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Fentanyl Alternatives, Side Effects, Withdrawal and FAQs

Fentanyl is a synthetic opiate 50 – 100 times more potent than morphine and is administered by injection, lozenges, transdermal patches and oral spray; used in treating severe pain or chronic pain where the patient has become tolerant to other opioids.
Recreational use poses high risk for addiction and death.
Fentanyl deaths have occurred across the US since 1979 and, unfortunately, continue to date and reported on thousands of autopsy reports. Because it is available for use in various forms to include powder, liquid, patch, spray and also interspersed in other drugs, people can inadvertently take fentanyl without their consent until it’s too late, and a medical crisis occurs.

Below is a compilation of information on topics relating to fentanyl that are frequently asked about, including side effects of the drug, what it is used for, warnings and cautions, and other matters that relate to safety and health.

What Is Fentanyl Used for?

Fentanyl is a pain medication designed for use in specific types of scenarios, including:

  • As a potent pain reliever where rapid relief is necessary for severe pain
  • When morphine or other opioids no longer work for chronic pain
  • In cancer patients over the age of 18 who are opioid-tolerant
  • Treatment for patients with post-surgical pain
  • Recreational use to bring about feelings of euphoria and relaxation

Fentanyl, when used for recreational purposes, is commonly mixed with other opiates or illicit substances. Mixing alcohol or any other depressant drug significantly compounds the likelihood of overdose and fatality as it compromises the central nervous system. Because of the effects on the respiratory system and heart, and the unknowns related to drugs manufactured through the underground and sold on the street, the risk for injury and death due to overdose is exceptionally high¹

Many deaths from fentanyl occur in first time users, or those using for only a short time, as they are unaware of the drug’s powerful depressant effects. However, drug use comes with risk. For example, there is no way of knowing whether heroin purchased contains fentanyl, knowing its’ strength or concentration, or if fentanyl is present as a lacing agent. Fentanyl pills often come from unregulated labs. Apart from the deaths due to overdose from pure fentanyl, a high percentage of fentanyl deaths are traced to the dangerous additive effects from laced heroin or when combined with other drugs.

Fentanyl Alternative Names and Slang

Fentanyl is the generic name for a synthetic opioid medication developed in the 1960s. Brand names include Duragesic (transdermal patch), Actiq (lollipops), Fentora (effervescent buccal tablets), and oromucosal Abstral. There is a nasal spray under the brand name Lazanda. Other brand names include Matrifen, Haldid, Onsolis, Instanyl, Durogesic and innumerable others in the US and across the globe. (6)

Names for fentanyl or drugs laced with fentanyl include China White, China Girl, Tango, Cash, Goodfella, Friend, Murder 8, Jackpot, TNT, Apache, Dance Fever, Heroin Popcorn, Fenny, and for the transdermal form, patch, sticky, sticker, strips. (2)

Fentanyl and various derivatives such as acetyl fentanyl come from clandestine sources and are less powerful than fentanyl. Sometimes referred to as designer drugs, these have been identified and put on the US Drug Enforcement Agency (DEA) list of Schedule 1 drugs. These are linked to many recreational drug overdoses that occur outside of clinical settings. (5)
Hundreds of tons of fentanyl are brought into US ports of entry from other countries each year, only a fraction of which are intercepted, though customs officers are using spectrographic devises and other extremely high tech means of detection. The sheer volume of fentanyl successfully brought in makes the problem difficult to overcome.

Fentanyl Side Effects

Fentanyl is a pain reliever with euphoric, relaxation and other effects. (3)
Some of these can include:

  • Euphoria
  • Seizure
  • Slowed respiration, difficulty breathing
  • Difficulty swallowing
  • Changes in mood (i.e. exhilarated, depressed, irritated)
  • Pains and aches (i.e. headache, muscle cramps, chest pain, stomach pain, back pain)

Skin reactions such as burning, itching, hives, rashes, numbness, tingling, swelling (especially around the site of a fentanyl patch the skin can be red and itchy)

  • Drowsiness, groggy feeling
  • Loss of appetite
  • Insomnia, trouble staying asleep
  • Dry mouth, hoarseness
  • Diarrhea
  • Weakness
  • Dizziness
  • Sexual dysfunction, loss of libido
  • Menstrual changes
  • Indigestion
  • Feeling cold
  • Tremors, uncontrolled shaking (i.e. in the hands or legs)
  • Difficult or painful urination
  • Swelling of the eyes, mouth, tongue, ankles, or other body parts

Some side effects of fentanyl can be extremely severe, requiring medical intervention at once. Call for help, by ambulance if necessary, if the following symptoms appear:

  • Difficulty breathing, chest does not rise, shallow breathing
  • Hallucination
  • Fainting, syncope, weakness
  • Fever accompanied by tachycardia, sweating, vomiting, and mental confusion
  • Stiff or rigid muscles, twitching muscles, loss of balance or coordination

Fentanyl Withdrawal Symptoms

Fentanyl withdrawal symptoms are similar to heroin and other opiate drugs. Dehydration caused by loss of bodily fluids is of particular concern during withdrawal from opiates of any kind. Withdrawal symptoms may range from mild to severe, and can include:

  • Dysphoria, general malaise
  • Drug cravings
  • Runny nose
  • Clammy skin
  • Sweating
  • Diarrhea
  • Yawning
  • Irritability
  • Weakness
  • Bone pain
  • Cramping, particularly in stomach or abdomen
  • Vomiting
  • Restlessness
  • Restless legs
  • Aches and pains, muscle spasms
  • Chills, goose bumps
  • Fever
  • Insomnia, interrupted sleep

These effects tend to begin about 12 to 30 hours after the last opioid dose taken. These effects will intensify over a number of days, and then begin to ease. It may take several months to start to feel normal again. There is more information on this topic below in the Treatment section. Find ways to accelerate the healing period significantly through proper support.

Discontinuing/Quitting Fentanyl

In a hospital or clinical setting, fentanyl intake can be gradually reduced but must be done with careful monitoring is in place. In addition, the withdrawal process must be managed by physicians or caregivers who are licensed and trained in the proper administering of fentanyl.
This is also important when the patient is being bridged over to other opiates or other medications, known as MAT or medication-assisted treatment. The risk for respiratory collapse or other injury is great, if drug tapering is done outside the scope of recommended dosages and timelines.

The same cautions would apply to someone using fentanyl illicitly. Often the danger of dehydration is overlooked in opiate withdrawals. It is possible for dehydration to lead to an increased risk of death due to rapid or continuous fluid loss through sweating, diarrhea and vomiting.

Seek qualified help to avoid the risks that can accompany incorrect opioid tapering procedures.

Fentanyl FAQs

Fentanyl is one of the most deadly drugs ever to have developed a street presence. To prevent a loved one or you from being exposed unwittingly to this medication, we recommend to become as knowledgeable as possible to help avoid any chance of addiction, accidental injury or death.

Fentanyl comes in various forms, including transdermal patches, dissolving tablets, lollipops, injectable liquid, oral spray and a nasal spray version.

In the event that you’d like to return unused fentanyl products, bring them to your pharmacy to prevent environmental damage and contamination as they will be disposed of safely. Never flush or release fentanyl or other leftover medication into your community water system. (4)

What is Subsys (Fentanyl)?

Subsys is a sublingual form of Fentanyl that should be prescribed only to patients who have become opiate-tolerant. Subsys is placed under the tongue, where the tablet dissolves allowing the drug to enter the bloodstream quickly. Due to the number of accidental deaths of children related to fentanyl products, the drug must be securely stored where children cannot reach it.

What is Fentora (Fentanyl)?

Fentora is the name for an effervescent lozenge form of fentanyl that is dissolved by placing inside the buccal cavity, or mouth (not for use under the tongue). As the tablet dissolves, it reacts with saliva and creates bubbles of carbon dioxide, thought to enhance speed of delivery. It is only to be prescribed to cancer patients age 18 or over who have become opioid-tolerant on round-the-clock doses of morphine or other pain medications for break-through pain.

What is Abstral (Fentanyl)?

Abstral is a form of fentanyl in a citrate base (fentanyl citrate) placed under the tongue where it dissolves. It is prescribed for break-through pain in cancer patients over the age of 18 who have already become tolerant to opioid medication during treatment.

What is Buccal Fentanyl?

Buccal refers to the oral cavity, or mouth, but does not include under the tongue. Buccal Fentanyl is an effervescent (fizzing) form of fentanyl in a dissolving tablet that is placed on the inside of the cheek. It is prescribed to cancer patients over the age of 18 who have already developed opioid tolerance. Buccal Fentanyl acts quickly in treating break-through pain.

Treatment for Fentanyl (Duragesic) Abuse and Addiction

When powerful drugs like fentanyl become entwined and embedded into every segment of a life, yours or a loved one’s, solutions can seem out of reach and the sense of hopelessness in the face of such chaos can overwhelm. It may help to understand how opiates can have such a devastating effect emotionally, physiologically and mentally, eliminating everything that may have once held meaning and value.

A starting point to healing may be found in the knowledge that it is possible to devise a powerful solution strategy to overcome addiction and become free of its imprisonment. The Alternative to Meds Center program is structured to provide these strategic tools.

Fentanyl addiction is killing thousands daily, fast or slow, and the death rates seem to climb at a rate we have never seen before. To understand the immenseness of fentanyl and its full weight of destruction, just a small dose can knock out a full-sized elephant. Imagine what it does to the human mind, body and soul.

People are gifted with a natural, magnificent system for internal pain control. Two primary neurotransmitters for this function are called endorphins and enkephalins. (7) The pharmaceutical opiates have been designed to mimic these. They are synthetic analogs to our naturally produced chemicals (also called hormones, neurotransmitters, endorphins, enkephalins, peptides, etc.).

Our natural pain control chemicals are designed to be powerful pain blockers. These natural chemicals also have a function of emotional responses, such as pleasure and the sense of reward.

Clinically, we see that people suffering with pain also may be burdened emotionally. However, without the interference or blocks that drugs temporarily provide, both the emotional and painful feelings we experience could be perceived as guideposts to help us navigate more successfully through the trials of life. Though not always pleasant, fears and emotional or physical pains could be compared to warning signals that alert us to threats, danger, or something to avoid. And created with perfect balance, feelings of joy, happiness, physical touch, etc., also shine a light that beckons toward the pleasures in life, the positive connections, goals and experiences that are available to us.

When emotional or physical suffering becomes chronic, as in PTSD conditions, a person is placed in the precarious position of spending all available reserves of these precious natural commodities. As the situation goes on, they are struggling in a chronic and worsening condition, existing in a deficit.

When the body responds to the presence of fentanyl or other opioids, it shuts down its own natural chemical production, further compounding the deficit. There is another equally important change that occurs; the body, sensing a need to defend itself, instinctively begins building new pain receptors, in an attempt to continue to maintain its built-in warning system.
As a result, natural endorphins are in low supply and we are at a disadvantage on every count. Additionally, painful situations become more excruciating, not less. Joyful or happy experiences become less so, as we are unable to positively respond or feel any appreciation for them. This might describe a day in the life of an opiate user. The supply of natural pain-blocking chemicals has been cut off. And the number of newly created pain receptors is off the chart. So when the artificial analog, i.e. fentanyl, is withdrawn, there is no buffer or defense, and there is also a greatly magnified sensation of pain, including emotional pain.

The temporary solution to this situation is to procure more fentanyl in a desperate attempt to stop the emotional and physical pain. Fentanyl cravings, left unanswered, impact and pervade the entire body with magnified, aggressive and intolerable withdrawals.

But there are many safe and proven ways to provide relief and hope for a better future. There are bridge medications that can temporarily provide a way out of the pain that is driving the addiction. And there are ways to help the body regenerate adequate endorphins and balance many other factors that support healing on the journey back to vibrant health. There are ways to help assuage and soothe emotional pain and release it through various genres of therapy offered here. Life choices can be re-examined in a safe and nurturing setting with the help of a trusted and compassionate Life Coach.

There is much, much more to learn about the mechanics of healing from fentanyl addiction. At the Alternative to Meds Center, we incorporate education as a foundational part of understanding , accelerating the ability to regain strength and health in very practical and pragmatic ways.

Please contact us for more information about how our program might provide the means for you or a loved one to successfully navigate back to a life that is free from fentanyl and full of natural joy that comes with having control of your natural, mental health.

  1. NIDA. (2016, June 3). Fentanyl. Retrieved from https://www.drugabuse.gov/publications/drugfacts/fentanyl on 2018, October 12  
  2. NIDA. (2016, June 6). Fentanyl. Retrieved from https://www.drugabuse.gov/drugs-abuse/fentanyl on 2018, October 12
  3. https://www.healthline.com/health/fentanyl/transdermal-patch#side-effects
  4. https://www.canada.ca/en/health-canada/services/healthy-living/your-health/medical-information/opioid-pain-medications-frequently-asked-questions.html#a3
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640434/
  6. https://www.drugs.com/international/fentanyl.html  
  7. Enkephalins Encyclopedia Britannica  

This content has been reviewed, and approved by a licensed physician.

Dr. Michael Loes, M.D.

Dr. Michael Loes is board certified in Internal Medicine , Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally he is a well published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.

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