Fentanyl Abuse

Fentanyl is one of the strongest opioids prescribed by doctors. Misuse of any opioid can be deadly, but fentanyl is one of the riskiest to abuse. The drug can cause a fatal overdose, and it's often found in heroin and counterfeit medications.
Topics On this page
| | 14 sources

People who intentionally misuse fentanyl either have a high tolerance to opioids or they don’t know what they’re getting into. Many authorities believe that most people who overdose on the highly potent drug don’t know that they’re using it.

Fentanyl has become an increasingly common substitute for heroin and other street drugs in the last decade. Drug dealers commonly add it to heroin and counterfeit prescription pills. According to data from the National Vital Statistics System, fentanyl accounted for nearly half of all opioid-related overdose deaths in 2016.

Fast Facts: Fentanyl

Abuse Potential
Brand Names
Abstral, Actiq, Fentora, Onsolis
Drug Class
Street Names
Apache, China girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, Tango and Cash
How It's Used
Swallowed, Injected, Smoked, Placed Under the Tongue, Applied to the Skin
Side Effects
Nausea, Dizziness, Slowed heart rate, Shortness of breath, Fever, Chills
Legal Status
Schedule II

Despite increased awareness about the dangers of the drug, some people do intentionally misuse fentanyl to get high or to avoid opioid withdrawal. Prescription fentanyl patches are the most commonly sought forms of the drug, but people also misuse other types of fentanyl.

The Drug Enforcement Administration classifies fentanyl as a Schedule II controlled substance, which means it has a medical use and a high potential for abuse. The drug was introduced in 1968, but pharmaceutical companies marketed several new forms of the drug throughout the 1990s and 2000s. Illicit fentanyl production likely influenced a spike in overdose deaths during the past decade.

What Is Fentanyl?

Fentanyl is a synthetic opioid prescribed to relieve pain. Opioids are drugs similar to morphine and other chemicals found in the opium plant. Synthetic opioids are man-made versions of the drugs.

Morphine is the standard that other opioids are compared to. It’s about 360 times stronger than Tylenol or aspirin. Comparatively, fentanyl is about 100 times stronger than morphine. A tiny amount of the drug can cause intoxicating effects.

Even using a prescription fentanyl patch without a doctor’s prescription can cause a deadly overdose, according to a 2014 article in The Journal of Sedation and Anesthesiology in Dentistry.

Prescription fentanyl comes in the following forms:

  • A patch placed on the skin (Duragesic)
  • A lozenge placed between the cheek and gum (Actiq)
  • A buccal tablet placed between the cheek and gum (Fentora)
  • A sublingual tablet placed under the tongue (Abstral)
  • A film placed on the inside of the cheek (Onsolis)
  • An injection administered by a doctor (Sublimaze)

Doctors only prescribe or administer fentanyl to people with severe pain, such as cancer patients, who are already tolerant to opioids, according to the National Institute on Drug Abuse.

Tolerance is the body’s natural adaptation to a drug. When people take opioids regularly, they require higher doses or more potent opioids to achieve the same effects.

On the street, fentanyl is often available in powder form. The powder may come in tablets, on blotter paper or in bags disguised as other drugs. It’s impossible to determine if a drug purchased on the street contains fentanyl just by looking at it.

Some harm reduction groups distribute test strips that can effectively identify fentanyl in drug samples. However, the strips only test for six legal forms of fentanyl. It’s unlikely that they can detect every variety of illicit fentanyl sold on the streets.

Street fentanyl commonly comes from illegal labs. Unlike prescription drugs, fentanyl’s strength is unknown to the people selling it.

Effects of Fentanyl

People who misuse fentanyl usually swallow, snort or inject the drug. They may also place blotter paper containing fentanyl in the mouth.

The effects of fentanyl vary depending on the strength of the drug, the form of the drug, the method of use and the person’s tolerance to opioids.

In general, effects of fentanyl include:

  • Pain relief
  • Euphoria
  • Relaxation
  • Drowsiness
  • Trouble thinking
  • Dry mouth
  • Constipation
  • Nausea

Misusing fentanyl or taking high doses of the drug can cause vomiting, sweating, confusion and slowed breathing, according to the U.S. National Library of Medicine. These are signs of a fentanyl overdose. Other warning signs include trouble breathing, dizziness, low body temperature and fainting.

People experiencing symptoms of an overdose should call 911 immediately. If you’re with someone experiencing an overdose, call for help, perform rescue breathing and administer naloxone if it’s available.

Naloxone can reverse an opioid overdose, but it often takes multiple doses of naloxone to revive someone experiencing a fentanyl overdose.

Signs of Fentanyl Abuse

If they don’t overdose, people under the influence of fentanyl usually appear extremely tired and loopy. They may seem calm and peaceful. Or they may complain of headache or nausea.

Physical signs of fentanyl use include abnormally small pupils, a flushed face and slowed breathing. Falling asleep in odd locations and struggling to stay awake are common signs of opioid misuse.

Other warning signs of fentanyl use include:

  • Discarded fentanyl patches or packaging
  • Torn or punctured patches
  • Spoons in odd locations
  • Needles or syringes
  • Used blotter paper
  • Pieces of foil
  • Glass vials
  • Empty plastic bags

Few people can conceal regular fentanyl misuse. All opioids cause changes to the brain and other parts of the body. Fentanyl is one of the strongest opioids.

Misusing the drug causes tolerance and dependence. It also increases the risk of becoming addicted to fentanyl. People dependent on or addicted to fentanyl may behave differently. Whether they’re addicted or dependent, they’re usually concerned about avoiding fentanyl withdrawal.

Fentanyl Addiction

Addiction is a disease of the brain. Fentanyl addiction occurs when the drug changes the brain’s pleasure and reward system. Regular exposure to the drug makes the brain crave fentanyl. The disease reduces your ability to exert self-control and recognize the consequences of your actions.

Many people who become addicted to fentanyl start with other drugs. They may begin with weaker prescription drugs, such as oxycodone or hydrocodone. Or they may start with the illicit drug heroin. As their tolerance to opioids grows, they may turn to fentanyl as a cheaper and stronger alternative.

It’s also possible to become addicted to prescription fentanyl. People may become dependent on fentanyl patches or lozenges prescribed to treat pain. They can become dependent on the drug and experience fentanyl withdrawal if they suddenly stop taking it.

Taking a drug to avoid withdrawal is a classic sign of addiction. Fentanyl addiction is a life-threatening condition. People with addiction often take drugs in risky ways, and misusing fentanyl is more dangerous than misusing almost any other type of opioid.

Treatment for Fentanyl Addiction

Rehab for fentanyl addiction uses the same process as opioid rehab. The detox process for fentanyl addiction is usually more intensive than the approach used for other types of opioid addiction. Fentanyl withdrawal symptoms will likely be more severe than those of other opioids.

Addiction professionals may ease fentanyl withdrawal symptoms with medications, such as methadone or Suboxone (buprenorphine). Rehab facilities monitor people detoxing from opioids while keeping them as comfortable as possible.

People addicted to opioids benefit most from inpatient addiction treatment, also known as residential treatment. Most experts recommend a minimum of 30 days of inpatient care for people with severe addiction, and people addicted to fentanyl likely have a severe drug addiction.

During inpatient treatment, patients participate in a daily schedule of individual counseling, group therapy and educational classes. They may also have access to alternative treatments, such as yoga classes or animal-assisted therapy. These activities help individuals recognize triggers, cope with cravings and learn healthy ways to enjoy life.

Inpatient treatment is usually followed by outpatient care and support group attendance. Many people live in sober living homes after rehab. These homes provide structure and accountability during early recovery.

Fentanyl is a dangerous drug capable of causing death. Misusing fentanyl patches is risky. People addicted to other opioids worsen their addiction when they switch to fentanyl. Addiction to fentanyl is a serious disease, but recovery is possible with treatment and support.

Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Chris Elkins, MA
Senior Content Writer, DrugRehab.com
Chris Elkins worked as a journalist for three years and was published by multiple newspapers and online publications. Since 2015, he’s written about health-related topics, interviewed addiction experts and authored stories of recovery. Chris has a master’s degree in strategic communication and a graduate certificate in health communication.
Featured Expert
Jason Fields
Associate Medical Director, DACCO Behavioral Health

Was this article helpful?

How helpful would you rate this article?


    DrugRehab.com logo

    Thanks for helping us make our website better for visitors like you!

    View Sources

    Ready to make a change?

    Get cost-effective, quality addiction care that truly works.

    Start Your Recovery
    We're here to help you or your loved one.
    Question mark symbol icon

    Who am I calling?

    Calls will be answered by a qualified admissions representative with Advanced Recovery Systems (ARS), the owners of DrugRehab.com. We look forward to helping you!

    Question mark symbol icon

    Who am I calling?

    Phone calls to treatment center listings not associated with ARS will go directly to those centers. DrugRehab.com and ARS are not responsible for those calls.