Updated: 05 April 2023 & medically reviewed by Dr. Celeste Small
Fentanyl is a highly potent synthetic opioid painkiller. Its high potency makes it highly addictive and potentially lethal if abused in high doses or combined with other substances.
- Fentanyl and other synthetic opioids are now the most common drugs involved in opioid deaths in the United States. In 2017, nearly 60 percent of opioid-related deaths involved synthetic opioids like fentanyl
- Mixing fentanyl with other illicit drugs like heroin and cocaine can amplify the opioid effects, greatly increasing the risk of overdose, which can be life-threatening
- Fentanyl affects the central nervous system significantly, causing large amounts of dopamine to flood the brain. Over time, those who abuse fentanyl regularly will develop a tolerance to the substance, meaning they will require larger doses to feel the drug's effects, often more than they are prescribed
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What is fentanyl?
Fentanyl is an extremely potent synthetic opioid painkiller, similar to morphine but 50 times stronger. It works as a narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; increases pain threshold; produces analgesia, respiratory depression, and sedation. It is available under prescription and is also often used as a medicine to treat those recovering from surgery or who have experienced extremely painful surgery. It is also sometimes used to treat those suffering from chronic pain conditions who have built up a tolerance to other opioid painkillers.
In recent years, Fentanyl has been used in the manufacturing and distribution of illicit drugs like heroin as a cutting agent. Cutting drugs such as heroin and other opioids with fentanyl is extremely dangerous owing to the substance's high potency. Fentanyl and other synthetic opioids are now the most common drugs involved in opioid deaths in the United States. In 2017, nearly 60 percent of opioid-related deaths involved synthetic opioids like fentanyl.
Brand names of fentanyl
Fentanyl is offered as a medicine and prescription painkiller under various brand names, which are used to treat different conditions and severity of pain, and are administered in different ways.
Sublimaze - Mostly used in hospitals, Sublimaze is a liquid form of fentanyl that is administered alongside anesthetics before surgery.
Subsys - Subsys is a spray that is administered under the tongue for immediate pain relief, often used to treat those with breakthrough cancer pain (BTcP).
Abstral - A quick-dissolve tablet, Abstal is also used to treat those with BTcP.
Duragesic - Also known as “the fentanyl patch”, it is prescribed to treat moderate to severe pain and a single patch can last up to three days.
Lazanda- Another form of fentanyl that is widely used in cancer pain relief, Lazanda is administered as a nasal spray.
Actiq - Comes as an edible lozenge on a stick, designed to be ingested over a long period by sucking it.
Effects of fentanyl abuse
As with all forms of opioid painkillers, fentanyl abuse holds a high risk of dependence and can be addiction-forming. Synthetic opioids such as fentanyl are widely recognized as being a core component of the opioid epidemic that is currently raging in the US. Fentanyl carries the risk of opioid addiction, abuse, and misuse, which can lead to overdose and death. Serious, life-threatening, or fatal respiratory depression may occur if fentanyl is abused. Usage should be monitored for respiratory depression, especially during initiation or following a dose increase. Oftentimes, the exact dose can be difficult to determine and this can lead to overdosing.
When abused, fentanyl causes similar effects to heroin, namely a sense of euphoria and deep physical and mental relaxation.
Someone who is abusing fentanyl will often display at least one of the following symptoms:
Nausea and vomiting
Mixing fentanyl with other illicit drugs like heroin and cocaine can amplify the opioid effects, greatly increasing the risk of overdose, which can be life-threatening. Profound sedation, respiratory depression, coma, and death may result from concomitant administration with benzodiazepines or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, and alcohol).
Related: Fentanyl test strips (FTS)
Fentanyl overdose treatment
As fentanyl is often mixed by drug dealers into other drugs like cocaine, ketamine, heroin, and methamphetamine, it can be difficult to identify which drug is causing an overdose. Like with other potentially fatal opioid overdoses, Naloxone is a medicine that can potentially save lives if administered right away. Available in an injectable form (Narcan) and a nasal spray (Koxxado), Naloxone binds with opioid receptors in the brain and blocks the effects of opioid drugs.
Fentanyl is an extremely potent opioid and therefore may require multiple doses of naloxone to counteract an overdose. If you believe someone has taken an opioid overdose, the first and most important thing to do is call 911 and ensure the person receives immediate medical attention and will often administer naloxone.
Read here for what to do in the event of an overdose.
Is fentanyl addictive?
Many people who develop dependence and eventual addiction to opioid painkillers do so by abusing their prescription doses. Some people do this in order to self-medicate if they believe their current dosage is inadequate to handle their level of pain, while others do so intentionally to abuse the opioids' euphoric effects.
Fentanyl affects the central nervous system significantly, causing large amounts of dopamine to flood the brain. Over time, those who abuse fentanyl regularly will develop a tolerance to the substance, meaning they will require larger doses to feel the drug's effects, often more than they are prescribed. This physical dependence is what drives many to find illegal methods of obtaining the drug and can lead to the negative consequences that cause addiction.
These negative consequences, as outlined in the Diagnostic and Statistical Manual of Mental Health (DSM-5), are the criteria by which addiction is measured and diagnosed. Some of the warning signs of addiction to fentanyl include:
- Hazardous use: You have used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.
- Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.
- Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.
- Withdrawal: When you stop using the substance, you experience withdrawal symptoms.
- Tolerance: You have built up a tolerance to the substance so that you have to use more to get the same effect.
- Used larger amounts/longer: You have started to use larger amounts or use the substance for longer amounts of time. 
What treatment options are there for fentanyl addiction?
Quitting fentanyl cold turkey can be a deeply uncomfortable, even painful experience and one that will lead many to relapse if attempted alone. The withdrawal symptoms associated with opioid painkillers are notoriously unpleasant, varying in severity depending on multiple factors such as length of opioid abuse and any other existing substance abuse.
For the best chance at a successful recovery from fentanyl addiction, it is advised to seek treatment from an inpatient or outpatient rehab facility. The treatment programs on offer at these rehab centers can help patients go through detox safely and comfortably, help addicts by offering medication to help with cravings as part of the withdrawal process, and offer behavioral therapy to help manage triggers, identify the causes of addictive behavior and manage any co-occurring disorder. These treatment programs are available all over the country and offer the best chances to quit fentanyl abuse and begin long-term recovery.
If you or someone you know is suffering from fentanyl addiction, contact a treatment center today.
Here are some commonly asked questions about fentanyl:
How can you test for fentanyl?
Fentanyl is difficult to detect by sight, smell, and taste alone. Thankfully, fentanyl test strips are able to identify the presence of fentanyl in most illicit substances. The increasing presence and awareness of test strips will hopefully reduce the amount of accidental overdoses as a result of ingesting fentanyl. Learn more about fentanyl test strips here.
What does fentanyl look, smell, and taste like?
While using the senses to identify fentanyl is not recommended over test strips, knowing what the substance looks, smells, and tastes like can also help to avoid overdose. Read here to learn more about identifying fentanyl through appearance, smell, and taste.