Signs of Fentanyl Use: What Families Need to Know and How to Help
When questioning if a loved one is struggling with fentanyl abuse, it can be easy to fall into the rabbit hole of search terms like “is fentanyl dangerous,” “signs of fentanyl addiction,” and maybe even “how to stage an intervention.”
Fear is an understandable response to a loved one struggling with any kind of addiction, but especially a drug whose headlines are often accompanied by imagery of people in hazmat suits, with the implication being so much as touching the stuff would irreparably harm someone.
Yes, fentanyl use should be taken seriously. But no, this article isn’t designed to scare you. Instead, we hope to empower you with information that allows you to support someone who may be struggling.
Any kind of drug abuse, regardless of the reputation of the drug, deserves compassion and care. Your loved one is not a bad person for potentially coping with difficulty the best way they know how.
We’re glad you’re here to learn — take a deep breath!
Here are the most frequently asked questions about the signs of fentanyl misuse, as well as how to support someone who may be struggling.
What Exactly is Fentanyl?
Fentanyl is an opioid medicine. Fentanyl works on the central nervous system to block pain signals between the brain and body.
When obtained legally, it’s used either for anesthesia or acute and/or severe pain. Fentanyl is often used after a major trauma or surgery, or for the management of chronic pain, especially during palliative or end-of-life care (like with cancer and other terminal patients).
As you might imagine, then, fentanyl is a very strong medicine, and it’s an important support for those with debilitating pain.
However, its potency is why it has also become more common in illegal drug markets, as only a small amount is needed to be effective, and it can be combined with other drugs to make the effects stronger and more addictive, while being cheaper to produce overall.
What Are the Signs of Fentanyl Use?
The effects of fentanyl, especially over time, can vary widely from person to person.
Additionally, there is overlap between the effects of fentanyl and other drugs, as well as other mental health conditions. This can make it difficult to know at a glance if someone is using fentanyl or struggling in some other way.
The physical signs of fentanyl use include:
- Drowsiness or intense fatigue
- Noticeably constricted (small) pupils
- Insomnia or difficulty sleeping
- Shaking or tremors
- Complaints of a rapid heartbeat
- Frequent vomiting and/or diarrhea
- Swollen body parts (especially extremities like hands, arms, feet, and legs)
- Euphoria (intense joy or elation)
- Depression or apathy
- Struggles with memory, judgment, and/or concentration
Sometimes, fentanyl use can cause “psychomotor retardation,” which can include:
- Very slowed-down speech
- Delayed reactions
- Minimal facial responses
- Sluggish body movements
Alternatively, fentanyl use can cause “psychomotor agitation,” which can include:
- Restlessness
- Struggling to sit still or relax
- Excessive fidgeting
- Rapid and/or nonsensical speech
- Intense fear, paranoia, overwhelm, or anxiety
The behavioral signs of fentanyl use include:
- Withdrawing from others socially and emotionally
- Nonsensical and/or slurred speech
- Struggling to perform at work or school
- No longer showing up for work or school
- Abandoning daily care tasks and responsibilities
- Mood swings
- Paranoia or secretive behavior
- Disappearing for days at a time
Behavioral signs related to acquiring fentanyl include:
- Visiting multiple doctors to obtain the same prescription
- Frequent visits to loved ones who have access to the drug
- Prescriptions for others going missing or disappearing
- Attempting to forge prescriptions to obtain more
- Becoming more protective over device access (for example, who can see and use their phone or computer)
- Becoming more protective over personal property (for example, keeping bedroom locked when it wasn’t before)
What is Fentanyl Use Disorder (Fentanyl Addiction)?
In short, fentanyl use disorder is when someone’s fentanyl use impacts their daily functioning, and they continue to use despite the unwanted consequences for their life, well-being, economic security, and personal relationships.
This usually coincides with building a greater tolerance for it, requiring higher and higher doses of fentanyl to achieve the same desired effects.
What Are the Signs of Fentanyl Withdrawal?
Fentanyl withdrawal happens when someone’s use is abruptly stopped or drastically cut back.
This may be because they are attempting to quit using on their own, or because they have run out and are not able to obtain more.
Common symptoms of fentanyl withdrawal include:
- Nausea and/or vomiting
- Diarrhea
- Fever
- Sweating
- Dilated (large) pupils
- Muscle aches
- Insomnia
- Mood swings
- Agitation, anxiety, or irritability
- Profound guilt, shame, and/or depression
- Intense cravings for fentanyl
Withdrawal can be extremely unsettling and uncomfortable, both for the person experiencing it and for those supporting them. Symptoms can also be prolonged, especially if the individual has been using fentanyl for a long period of time, making it harder for their body to adjust over time.
You might encourage your loved one to explore medical supervision if withdrawal is expected or occurring.
Is Fentanyl Dangerous?
Due to its potency alone, yes, fentanyl use without medical supervision is dangerous when compared to other types of drugs. It’s particularly risky when taking non-pharmaceutical fentanyl, because it’s often mixed with other drugs.
It’s important to remember, however, that most people struggling with fentanyl misuse are already aware of how dangerous it is. Attempting to “scare them” by highlighting the risks can come across as shaming rather than concern, which may push them further into self-isolation.
One of the greatest dangers to someone struggling with a high-risk addiction like fentanyl is when they further isolate themselves from others. This makes it more difficult to ask for help when they’re ready, and more difficult for others to intervene if they are at risk of overdose or other serious harm.
So while fentanyl can technically be dangerous, and any misuse should be taken seriously, it’s important to not allow shame and pressure to be the driving force behind how you offer your support to a loved one.
Is Secondhand Exposure to Fentanyl Dangerous?
Accidental exposure to fentanyl, including smoke, powder, or other residue is extremely unlikely to cause an overdose or serious harm. Exhaled smoke may have trace amounts of fentanyl, but that disperses through the air immediately, and the substance is not well-absorbed through the skin.
If you are concerned that you or someone else has accidentally ingested fentanyl, you should contact emergency services or poison control.
What Are the Signs of Fentanyl Overdose?
A fentanyl overdose happens when someone has ingested more than their body can safely metabolize. This can happen quickly, even within two minutes of use.
It’s common to believe that if someone has safely taken a specific dose before, they can’t overdose on the same amount.
However, how much the body can metabolize — and, depending on the source of fentanyl, how precise and accurate the dosing is, as well as what it’s potentially mixed with — may vary significantly.
While most deaths by overdose are associated with non-pharmaceutical use of fentanyl, it’s important to know the signs of an overdose, regardless of where the drug was sourced.
Key signs of fentanyl overdose include:
- Shallow breathing: Breaths taken are small, quick, and short, also known as “chest breathing,” rather than deep and full breaths
- Slow, labored breathing: Struggling to breathe in any way, which may include choking or gurgling sounds
- Intense fatigue: Being unable to stay awake, or profound sleepiness
- Dizziness: Especially when severe and lasting
- Confusion: Inability to think, respond, and/or focus in a normal, coherent way
- Disorientation: Not knowing where they are, what day or time it is, or even who they are
- Struggles with walking: Inability to walk or maintain balance while walking
- Speaking difficulties: This can include slurred, incoherent, and/or nonsensical speech
- Cold or clammy skin: Feeling cold to the touch and sweaty or moist
When is it an emergency?
If the person is struggling to breathe or stay awake, and/or is largely not responsive, call 911.
If their skin color has changed (to bluish-purple in people with light skin, or gray/ashen in people with dark skin), become cold, or their body has gone limp, these are also signs of an emergency.
Try to keep them awake and breathing, lay them on their side to prevent choking, and stay with the person until emergency services arrive. If you are trained in CPR, you may attempt to resuscitate them according to your training.
What if I have a Naloxone nasal spray?
Naloxone nasal sprays (like NARCAN) can reverse the effects of a life-threatening opioid emergency, including fentanyl overdoses.
If you suspect an overdose while carrying Naloxone, you should:
- Check for signs: More specifically, the person will not wake up OR is very sleepy and not breathing well.
- Attempt to stir them: Yell “wake up!” and gently shake the individual.
- If they are not responsive, follow the recommended instructions for dosing and call 911.
Why Would My Loved One Use Fentanyl?
Every individual has a unique struggle that led them to misuse a drug like fentanyl.
For those with chronic and debilitating pain, housing insecurity, significant mental health challenges, or other dire circumstances, fentanyl’s anesthetic properties can provide relief from immense pain and unmanageable challenges.
Some people start with legal prescriptions and become dependent, needing higher and higher dosages to achieve the same relief.
Because fentanyl is impossible to detect by sight or smell, some who started out by using other drugs may have been deceived or misled, becoming dependent due to a lack of transparency around what was taken and the degree of risk involved. Or, because it is cheaper, it may have become the only drug they could still afford.
It’s important to remember that addiction is a biopsychosocial phenomenon, not a personal failing.
For most people struggling with drug abuse, some combination of biochemical factors (like a predisposition to dependency and/or compulsive behavior), individual vulnerabilities (like mental health struggles and trauma), and the larger social context someone is experiencing (including homelessness, disability, and access to health care and social support) can all increase someone’s vulnerability to a substance like fentanyl.
What Should I Do If I Think a Loved One is Misusing Fentanyl?
If you are concerned that a loved one may be misusing fentanyl, consider:
- An honest conversation: As best you can, express your concerns without accusation or shame, by noting what you’ve directly observed and why it worries you.
- Providing resources: If you are able and they are willing, discuss available resources and help that may be accessible to them.
- Carrying (and learning to use) Naloxone: Because fentanyl is such a potent drug, those misusing it are at high risk of overdose. Naloxone is a nasal spray that can be used to reverse the effects of overdose and potentially save a life. In addition to asking your loved one if they are open to carrying it with them, you might consider obtaining your own as well.
- Get support for yourself: You don’t have to navigate this alone. Be sure that you’re supported in navigating how this may be impacting you, and speak to professionals who can advise you on how to hold the boundaries necessary to keep yourself emotionally safe.
Available with compassionate and expert care, 24/7.
At Fellowship Hall, we offer support to those struggling with addiction as well as their loved ones with expertise and empathy.