Fentanyl Abuse: Signs, Treatment, & Recovery

What Is Fentanyl?

Fentanyl is a synthetic opioid analgesic 100 times more potent than morphine that was originally developed for the management of severe pain, primarily for cancer patients and the acute, post-operative pain of those who have undergone surgery.[1] It works by binding to receptors in the brain and body to produce powerful pain relief, drowsiness, euphoria, and respiratory depression.[2]

When fentanyl is legally prescribed, the medication is controlled and dispensed via transdermal patches, lozenges, or injectables. However, much of the fentanyl in circulation today is manufactured illicitly, produced in labs with no regulations, and distributed through drug supply chains.[3] According to the Centers for Disease Control and Prevention (CDC) and the Drug Enforcement Administration (DEA), the drug is also widely found in counterfeit pills, heroin, cocaine, and methamphetamine, meaning people using these illicit substances may be exposed to fentanyl without knowing it.[4]

Because the drug supply is now contaminated with fentanyl, the risk of overdose has increased dramatically. This is the heart of the current public health emergency: the level of risk associated with any active substance use has climbed sharply because fentanyl is now in nearly everything.

Fentanyl Abuse Signs and Overdose Risk

Recognizing the signs of fentanyl use, as well as the signs of overdose, is clinically critical because the line between use and overdose is so thin.

Common signs of fentanyl abuse and addiction include:

• Using fentanyl in larger amounts or more frequently than originally intended
• Inability to decrease or stop using fentanyl, despite multiple attempts
• An intense desire for or obsession with obtaining fentanyl or using it
• Withdrawal symptoms when not using fentanyl, such as pain, anxiety, excessive sweating, nausea, vomiting, or agitation,
• Continuing to use fentanyl despite serious negative health consequences, relationship damage, or impact on employment
• Getting fentanyl from multiple prescribers or by illicit means
• Withdrawal from social engagements, neglecting personal responsibilities, and increased isolation from friends and family
• Using fentanyl in combination with other substances, primarily other opioids, alcohol, or benzodiazepines, which significantly increases overdose risk

Signs of fentanyl overdose, which is a medical emergency that requires immediate treatment, include:

• Extreme drowsiness or loss of consciousness
• Slow or compromised breathing, or a complete cessation of breathing
• A choking or gurgling sound audible every time the person tries to breathe
• Cold, clammy skin; blue or gray lips or fingertips
• The person not responding to touch or verbal stimulation

Naloxone, sold as Narcan, is the antidote for a fentanyl overdose if administered immediately.[5] However, due to the potency of fentanyl, multiple doses may be needed depending on the severity of the overdose. If you suspect someone is experiencing a fentanyl overdose, call 911 immediately.

Fentanyl and Mental Health

The relationship between fentanyl addiction and mental health is one of the most significant clinical relationships in the field of behavioral health. Co-occurring mental health conditions are extremely common in people with opioid use disorder, and the connection between the two is deeply intertwined.[6]

Depression is a common co-occurring condition in fentanyl addiction.[7] The mood-elevating and pain-relieving qualities of fentanyl make it a powerful, but ultimately destructive, way of managing depressive symptoms. Fentanyl’s extreme potency makes it very effective at suppressing emotional pain, which is one reason fentanyl is used not only for physical pain, but for emotional pain as well.

Post-traumatic stress disorder (PTSD) and trauma are also among the most powerful predictors of fentanyl abuse.[8] Unaddressed trauma — childhood abuse, sexual assault, combat-related trauma, or other significant life experiences — creates such intense internal distress that fentanyl may feel like the only way to get relief. 

Chronic pain is also tightly intertwined with mental health. There are shared neurological pathways between physical and emotional pain, and the relationship between chronic pain, depression, and fentanyl use is well-documented.[9] When fentanyl is used to manage physical pain, the underlying mental health issues that amplify or feed that pain often go untreated.

ADHD, bipolar disorder, and anxiety disorders commonly co-occur with fentanyl or opioid addiction as well.[10] Each disorder carries its own unique vulnerability that makes opioid use appealing as a coping mechanism.

Treating the Underlying Causes of Fentanyl Abuse

People who arrive at Helios West Palm for fentanyl addiction have traditionally been treated for their substance use alone. Detox, medication-assisted treatment with methadone or buprenorphine, and addiction-specific therapy may have stabilized their substance use, but the underlying issues that led to fentanyl use in the first place have rarely been addressed. As a result, many of these patients see shorter and shorter periods of stability between relapses, because the co-occurring mental health disorders that drove the use were never treated.

It’s not that these people have failed treatment. More accurately, they were treated for the most visible aspect — the fentanyl — without anyone addressing the underlying psychiatric disorder that was the actual driver. Fentanyl is the symptom. The mental health condition underneath it is the real diagnosis.

Helios West Palm is not a detox facility, methadone clinic, or primary addiction treatment program. We are a residential mental health facility, and for those whose fentanyl or opioid use disorder co-occurs with untreated mental health issues, we provide integrated psychiatric care that treats the actual cause of the addiction. For many of these patients, the integrated psychiatric treatment received at Helios West Palm is the first treatment that has actually addressed the real reason for their opioid use.

When a patient with a history of fentanyl or opioid use comes to Helios West Palm, we start with a complete psychiatric evaluation that takes a close look at their medical history, the relationship between any psychiatric conditions and their substance use, and their general well-being. Based on what comes out of that evaluation, the treatment plan is built to handle both the underlying mental health conditions and the opioid use disorder.