Signs and Symptoms of Fentanyl Use

man deep in thought representing signs of fentanyl use

As fentanyl is the primary driver of the third wave of the U.S. opioid epidemic, recognizing the signs of fentanyl use in someone can be a lifesaving skill. 

Data from NSDUH 2020 shows that 356,000 over-12s in the United States misused fentanyl prescriptions in the previous year. According to SAMHSA (Substance Abuse and Mental Health Services Administration), this does not account for those abusing IMF (illicitly manufactured fentanyl.)

This guide highlights the many physical and mental signs of fentanyl use.


Fentanyl is a fully synthetic opioid that is structurally  similar to morphine but 100 times stronger.

As a prescription drug, Fentanyl is available in the following branded forms:

  • Actiq
  • Sublimaze
  • Duragesic

First synthesized as a pain reliever, fentanyl is still prescribed to treat severe pain following surgery. The medication is also sometimes prescribed to treat chronic pain in patients tolerant to opioids. The four-hour half-life of fentanyl renders it highly suitable for recovery from sedation and analgesia.

It is due to these accepted medical uses that fentanyl is classified as a Schedule II controlled substance under the Controlled Substances Act regulated by the DEA. All drugs in this schedule have some legitimate medical uses, but they also have a high potential for both abuse and addiction. Other substances classified under Schedule II include Ritalin and Adderall – ADHD stimulant medications –  meth, methadone, and cocaine.

Over the past decade, fentanyl has increasingly spilled over onto the black market. As of 2020, synthetic opioids are associated  with the most drug overdoses in the United States, per NIDA (the National Institute on Drug Abuse).

While some legally prescribed fentanyl is diverted to abuse, the main problem lies with the large-scale manufacture of fentanyl in underground labs.

In addition to these issues, Mexican drug cartels are using fentanyl as a cheap cutting agent for heroin. Fentanyl is not only cheaper to produce and easier to obtain than heroin, but the potency of the drug means those using the drug run an even higher risk of overdose.

Now let’s look at the fentanyl signs and fentanyl use symptoms so you can determine the signs someone is on fentanyl. 

woman deep in thought representing signs of fentanyl use


The most common and most dangerous signs and symptoms of fentanyl abuse come in the form of addiction (clinically described as opioid use disorder, a type of substance use disorder).

The sustained use of fentanyl causes tolerance to form rapidly. When this occurs, you will need more fentanyl or more frequent doses to achieve the initial effects. Tolerance is a diagnostic criteria of fentanyl addiction. By continuing with these abusive patterns of consumption, physical dependence on fentanyl is liable to develop. If this happens, withdrawal symptoms will manifest in the absence of fentanyl. Addiction often but not always follows.

Addiction is diagnosed using the criteria outlined in DSM-5-TR, the most recent edition of APA’s Diagnostic and Statistical Manual of Mental Disorders, a diagnostic tool widely used within the addiction treatment and mental health communities.

DSM-5 lists eleven possible symptoms of substance use disorder. The more of these symptoms that present, the more severe the substance use disorder. A diagnosis of substance use disorder requires the emergence of at least two symptoms during any given year.

In addition to substance use disorder, DSM-5-TR also recognized opioid use disorder (OUD). Someone suffering fentanyl addiction, then, would likely be diagnosed with severe opioid use disorder.

Fentanyl addiction signs include:

  • Taking more fentanyl than intended or using fentanyl for longer than intended.
  • Experiencing powerful cravings and urges for fentanyl.
  • Failing to meet responsibilities at work, school, or home.
  • Spending large chunks of time obtaining and using fentanyl, as well as recovering from its after-effects.
  • Trying and failing to stop using fentanyl.
  • Withdrawing from social activities to use fentanyl.
  • Abusing fentanyl with an awareness of danger (while driving, for instance).
  • Continuing to abuse fentanyl despite problems caused in all areas of life.
  • Using fentanyl despite the substance causing or inflaming a physical or psychological condition.
  • Tolerance to fentanyl building so you need more fentanyl to achieve the same effect.
  • Experiencing withdrawal symptoms when the dose of fentanyl is reduced or discontinued.


There are many physical  side effects associated with symptoms of fentanyl use. If you abuse this drug, these effects are likely to present with greater severity. The most common of these adverse outcomes include:

  • Chest pain
  • Irregular heartbeat
  • Labored breathing
  • Convulsions
  • Confusion
  • Blurred vision
  • Fatigue
  • Nervousness
  • Back pain
  • Side pain
  • Pale skin
  • Pounding in ears
  • Tingling in the hands or feet
  • Ulcers or sores in the mouth
  • Sneezing
  • Sore throat
  • Sunken eyes
  • Swelling in the feet and hands
  • Fever or chills
  • Mood changes
  • Loss of appetite
  • Dry mouth
  • Cough
  • Decreased urine flow
  • Dizziness
  • Lightheadedness
  • Fainting
  • Black stools

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If you have a loved one that you suspect is abusing fentanyl, look out for the following behavioral indicators to identify fentanyl use signs:

  • Obtaining illicitly-manufactured fentanyl.
  • Buying fentanyl from someone with a legitimate prescription.
  • Opening up fentanyl patches to ingest the contents.
  • Attempting to conceal fentanyl abuse.
  • Spending less time on previously favored activities.
  • Changes to social circle.
  • Paying less attention to appearance and personal hygiene.
  • Disrupted sleep patterns.
  • Weight gain or weight loss.

woman deep in thought representing signs of fentanyl use


Abusing fentanyl long-term can trigger many severe complications, both physical and mental. These symptoms of fentanyl use can include:

  • Breathing difficulties
  • Heart conditions
  • Gastrointestinal disorders
  • Liver damage
  • Hormone imbalances
  • Addiction
  • Mental health disorders
  • Brain damage
  • Social difficulties
  •  Incarceration risk
  • Financial drain


  • Severe gastrointestinal problems
  • Bowel obstruction
  • Bowel perforation
  • Compromised immune system.
  • Breathing difficulties
  • Seizures


  • Reduced motivation
  • Paranoia
  • Social withdrawal and isolation
  • Delusions
  • Personality changes

Note: if fentanyl is used in combination with other illicit drugs like heroin that act as CNS (central nervous system) depressants, there is an increased risk of:

  • Overdose
  • Respiratory depression
  • Coma
  • Death

Although fentanyl addiction is a chronic condition like all opioid use disorders, it nevertheless responds favorably to evidence-based treatment. We can help you with that here at Gratitude Lodge. t

an image of Gratitude Lodge | signs of fentanyl use


If you are addicted to fentanyl, we can help you initiate a sustained recovery at Gratitude Lodge. We have affordable fentanyl addiction treatment centers located in San Diego,  Long Beach, and Newport Beach. All treatment facilities offer supervised medical detox programs, 30-day inpatient programs, and intensive outpatient programs.

Those addicted to fentanyl can take advantage of a streamlined supervised detoxification. Clinical and emotional care is available around the clock to mitigate complications during withdrawal and to minimize the likelihood of relapse in early recovery. The treatment team may administer medications approved by the FDA for reducing the intensity of cravings and withdrawal symptoms.

Fentanyl addiction typically responds well to pharmacological interventions, meaning that MAT (medication-assisted treatment) may be beneficial not only during detox, but also during ongoing inpatient or outpatient treatment. MAT is most effective when combined with behavioral therapies, such as:

  • Psychotherapy
  • Individual counseling
  • Group counseling
  • Family therapy

When you are ready to move from active fentanyl addiction into ongoing recovery, build the firmest foundation here at Gratitude Lodge in Southern California. Call 800-994-2184 today for immediate assistance.