6 Signs of Fentanyl Abuse You Need to Know
This article was originally published on WebMD Connect to Care
Fentanyl is a powerful synthetic opioid (a strong type of medication meant to treat severe pain) normally prescribed under careful medical supervision. However, the drug is also made and used illicitly. According to the CDC, fentanyl is 50 to 100 times more potent than morphine, and this high potency increases the risk of overdose. Synthetic opioids, like fentanyl, are the most common drugs involved in overdose deaths in the US. Deaths from fentanyl are on the rise, with 59% of opioid-related deaths involving fentanyl in 2017 compared to 14.3% in 2010. In 2020, the number of overdose deaths involving synthetic opioids was 18 times the number of overdose deaths in 2013.
The side effects of fentanyl can be dangerous and even fatal, especially when the drug is misused. Read on for 6 serious side effects of fentanyl that can result when it’s taken in excessive amounts.
Difficulty Breathing
Fentanyl overdose fatalities have reached "epidemic" levels in North America, and these deaths have, across the board, resulted from respiratory depression, according to a 2019 article published by the British Pharmacological Society. Opioid-induced respiratory depression is when your breathing becomes slow and shallow due to the effects of opioids on the brain.
“Fentanyl will cause respiratory depression due to the effects it has on the respiratory drive by increasing the body's acceptable threshold for carbon dioxide in the blood,” Mike Martinez II, DO, owner and lead physician at Way Out West Spine and Mobility and associate professor at TCU and UNTHSC School of Medicine, tells WebMD Connect to Care.
2. Severe Digestive Tract Issues
“Physical side effects of fentanyl addiction include severe digestive tract problems, including constipation, possible bowel obstruction, and tearing of the bowel.” explains Dr. Shirley Jankowski, Program Director Changes Rehabilitation. Fentanyl binds to opioid receptors, and there are many opioid receptors that line the gastrointestinal tract. Since fentanyl is a depressant, it can cause dysmotility of the GI tract where the muscles of the digestive system are impaired leading to changes in speed, strength, and coordination of the digestive organs. This can lead to slow gastric emptying, nausea, constipation, and bowel obstruction.
3. Mood Instability
Fentanyl misuse can also lead to mood swings, paranoia, and anger because opioid receptors also influence our emotions. According to the National Institute on Drug Abuse, an individual can feel extreme happiness, drowsiness, confusion, and can experience mood swings.
“Overdose and death are the most talked about effects but more important are the dramatic changes in the brain that lead to unusual behaviors and conflicts with family and friends.” explains Dr. Chris Johnston, Chief Medical Officer at Pinnacle Treatment Centers.
4. Addiction
According to a 2021 review published in World Psychiatry, fentanyl misuse can rapidly result in addiction because of its high potency. It binds to mu-opioid receptors in the brain, which is responsible for its analgesic, euphoric, and respiratory depressing effects. However, it is 80-100 times more potent than morphine and 30-50 times more potent than heroin at activating mu-opioid receptors. Additionally, fentanyl has a higher lipophilicity than other opioids, meaning it is able to penetrate fat and cell membranes better. This leads to more of the drug reaching the brain and reaching the brain at a faster rate than other opioids.
5. Coma and Death
The National Institute on Drug Abuse notes that fentanyl circulates as an illegal street drug, and is also mixed into other illicit substances such as methamphetamine, heroin, cocaine, and MDMA. As a result, some users do not know that they are taking fentanyl, let alone how much of it they are ingesting.
When respiratory depression resulting from excessive amounts of fentanyl develops, hypoxia, or low oxygen levels in the body’s tissues, can result.
According to the National Institute on Drug Abuse, hypoxia of the brain is a potential consequence of a fentanyl overdose. And when your brain is starved of the oxygen it needs, coma, permanent brain damage, and death can occur.
6. Wooden Chest Syndrome
In addition to respiratory depression, a fentanyl overdose can also cause death when a patient develops wooden chest syndrome. This condition is characterized by extreme muscle rigidity in the muscles of the chest, airways, and diaphragm, according to a 2021 article published by the Journal of Clinical Pharmacy and Therapeutics.
“Wooden chest syndrome is a unique side effect where the breathing muscles lock up, and this does not respond to naloxone,” Christopher Johnston, MD, ABPM-ADM, Chief Medical Officer of Pinnacle Treatment Centers, tells WebMD Connect to Care.
Mayo Clinic explains that naloxone is an emergency nasal spray that can be used in many circumstances to temporarily reverse the effects of an opioid medication.
However, with wooden chest syndrome, “it is almost impossible to get air into the lungs, even with advanced life support techniques,” Johnston notes.
“Larger doses of Fentanyl produce rigidity in the chest wall and diaphragm.” explains Manzoor Ahmad, Pharmacist and Founder and CEO of DrugsBank. “This can eventually lead to death if not treated quickly enough with standard doses of succinylcholine.” Succinylcholine is a paralytic medication and a powerful muscle relaxant. It is typically used to prevent movement during surgical procedures and to aid in intubation for the treatment of wooden chest syndrome.
Fentanyl Addiction Treatments
“If someone is suspected of overdosing on fentanyl, it is important to call 911 immediately.” explains John Bartholdi, MPharmacol from Nootropicology. “Treatment for a fentanyl overdose typically includes administering the antidote naloxone and providing supportive care, such as oxygen and IV fluids. Sometimes, a person may need to be placed on a ventilator to help them breathe.”
According to the National Institute on Drug Abuse, naloxone rapidly binds to opioid receptors in the brain and blocks the effects of fentanyl. Naloxone binds tighter to opioid receptors than fentanyl or other opioids do, so it is able to compete and rapidly replace fentanyl in the brain. Since fentanyl is stronger than other opioids like morphine and heroin, it may require multiple doses of naloxone to treat an overdose. Naloxone can be administered as an injectable solution or as a nasal spray, also known as Narcan.
It’s important to know that the spray formulation of Narcan was developed for layperson use. It can be purchased at many pharmacies and is also sometimes given away for free by community health or harm reduction organizations. If you or a loved one is engaged in excessive opioid use, Narcan could be a life-saving medication to keep on hand. But emergency medical services should still always be secured after Narcan has been administered.
“The downside to Narcan administration is that it will put you into withdrawal.” says Nicholas Mathews, founder of Stillwater Behavioral Health Treatment Center. “So generally, coming out of overdose, you're simultaneously sick. It's probably one of the wildest things we see in active addiction: Somebody will overdose and then immediately try to use again because the medication that saved them from the overdose caused feelings of withdrawal. Hence, they return to the drug immediately. This cycle is a good example of what active addiction looks like and what it really is.”
Fentanyl addiction is generally treated with a combination of medication and behavioral therapy. “Medication assisted treatment uses medications like methadone or buprenorphine to help people reduce the desire for the drug and reduce withdrawal symptoms such as chills, sweating, diarrhea, confusion, restlessness, muscle and joint pain, irritability, stomach cramps and anxiety.” shares Dr. Alice Williams, Physician and Owner of DrAliceWilliams.com.
Options for medication assisted treatment include:
Buprenorphine, methadone, and naltrexone. These medications bind to the same opioid receptors as fentanyl, but do not cause euphoria or addiction. They can help reduce withdrawal symptoms and cravings.
Lofexidine and clonidine. These are non-opioid medications that help to reduce withdrawal symptoms.
A 2017 review published in Cochrane Database, looked at 27 studies comparing buprenorphine with either clonidine or lofexidine and found that overall, buprenorphine was associated with less severe withdrawal symptoms, increase likelihood of completing detox, and longer time in treatment after detox.
After detox, the National Institute on Drug Abuse recommends counseling. “Behavioral therapy helps people learn how to cope with triggers and behaviors around using the drug” continues Dr. Williams. Counseling can occur in an inpatient or outpatient setting depending on the individual’s needs and lifestyle. Options for counseling include:
Cognitive behavioral therapy (CBT) to help the individual learn to manage triggers and stress without drug use
Contingency management, which uses a voucher-based system to give patients points based on negative drug tests. The points they earn can be used to get prizes
Motivational interviewing, which helps the individual address their mixed feelings about changing their lifestyle
“Treatment of fentanyl addiction requires careful and close monitoring by, ideally, a physician trained and practiced in addiction medicine/psychiatry.” explains Dr. Kory S. London, MD, FACEP, Director of Clinical Operations at Jefferson Methodist Hospital Emergency Department. “Treatment should also focus on the social determinants of the patient’s health, including any co-existing mental illness, housing/food insecurity and the development of a healthy and reinforcing social support system. Given the difficulty of doing these things independently, use of recovery support services, such as peer mentors (those in long term recovery who can support and help guide the bumps in the road), can be tremendously beneficial.”
Sources:
CDC. Fentanyl.
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Gowing L, Ali R, White JM, Mbewe D. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev. 2017;2(2):CD002025. Published 2017 Feb 21.
Volkow ND. The epidemic of fentanyl misuse and overdoses: challenges and strategies. World Psychiatry. 2021;20(2):195-196.
National Institute on Drug Abuse. Fentanyl Drug Facts.
Camilleri M, Lembo A, Katzka DA. Opioids in Gastroenterology: Treating Adverse Effects and Creating Therapeutic Benefits. Clin Gastroenterol Hepatol. 2017;15(9):1338-1349.
Torralva R, Janowsky A. Noradrenergic Mechanisms in Fentanyl-Mediated Rapid Death Explain Failure of Naloxone in the Opioid Crisis. J Pharmacol Exp Ther. 2019;371(2):453-475.
