Fentanyl Patches: Uses, Side Effects, & Dosages

What Is a Fentanyl Patch?

Fentanyl is a potent opioid medication used for the management of severe pain.¹ It belongs to the class of synthetic opioids and is much stronger than other commonly used opioids like morphine or oxycodone. In fact, fentanyl is approximately 50 times more potent than heroin and 100 times more potent than morphine (to put it into perspective).² Fentanyl patches are one specific form of administering fentanyl. They are applied directly to the skin and slowly release the medication into the bloodstream over a designated period.

The duration of a fentanyl patch can vary, but it typically lasts for 72 hours (3 days).¹ This extended-release feature makes it suitable for individuals who require continuous pain relief without the need for frequent dosing. Fentanyl patches are commonly used when other pain medications have not been effective or are not well-tolerated. They are particularly beneficial for managing chronic pain associated with conditions such as cancer, where consistent and long-lasting pain relief is crucial for maintaining a good quality of life.

How Should Fentanyl Patches Be Used?

Fentanyl patches should always be used as prescribed. They are typically prescribed for individuals with severe, chronic pain that requires continuous opioid analgesia. Fentanyl patches are commonly used to manage acute pain, such as when one has experienced trauma, is recovering from a major surgery, or administered as an epidural during childbirth as well as with pain associated with chronic and pervasive conditions such as cancer.³ The duration of fentanyl patch use varies depending on the individual’s pain condition and response to treatment. Some individuals may use fentanyl patches for a short period, such as a few weeks, while others may require long-term use for months or even years.

Fentanyl is significantly stronger than other opioids due to its high potency.^4,5 It binds to opioid receptors in the brain and spinal cord more efficiently, resulting in a potent analgesic effect. The dosage of fentanyl patches is carefully determined by the healthcare provider based on factors such as the individual’s pain severity, previous opioid exposure, and tolerance. The dose is usually initiated at a low level and titrated up gradually to achieve optimal pain control while minimizing the risk of side effects.

How Are Fentanyl Patches Abused?

Fentanyl patches are commonly abused due to the powerful opioid effects of fentanyl. As they are more potent than morphine or heroin, they are highly sought after for their intense euphoria and pain-relieving properties. Illegally produced fentanyl is often used to cut or adulterate other drugs, such as heroin or cocaine, to increase their potency. Individuals may tamper with them to extract and consume the gel or liquid containing fentanyl. They may cut open the patch, chew it, or dissolve it in liquid for injection or snorting. This bypasses the intended slow-release mechanism of the patch, leading to a rapid and dangerous surge of the drug in the body.

Fentanyl patches have been recalled in the past due to issues with their manufacturing or packaging. One such example occurred in April 2019 when Alvogen Inc. voluntarily recalled two lots of fentanyl transdermal system patches labeled 12 mcg/h that contained 50 mcg/h.⁶ Given the potency of the drug, this amplified overdose risk for even those taking the medication as prescribed. As in this example, recalls may be initiated if there are concerns about the patches delivering excessive amounts of fentanyl, which can lead to accidental overdoses.

There are several methods of abusing fentanyl patches:

Chewing Fentanyl Patches

Chewing or otherwise modifying fentanyl patches is a method of illicitly consuming the drug by bypassing the intended slow-release mechanism. When chewed, the fentanyl contained within the patch is rapidly absorbed through the mucous membranes in the mouth and throat, leading to a quick and potent effect. Consuming a concentrated amount through chewing can overwhelm the body’s opioid receptors, leading to a dangerous suppression of the respiratory system. [7] This can result in slowed or shallow breathing, oxygen deprivation, and, in severe cases, respiratory arrest and death.

Moreover, chewing fentanyl patches can also lead to an unpredictable dose of the drug entering the bloodstream. The patches are designed to provide a controlled release of fentanyl over time, ensuring a steady and safe blood concentration. When chewed, the rapid absorption can cause an excessive and unpredictable surge of fentanyl, increasing the risk of overdose and its associated complications.⁷

Placing Multiple Fentanyl Patches

Placing multiple fentanyl patches on the skin is another method employed by individuals to increase the drug’s effects. By applying multiple patches simultaneously, they aim to enhance the overall dosage and achieve a more potent high. The dangers of placing multiple fentanyl patches include an increased risk of overdose and respiratory depression. Combining multiple patches significantly boosts the amount of the drug entering the bloodstream. This can overwhelm the body’s opioid receptors and lead to a dangerous suppression of the respiratory system, potentially resulting in respiratory failure and death.⁷

The duration of fentanyl’s presence in the system can vary depending on factors such as the individual’s metabolism, dosage, and frequency of use.¹ Generally, fentanyl has a half-life of around 7-14 hours, meaning it takes that amount of time for the concentration in the body to decrease by half. However, it’s important to note that even after the drug has been metabolized and eliminated from the body, its effects can still linger. Misusing multiple fentanyl patches can prolong the duration of drug activity, increasing the risk of overdose and prolonged respiratory depression.

Injecting Fentanyl

Injecting fentanyl extracted from a patch is a highly dangerous method of administration that some individuals may resort to for a more immediate and intense high. To obtain the drug for injection, individuals may extract the fentanyl gel or liquid from the patch, dissolve it, and inject it into their veins. The dangers of injecting fentanyl from a patch are like injecting any other illicit opioid, including heroin. Injecting fentanyl bypasses the body’s natural barriers, rapidly delivering a concentrated dose of the drug directly into the bloodstream.

Accordingly, this can lead to a rapid onset of intense euphoria but also increases the risk of overdose and respiratory depression. The injected dose can easily overwhelm the body’s opioid receptors, causing a dangerous suppression of the respiratory system, which may lead to respiratory arrest and death.⁷ Furthermore, injecting fentanyl obtained from patches can be particularly risky due to the lack of quality control. The gel or liquid extracted from the patch may contain impurities or inconsistent concentrations of fentanyl, making it difficult to gauge the actual strength of the dose. This unpredictability increases the risk of overdose and adverse reactions.

Drinking Boiled Fentanyl Patches

Drinking a “tea” made from boiled fentanyl patches is an extremely dangerous and ill-advised practice. Some individuals may attempt to extract fentanyl from the patches by boiling them in water and then consuming the resulting liquid. Boiling fentanyl patches and consuming the resulting liquid can lead to an uncontrolled and potentially fatal dose of the drug. When extracted in this manner, the concentration of the drug in the liquid can be unpredictable and highly concentrated. This increases the risk of overdose and respiratory depression, which can result in respiratory arrest and death.⁷

Further, boiling fentanyl patches can also release other harmful substances or contaminants from the patch material. The patches may contain adhesives, dyes, or other chemicals that are not intended for ingestion. Consuming these substances can lead to additional health risks and complications.

Smoking Fentanyl Patches

Smoking fentanyl from a patch is another hazardous and highly discouraged practice. Individuals who attempt to smoke fentanyl patches typically extract the drug by removing the gel or liquid from the patch and heating it to produce vapor or smoke. The risks of smoking fentanyl from a patch are primarily associated with the rapid and concentrated delivery of the drug to the lungs and bloodstream. Smoking allows for a quick absorption of the drug’s effects. However, this also increases the likelihood of overdose and respiratory depression.

Moreover, smoking fentanyl patches can introduce additional risks due to the potential inhalation of harmful substances. The patches contain adhesive and other materials that are not intended for combustion and inhalation. Smoking these substances may result in the inhalation of toxic fumes or particles, leading to respiratory issues or other health complications.

Snorting Fentanyl Patches

Snorting fentanyl from patches involves extracting the drug from the patch and converting it into a powder form for nasal inhalation. To accomplish this, individuals may scrape or cut the patch to collect the fentanyl gel or liquid, dry it, and then crush it into a fine powder to be snorted. The risks of snorting fentanyl patches primarily stem from the concentrated and rapid absorption of the drug through the nasal membranes. When fentanyl is snorted, it bypasses the body’s natural protective mechanisms and quickly enters the bloodstream, leading to a rapid onset of effects, which also increases the risk of suppressing the respiratory system and potentially leading to respiratory arrest and death.⁷

The patches may contain other substances or chemicals that are not meant to be inhaled, which can cause irritation, damage to the nasal passages, or other adverse reactions. Additionally, the unpredictable potency of the extracted fentanyl and the difficulty in accurately measuring doses increase the risk of overdose and adverse health effects.

Dangers of Abusing Fentanyl Patches

Fentanyl abuse is a serious problem and a growing one amid the opioid epidemic. According to the National Institute on Drug Abuse, “Deaths involving synthetic opioids other than methadone (primarily fentanyl) continued to rise with 70,601 overdose deaths reported in 2021.”⁸ As previously discussed, abusing fentanyl patches carries significant risks and dangers, including a range of adverse effects on both physical and mental health. An overdose, for example, can result in respiratory depression, leading to oxygen deprivation, brain damage, or even fatal respiratory arrest. Additionally, fentanyl abuse can cause various other harmful effects, including decreased heart rate, lowered blood pressure, and impaired cognitive function. Prolonged abuse may result in long-term brain damage and memory problems. It can also contribute to the development of substance use disorders and addiction, leading to a cycle of continued abuse and difficulty in quitting.

Fentanyl abuse can also lead to physical injuries. The impaired judgment and coordination caused by the drug can increase the risk of accidents, falls, and other injuries. Additionally, individuals who abuse fentanyl patches may engage in risky behaviors to obtain the drug—potentially exposing themselves to legal consequences, financial troubles, and strained relationships.

Symptoms of fentanyl patch overdose include:

• Difficulty breathing or shallow breathing
• Slowed or irregular heartbeat
• Extreme drowsiness or sedation
• Confusion or disorientation
• Loss of consciousness
• Blue lips or fingertips (indicating lack of oxygen)
• Cold and clammy skin
• Pinpoint pupils (extremely small pupils)
• Muscle weakness or limpness
• Dizziness or lightheadedness
• Nausea or vomiting
• Seizures or convulsions
• Unresponsiveness or inability to awaken¹

Fentanyl Patches Vs. Other Forms of Fentanyl

Like many other drugs, fentanyl comes in several forms (e.g., oral tablets, nasal spray, sublingual film, etc.). These different formulations of fentanyl offer various routes of administration, each with its own characteristics and intended uses. Regardless of form, fentanyl is already considered one of the most potent opioids available.² Fentanyl patches, however, typically contain a substantially higher amount of the drug, making them even more potent in comparison to other forms. The intense euphoria and pain relief produced by fentanyl makes it highly sought after for recreational purposes, increasing the risk of misuse and abuse.

Moreover, the higher concentration of fentanyl in patches can also increase the potential for accidental overdoses. The slow-release mechanism of patches is designed for controlled and gradual absorption of the drug, ensuring safe and steady blood levels. Misuse or tampering with fentanyl patches can disrupt this mechanism, leading to a rapid and dangerous surge of the drug in the body, elevating the risk of overdose.¹

Other forms of fentanyl include:

• Lozenges (Actiq)
• Sublingual tablets (Abstral)
• Film (Onsolis)
• Nasal spray (Lazanda)
• Sublingual spray (Subsys)
• Injectable solution (Sublimaze)
• Oral tablets (various brand names)
• Intranasal spray (Instanyl)
• Transmucosal lozenges (Fentora)
• Transdermal gel (Ionsys)²

Fentanyl Patch Side Effects

Common side effects of fentanyl patches can vary by individual, but it’s essential to be aware of potential adverse effects and seek medical advice if necessary. While some side effects may be mild and transient, others can be more concerning and require medical attention. Common side effects of fentanyl patches may include constipation, nausea, vomiting, dizziness, drowsiness, headache, dry mouth, and sweating.¹ These side effects are relatively common and may improve over time as the body adjusts to the medication.

More concerning side effects that should prompt immediate medical attention include difficulty breathing, slow or shallow breathing, chest pain, rapid heartbeat, extreme drowsiness, confusion, severe dizziness, fainting, or signs of an allergic reaction such as rash, itching, swelling, or difficulty swallowing.¹ It’s important to note that this is not an exhaustive list of side effects, and individuals should always consult their medical provider for comprehensive information and guidance specific to their situation.

Other fentanyl patch side effects include:

• Nausea
• Vomiting
• Sweating
• Itching or skin irritation at the patch site
• Sleep disturbances (insomnia or excessive drowsiness)
• Muscle stiffness or tightness
• Decreased appetite
• Fatigue or weakness
• Blurred vision
• Mood changes (anxiety, depression, or irritability)¹

The Addictive Nature of Fentanyl

Fentanyl addiction shares many similarities with other opioid addictions but is particularly concerning due to its high potency. Fentanyl’s potency can make it even more addictive than other opioids, as individuals may quickly develop a tolerance and require higher doses to achieve the desired effects. The intense euphoria and pain relief produced by fentanyl can lead to a rapid onset of addiction and make it difficult for individuals to control their use.

Furthermore, fentanyl has become prevalent in other types of substance use disorders as well. It is frequently found laced with other illicit drugs such as heroin, cocaine, or counterfeit prescription pills, often without the user’s knowledge. This increases the risk of accidental overdose and complicates treatment approaches, as individuals may be unknowingly exposed to fentanyl and become addicted as a result.

It’s important to differentiate between physical dependence and addiction when discussing fentanyl withdrawal experiences. Physical dependence refers to the body’s adaptation to the presence of a substance. This is a naturally occurring phenomenon (associated with the natural cycle of tolerance and withdrawal) that occurs even in the absence of an addiction. Abruptly stopping fentanyl use can lead to withdrawal symptoms such as muscle aches, restlessness, sweating, and nausea. Addiction, on the other hand, is a complex psychological, emotional, and behavioral condition characterized by compulsive drug-seeking behavior and an inability to control drug use despite negative consequences. When individuals who abuse fentanyl abruptly stop taking the drug, they may experience intense withdrawal symptoms due to both physical dependence and addiction. These symptoms can include severe cravings, anxiety, depression, insomnia, irritability, and flu-like symptoms.

Treating Transdermal Fentanyl Patch Addiction

Treating transdermal fentanyl patch addiction requires a comprehensive approach that addresses the physical, psychological, and emotional aspects of addiction. While there are similarities in treating fentanyl patch addiction compared to other opioid addictions, there are some unique considerations due to the specific form and potency of fentanyl patches. One key difference is the need for careful management of withdrawal symptoms. Individuals who are physically dependent on the drug may require a gradual tapering (medical detox) process under medical supervision to minimize the intensity of withdrawal symptoms. This approach helps to safely alleviate physical dependence while providing support to manage the associated discomfort.

Professional help is highly recommended. A healthcare provider or addiction specialist can provide an individualized treatment plan based on the person’s specific needs. Treatment may involve a combination of medication-assisted treatment (MAT), counseling, behavioral therapies, support groups, and other supportive services. Additionally, the involvement of a supportive network, such as family and friends, can provide valuable support throughout the treatment process. Motivation in respect of open communication and a willingness to seek help are essential first steps towards overcoming fentanyl patch addiction and embarking on the path to recovery.

Options for treating fentanyl patch addiction include:

Group Therapy & Support Groups

Group therapy and support groups play a vital role in the treatment of fentanyl patch addiction. These settings provide a safe and supportive environment where individuals with similar experiences can come together to share their struggles, insights, and successes. The benefits of group therapy and support groups are numerous. Individuals with fentanyl patch addiction often feel isolated and stigmatized, but in group settings, they realize they are not alone in their struggles. Additionally, group therapy and support groups offer a platform for learning and gaining new perspectives.

Twelve-step programs, such as Narcotics Anonymous (NA), can also be beneficial for individuals with fentanyl patch addiction. These programs follow a structured approach that involves surrendering to the addiction, working through the 12 steps, and providing ongoing support and accountability. The principles of 12-step programs, such as honesty, self-reflection, and support through sponsorship, can facilitate personal growth, self-discovery, and sustained recovery. Such groups are recommended in combination with treatment as a holistic approach.

Therapy

Therapeutic interventions provide individuals with the necessary tools and support to manage the physical, emotional, and psychological aspects of addiction. Further, it can help individuals develop coping mechanisms to navigate withdrawal symptoms and cravings. Therapists can assist with identifying triggers and developing strategies to avoid or cope with them effectively. They can also address underlying issues that may have contributed to the development of addiction, such as trauma, mental health disorders, or relational difficulties. Therapy can provide a safe space for individuals to explore their thoughts and emotions, learn healthier coping skills, and develop a relapse prevention plan.

Online therapy, commonly referred to as teletherapy or telehealth, offers a convenient and accessible option for individuals seeking therapy. It is oftentimes more affordable as well. Online therapy allows individuals to receive professional help from the comfort of their own homes, eliminating barriers such as transportation, distance, and scheduling conflicts. Several reputable platforms offer online therapy services, including BetterHelp, Talkspace, and Amwell. Depending on the severity of the condition, however, more invasive and/or restrictive forms of therapy may be warranted.

Therapeutic methods that can help address addiction and withdrawal symptoms include:

• Cognitive-behavioral therapy (CBT): CBT focuses on identifying and changing negative thought patterns and behaviors related to addiction. It helps individuals develop healthier coping mechanisms, manage cravings, and build skills to prevent relapse.
• Dialectical behavior therapy (DBT): DBT combines elements of CBT with mindfulness techniques. It helps individuals regulate emotions, manage distress, and improve interpersonal skills, making it particularly useful for individuals with co-occurring mental health issues.
• Eye Movement Desensitization and Reprocessing therapy (EMDR): EMDR is commonly used to treat trauma-related disorders. It utilizes eye movements or other forms of bilateral stimulation to process distressing memories and reduce their impact, which may be beneficial for individuals with underlying trauma contributing to addiction.
• Motivational interviewing: MI is a person-centered approach that aims to enhance intrinsic motivation and commitment to change. It helps individuals explore their ambivalence about addiction, strengthen their motivation to recover, and develop a personalized plan for change.
• Family therapy: Involving family members in therapy can be crucial for addressing family dynamics, improving communication, and healing relationships affected by addiction. Family therapy helps educate and support loved ones, promoting understanding and a healthier support system for the individual in recovery.

Intensive Outpatient Programs

Intensive outpatient programs (IOPs) offer a comprehensive level of care for individuals with fentanyl patch addiction while allowing them to continue living their lives outside of a residential treatment setting. These programs typically involve a structured treatment schedule that includes a combination of individual therapy, group therapy, psychoeducation, and support services. Participants often attend treatment sessions several times a week, typically ranging from 3 to 5 days per week, for a few hours each day.

While participating in an IOP, individuals continue to live their lives as usual, attending work or school and engaging in daily activities. The flexibility of IOPs allows individuals to receive treatment while maintaining their responsibilities outside of the program. This level of care offers a balance between structured treatment and the ability to apply newly acquired skills and strategies in real-life situations, promoting a smoother transition back into daily routines. Additionally, IOPs often provide ongoing support and assistance with developing relapse prevention strategies, coping mechanisms, and a strong support network.

Rehab & Detoxification Centers

Detoxification centers and rehabilitation centers are vital components of the treatment journey for individuals with fentanyl addiction, each serving specific purposes in the recovery process. Detoxification centers focus on safely managing the physical withdrawal symptoms that occur when discontinuing fentanyl use. Rehabilitation centers provide structured and comprehensive treatment for addiction. To enroll in detox or rehabilitation programs, individuals typically undergo an assessment by healthcare professionals to determine the appropriate level of care and treatment needs. Detoxification may be required before entering a rehabilitation program, as it helps individuals achieve stability and readiness for further treatment. Social work or casework programs can play a crucial role in aiding individuals seeking treatment by providing support and assistance in navigating the complex process of enrollment.

Fentanyl rehab programs may differ from alcohol-focused ones due to the specific challenges and risks associated with fentanyl addiction. Fentanyl is an extremely potent opioid, and its addiction requires specialized treatment approaches. Fentanyl rehab programs may focus on medication-assisted treatment (MAT) with medications like methadone or buprenorphine to manage cravings and dependence. Additionally, these programs may prioritize addressing co-occurring mental health conditions, trauma, or pain management issues that may be driving the addiction.