The Brain and Fentanyl: Its Effects

Fentanyl is a potent synthetic opioid primarily used for pain management, especially during sedation or with people who experience severe pain from trauma or illnesses like cancer. It works by binding to opioid receptors in the brain and spinal cord, part of the body's natural pain control system. When a person uses fentanyl, it can have significant and potentially dangerous effects on the brain and nervous system, especially if it is unregulated and bought on the street. It is a highly addictive drug, and yet a very popular drug among people with opioid use disorder.

How Fentanyl Effects the Brain

Fentanyl primarily acts on the mu-opioid receptors in the brain, which are the receptors that manage pain perception, reward, and mood regulation. When fentanyl binds to these receptors, it can produce powerful pain relief, but it also can lead to an intense high or euphoria. It alters pain perception by affecting how the brain interprets these signals, making it a powerful pain reliever. It is also powerful in how it affects a person’s mood or feelings of pleasure.

The euphoria and pleasure are due to the activation of the brain's reward system, which releases dopamine, a neurotransmitter associated with pleasure and behavior reinforcement. (This is the same neurotransmitter that activates every time a person gets a “like” or interaction on social media, although, with opioids, the feeling is 100s of times more intense.)

Fentanyl can cause sedation and drowsiness, which can be dangerous if individuals operate machinery or drive while under its influence. Respiratory depression is another effect that fentanyl can cause in the brain. Opioids can suppress the respiratory centers in the brain, leading to slow and shallow breathing. People who have mixed drugs or have taken a large dose of the drugs can experience an overdose due to this, resulting in respiratory failure and death.

The brain does not go without harm when you use the drug. Opioids like fentanyl can also impair cognitive function, attention, and memory. Long-term use may have negative effects on overall cognitive performance.

Chronic use of opioids, including but not limited to fentanyl, can lead to the development of tolerance, dependence, and addiction. Tolerance means that higher doses are needed to achieve the same effect, and dependence leads to withdrawal symptoms when the drug is not present. People with an opioid use disorder may try to use more to get the same effect and it can lead to overdose. This is especially a concern for people who buy it on the street, where the quality and potency can vary significantly.

Illegally manufactured fentanyl and its analogs, which may be found on the streets or online via illicit markets, pose an especially high risk to users due to their potency. Many people who are opioid-naïve users, i.e. not regular users of opioids, have overdosed because of the high potency of these narcotics.

How Fentanyl Is Different from Other Opioids

Fentanyl differs from other opioids in several key ways. It’s a highly addictive drug that is also highly potent and deadly, depending on who takes it and how much they take. Addiction, over time, can cause many changes in the brain. Here are some key differences and considerations when it comes to fentanyl use:

1. Potency: Fentanyl is estimated to be 50 to 100 times more potent than morphine and about 50 times more potent than heroin. This means that even a small amount of fentanyl can have a significant impact on the central nervous system, putting users in danger of overdose. Street fentanyl may be even more potent, and it can also contain contaminants like xylazine.
2. Rapid Onset and Short Duration: Fentanyl has a rapid onset of action, meaning it acts quickly in the body, and its effects are relatively short-lived compared to other opioids. This rapid onset is great quick pain relief, but it also increases the risk of overdose when not used as prescribed. Some people who use fentanyl have said they have to take it every few hours to get high, which can easily lead to physical dependence and increased risk of overdose.
3. Risk of Respiratory Depression: Fentanyl, like other opioids, can cause respiratory depression, where breathing becomes slow and shallow. Due to its potency, there is always the danger of life-threatening respiratory suppression, especially in cases of overdose.
4. Illicit Production and Adulteration: Illicitly produced fentanyl and its analogs are a significant concern. They may be added to other drugs like heroin or counterfeit prescription pills without the user's knowledge, leading to unintentional overdose. The variability in illicit drug formulations makes it challenging for users to gauge the potency of what they are taking.
5. Increased Addictive Potential: The potency of fentanyl may contribute to a higher potential for addiction, as individuals may rapidly develop tolerance, leading to an increased risk of dependence. Dependence on fentanyl is considered an opioid use disorder, and most people will need help getting sober, including assistance with Medication-Assisted Treatment and therapy.
6. Combining with Other Substances: Combining fentanyl with other substances, especially central nervous system depressants like benzodiazepines, alcohol, or other opioids, can significantly increase the risk of overdose and respiratory depression. Polydrug use is a major factor in opioid-related deaths, and many people may not even realize they’re using more than one medication! Fentanyl bought on the streets often has adulterants, which can also affect the brain.

The dangers associated with fentanyl are not solely due to its inherent properties but also because of its misuse, illicit production, and the potential for addiction for people who are predisposed to it. Individuals using opioids, whether prescribed or illicit, should be aware of the risks, follow medical guidance, and avoid combining them with other substances without consulting a healthcare professional. Healthcare professionals should be educated about the potential for misuse and also have tools to help their patients with addiction and recovery.

Getting Help With Opioid Use in North Carolina

If you or somebody you love has a problem with using opioids, we're here to help you. Our fentanyl addiction treatment often includes MAT and therapy, depending on your needs. Please get in touch to learn about your options and how we can help.