An extremely potent opioid drug – up to 100 times as powerful as morphine and heroin, according to the journal The Primary Care Companion for CNS Disorders – fentanyl is a prescription narcotic manufactured in a patch format (Duragesic). It is meant to relieve chronic and breakthrough pain in an around-the-clock fashion for up to three days. With a long half-life of around 17 hours, according to the US Food and Drug Administration (FDA), fentanyl patches release medication that stays active in the body for longer than many opioid drugs.
Fentanyl can cause extreme euphoria and other desirable effects, such as reduced stress and anxiety, a mellow feeling, decreased inhibitions, increased sociability, and overall happiness when misused, making it a popular drug of abuse. The National Survey on Drug Use and Health (NSDUH) reported than approximately 4.3 million Americans who were at least 12 years old in 2014 were currently abusing a prescription-strength pain reliever.
Abuse of specific drugs is calculated with a variety of methods, from overdose statistics to emergency department (ED) visits relating to misuse. The Drug Abuse Warning Network (DAWN) of 2011 reported over 20,000 ED visits for fentanyl abuse that year. The Wall Street Journal (WJS) publishes that in 12 states located in the South, Midwest, and New England region of the country, over 5,500 people died from a fentanyl overdose between 2013 and 2015. Fentanyl abuse seems to be on the rise, and there are numerous ways that individuals may attempt to abuse a fentanyl patch to get “high.”
Methods of Fentanyl Patch Abuse
Anytime someone uses a prescription drug without a legitimate medical need and prescription for that drug, it is considered drug abuse. Using a prescription drug in any manner outside of its prescribed and directed method of use is also abuse. Fentanyl patches may be abused in a variety of methods that include:
- Changing the patch more frequently than directed: The dosage of fentanyl is set, and putting a new one on before it is necessary elevates the dosage.
- Using more than one patch at a time: This sends higher doses into the bloodstream at one time.
- Chewing, sucking on, or swallowing the patch: This detracts from the intended absorption and metabolism of the patch, sending more of the drug into the system at once.
- Freezing, cutting, and placing the patch under the tongue or in the cheek: The drug is absorbed quickly through the oral mucosa when taken this way.
- Removing the gel from the patch and smoking it: Scraping off the gel from the patch and heating it in a pipe sends the drug rapidly into the bloodstream and respiratory system.
- Dissolving the gel from the patch into soluble liquid and injecting it: The gel is removed from the patch and introduced into the body via intravenous (IV) methods, bypassing the extended-release format.
- Brewed in tea: Taking the gel from the patch, brewing it in tea, and drinking it puts it into the gastrointestinal system.
- Inserting into the rectum: Fentanyl patches are sometimes placed into the rectum when abused.
- Inhaling fentanyl gel from the patch: Heating the patch and inhaling the residue puts the drug into the respiratory system and quickly into the bloodstream.
The FDA places multiple warnings within the labeling information for the name-brand form of the fentanyl patch (Duragesic), warning individuals of the high potential for diversion, abuse, tolerance, and dependence. Fentanyl is in the class of prescription drugs most tightly controlled and regulated by the Drug Enforcement Administration (DEA): Schedule II. These substances are the highest level of controlled substances that have approved medical use in the United States, indicating their high level for possible diversion and abuse.
According to the DEA, fentanyl is most often diverted by patients with licit prescriptions, by prescribing physicians and pharmacists, through pharmacy and nursing home theft, and via fraudulent prescriptions. The 2014 NSDUH indicates that prescription painkillers are most often abused by individuals between the ages of 18 and 25.
Dangers of Fentanyl Abuse
Fentanyl is designed to be released into the bloodstream in a controlled fashion over a period of 48-72 hours. When it is altered and smoked, swallowed, chewed, or injected, the drug’s time-release format is hijacked, and the entire dosage is put across the blood-brain barrier at once. This can have disastrous consequences, potentially resulting in a fatal overdose.
Opioid overdose has reached epidemic levels in the United States. The Centers for Disease Control and Prevention (CDC) reports that overdose fatalities for synthetic opioid drugs, which includes fentanyl, doubled from 2013 to 2014, and in 2014, close to 30,000 Americans died from an opioid overdose.
A fentanyl overdose slows down some of the functions of the central nervous system, such as respiration, heart rate, and blood pressure, to levels that are too low. Shallow breathing, weak pulse, coldness to the touch, mental confusion, severe fatigue and drowsiness, nausea and vomiting, dilated pupils, muscle weakness, lack of motor coordination, and possible loss of consciousness or coma are signs of an opioid overdose, which can be fatal without swift medical intervention. A fentanyl overdose can be reversed with the administration of an opioid antagonist like naloxone (Narcan), which is often carried by first responders.
Additional side effects of fentanyl use and abuse include:
- Mood swings
- Dry mouth
- Abdominal pain
- Mental cloudiness
- Muscle weakness
- Back pain
- Loss of appetite
- Difficulties urinating
- Irregular heart rate
Certain methods of fentanyl patch abuse can also cause other potential side effects. For example, when wearing the patch, or multiple patches, individuals may experience skin irritation or rashes at the site. IV drug use can lead to collapsed veins, infections, and an increased risk for contracting an infectious disease like HIV/AIDS or hepatitis. Smoking or inhaling fentanyl patches can irritate the lungs and respiratory system, and cause chronic cough or lung infections. Stomach ulcers and gastrointestinal upset may occur with continued swallowing of a fentanyl patch. Fentanyl may also be mixed with heroin or cocaine when abused, which the National Institute on Drug Abuse (NIDA) reports greatly increases the risk for overdose or other adverse reactions.
The presence of drug paraphernalia or residue may be signs that someone is abusing fentanyl patches. Finding discarded patches, pipes, or syringes and needles may be further indications of drug abuse. Swinging from elevated, happy moods, to being irritable, depressed, and anxious can be evidence that a loved one is abusing fentanyl.
Fentanyl decreases a person’s inhibitions, potentially leading to accidents, injuries, or questionable sexual practices that may cause unwanted pregnancy or the possible contraction of a sexually transmitted disease are also possible consequences of fentanyl abuse.
Fentanyl Dependence and Addiction
Fentanyl binds to opioid receptors in the brain and along the central nervous system, slowing down autonomic functions and increasing levels of dopamine, the pleasure-inducing neurotransmitter. In turn, fentanyl interacts with parts of the brain responsible for controlling emotions, pain sensations, and willpower. When someone uses fentanyl on a regular basis, the drug makes changes to these parts of the brain and in the production of dopamine, resulting in difficulty feeling happy without the drug and trouble controlling drug use.
Difficult withdrawal symptoms then occur when fentanyl leaves the bloodstream. Fentanyl withdrawal can include emotional side effects, such as depression, anxiety, irritability, restlessness, insomnia, mental “fogginess,” and drug cravings as well as physical symptoms like stomach cramps, nausea, vomiting, muscle and joint pain, yawning, tearing up, runny nose, diarrhea, sweats, chills, tremors, racing heart rate, and high blood pressure.
Addiction may be the result of the brain changes caused by drug dependence as well as attempts to avoid withdrawal symptoms and being unable to control drug cravings. Compulsive drug-seeking and using behaviors, multiple unsuccessful attempts to stop using fentanyl, using it in full awareness of and despite possible side effects, abusing fentanyl in situations that may be hazardous or dangerous, and an inability to control how much of the drug is used at one time and for how long are all signs of fentanyl addiction.
Medical Detox and Addiction Treatment
Since fentanyl can have such significant withdrawal symptoms, the FDA recommends not stopping the drug suddenly or without professional help. Medical detox can help individuals to slowly taper off fentanyl or use an opioid substitution medication, such as methadone or buprenorphine, to wean off the opioid.
Fentanyl abuse and addiction treatment options include both inpatient (residential) and outpatient models, both of which offer therapeutic and supportive methods. Behavioral therapies help to modify potentially harmful behaviors by addressing the thought patterns that may lead to these actions. Stress reduction, coping mechanisms, and healthy communication skills are taught in group and individual therapy. Relapse prevention techniques are taught and strengthened with the support of a 12-Step program or other peer support group. Yoga, massage therapy, acupuncture, chiropractic services, diet planning, fitness programs, mindfulness meditation, creative therapy, and many other adjunct methods are also beneficial during opioid abuse treatment programs when combined with traditional therapeutic methods.
Fentanyl addiction is a treatable disease with a multitude of treatment options and methods to choose from in order to aid long-term recovery.