Fentanyl Use and Addiction: Risks and Symptoms

Safe Prescribing Practices for Fentanyl

Prescribing Guidelines for Healthcare Providers

Because fentanyl is so strong, healthcare providers follow strict guidelines when they prescribe it. Doses must be carefully calculated to avoid overdose, and patients are closely monitored. Its risks increase even further when it’s mixed with other substances like alcohol or benzodiazepines. 

Researchers on pain management and substance abuse⁶ say “the concurrent use of opioids, benzodiazepines, and/or alcohol poses a formidable challenge for clinicians who manage chronic pain,” even warning about increased risks when each of these substances is “used appropriately.” They recommend regular drug screening for patients on chronic opioid therapy to reduce the risk of addiction, overdose, and other serious side effects. 

Patient Education on Safe Use

If you’re prescribed fentanyl, your doctor must explain how to use it safely. “Patient education regarding the risks of fentanyl,⁷ especially regarding its potential for respiratory depression and addiction, is vital for promoting safe use and preventing misuse or overdose,” says Indunil Karunarathna of Badulla Teaching Hospital. 

Patients should be aware of the risks of misuse, like taking more than prescribed or mixing fentanyl with other substances, which raises the risk of addiction or overdose. Knowing how to store and dispose of fentanyl properly also helps prevent accidents and misuse.

Understanding Fentanyl Addiction

How Fentanyl Addiction Develops

Because of fentanyl’s extreme potency, it’s even harder to protect against adverse effects like addiction. Fentanyl works by binding to specific brain receptors, causing a dopamine rush that creates pleasure and relief. Over time, people may feel they need more to feel the same effect, which leads to increased tolerance and dependency. It’s highly addictive even when it’s used for pain relief as prescribed. 

Risk Factors for Fentanyl Addiction

People dealing with chronic pain who need long-term opioids, those with a history of addiction, or those struggling with their mental health may be more likely to use fentanyl as a form of self-medication. 

Some people use fentanyl intentionally, and some take it accidentally because of the presence of fentanyl in illicit drugs. Either way, fentanyl increases risk factors for overdose and addiction. In one study on fentanyl’s impact on opioid overdose, 40% of participants said they had knowingly used fentanyl.⁸ Outcomes were worse if they were using drugs as a response to mental health conditions like PTSD. 

Signs and Symptoms of Fentanyl Addiction

Physical Symptoms

Common physical signs of fentanyl addiction include: 

• Feeling drowsy and confused
• Respiratory depression (shallow or slow breathing)
• Pinpoint pupils
• Slurred speech
• Nausea or vomiting

Behavioral Indicators

Behavioral changes like these might also suggest an addiction:

• Seeking multiple prescriptions (“doctor shopping”)
• Acting secretive or avoiding others
• Failing to show up for responsibilities
• Continuing to use fentanyl despite its negative consequences

Psychological Symptoms

Fentanyl takes a heavy psychological toll. Common symptoms include:

• Depression and anxiety
• Irritability and mood swings
• Trouble thinking clearly

Side Effects of Fentanyl Use

Common Side Effects

Even when used as prescribed, fentanyl can cause:

• Dizziness or lightheadedness
• Nausea and vomiting
• Constipation
• Sedation and fatigue

These may be manageable under medical supervision, but can become dangerous if fentanyl is misused.

Severe Side Effects

Fentanyl can cause more severe consequences, especially in high doses or when mixed with other drugs:

• Dangerous breathing issues (most opioid overdoses are the result of respiratory depression)
• Hallucinations or confusion
• Coma or death

Risk Factors for Fentanyl Overdose

Overdose 

The biggest danger of fentanyl use is its dangerously high risk of overdose. Because it’s so potent, even a small dose can be deadly. Illicit drug markets now commonly mix fentanyl with heroin or cocaine, often without the person’s knowledge. This increases the risk of accidental overdose, which has fueled the ongoing opioid crisis. 

High Potency and Small Doses

Fentanyl is far stronger than other opioids, meaning only a small amount is needed for effect—but it’s easy to take too much. This makes accidental overdose a big risk. Sadly, little is understood about how to reverse its effects. While medications like naloxone may help in emergencies, they aren’t always effective with fentanyl.

Fentanyl’s extreme strength makes its risks even harder to manage than other opioids like heroin or oxycodone. According to pharmacological researchers,

Because fentanyl is so potent, only small amounts are needed to produce pharmacological effects, but the margin between safe and toxic doses is narrow.⁹ Surprisingly little is known about the exact signaling mechanisms underlying fentanyl-related respiratory depression or the effectiveness of naloxone in reversing this effect. Similarly, little is known about the ability of treatment medications such as buprenorphine, methadone, or naltrexone to reduce illicit fentanyl use.

Illicit Use of Fentanyl

Some people intentionally seek out fentanyl for its intense effects, despite its deadly risks. Known for its extreme potency, fentanyl is often sought out as an alternative to heroin or other opioids by those with a high opioid tolerance. However, even small miscalculations in dosing can be fatal, making intentional use particularly dangerous and unpredictable. The adverse effects of fentanyl are especially pronounced in the context of street drugs, where the purity and composition are unregulated.

Dangers of Fentanyl

Fentanyl in Illicit Drugs

Fentanyl is often added to street drugs like heroin or cocaine to make them feel stronger. Most people who buy these drugs don’t realize there’s fentanyl in them. Even a tiny amount of fentanyl is extremely powerful, so when it’s mixed in without people knowing, the overdose risk goes up dramatically.

The Danger of Mixing Fentanyl With Other Substances

Mixing fentanyl with other substances, especially other depressants like alcohol or benzodiazepines, compounds the risk of overdose. Both fentanyl and these substances depress the central nervous system, slowing breathing and heart rate. When combined, they can lead to fatal respiratory depression, even in people with a higher tolerance.

Treatment Options for Fentanyl Addiction

Detoxification Processes

The first step in recovery is often detox, where the drug is safely removed from the body under medical care. Detoxing from fentanyl involves intense withdrawal symptoms, which are a primary cause of relapse for those trying to get sober. Withdrawing from opioids can be life-threatening,¹⁰ so it’s best to do so in a safe, controlled environment.

Withdrawal Symptoms

Fentanyl withdrawal can be particularly challenging, with symptoms that range from flu-like discomfort to severe anxiety and agitation:

• Intense cravings
• Sweating and chills
• Muscle aches
• Clammy skin 
• Insomnia
• Nausea and vomiting 

The withdrawal process can last anywhere from a few days to a few weeks, depending on each person and the severity of their addiction.

Rehabilitation and Therapy Approaches

After detox, rehab programs—either inpatient or outpatient—offer support to address the mental side of addiction. These programs often combine talk therapy, support groups, and recovery-focused activities to help you heal from both the symptoms of addiction and its underlying cause. 

Addiction often stems from unresolved trauma, and fentanyl dependency is no exception. Research shows that treating co-occurring mental health disorders alongside fentanyl addiction can reduce its risks and encourage long-term sobriety: 

Other mental disorders, such as depression, insomnia, and suicidality, can also occur with fentanyl abuse, contributing to relapse and a higher risk of respiratory depression or overdose death. The treatment of these mental disorders may help prevent fentanyl-related fatalities¹¹ and achieve abstinence.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) is an effective option for managing fentanyl addiction. Prescribing doctors use medications such as buprenorphine, methadone, and naltrexone to reduce cravings and manage fentanyl withdrawal symptoms. For comprehensive, lasting recovery, it’s best to combine MAT with counseling and behavioral therapies.

Harm Reduction Strategies for Fentanyl Users

Overdose Prevention Efforts

Public health initiatives aimed at preventing fentanyl overdoses are a key part of combating the opioid crisis. Education campaigns, community outreach, and access to resources like naloxone (Narcan) have helped reduce overdose deaths by providing life-saving interventions. 

Addiction treatment professionals widely recommend promoting harm reduction practices around fentanyl use. The CDC’s fentanyl overdose prevention campaign¹² includes: 

• Education to reduce stigma and increase awareness 
• Expanding access to naloxone 
• Promoting fentanyl addiction treatment 
• Detecting and responding to overdose outbreaks 

Access to Naloxone

Naloxone, an opioid overdose reversal drug, is an important tool in the fight against fentanyl overdose. It works by quickly binding to opioid receptors, reversing the effects of the opioid. Naloxone is now widely available, and many organizations are working to increase access to this life-saving medication for people who use drugs that might contain fentanyl or otherwise put themselves at risk of overdose.

Learn more about obtaining and using naloxone here.

Safe Use Practices

For people who continue to use fentanyl or other synthetic opioids, harm-reduction strategies like these can help reduce the risk of overdose:

• Using fentanyl with a trusted friend who can seek help in an emergency
• Avoiding mixing fentanyl with other depressants
• Testing drugs for fentanyl contamination using test strips

Fentanyl test strips¹³ are inexpensive and results take as little as 5 minutes. Even if the test is negative, note that test strips might not detect other dangerous opioids like carfentanil.

Seeking Help and Resources for Fentanyl Addiction

Finding Support Groups

Support groups like Narcotics Anonymous (NA) can be incredibly helpful for those working toward recovery from fentanyl addiction. These groups provide a safe space to share experiences, build community, and learn strategies to stay sober—all while receiving the support and accountability of others who understand.

Professional Treatment Facilities

Addiction treatment centers offer targeted support for people dealing with fentanyl addiction, with programs that include detox, rehab, and aftercare. Whether inpatient or outpatient, these programs are designed to guide you through each stage of recovery, giving you the space, structure, and support you need to start your fentanyl-free life.

Finding Hope in Recovery from Fentanyl Addiction

Fentanyl can be a valuable tool for people with severe pain, but it comes with serious risks, even when it’s used as directed. Its potency has led to a tragic rise in addiction and overdoses. 

Comprehensive treatment, harm reduction initiatives, and support groups offer a path out of the dark and into a healthy, fulfilling, fentanyl-free life. Overcoming fentanyl addiction is a huge challenge, and one you shouldn’t take on alone. Search for an opioid addiction treatment center that can help you start your recovery journey with the best possible chance of success, and reach out to a support specialist today.