanyl Addiction

Substance addiction is caused by two broad factors:

  • Genetic factors
  • Environmental factors

There is no single “addiction gene” that causes people to become addicted when they are exposed to drugs. Rather, there are various genes that influence whether a particular person is predisposed to addiction. There are genes that are protective against developing addiction. The combination of these genes determine individuals’ predisposition to becoming addicted when they are exposed to drugs.

Addiction is also closely tied to other mental health disorders because they each can cause the other. Mental health disorders and substance use disorders share many of the same genetic causes, risk factors and even symptoms. A co-occurring mental health disorder occurs in more than 50% of people with addiction. Many people begin their drug or alcohol use to self-medicate symptoms of a mental health disorder.

Likewise, many people use drugs or alcohol as a dysfunctional coping mechanism for dealing with life stressors, past traumas or other elements that cause negative thoughts, emotions and feelings.

Fentanyl Abuse Facts and Statistics

Data on fentanyl abuse rates is difficult to obtain. It is a primarily illicit drug and so people are not forthcoming about using it. The Substance Abuse and Mental Health Administration (SAMHSA) National Survey on Drug Use and Health does not tabulate data for fentanyl abuse. However, data from the CDC on fentanyl overdose deaths provides a view of the extent of the fentanyl problem in America:

  • In 2016, fentanyl overtook heroin and oxycodone as the deadliest drug in America, with 29% of all drug overdose deaths involving fentanyl alone, and 69.2% involving fentanyl with another drug
  • In 2016, 18,335 Americans died from a fentanyl-related overdose

Prevalence in Men and Women

The death rate from fentanyl for men is 2.8 times higher than it is for women (8.6 per 100,000 population for men, compared to 3.1 for females)

Teen Abuse

Age-based data from the CDC shows that adolescents are heavily represented among fentanyl users. One of the groups with the largest increase in fentanyl overdose deaths between 2011 and 2016 was the 15 to 24 years-old age group, with an average 93.9% per year increase. Data was not collected for teens under 15. Annual death rates from fentanyl overdoses were among the lowest in this age group, with 4 per 100,000 people per year.

Elderly Abuse

The over 65 age group had the lowest increase in fentanyl use among all age groups (41.6% per year). This age group also has the lowest rate of fentanyl overdose deaths, with less than 1 per 100,000 population. Because the elderly are more likely to have medical conditions that warrant prescriptions for fentanyl (such as cancer pain, severe arthritic pain, post-operative pain or palliative pain) they are more likely to be prescribed these medications, particularly the fentanyl patch. Fentanyl patch side effects in elderly people may be more pronounced.

Other Affected Demographics

Data for fentanyl-related overdose deaths in the United States based on general racial background (CDC data is limited to only three groups) show that non-Hispanic white people experienced the second greatest increase in deaths (108.8% per year), and the highest death rate (7.7 per 100,000 persons), non-Hispanic black persons had the largest increase and second-largest death rate (140.6% and 5.6 respectively), and then Hispanic people had the lowest increase and lowest death rate (118.3% and 2.5 respectively).

Fentanyl Abuse and Treatment Trends in South Florida

The Centers for Disease Control and Prevention groups Florida in region 4 of their analysis of United States territories. Region 4 saw consecutive increases in fentanyl-related deaths from 2011 to 2016. Data collected by the Florida Department of Law Enforcement show that in 2016 there were 1,644 fentanyl-related overdose deaths in Florida.

Fentanyl abuse remains a deadly challenge for communities within South Florida and the rest of the state. The more awareness that is spread regarding fentanyl’s dangers, the more people can be vigilant which will hopefully reduce overdose deaths.

How to Help Someone Abusing Fentanyl

It is best to talk to a healthcare professional who is familiar with addiction and fentanyl to obtain advice prior to helping a loved one who may be abusing fentanyl or other drugs.

Forcing someone into treatment seldom goes well because addressing addiction is challenging and to fully address it requires that the individual fully commit themselves to the treatment process.

However, there is a fine line between helping someone with an addiction and becoming an enabler. For people who are close to the person with an addiction, that line may blur. It is best to obtain the advice of an addiction professional when trying to help a loved one.

Recovery is a lifelong process and people in recovery from substance use require ongoing support. Friends and family can become involved in the recovery counseling process as well.


An intervention is a method of confronting individuals with substance addiction with facts and concerns from loved ones with the hope of getting them to admit to the extent of their addiction. The intent is to provide emotional and factual guidance to lead them to the point of readiness to accept help and to willingly participate in a treatment program.

People with substance addictions often deny it to themselves and others. They may go to great lengths to rationalize their substance use and related behaviors or to conceal the extent of their problem. The intervention is designed to break through this behavior, as well as the pathological need for control and mistaken belief of their ability to stop their drug use on their own.

Fentanyl Addiction Treatment Options

Fentanyl rehab treatment empowers people with addiction to break the cycle of substance use and address the underlying causes of addiction and heal the physical and mental damage caused by drug use and related behaviors.

Further, addiction treatment centers allow for a proper assessment and treatment of any co-occurring mental health disorder underlying the substance use. More than half of people with substance use disorder have a co-occurring mental health disorder, often previously undiagnosed. Identifying and treating such comorbid conditions is a key requirement for successful recovery and a return to good health and function.

Rehab for fentanyl addiction can be a transformative and restorative experience for those who are mentally ready and willing to participate. There are a number of options to choose from when considering treatment.

View Sources

Boyer, Edward. “Management of opioid analgesic overdose.” The New England Journal of Medicine, July 12, 2012. Accessed July 13, 2019.

Centers for Disease Control and Prevention. “Drugs most frequently involved in drug overdose deaths: United States, 2011–2016.” National Vital Statistics Reports, December 12, 2018. Accessed July 13, 2019.

Centers for Disease Control and Prevention. “Drug overdose deaths involving fentanyl, 2011–2016.” March 21, 2019. Accessed July 13, 2019.

Centers for Disease Control and Prevention. “Synthetic opioid overdose data.” December 19, 2018. Accessed July 13, 2019.

Chalana, Harsh; et al. “Predictors of relapse after inpatient opioid detoxification during 1-year follow-up.” Journal of Addiction, April 7, 2016. Accessed July 13, 2019.

Florida Department of Law Enforcement. “Drugs identified in deceased persons by Florida medical examiners.” November 2017. Accessed July 13, 2019.

Substance Abuse and Mental Health Administration (SAMHSA). “National Survey on Drug Use and Health 2017.” September 2018. Accessed July 13, 2019.