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Fentanyl is the most potent prescription painkiller currently on the market, and its classification as a Schedule II substance means it also has a high potential for abuse. The narcotic medication is 100 times stronger than morphine and 50 times stronger than heroin. When it is doctor-prescribed, fentanyl usually comes in the form of a lozenge, injection or transdermal patch; on the street, the drug is more likely to show up in pill form or as a white powder that is often mixed into batches of heroin or cocaine and then sold to users without their knowledge.
Because fentanyl is so strong and can pose serious health dangers to users — illicit versions have reportedly earned the street name, “the kill pill” — there are strict medical guidelines in place regarding how and when to prescribe the drug for patients with severe pain. In fact, pharmaceutical fentanyl is usually reserved only for patients with advanced cancer, for whom other pain-relieving medications have not worked in managing acute or chronic pain.
Illicitly manufactured, non-pharmaceutical fentanyl is, on the other hand, increasingly available on the streets — or so lethal overdose rates seem to suggest, according to current data from the Centers for Disease Control and Prevention (CDC). In the course of only one year (2014-2015), deaths from synthetic opioid medications increased by 72 percent, mainly thanks to illicitly manufactured fentanyl, the CDC reported. That growing number of fentanyl-related casualties included the pop star legend, Prince, whose lethal overdose in April 2016 was attributed to fentanyl found in counterfeit painkiller pills.
This article will educate readers on everything they need to know regarding fentanyl addiction, with firsthand insights from medical and scientific experts on the frontlines of researching opiates and treating their abuse. Salient details include:
- Signs and symptoms of fentanyl abuse
- Who is more at risk
- Rates of fentanyl overdose
Signs and Symptoms of Fentanyl Abuse
The signs and symptoms of fentanyl abuse can vary. One potential sign of fentanyl abuse is tolerance for the drug, which may also be accompanied by symptoms of withdrawal and dependence — but fentanyl tolerance, withdrawal and/or dependence do not automatically signal fentanyl abuse.
The widely-accepted definition of addiction, after all, is that it is “a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors,” according to the American Society of Addiction Medicine (ASAM). A more reliable indicator of substance abuse, then, is any evidence of a pattern of compulsive drug use despite negative consequences. The same holds true for fentanyl.
Fentanyl users with a severe addiction to the drug can end up plastering their body with multiple fentanyl patches, according to Dr. Edward Zawadzski, who like the medical director for Beach House Center for Recovery, has personally witnessed the phenomenon. He has also treated clients who, in pursuit of a more intense high, either lick the patches or insert them into their rectum, thereby exposing themselves to even higher levels of toxicity.
Other documented methods of abusing fentanyl patches include:
- changing patches more frequently than prescribed
- injecting extracted fentanyl intravenously
- chewing or swallowing patches
- inhaling fentanyl gel
- diluting fentanyl in tea
Fentanyl, unlike other opiates, “is such a potent agonist, with a rapid onset,” says Dr. Anne Murphy, Ph.D. Dr. Murphy is an associate professor at Georgia State University’s Neuroscience Institute. What she means is that fentanyl binds to the brain’s opioid receptors much faster than other opiates (like morphine, for example), so that fentanyl’s analgesic effects, including euphoria, are immediate.
Opiates cause respiratory depression. With fentanyl, however, this slowdown in breathing can come on more suddenly and can last for a longer duration, raising the risks of overdose. In instances of a fentanyl overdose, moreover, more of the life-saving drug naloxone is generally required to reverse the opiate drug’s life-threatening side effects.
Signs of fentanyl abuse may include symptoms of a potential overdose:
- Slow, shallow and/or erratic breathing
- Little to no show of a pulse (heartbeat)
- Unresponsiveness to external stimuli
- Inability to talk despite appearing awake
- A change in skin tone to bluish (for fair-skinned people) or grayish or ashen (for dark-skinned people)
- Limp limbs
- A change in color of fingernails and lips to blue or purplish black
- Choking sounds or a snore-like gurgling (sometimes called the “death rattle”)
Cited from: The Harm Reduction Coalition
Someone who is high on fentanyl may exhibit the following symptoms:
- Small, contracted pupils
- Muscle droopiness
- Nodding out
- Slurred speech
- Scratching of itchy skin
- Slower responses to external stimuli
Who Is More at Risk of Fentanyl Abuse
Who is more at risk of abusing fentanyl? The latest findings by Dr. Murphy and her team of researchers suggest women with pain issues may be more susceptible, based on sex differences between how their brains both process pain and respond to opiate painkillers like fentanyl.
One extension of these differences is that women have a significantly higher tolerance for opiates —in the case of morphine, for example, they typically require two times the amount of morphine that men require in order to experience the same analgesic effects.
The study that Dr. Murphy recently co-authored, which appeared in the March 2017 issue of the Journal of Neuroscience, now has a biological explanation for women’s much higher tolerance for morphine: “microglia” or tiny immune cells in the brain, which in women turn out to be more active in the brain’s key pain-processing regions.
“Microglia are more primed in females, so they initially have to take more [morphine] to get the same euphoria as males experience, which puts them at much greater risk [of opiate abuse],” Dr. Murphy explained in an interview with Beach House. “Our study was looking at the ability of morphine to alleviate pain … if you give morphine in the absence of chronic pain, the brain produces more of an immune response (activated microglia) … if you block microglia activation and then give morphine, there’s no sex difference in response to the analgesic effects of morphine.”
In other words, when microglia activation is turned off, females can get the same analgesic effects from morphine with just half the dose of morphine that they previously required, meaning safer pain relief with less danger of abuse or overdose.
Dr. Murphy is quick to clarify that less than 2 percent of chronic pain patients are addicted to their medications. (Other estimates can be grimmer, pegging the rate of addiction among those who are prescribed opiates as high as 40 percent, according to one source.) In her view, those who are more prone to fentanyl addiction are people who take fentanyl for recreational purposes or who don’t stop taking the drug once their pain has been resolved. “They like the feeling because they’re sleeping better and everything is blunted and stress levels are lower.”
Adolescent-aged children (ages 12 to 17) may also be more susceptible to abusing opiates like fentanyl, according to ASAM, which cited data that supports this claim.
Rates of Fentanyl Overdose
Meanwhile, rates of fentanyl overdose are on the rise. 78 people die every day from opiate overdose in this country, according to a June 2016 article in The New York Times, with fentanyl responsible for a growing proportion of these deaths.
In recent years, too, rates of opiate overdose among women have dramatically outpaced those among men (although men are reportedly still more likely to die from fentanyl-related overdoses). In a 2013 CDC press release, the CDC Director Tom Frieden contextualized the uptick among women this way: “Prescription painkiller deaths have skyrocketed in women (6,600 in 2010), four times as many as died from cocaine and heroin combined.”