Transdermal fentanyl addiction and misuse are major problems in the U.S. As people with opioid use disorders search for more intense highs, fentanyl has become a natural drug of choice.
Transdermal fentanyl is a prescription painkiller applied to the skin. The U.S. Food and Drug Administration (FDA) approved this drug in people with moderate-to-severe pain that requires around-the-clock care that can’t be treated with traditional pills and tablets.[1]
If you’ve been dealing with strong pain and can’t use pills or tablets, transdermal fentanyl can be a good choice. But it’s also risky. This medication can expose you to problems such as drug misuse, addiction, overdose and uncomfortable withdrawal.
As the name implies, a transdermal fentanyl patch is a sticky bandage infused with a powerful opioid. When placed on the skin, the drugs move into the bloodstream, triggering chemical reactions that could ease pain.
Transdermal patches are typically replaced every 72 hours, and they're made for skin contact only.[2] Chemists didn't make them for oral or injectable use, and they can contain chemicals that aren't safe for your digestive or cardiovascular system.
Doctors reserve transdermal fentanyl patches for people who meet the following requirements:[3]
Since fentanyl is a controlled substance, people need a prescription to get it, and they must visit a pharmacy that carries it. Not all pharmacies do.
In prescribing information approved by the FDA, doctors are told that fentanyl patches increase the risk of opioid use disorders (OUDs).[4]
All opioids, including fentanyl, change chemical levels within the brain. Large amounts of dopamine are released with each dose, and in time, cells won’t make much dopamine without the opioid’s presence.
People with OUD struggle without the drug in their system, as they often feel sick and desperate for another dose.
An OUD also spurs people to take larger and larger doses. Cells downregulate their response to the drug, and in time, people will feel sick between their doses. Someone who started using one patch may find it’s just not enough to keep them from experiencing discomfort.
Anyone can develop OUD, including people prescribed fentanyl patches for legitimate reasons like chronic pain.
Someone with a developing OUD may have these symptoms:
Some people develop addictions to fentanyl patches they bought from dealers or stole from patients. They may get creative to extract enough active ingredients to get high.
Some people extract fentanyl from patches and inject it.[5] Others snort the fentanyl they can pull from patches.
Anyone using patches should dispose of them carefully. A large amount of active ingredient remains in products even when they’ve been attached to someone for three days.[6] The patch you throw away could get someone else high.
Fentanyl is a powerful drug, no matter if you take it orally or use it via patches. Anyone who uses high doses of fentanyl can overdose.
You might feel as though you’re accustomed to high doses of fentanyl, but your central nervous system is not. Take too much, and you can overwhelm those delicate processes, breathe too slowly and fall into a deep sleep and not awaken.
An opioid overdose can be a dramatic event, just like they're portrayed in movies and on television shows. But they can also be very quiet episodes that are easy to ignore.
Symptoms of an overdose can include the following:
An overdose is a medical emergency. Treatment with naloxone can immediately reverse the medical problem and deliver people back to sobriety. But fentanyl patches can continue to deliver the drug, and the residue from the patch must be washed away completely to ensure you don’t overdose repeatedly.
Even if you administer naloxone, emergency medical attention is needed. Without it, the overdose could return once the naloxone’s effects diminish.
As brain cells become accustomed to fentanyl, people feel as if they cannot function normally without it. If you stop taking the drug abruptly, you can develop an uncomfortable withdrawal episode.
Opioid withdrawal symptoms can include the following:[1]
You may also develop diarrhea accompanied by strong cravings for drugs.
While fentanyl is a very powerful drug, researchers say withdrawal symptoms aren’t stronger in people with OUD from fentanyl than symptoms in those taking other opioids.[7]
Symptoms can begin within a few minutes of the last dose of fentanyl, and they can last for weeks without proper treatment. Medications can ease chemical imbalances and help you remain comfortable.
An OUD is a chronic condition, and medication can help. Medication for Addiction Treatment (MAT) programs use therapies like Suboxone to correct chemical imbalances caused by drugs like fentanyl. Using these medications can ease withdrawal symptoms and lessen opioid cravings, and they can also help you to stay sober.
People using MAT also benefit from therapy. In sessions, you can build sober behaviors and learn how to structure your life to support long-term recovery. The skills you acquire in therapy can help you to resist the urge to relapse, which is very common in early recovery.
If you're misusing fentanyl, either via pills or patches, talk with your doctor about MAT programs. You can also reach out to us here at Bicycle Health with any questions you have.
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
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