Fentanyl is an opioid painkiller that is prescribed to patients who have such levels of pain that other painkillers are unable to completely suppress it, which is known as breakthrough pain.
For example, fentanyl tablets are given to cancer patients when their morphine treatment is not enough to provide them with relief, according to the Journal of Pain Symptom Management. It is sold and prescribed under brand names like Duragesic, Sublimaze, Fentora, and Onsolis, among others.
There are a number of ways fentanyl can be administered to patients:
- As a tablet
- As a film strip that is placed under the tongue and left to dissolve
- Via a transdermal (skin) patch
- As a lozenge
The variety of options is important. Because fentanyl is such a potent opioid, a prescribing doctor has to choose the best method with regards to the patient’s medical needs, as well as any other factors that might help or hinder how the body responds to the fentanyl.
Transdermal Fentanyl Patches
Because drugs that are prescribed (and consumed) orally are relatively easy to abuse, a doctor might feel that a transdermal patch is the best option for a patient. The adhesive patch works by being placed on the patient’s skin. It gradually releases fentanyl through the pores of the skin and into the bloodstream. This reduces the possibility of people abusing fentanyl, as they might with an oral supply by simply swallowing multiple tablets at a time, but it does not outright eliminate the potential for abuse. Even though transdermal patches have enough doses to last patients for up to a week, people can still chew on the patches, dissolve the patches in water, apply multiple patches simultaneously, or leave patches on their skin beyond prescribed time limits (usually three days or whatever is specified by a doctor, says Mayo Clinic).
Transdermal fentanyl patches are made to work slowly, so as not to overwhelm patients with their doses of opioids.
For some people, buckling under breakthrough pain, transdermal patches may not work quickly enough, leading them to question if the patches are working at all. This can lead them to use the patches in some of the ways mentioned above, even though these methods of use are dangerous. Chewing the patches or using multiple patches at a time provides an immediate respite from the pain, but it also floods the body with a shockingly powerful narcotic. Once in the blood, fentanyl attaches to the brain’s opioid receptors and dulls the communication of pain to the brain. People feel better, but they also feel a huge rush of wellbeing and pleasure that is often far too irresistible to experience only once.
The Power and Danger of Fentanyl
That level of desperation is why the National Institute on Drug Abuse calls fentanyl a “powerful” painkiller. It is up to 100 times more powerful than morphine, writes the U.S. Drug Enforcement Administration, and “much more potent than heroin.” The Centers for Disease Control call fentanyl a drug of abuse, so strong that the Russian military used a derivative of fentanyl in a gas to incapacitate terrorists. The DEA has placed it on its list of Schedule II controlled substances, which legally classifies fentanyl as having legitimate medical applications, but also possessing a high potential for abuse and a significant risk for causing physical and psychological dependence in its users.
Fentanyl’s design as a rapid onset drug, providing instant relief from breakthrough pain, is what drives its addictiveness.
According to the Annals of Palliative Medicine, fentanyl is the only painkiller that can curb such levels of pain in distressed patients. It does it effectively, and it does it quickly. For those reasons, it is given to patients whose daily lives have become unbearable because of the levels of pain they experience.
But for all the good it does, fentanyl becomes a drug of abuse when desperate individuals take to consuming it off-label (i.e., in violation of their prescription instructions), or when people who want to feel the narcotic high steal the drug from friends and relatives. Sometimes, patients may even share their fentanyl doses and patches with others, believing that since the drug is given to them by a doctor, it cannot be inherently harmful and is a preferable alternative to illicit drugs. The Fix writes that young people are lured into fentanyl abuse because of its status as a “wonder drug” that provides a safer high than heroin or cocaine. Nothing could be further from the truth.
The Cost of Fentanyl Abuse
Fentanyl’s power as a drug of abuse has led to it being used in underground (illegal) laboratories, where it is mass produced (often with impurities) for people who either really need pain medication and cannot afford a prescription, or for people who are simply looking for something to experiment with. In Montreal, for example, local police raided an underground lab and found equipment that was capable of producing 3 million fentanyl pills a day, approximately one pill per second.
Naturally, the people responsible for producing fentanyl like this do not have their customers’ best interests in mind. In New Mexico, for example, fentanyl is typically mixed with heroin, and a couple of grains of this mixture could kill a person.
The seedy underbelly of fentanyl has a very human cost. The Morbidity and Mortality Weekly Report published by the Centers for Disease Control writes that between 2004 and 2005, there were 1,000 deaths caused by fentanyl in Chicago and Philadelphia. The director of toxicology studies at the University of Florida’s College of Medicine told the school’s paper that abusing a fentanyl transdermal patch for three days can cause a very quick death. According to the paper and the Florida Department of Law Enforcement, 2005 saw 115 fatalities because of this form of fentanyl abuse.
Even though fentanyl patches are thought of as a way to avoid the risks of oral consumption, the Journal of Forensic Sciences published a report that showed that the mastication of Duragesic patches was connected to the deaths of seven people. Two of the people were determined to have died as a result of overdosing on fentanyl and nothing else, while the other five had combined fentanyl with other substances.
Fentanyl provides a strong shield against breakthrough pain and the euphoria typical of opioids; but the way it dulls communication between the brain and the central nervous system causes other, less pleasant effects, such as:
- Difficulty breathing
- Lowered heart rate
- Difficulty concentrating
Withdrawing from Fentanyl
People who abuse fentanyl will not find it easy to simply stop their intake. The body and brain become so hooked on the overwhelming flood of opioids (more powerful than morphine and heroin) that natural functions are rewritten with every dose of fentanyl. Cutting off that supply forces those systems to go into overdrive to try and regain a sense of balance, leading to withdrawal symptoms:
- Muscle pain
- Rapid heart rate
- Cravings for more fentanyl
Researchers in the Journal of Pediatric Nursing write that patients who have their continuous infusions of fentanyl discontinued had further symptoms of tremors and shallow, painful breathing.
How long these symptoms are in place depends on a number of factors, such as how the fentanyl was abused, how long the person had been taking fentanyl, the amount of dosage, genetic factors that might influence a predisposition towards certain mental health disorders and susceptibility to addiction, as well as the general level of tolerance to pain and how much medication has to be taken before relief is felt.
Generally, the first withdrawal symptoms are felt 6-36 hours after the last dose. The physical symptoms are the first to be experienced; once these break (usually 48-72 hours after they begin), the person feels the brunt of the psychological symptoms. These last for another 2-3 days, until the person reaches 6-7 days since the last dose of fentanyl. By this point, the person may be very physically weak and need soft, nutritious food to regain strength.
Treating Fentanyl Abuse
Fentanyl’s potency as an opioid notwithstanding, stopping its intake should not be attempted outside of the controlled environment of a treatment center. There are far too many risks and dangers associated with the various stages of withdrawal for the process to be conducted without a trained medical professional who can help the person (for example, hallucinations or seizures may be possible withdrawal symptoms for those with severe abuse problems). Medical detox may involve anticonvulsant medications for physical symptoms, anti-anxiety medications for psychological symptoms, and continual medical supervision.
To this effect, getting off fentanyl should be done gradually, assisted by the training, resources, and experience of medical professionals. Once this is done, the person should next undergo a course of therapy, which will address the mental damage done by the fentanyl abuse. In therapy, a person can learn how to cope and thrive in life without depending on fentanyl.
The therapeutic process is incredibly important, because the person could still have the breakthrough pain that initially led to fentanyl abuse.
The staff at a treatment center will know this, and be able to construct a recovery program that takes the individual’s medical needs into consideration. Such a level of care cannot be provided if the person tries to quit fentanyl alone, without medical supervision.
For that reason, it is vital that the person has a support network in place after program completion. This network could be made up of family members who take part in the treatment program to understand the needs of their loved one better; or it could be made up of other people who have struggled with a fentanyl abuse problem and are further down the road of recovery. Whatever the dynamic, a person should not have to face recovery alone. There are other people out there who know what fentanyl abuse is like, who have benefitted from treatment, and who are ready to share their stories and experiences with someone who needs help.