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Signs of Fentanyl Abuse

Side effects of fentanyl vary based on the form of drug administered, dosage, duration of use and individualized factors. Even when taken as prescribed, fentanyl is associated with a wide range of side effects, ranging from common and less serious to life-threatening. Hives, labored breathing, swelling of the face, lips, tongue or throat are signs of an allergic reaction and 911 should be called without delay. Like other narcotic medicines, fentanyl can result in respiratory depression, which can be fatal.1 The following are possible signs of an overdose and require emergency medical intervention:

  • Cold, clammy skin
  • Convulsions (seizures)
  • Pinpoint pupils
  • Slow heartbeat or cardiac arrest
  • Very slow or labored breathing
  • Difficulty swallowing
  • Dizziness and fainting
  • Non-responsiveness to painful stimuli
  • Extreme fatigue or drowsiness
  • Severe confusion
  • Altered level of consciousness1,2,3

Major Fentanyl Side Effects

The side effects below are associated specifically with fentanyl film, lozenges, spray and tablets. If any of the following more common side effects occur, a physician should be called immediately.

  • Black, tarry stools
  • Blurred vision
  • Chest pain
  • Confusion
  • Convulsions
  • Cough
  • Decreased urine
  • Difficult or labored breathing
  • Dizziness
  • Dry mouth
  • Fainting
  • Fever or chills
  • Increased thirst
  • Irregular heartbeat
  • Lightheadedness
  • Loss of appetite
  • Lower back or side pain
  • Mood changes
  • Muscle pain or cramps
  • Nausea or vomiting
  • Nervousness
  • Numbness or tingling in the hands, feet or lips
  • Painful or difficult urination
  • Pale skin
  • Pounding in the ears
  • Rapid breathing
  • Sneezing
  • Sore throat
  • Sunken eyes
  • Swelling of the hands, ankles, feet or lower legs
  • Tightness in the chest
  • Troubled breathing with exertion
  • Ulcers, sores or white spots in the mouth
  • Unusual bleeding or bruising
  • Unusual tiredness or weakness
  • Wrinkled skin1

The fentanyl patch may cause headache, constipation, diarrhea, mild stomach pain, nausea, dizziness, drowsiness, dry mouth, feeling cold, loss of appetite, mild itching, redness or discomfort at the skin application site, sweating and trouble sleeping. Moreover, misuse or abuse by placing the patch in the mouth, chewing, swallowing, injecting or snorting it can lead to overdose and death. A 2008 a study published in the Journal of Forensic Sciences tied the deaths of seven people who abused the Duragesic skin patch orally to fentanyl overdose.4,5

A total of 904 drugs (4,795 brand and generic names) are known to interact with fentanyl. Potentially fatal respiratory depression may occur not only with co-occurring use of some of these drugs, but also after consuming grapefruit or grapefruit juice. Moreover, taking fentanyl with central nervous system depressants such as sedatives, hypnotics, alcohol and other opioids can cause abnormally low blood pressure, profound sedation, coma, respiratory depression and death.1,5

Mental and Behavioral Signs of Fentanyl Abuse

  • Paranoia
  • Depression
  • Social withdrawal
  • Lack of motivation
  • Delusions and personality changes
  • False sense of well-being
  • Drug-seeking behavior (e.g. doctor-shopping, forging prescriptions or stealing)6,7

Other signs of abuse include requiring more of the drug to achieve the same effect (tolerance) and suffering from withdrawal symptoms when stopping use of the drug.7

  1. Fentanyl Side Effects. Drugs website. https://www.drugs.com/sfx/fentanyl-side-effects.html Updated February 6, 2017. Accessed February 11, 2017.
  2. Drugs website. https://www.drugs.com/fentora.html Updated November 3, 2016. Accessed February 11, 2017.
  3. The Effects of Fentanyl Use. Drug Abuse website. http://drugabuse.com/library/the-effects-of-fentanyl-use/ Accessed February 11, 2017.
  4. Fentanyl patch. Drugs website. https://www.drugs.com/cdi/fentanyl-patch.html Updated February 6, 2017. Accessed February 11, 2017.
  5. What Is Fentanyl (Duragesic)? Everyday Health website. http://www.everydayhealth.com/drugs/fentanyl Accessed February 11, 2017.
  6. Fentanyl Abuse. Drug Abuse website. http://drugabuse.com/library/fentanyl-abuse/ Accessed February 11, 2017.
  7. What Does a Fentanyl Overdose Look Like? Project Know website. http://www.projectknow.com/research/fentanyl-overdose/?v=lib1-control Accessed February 11, 2017.
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