Blog - Beach House Rehab Center
drawing of the brain
October 25, 2018

What Fentanyl Abuse Does to Your Brain

Fentanyl is a Schedule II controlled substance, a highly addictive and extraordinarily potent synthetic opiate narcotic drug with a high potential for abuse. Prescription fentanyl, 50 to 100 times more powerful than heroin, is used to manage post-surgical pain and to treat severe and chronic pain (in those who are tolerant to other opiates). Fentanyl use, abuse and addiction is wreaking havoc in America today, and is considered a significant contributor to the dramatic surge in opiate overdose deaths. The increase in illicitly manufactured fentanyl and fentanyl analogs imported from clandestine labs in China, Mexico and Canada closely parallels the skyrocketing synthetic opioid overdose deaths in the U.S.


Similar to heroin, morphine and other opiate drugs, fentanyl binds to the opioid receptors in the brain in areas responsible for controlling pain and emotions. Euphoria and relaxation are the result of increased levels of dopamine in the brain, following binding of the opiate drug to the brain receptors. But there are other opioid receptors in the brain that fentanyl affects, including the area of the brain controlling breathing rate. Fentanyl, due to its extreme potency, when taken in high doses, can cause breathing to stop completely, culminating in death. Street fentanyl may be mixed with heroin or cocaine, unbeknownst to the drug user, greatly increasing overdose risk.


On a molecular level, while heroin and other opiate drugs also bind to the opioid receptors in the brain, fentanyl provides a more perfect “fit,” making the fentanyl user more susceptible to its effects. Touching or inhaling even a small amount of fentanyl is extremely dangerous and can prove life-threatening.

Naloxone, an opioid receptor antagonist (brand name Narcan), is a medication that can reverse opioid overdose and restore breathing, if taken or administered in time. But for fentanyl users, much more naloxone (multiple doses) may be required to save the victim’s life.


Among the many side effects of fentanyl abuse are some that cause damage to the brain and brain functioning. Most notable are anxiety, confusion, depression, drowsiness, euphoria, hallucinations, insomnia, nightmares or bad dreams, unconsciousness, coma and death.


Long-term users of fentanyl are likely to experience dependence and addiction, classified as a brain disease. Using fentanyl for a long time or abusing it repeatedly builds tolerance to the narcotic drug. That means the user’s brain (and body) become accustomed to the availability of fentanyl, yet requires fentanyl at higher dosages to achieve similar euphoric effect.

Besides dependence and addiction, long-term fentanyl abuse can result in impaired psychosocial effects, including displaying poor judgement in activities and situations in the workplace, at home, school and other personal behavior. This is due to the breakdown and loss of white matter in the brain from chronic fentanyl use. Low levels of white matter may result in behavioral issues, feeling emotions differently, becoming more easily stressed, unable to make decisions.

Fentanyl used on a long-term or chronic basis may also initiate or exacerbate pre-existing mental health conditions, including, but not limited to, depression and mood changes.

Memory Loss

A 2014 study found cognitive deficits in chronic low-back pain patients treated with long-term opiates. Among the findings: patients required longer time to process information, had significantly reduced spatial memory capacity, impaired working memory, and reduced flexibility for concept change. Researchers noted that chronic back pain itself impaired distinct cognitive functions, and long-term opiate therapy results in further cognitive impairment.

A 2018 study looking at how cognitive performance and inflammation are altered in those with chronic low-back pain treated with long-term opiate therapy found significantly worse performance in attention and lower pain self-efficacy beliefs than patients not taking opiates.


When discontinuing fentanyl use or not taking the drug, withdrawal symptoms begin. These include anxiety, cramps, high blood pressure, insomnia, irritability, nausea, restlessness, sweating, vomiting and weakness. To avoid uncomfortable and sometimes severe withdrawal symptoms, many fentanyl users continue taking the drug, developing an addiction to it.

Taking larger doses of fentanyl, perhaps after attempting to self-wean or curtail use, can result in overdose that has potentially fatal symptoms: slowed breathing, coma and death.

Arguing against a proposed solution from some states to use fentanyl test strips to help stem the opioid epidemic, Elinore F. McCance-Katz, M.D., Ph.D., the assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services (SAMHSA), said that fentanyl users are not likely to be deterred from using the narcotic (or use it at a lower rate) even if they use a test strip to detect it. McCance-Katz, who’s spent most of her career treating opioid use disorder, said that opiate addicts are not making a rational choice about continuing drug use: “Addicted individuals whose bodies demand that they find their next opioid to stave off withdrawal symptoms are not in positions to weigh all options and choose to not use the only opioid at their disposal.” She further warns that it is not inconceivable to believe that those addicted to fentanyl will use the test strips to seek fentanyl, which will give them the high their current opioid no longer provides— and “places them at risk for overdose and death.” 

For more about fentanyl abuse, addiction and recovery, check out these articles:

What Fentanyl Abuse Does to Your Body 



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