What is Fentanyl?
Fentanyl is a type of opioid analgesic medication. Opioids are a class of drugs that work by activating naturally occurring opioid receptors in the brain and throughout the body. These drugs are used for a variety of purposes both medicinal and recreational in nature. As a prescription drug, fentanyl is classified as an analgesic, a formal word for pain-reliever. Its medical uses are generally limited to severe and chronic pain. As a synthetic opioid, fentanyl is more powerful than most opioids. It is 50 times more potent than heroin and 50-100 times more potent than morphine. While the strength of the drug makes it an effective treatment for dire situations, such as invasive surgery or cancer, fentanyl is extremely addictive and can easily lead to overdoses when used improperly.
Fentanyl is currently the driving force behind the opioid epidemic that is ravaging the United States and much of the world. In part due to misleading marketing campaigns of pharmaceutical companies that touted prescription opioids as non-addictive, fentanyl and other synthetic opioids have been significantly overprescribed for more than two decades. The frequency with which doctors prescribe prescription opioids is such that the Centers for Disease Control and Prevention estimates that for every 100 Americans, there are 58 opioid prescriptions. While some people do legitimately need fentanyl, a significant portion of people taking synthetic opioids legally are putting themselves at needless risk. Even people using fentanyl under medical supervision frequently develop debilitating dependence and addiction.
Prescription fentanyl is commonly sold on the street, but in recent years drug cartels have begun mass-producing illicit fentanyl in their own labs. Illicit fentanyl is unpredictable and significantly more dangerous, especially when added to other drugs, as is common practice. While fentanyl is not the most popular opioid drug among recreational drug users, it is frequently added to heroin, cocaine, and other substances to increase potency at a low cost. As a prescription drug, it is also a common gateway to other substances.
The opioid epidemic has reached a point where drug overdoses have surpassed automobile crashes as the leading cause of premature death in the United States. In 2015 alone, 20,101 people died as a result of using prescription opioids. That number continues to increase, with 2018 claiming 31,000 lives — approximately 128 deaths every day due to synthetic opioid overdose.
Sober living homes began at the dawn of the 19th century, when religiously devout landlords made sobriety a condition for renters. Many of these landlords were part of the Temperance Movement. The movement to create sober living environments for people was spearheaded by Christian organizations like the YMCA and the Salvation Army.
Their motivation was not based on the desire to help people recover from problems with substance abuse, but rather from the conviction that alcohol and drugs were social evils that society would be better off without.
Opioids have a long history going back thousands of years. Ancient indigenous civilizations used the opium poppy, from which natural and semi-synthetic opioids are derived, for a variety of purposes. The opium poppy was consumed for its effects during religious rituals, for the treatment of ailments, and even for recreational purposes. Hyppocrates, an Ancient Greek doctor who many now refer to as the “Father of Medicine,” utilized opium poppies to help treat pain and induce sleep. However, even these proponents of the opium poppy recommended caution with this powerful drug, citing side effects and a potential for dependence.
Gradually, the opium poppy became an important crop in China, India, and the Middle East. After some time, scientists began to experiment with its chemical composition. The invention of laudanum, a tincture containing a mixture of alcohol and opium, was a world-changing event. Laudanum and opium were all the rage in Europe during the 17th and 18th centuries, especially among colonial powers. Britain’s illegal smuggling of opium into China, whose population was then devastated by addiction, resulted in several “Opium Wars” in the mid 19th century. The profitable crop was beginning to make its destructive effects known on a larger scale.
The development of more efficient methods of consuming opioids was driven by scientific advances, most notably the development of the hypodermic needle. In the 19th century, chemists succeeded in deriving two new substances, morphine and codeine, from the opium poppy. Medical practitioners widely prescribed both new drugs, believing them to be panaceas for all manner of ailments, including lung problems, menstrual pain, gastrointestinal problems, and even emotional issues. These drugs were believed to be non-addictive and were largely unregulated. By the time physicians and the general public understood the risks and began exercising greater caution, many people had already developed debilitating addictions.
At the turn of the 20th century, scientists and drug companies worked hard to derive forms of opium that would alleviate pain but not cause addiction. The result was the invention of semi-synthetic and entirely lab-produced synthetic opioids. These drugs, which were initially marketed as non-addictive, eventually were revealed to be not only more potent than natural opioids, but far more addictive. Heroin was at first marketed as a prescription drug for treating chronic pain and lung disease. Oxycodone and hydrocodone, semi-synthetic opioids, were recommended for similar purposes and continue to be prescribed up to the present day. In 1932, meperidine was developed. Meperidine, the first entirely synthetic opioid, was marketed as Demerol. The world had entered the age of high-potency synthetic opioids.
In 1960, a Belgian scientist named Paul Janssen developed a new synthetic opioid: fentanyl. Fentanyl was approved by the United States government for medical purposes in 1968. It was initially only used sparingly by anesthesiologists for dire situations of extreme pain. However, in the 1990s Janssen Pharmaceutica released the fentanyl transdermal patch, which revolutionized the treatment of pain. The patch could be applied for 24 hour periods, allowing for the slow and steady release of a dosage over a long period of time. The World Health Organization lists the fentanyl patch on its list of essential medicines. Shortly thereafter, the development of the quick-acting fentanyl lollipop allowed for fentanyl to be effectively used to treat the sudden onset of severe pain. That same decade, pharmaceutical companies spent resources and money to run marketing campaigns promoting the use of opioid analgesics, resulting in skyrocketing prescriptions. Today, while there are more than 150 synthetic opioids available on the market, fentanyl is the most frequently utilized in clinical practice.
While it can’t be denied that fentanyl is an essential medicine in clinical practice, fentanyl, along with other synthetic opioids, is the number one cause of premature death in the United States today. In 2016 alone, fentanyl was responsible for half of all opioid deaths — a staggering 20,000 people. While fentanyl remains a fairly unpopular recreational drug, its use as an additive in other drugs and its nature as a gateway drug to other substances, like oxycodone and heroin, make it a serious public health threat.
How is Fentanyl Made
There’s a pandemic devastating the United States and countries abroad, one largely unchecked with no signs of relenting. It kills quietly and threatens the future of generations to come. It claimed the lives of nearly 72,000 Americans in 2019, a death toll accelerating rapidly in 2020.
Its presence does not permeate social media or the nightly news like COVID-19, yet it cripples families and impacts communities—the young and the old, the rich and the poor—just as tragically.
It is the opioid crisis, and 175 Americans die every day because of it. Combined with alcoholism and other forms of substance abuse, it is part of a more subtle pandemic of addiction that former United States Surgeon General Vivek Murthy claimed must be treated with the same urgency as heart disease, cancer, or diabetes.
Although Murthy’s words did not fall on deaf ears—U.S. health officials allocated more than $1.8 billion in state funding last year to combat the crisis—burgeoning problems persist. Overdose mortality rate and suicide continue to reduce average life expectancy in the United States, a trend seemingly bolstered by the mandated isolation and ubiquitous fear from the coronavirus.
Indeed, as the world awaits a vaccine—a drug to serve as a panacea for global panic and uncertainty—more addicts return to their own familiar remedies. It is a step backwards that many will make only once, as families are forced to bury a loved one gone too soon.
This article is an attempt to illustrate the unique challenges—physically and psychologically—facing those with substance abuse disorder during Covid-19. Furthermore, it is meant to offer strategies to combat these challenges, strategies borrowed from Centers for Disease Control and Prevention (CDC), the National Institute on Drug Abuse (NIH), and scholarly journals published via the National Center for Biotechnology Information (NCBI).
Fentanyl Street Names
When fentanyl is taken as prescribed, people generally refer to it by its brand name or simply as “fentanyl.” However, when these prescription medications are distributed on the street or when people buy fentanyl online, it is often listed under other names. Drug dealers and distributors use alternative words for the drug to avoid detection and legal consequences. While consumers may also use alternate terms as a form of self-protection, many do so because they are immersed in a drug culture where these terms proliferate. These are commonly used to refer to fentanyl and other synthetic opioids. However, the list is non-exhaustive because the language used to refer to drugs is constantly evolving.
- China White
- Dance Fever
- China Girl
- Murder 8
- Tango and Cash
People who are prescribed opioid pain medications are at a high risk of developing addiction. The National Institute on Drug Abuse estimates that among people with legitimate prescriptions, 21% to 29% end up abusing them. Beyond that, roughly 8% to 12% ultimately develop opioid use disorders due to regular misuse. While not everyone who develops an opioid use disorder continues to abuse fentanyl, 1 in 20 eventually turn to heroin, due to its affordability and ease of access. Four out of every five heroin users began to use opioids while taking a prescription opioid such as fentanyl. As such, fentanyl is not only dangerous in its own right as the main driving force behind the opioid epidemic since 2013. It is also a significant gateway drug for people who would otherwise not engage in recreational drug use.
Since the 1990s, fentanyl overdoses have soared. Between 1999 and 2017, the number of people in the United States who die every year from synthetic opioid overdoses has skyrocketed from 3,442 to 17,029. Beginning in 2013, the rates of heroin overdoses have also increased. However, many heroin-related deaths can in fact be attributed to people consuming a mixture of heroin and fentanyl, a life-threatening combination that exponentially increases a person’s risk of overdosing. While most recreational drug users do not seek out fentanyl on their own, drug dealers frequently add it to heroin, cocaine, and other products to increase perceived potency and save on costs. Unfortunately, the overdoses that stem from opioid use do not show any signs of debating soon. Between 2016 and 2017, emergency department visits in the United States for opioid overdoses increased by 30%. Most people who overdose never receive treatment for their addiction and ultimately relapse. Without increased access to treatment programs, the fentanyl and the broader opioid epidemic is likely to continue taking more lives each year.
How is Fentanyl Abused?
People holding legitimate fentanyl prescriptions often misuse the drug by misunderstanding or failing to follow directions. Many, however, are driven by dependence to deliberately abuse the drug. This can be as simple as taking higher or more frequent doses than recommended. However, a variety of other methods exist for abusing fentanyl that are specific to the different forms fentanyl takes.
- Snorting or sniffing. Fentanyl can be snorted in powder form. This is common practice when fentanyl is mixed with other drugs, such as cocaine.
- Fentanyl can be injected directly. While this is the most effective method for people trying to get high, it is also the method most likely to result in an overdose.
- People often smoke fentanyl mixed with heroin, both intentionally and unintentionally, to achieve their desired high. Smoking fentanyl makes it difficult to control the dose, and it is particularly dangerous when a drug interaction is at play.
- Altering fentanyl patches. Fentanyl patches are designed to provide a slow and steady dose over a long period of time. People intending to abuse the patches to get high often scrape off the sticky psychoactive substance on the bottom of the patch. They can then inject this substance into their bloodstream. Another common method is to boil the sticky substance into a kind of fentanyl tea, which can then be consumed orally.
Who is Most Likely to Abuse and Become Addicted to Fentanyl
People who suffer from severe or chronic pain are likely to be prescribed an opioid analgesic like fentanyl. A significant portion of people taking pain medications develop dependence and addiction. Many of these individuals are led to believe that prescription painkillers are non-addictive and risk-free because they are used in clinical practice. The truth could not be further from that. In fact, even people who do not misuse fentanyl are likely to develop some level of physical dependence after only a short period of time. This can lead even people who would never consider abusing drugs to engage in dangerous drug-seeking behavior.
Aside from people suffering from pain, recreational drug users are the other main population who is most likely to abuse and become addicted to fentanyl. In part, this is because they might seek out fentanyl as a means of getting high. However, because fentanyl is frequently added as a contaminant to other drugs, recreational drug users are also at a higher risk of accidentally consuming fentanyl. Mixing fentanyl with other drugs, particularly stimulants like cocaine and methamphetamine, is extremely dangerous and can lead to respiratory depression. Unfortunately, fentanyl overdoses are very difficult to avoid when the drug is inadvertently consumed. Because fentanyl is so powerful even in small amounts, users have a limited margin of error for dosage mistakes.
Certain factors make people more susceptible to engaging in drug abuse. Addiction rarely has one cause, but it is often best to be particularly cautious if you have any of the following characteristics. These qualities have been shown to be correlated with higher rates of substance abuse.
- A family history of addiction
- Poverty in one’s community
- Lack of parental supervision as a child
- Child abuse or early childhood post-traumatic stress disorder (PTSD)
- Wide availability of drugs in one’s community
- Aggressive behavior in childhood
- Lack of economic opportunities
- Having a weak social support network
What are the Signs of Fentanyl Abuse and Withdrawal?
Psychiatrists refer to fentanyl addiction as opioid use disorder. This term refers to all opioid addictions, ranging from heroin addiction to other synthetic opioids. While fentanyl is a particularly potent and dangerous opioid, the characteristics of opioid addiction are generally similar in nature. When making a diagnosis of opioid use disorder, psychiatrists consult a book called the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), which lists criteria for diagnostic purposes. The DSM-5 lists eleven symptoms that characterize opioid use disorders. Meeting only two of the criteria is sufficient to receive a clinical diagnosis.
- Opioids are often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
- A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
- Craving, or a strong desire or urge to use opioids.
- Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
- Important social, occupational, or recreational activities are given up or reduced because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous.
- Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance, as defined by either of the following:
- A need for markedly increased amounts of opioids to achieve intoxication or desired effect.
- A markedly diminished effect with continued use of the same amount of an opioid.
- Withdrawal, as manifested by either of the following:
- The characteristic opioid withdrawal syndrome
- Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.
Fentanyl withdrawal generally begins within a few hours of a person’s last dose. Withdrawal symptoms include:
- Insomnia and other sleep disorders
- Gastrointestinal problems like diarrhea and vomiting
- Cold flashes with goosebumps
- Bone and muscle pain
- Uncontrollable leg movements
- Extreme cravings
Opioid use disorder is a spectrum condition, meaning people experience it at a range of intensities. People who suffer from two to three symptoms are said to have a mild disorder. Those who experience four to five symptoms have a moderate condition. Exhibiting six or more symptoms is indicative of a severe opioid use disorder that requires immediate treatment. Even mild cases, however, are best treated as soon as possible. Addiction is a progressive illness that is likely to worsen if left untreated.
Why is Fentanyl so Addictive?
When people misuse or abuse fentanyl, they do so fundamentally because the drug provides them relief or makes them feel good. Even when used legitimately to treat authentic pain, fentanyl provides a feeling of euphoria, sometimes known as a “high.” On the most basic level, fentanyl abuse comes down to pleasure. But how do people begin abusing fentanyl, despite widespread awareness of the risks?
When fentanyl enters the body, it binds to opioid receptors in the brain and in many of the body’s organs. These opioid receptors have a significant role in the regulation of pain and emotions. Not only do opioids block pain signals, they cause people to experience profound feelings of physical pleasure and emotional joy. Many of these positive subjective experiences can be attributed to the release of dopamine in the brain. Dopamine, the brain’s “feel-good” chemical, is how the brain typically rewards itself for behaviors. Dopamine is released when people win a basketball game, have sexual intercourse, and accomplish a task they’ve set for themselves. The chemical reinforces behavior and plays a large role in the brain’s motivation and decision-making centers. Because fentanyl releases such large quantities of dopamine, the brain is trained to continue taking it.
Over time, the brain and body adapt to the drug. Opioid receptors multiply, and the brain becomes less responsive to dopamine. As a result, the euphoric and pain-relieving effects of fentanyl decrease. To achieve the same desired effects, a user must either take a higher dose of opioids or increase the frequency of their consumption. As the body acclimates to regular doses of fentanyl, a person may begin to experience negative side effects when they stop taking the drug. As dosages increase, so too do these negative symptoms. These two phenomena, known respectively as tolerance and withdrawal, can lead people to be physically dependent on fentanyl.
Not everyone who develops a physical dependence on fentanyl develops an addiction. Addiction is characterized by an inability to control one’s consumption of a substance despite negative consequences. When a person suffers from addiction, they may try repeatedly to control their use or to quit entirely. While sometimes this may be possible for a few days, weeks, or months, someone who suffers from opioid use disorder will inevitably return to substance abuse unless they learn to manage their condition. As a result, fentanyl addicts experience a range of harms, including interpersonal problems, legal issues, economic devastation, and difficulty managing everyday tasks. Many also lose their lives.
How is Fentanyl Addiction Treated?
People who suffer from a fentanyl addiction are often tempted to try to overcome it by themselves. Addiction carries a great deal of stigma with it, and our culture continually emphasizes a need for self-reliance and personal determination. As such, those with addiction are frequently loath to ask for help. Others are simply unwilling or unable to recognize the condition of addiction at all. When a person’s life doesn’t match the media’s stereotypical depiction of an addict’s life, it can be tempting to deny that one has a substance use disorder. However, it should be emphasized here that there are just as many addicts with mansions and sportscars as there are addicts who are homeless and destitute. Addiction, by its very nature, affects a person’s willpower and decision-making ability. When a person suffers from addiction, no matter their station in life, the only way they can get relief is by seeking outside help.
Addiction treatment centers provide a means for people suffering from fentanyl addiction to obtain their freedom. The first step involves withdrawing from fentanyl. At medical detox centers, addiction experts and physicians can provide support as well as a safe, supportive, trigger-free environment. Many medical detox centers offer medication-assisted treatment (MAT), which can involve drugs such as methadone and buprenorphine. These medicines can mitigate some of the more harmful side effects of fentanyl withdrawal and weaken cravings. During the course of detox, case workers generally work with patients to ensure they have a longer-term plan for treating their opioid use disorder.
Addiction can not be “cured,” merely managed. As such, while abstinence may be a helpful foundation for recovery, merely avoiding fentanyl rarely results in long-term sobriety. After detoxing, it is recommended that individuals enroll in more long-term treatment programs, such as a residential treatment program, intensive outpatient program. These resource centers allow people to develop strong sober social support systems and new coping skills to avoid relapse. They also work with individuals to rebuild their lives from the ground up. Doing so ensures not only that recovering addicts avoid relapse, but that they can begin to thrive in sobriety in ways they had never before imagined.
You can get sober at Design for Recovery….recovery is possible.
Design for Recovery is a structured sober living home for men located in Los Angeles, California. While sober living homes are often recommended as part of an aftercare plan when people graduate from treatment centers, Design for Recovery’s intense peer driven program is ideal for young men at any stage of recovery, including detox. Our program, which is firmly rooted in the 12 steps of Alcoholics Anonymous, emphasizes core values, including accountability, honesty, and personal integrity. Our dedicated and experienced staff ensures that residents follow programs that meet their unique needs.
It’s our goal to help residents develop the tools they need to avoid relapse over the long term and build new and prosperous lives in sobriety. Services we offer include:
- One-on-One Mentoring.
- Unity House Meetings.
- Medication Monitoring.
- Employment Support.
- Money Management.
- Family Services.
At Design for Recovery, it is our philosophy that quitting drugs and alcohol is only the beginning of a long and rewarding journey. Our residents graduate with a strong sober social support system and a new approach to living. By the time they leave our sober living home, many are already beginning new careers or enrolled in school. No matter how hopeless a person’s addiction at one point seemed, recovery — and a life of freedom and joy — are possible. Reach out to Design for Recovery today to discuss how we can meet your needs.