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Fentanyl FAQ: Fentanyl Abuse, Withdrawal, and Symptoms

What is Fentanyl?

The National Institute on Drug Abuse defines Fentanyl as a power synthetic opiate (e.g. an opioid) that is chemically similar to Morphine, but more potent. Fentanyl is typically used in healthcare scenarios to treat patients with severe pain or after a surgical procedure. It is also used to treat pain in individuals who’ve developed tolerances to other opioids.

Illicit Fentanyl use has dramatically increased in the last 10 years. Pharmaceutical Fentanyl is available in patch, liquid, and pill form, while illegally-produced Fentanyl generally comes as powder. Fentanyl’s powder form is proving most difficult and dangerous to manage in Canada as it is being found mixed in to other opiates/opioids such as heroin and oxycodone, and other drugs such as stimulants and hallucinogens. Fentanyl is both tasteless and scentless, making it an easy substance to mix in with other “more popular” drugs.

Who uses Fentanyl?

People who use Fentanyl for medical reasons are usually using it to manage severe pain. It is often used after surgery and among cancer patients. 

While many people are intentionally using Fentanyl, many are consuming it unintentionally. This is because Fentanyl is generally undetectable by drug users. Both individuals using Fentanyl knowingly and unknowingly are at high risk of overdose and fatality as it is much more potent than other commonly used opiates. There have been many reports across Canada on clusters of overdoses and deaths that have been linked to Fentanyl use. See the CCSA’s Bulletin on Fentanyl Deaths for fatality rates across Canada.

A person with an opiate addiction may be consuming Fentanyl as well. Many users who believe they are using Oxycodone or heroin have been found to, in fact, be using Fentanyl. Fentanyl has even been found in persons who primarily use stimulants such as Cocaine, since users cannot detect Fentanyl without proper drug testing.

Where does Fentanyl come from?

Fentanyl FAQ: Fentanyl Abuse, Withdrawal, and Symptoms

Pharmaceutical Fentanyl (e.g. pills, liquid, and patch) is legally produced by licensed pharmaceutical laboratories. These types of Fentanyl that are consumed illegally are usually purchased and acquired through the black market.

Fentanyl powder, often referred to as “China White”, is manufactured in illegal labs and sold on the streets.

What Happens when Someone uses Fentanyl?

Illegally used Fentanyl is often used in ways other than it is medically intended for in order to produce a stronger “high”. Fentanyl, like other opiates and opioid painkillers, mimic neurotransmitters in the body that block pain signals. The effects of Fentanyl include, most noticeably, pain reduction/elimination and sedation. Other effects include euphoria, numbness, disassociation, confusion, and drowsiness.

When Fentanyl wears off, a person will likely experience withdrawal systems that can range from depression, anxiety, and intense cravings for the drug. As a person continues to use Fentanyl, their tolerance for the drug increases, causing them to use more and more to relieve withdrawal symptoms.

How does my Loved one or I Prevent a Fentanyl Overdose?

An overdose is characterized by a depressed respiratory system or complete respiratory failure. In other words, extremely shallow breathing, irregular breathing, or no breathing at all. This can result in loss of consciousness, coma, and death. Other symptoms include confusion or hallucinations, pale and clammy skin, nausea and vomiting, seizures, diarrhea, and abdominal pain. 

Many overdoses can be reversed, and deaths prevented, if a person receives medical care shortly after the overdose begins. Having the anti-overdose drug, Naloxone, can temporarily reverse an overdose and allow enough time for first responders to transport a person to the hospital. It’s important to note that 911 must be contacted regardless if Naxolone has been administered. One dose of Naloxone does not always prevent an overdose, which is why it is recommended to carry more than one dose. Naxolone should always be used in combination with other medical/emergency care.

The most effective way to prevent yourself from an overdose death is by letting others know if you’re using any opioid or opiate, either medically or illicitly (although this is not an ideal option for many). Allowing others to be aware of your opioid/painkiller prescription or use can allow them to keep an eye on you and be able to respond as quickly as possible if you are potentially overdosing. Overdoses don’t just happen to those using painkillers illegally. It can happen to people with opiate prescriptions who consume other depressants (e.g. alcohol) at the same time. Avoid using Fentanyl and other opiates in places inaccessible to ambulances as well.

Having someone else with you while you’re using (or recommending to your loved one that they use in the presence of another) can also prevent an overdose death. In the event that you start to experience an overdose, they can call 911 or administer Naxolone if available on you or nearby (Note: Many businesses in Vancouver’s DTES keep Naloxone on-site).

What do I do when a Fentanyl Overdose is Happening?

If you are witnessing an overdose, call 911 as soon as possible. You’ll want to assess the scene of the overdose and look for any indicators of what drug was ingested if you do not know. Learn how to do a proper assessment of the scene.

If Naloxone is available or accessible, administer by following the directions include in the kit.

If the person experiencing the overdose is responsive, stay with them and be calm and reassuring (sometimes they’ll be agitated) while you wait for medics. If the person is unconscious and not breathing, begin CPR (check for poisonous material around mouth and use barrier device if possible). When the client has regained breathing but is unconscious, place them in the recovery position.

What type of Addiction Treatment is Available for Fentanyl or Other Opiates/Opioids?

Fentanyl can be treated in most programs that can treat and detox other opiates/opioids. Withdrawal from opiates and alcohol are two of the most challenging detoxes for individuals. Some treatment centres can both detox and treat opiate addiction, while some require individuals to detox first at an appropriate clinic before attending their program.

Where can I go for Fentanyl Detox and/or Treatment?

There are private, charity, and government-funded detox and/or treatment facilities that you can attend for Fentanyl dependency. Government-funded facilities are typically free or offer low cost fee-for-services. However, there is often a long waitlist for these services. Private treatment and detox generally don’t have waitlists, but require individuals to fund their stay out of their own pocket or via extended health (if you have it). Charity organizations are often a mix between the two; lower costs and fewer waitlists. However, charity organizations are often designed and reserved for special populations such as women with children.

What are the Street Names for Fentanyl?

Fentanyl goes by many street names including “fake oxy”, “greenies”, and “little monster”. As is true with all street drugs, street slang is always evolving and the purity of street drugs cannot be guaranteed. Street drugs are often mixed with other substances, some that are not potent at all, or subject to cross-contamination.

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