How Deadly is Fentanyl?

Fentanyl is a synthetic, or manmade, opioid that is 50 to 100 times more potent than morphine. When prescribed and dispensed under the supervision of a health care professional, fentanyl can be used for the legitimate treatment of severe pain. The drug is also suitable for chronic pain patients who have developed a physical tolerance to other opioids.

The National Institute on Drug Abuse (NIDA) shared that “deaths involving other synthetic opioids other than methadone (primarily fentanyl) continued to rise with more than 36,359 overdose deaths reported in 2019.”

The U.S. Drug Enforcement Agency (DEA) has found that illegally manufactured fentanyl can range widely in terms of the amount of the drug it actually contains. Illicit fentanyl has been found to contain anywhere from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet. Additionally, the lethality of fentanyl depends on a person’s body size, past drug usage, and tolerance. In many cases, even two milligrams of the drug can be fatal.

Fentanyl and the Brain

All opioids bind to the brain’s opioid receptors. These are the parts of the brain that regulate pain and emotional responses. Opioids alter the brain so that it becomes less sensitive, making it harder for someone to experience pleasure from other activities that do not involve drugs.

Fentanyl produces a temporary feeling of euphoria in users. This high is short but very intense. The negative physical effects are many, ranging from mild drowsiness to severe complications, including death. Common effects of fentanyl include:

• Slowed respiration
• Reduced blood pressure
• Nausea
• Fainting
• Confusion
• Constipation
• Sedation
• Unconsciousness
• Seizures

Fentanyl comes in many forms. Legal prescriptions of the drug include a transdermal patch, sublingual dissolving tablets, a nasal spray, lozenges, an injectable liquid, and dissolvable film strips.

Mixing Fentanyl and Other Illicit Drugs

The DEA found that opioid deaths rose more than 38% between January 2020 and 2021. The bulk of that increase can be traced back to illegally-made fentanyl.

Increasingly, street dealers have begun to mix fentanyl with other illegal substances, such as heroin, cocaine, methamphetamine, and MDMA. This is done because it takes very little fentanyl to produce a high, making it cheaper for the dealers to produce other drugs that are laced with fentanyl.

Because of this mixture, users taking the fentanyl-laced drug are more likely to overdose due to the presence of a much stronger opioid. And since the person may not be aware that they have taken fentanyl, it is harder to treat them if they do overdose.

One treatment option for a fentanyl overdose is naloxone. Naloxone binds to the brain’s opioid receptors to block the effects of any type of opioid on the body. This medicine can help in cases of fentanyl overdose if given right away. However, because of how much stronger fentanyl is than other opioids, an individual may require multiple naloxone doses.

Signs Of Fentanyl Overdose

Knowing the signs of a fentanyl overdose can help save a life. Although these signs can vary from person to person, some of the most common signs of a fentanyl overdose include:

• Fatigue
• Sleepiness
• Confusion
• Shallow breathing
• Clammy skin
• Chest pain
• Labored breathing
• Lethargy
• Confusion
• Blue lips or fingertips
• A general lack of awareness

How Much Fentanyl Is Lethal?

Even though fentanyl is an incredibly powerful opioid prescribed for severe pain, the drug also had a much darker side. It is estimated that even a small dose of accidentally ingested fentanyl can be fatal. A fatal dose of fentanyl typically ranges anywhere from 2 milligrams for those who are opioid-naive to upwards of 500 micrograms for those with a high tolerance to opioids.

Two milligrams is incredibly small – so small, in fact, that you can’t see it with the naked eye. You need a microscope to even get an idea of what 2 milligrams look like! To put this into perspective, 2 milligrams is about 1/25th of a teaspoon, which is less than the weight of a single paperclip. For people who are used to thinking and measuring in metric units, it’s more helpful to realize that 2 milligrams equal 0.0002 kilograms – roughly the same as a large snowflake.

This means that even one dose in a very diluted form is enough to have fatal consequences.

Fentanyl Addiction and Treatment

Because of fentanyl’s potency, it is also extremely addictive. Severe withdrawal symptoms can occur when someone stops taking fentanyl, even if they are taking the drug in a doctor-prescribed dosage. These symptoms can appear as soon as a few hours after they take their last dose of the drug. Symptoms include:

• Muscle and bone pain
• Sleep problems
• Diarrhea and vomiting
• Cold flashes with goosebumps
• Uncontrollable leg movements
• Severe cravings

Many people struggle to stop taking fentanyl because of the severity of these withdrawal symptoms. As with any opioid addiction, treatment involves a combination of both medications and behavioral therapies.

There are several medications and treatments currently being developed that can help with withdrawal from fentanyl and other opioids. One medication, lofexidine, recently received FDA approval for its ability to reduce withdrawal symptoms. Researchers are also exploring the potential of an electrical nerve stimulator placed behind the ear, known as the NSS-2 Bridge, to help with symptoms of acute opioid withdrawal.

Another well-known medication used during withdrawal is buprenorphine, which binds to the brain’s same opioid receptors. This helps to reduce cravings and withdrawal symptoms. While withdrawal from fentanyl is rarely deadly, it can be extremely unpleasant. Many people who attempt it without medical supervision relapse.

Behavioral therapy is also a key component of recovery from fentanyl addiction. This often includes:

• Cognitive behavioral therapy, which helps to modify harmful behaviors and teaches ways to manage triggers and stress
• Dialectical behavior therapy, which provides guidance on how to handle triggering or negative emotional states
• Motivational interviewing, which addresses any mixed feelings that someone with an addiction may have about changing their lifestyle

Unfortunately, there is no quick solution for fentanyl addiction. Treatment for any type of opioid addiction can take a year or more. A combination of counseling and medications has shown to be the most effective treatment for an addiction to fentanyl. Researchers also recommend more widespread availability and training with naloxone to help prevent fatal overdoses.

At Bridges of Hope Treatment Center, we take a comprehensive and integrated approach to addressing issues related to substance use and mental health disorders. We utilize therapeutically proven, evidence-based clinical practices to help people recover throughout Indiana.