Fentanyl Addiction

  • Generic Name or Active Ingridient: Fentanyl

Fentanyl is a strong opioid prescribed to patients to relieve breakthrough pain associated with cancer or to treat acute pain after surgery. Individuals may develop an addiction to fentanyl after using this medication to reduce pain or to get high.

Occupational or second-hand exposure may increase the risk for developing physical dependence to physicians working with fentanyl in the operating room. This risk is especially high for anesthesiologists.

The Journal of Addictive Diseases published a 2006 study of Florida physicians and found that only 5.6 percent of doctors in that state were anesthesiologists, yet 25 percent of Florida physicians followed for substance abuse and dependence were anesthesiologists. The risk for fentanyl abuse and dependence is especially high for anesthesiologists as compared with other physicians: Approximately 75 percent of physicians who abuse fentanyl are anesthesiologists. Anesthesiologists face special social and professional obstacles, which may prevent them from seeking qualified rehabilitative care.

The definition of addiction

Addiction is a primary, chronic neurological and biological disease whose development and manifestations are influenced by genetic, psychological, sociological and environmental factors. A person who is addicted to fentanyl may exhibit an inability to control his drug use, or use drug compulsively. An individual with an addiction to fentanyl might continue to use drugs, despite being aware of the harm strong opioids can cause. He will likely crave fentanyl and spend a great deal of time looking for or thinking about fentanyl.

Addiction versus Dependency

Addiction is not the same as dependency. Both addiction and dependence cause real changes in your body and brain but addiction and dependence manifest themselves in different ways. It is possible to become addicted to or dependent upon fentanyl.

You can be addicted to a drug, yet not be physically dependent upon it. Conversely, you can be physically dependent on a drug but not addicted to it. For example, you may be physically dependent on blood pressure medication to treat your hypertension; if you were to run out of your medication, your blood pressure would rise but you would not feel cravings for the drug as you might crave fentanyl. In contrast, cocaine does not cause physical dependence yet a person addicted to cocaine experiences very strong cravings for the drug.

Dependence on fentanyl means your body has adjusted to the presence of this strong opioid. When the fentanyl levels drop rapidly, either because you ran out of medicine or because you took a drug that drops the amount of fentanyl in your system, your body struggles to regain chemical balance. Withdrawal symptoms are a manifestation of this physiologic struggle. Cravings are a behavioral manifestation of the addiction.

Addiction: What Family Members Should Know

Addiction affects the entire family. Researchers are still working to establish the exact cause of drug abuse, dependence and addiction but scientists feel genetics and other environmental factors play a role. The American Society of Addiction Medicine thinks genetic factors account for about half the likelihood that an individual will develop an addiction. Events in your loved one's life, such as peer pressure, emotional distress, anxiety, depression and environmental stress contributed to his dependence and addiction. These factors also increase every family member's risk for abusing drugs or developing an addiction.

Family therapy can reduce the impact genetics and environmental factors play in addiction. Children who grow up in an environment where illicit drug use is acceptable are more likely to develop addictions. This is especially true for females; girls who grow up around substance abuse tend to use drugs as grown women. Therapy gives children the tools they need to break free from the familial patterns of drug abuse and addiction.

Addiction Symptoms: Physical and Psychological

Addiction causes changes in brain structure and function, especially in those areas of the brain associated with reward, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala. Addiction also changes the way the brain remembers rewards, inappropriately attributing positive rewards to fentanyl. These neurological changes manifest themselves in both physical and psychological symptoms.

Physical symptoms of drug addiction include:

  • Unexplained Weight Gain or Weight Loss
  • A Change in Sleep Patterns
  • Deteriorating Physical Appearance - Looks Sickly
  • Nagging Cough
  • Diminished Hygiene Care
  • Body or Clothing May Have an Unusual Odor
  • Bloodshot Eyes with Large or Small Pupils
  • Tremors
  • Slurred Speech

Psychological symptoms of addiction to fentanyl include:

  • Fear of Returning Pain
  • Inability to Abstain Consistently.
  • Impairment in Behavioral Control.
  • Cravings for Drugs or Intense Reward Experiences.
  • Diminished Capacity to Recognize Significant Personal or Relationship Problems.
  • Dysfunctional Emotional Response.

Addiction and gender: how women and men are affected differently

Several studies suggest women are more likely to abuse prescription drugs such as fentanyl than are men, who seem to prefer illicit drugs such as cocaine, marijuana and heroin. Females are also more likely to abuse multiple substances than are men.

Women have a higher incidence of pain and report more intense pain than do men, so females may be more willing to use prescription fentanyl to control pain. Doctors tend to prescribe more opioids to women than men. Physicians seem more likely to prescribe mood-altering drugs to women than to men out of a misperception that a female's complaints are due to depression, nervousness or some other emotional problem rather than from a physical ailment.

Girls raised in homes where illicit drug use was acceptable face a higher risk for addiction when they are older. Females addicted to drugs are more likely to have a partner or spouse with an addiction.

Men are more likely to exhibit social disorders, such as criminal activity, whereas addicted women are more likely to experience mood disorders. Women with addictions are more likely to express dislike for their bodies than are addicted men and are therefore at higher risk for developing eating disorders. Addicted men are more likely to engage in drugs socially, whereas an addicted woman tends to abuse drugs in private.

Men are more likely to report current drug abuse than are women, according to the 2002 National Survey on Drug Use and Health. Historically, women have a lower rate for entry into treatment, staying in treatment and completing treatment than men. Social stigmas, economic barriers and family responsibilities prevent addicted women from seeking or completing treatment programs.

Relapse for women seem to be tied to psychological distress and interpersonal relationships as compared to men.

Signs of addiction: For those around

Your friend, relative or co-worker is different than she used to be. Addiction to fentanyl and other opioids makes changes to a person's brain in a way that alters the way they behave, think and feel. Some changes are profound while others are subtle. Keep your eyes open for signs of addicted behavior, including:

  • Abnormal, Illegal and Anti-Social Actions
  • Arguments or Violent Outbursts
  • Excessive Drug Prescriptions for Self and/or Family
  • Frequent Emotional Crisis
  • Legal Problems
  • Neglect Of Children
  • Neglect of Social Commitments
  • Prioritizing Activities Involving Fentanyl
  • Separation Or Divorce
  • Unexplained Absences from Home
  • Unpredictable Behavior such as Inappropriate Spending
  • Withdrawal from Relationships, Family or Friends

Addiction causes profound changes in a person's behavior, thinking patterns, emotions and his interactions with others. Addiction alters an individual's executive functioning, or the way he connects past experiences with current events to plan, organize and solve problems. A person with an addiction to opioids such as fentanyl has difficulties with perception, learning, impulse control compulsivity and judgment.

Behavioral manifestation and complications of addition: Excessive use or participation in addictive behaviors, often at higher frequency or intensity than intended and frequently couple with an expressed intent and attempts to control behavior Excessive time lost pursuing, using or recovering from substance abuse Continued use of the substance despite understanding the consequences of abuse Narrowing behavioral repertoire focusing on the reward aspect of addiction Apparent lack of ability or interest in taking action to quit

Cognitive changes: Preoccupation with substance abuse Altered perception of the benefits and risks of drug abuse Inaccurate belief that the individual's problems are due to other causes rather than as a predicable consequence of drug abuse.

Emotional signs of addiction include: Increased anxiety, dysphoria and emotional pain Increased sensitivity to stressors. "Things seem more stressful" Difficulty identifying feelings or expressing them to others

Treatment options

The American Society of Addictive Medicine warns that addiction can cause "disability or premature death, especially when left untreated or treated inadequately." Individuals can best achieve recover from fentanyl addiction through a combination of self-management, support from family and friends and professional care from specially trained and certified rehabilitative experts.

Some individuals try to quit fentanyl alone, without the help of medical professionals. Known as quitting "cold turkey," self-detoxification is associated with profoundly uncomfortable withdrawal symptoms, including diarrhea, stomach pains, tremors, cold and clammy skin, body aches and insomnia.

These symptoms last for several days or even weeks and can drive even the most determined person back to fentanyl use. People attempting self-detox from fentanyl without medical supervision can suffer dangerous complications, such as vomiting and aspirating stomach contents into the lungs, or becoming dehydrated from excessive sweating, vomiting and diarrhea.

Other people use homemade remedies to reduce fentanyl withdrawal symptoms. One such formula is the Thomas Recipe, which calls for Valium, Xanax, Klonopin, Ativan or Librium to reduce symptoms and aide sleep. The individual then takes consecutively smaller doses of these drugs each day to wean from that medication. Fentanyl withdrawal symptoms are usually worst around the fourth day. Withdrawal symptoms should subside enough after five or more days to discontinue valium or other drugs.

Imodium helps control diarrhea and L-Tyrosine eases anxiety. Other supplements ease fatigue and depression while hot baths soothe body aches. The Thomas Recipe does not reduce the risk for complications, nor does it address the behavioral aspects of addiction to fentanyl.

Without professional intervention, withdrawal symptoms and behavioral problems drive many individuals back to fentanyl use. The risk for overdose is greater for a person who has recently gone through detoxification because detox has lowered the body's tolerance for opioids. A dose that would not get him high before detox is a lethal dose after detoxification. When the person returns to fentanyl abuse, he may mistakenly overdose.

Acute fentanyl intoxication or overdose requires emergency medical treatment. Physicians and nurses administer medications such as naloxone that rapidly reduce the levels of fentanyl in the body, monitor blood chemistry, vital signs and fluid levels, and provide life-saving measures whenever necessary. Staff members also watch for aspiration and dehydration.

Medically stable individuals may choose outpatient treatment, sometimes including drug replacement therapy. Physicians prescribe buprenorphine as a replacement for fentanyl so that a person does not suffer overwhelming withdrawal symptoms while he is trying to overcome his addiction to fentanyl. Opponents of drug replacement therapy worry it is trading one addiction for another.

Inpatient treatment always starts with detoxification. During detox, physicians administer drugs to lower fentanyl levels in the blood and medications to reduce subsequent withdrawal symptoms. Doctors and nurses also watch for signs of dangerous complications. Qualified medical intervention reduces the intensity and duration of withdrawal symptoms, which improves the chances for recovery from physical dependence. The patient still suffers the demoralizing symptoms of fentanyl withdrawal.

Rapid detox is a new, humane procedure that saves the individual from the demoralization and discomfort of withdrawal. During rapid detox, physicians administer anesthesia and sedatives along with the standard detoxification and anti-withdrawal drugs. Patients enjoy a short "twilight sleep" while doctors lower fentanyl levels and manage physical complications. The individual awakens a few hours later, unaware of the uncomfortable symptoms of fentanyl withdrawal. Participation in some sort of rehabilitation improves the chances for recovery from fentanyl addiction. Rehabilitation may be done as an outpatient, short-term inpatient or in an extended care facility. Many short term inpatient rehabilitation facility offer 28-day programs, while an extended care facility might offer programs lasting six months to one year. Behavioral modification through individual, group and family counseling reduces the risk for relapse by changing environmental and behavioral elements that led to or were a result of addiction to fentanyl.

The largest complication of fentanyl addiction rehabilitation is return to fentanyl use. Physicians and rehabilitation professionals should monitor patients closely for signs of relapse, especially for those patients who still need medication to control pain.