Originally developed and synthesized for use as an anesthetic and analgesic (or painkiller), fentanyl is one of the most potent opioids available today. It’s several tens of times more powerful than other medical opioids, like morphine, and it has a high potential for misuse, addiction, and overdose, making it one of the main exacerbating factors of the ongoing opioid epidemic.
Even in non-fatal instances of its use, fentanyl’s effects on the brain can be damaging and dangerous. To help spread awareness and keep yourself and others as safe as possible when around fentanyl, it’s crucial to understand how this substance works and what can be done to reduce the harm it causes in homes and communities.
How does fentanyl affect brain chemistry?
In humans (and many other vertebrates), the body and brain are filled with groups of specialized receptors known as opioid receptors. These structures come in four different varieties, and they all play critical roles in brain and bodily function. They help regulate various functions and feelings, like appetite, anxiety, relaxation, pain recognition, and happiness. Opioid receptors activate by binding with various compounds produced by the brain or extracted from the blood, and they produce a slew of different effects depending on what they’re activated by and how high the concentration of that compound is.
Opioids are a class of compounds — some naturally occurring and some synthetic — that have a high affinity for bonding with the brain’s opioid receptors. Because it’s a synthetic opioid, this is the mechanism that fentanyl uses, and it typically binds with one specific variety of receptor: the mu-opioid receptor. These structures help regulate pain, but they also influence respiration, euphoria, and physical dependence. This is what causes fentanyl’s hallmark side effects: extremely effective pain relief, a high feeling, and quick physical dependence.
Some neural pathways involved with fentanyl use release dopamine, creating euphoria and subsequent positive associations with the drug, while another set of neural systems build physical dependence and subsequent negative associations with cessation of fentanyl use by creating painful withdrawal symptoms.
Opioids other than fentanyl act on different types of opioid receptors, which don’t regulate the exact same bodily function, and therefore produce different effects at different potencies. This typically makes them less physically addictive.
What makes fentanyl dangerous for brain and body function?
Once introduced to the body — whether through ingestion, injection, or inhalation — fentanyl takes only minutes to begin having an effect. This rapid onset causes drastic changes in the brain and body that may be dangerous or even fatal. While the effects of fentanyl start in the brain, they are not strictly contained to it. The body’s opioid receptors also help regulate critical physical functions, such as breathing and heart rate.
Fentanyl acts as a strong central nervous system and respiratory depressant, meaning that it slows functions related to the brain and breathing. It’s these fentanyl side effects that make overdose pose such a deadly risk, especially when accounting for how small of a dose is able to create considerable and drastic effects.
A fentanyl overdose results when respiratory depression is so intense that an individual’s breathing becomes intermittent and erratic or stops entirely. During this process, the heart rate also slows down, which can cause dangerously low oxygen levels and lead to cardiac arrest. In this state, patients may also experience severe oxygen deprivation, leading to seizures or brain damage. Even if an individual survives this overdose, it can still leave permanent damage and worsen overall health.
Recent research has shown that fentanyl causes respiratory action to stop or slow down even in small amounts, and it happens minutes before other signs of an issue become apparent. Loss of alertness, loss of consciousness, and other fentanyl side effects are all preceded by these changes in breathing.
Even if a fentanyl user never overdoses or only uses it unknowingly, the drug can still have a long-term effect on their brain chemistry. This is because fentanyl manipulates the brain’s release of dopamine, an emotion- and pleasure-regulating neurotransmitter crucial to stable mental health. Fentanyl and other opioids cause a flood of dopamine in the brain, which is what causes the drugs’ euphoric effects, and repeated exposure to precipitated bursts of dopamine changes how your brain naturally regulates the neurotransmitter.
Effectively, your brain recognizes that you have an external source of dopamine and it doesn’t need to produce it at the same levels anymore. Without opioids, an individual naturally produces less dopamine than a non-opioid user, which can lead to feelings of depression and anxiety.
Does fentanyl withdrawal cause further effects on the brain?
Fentanyl withdrawal may be at least partly caused by the drug’s relationship to dopamine, but newer research shows that a different neural mechanism is largely responsible for the body’s physical dependence on this opioid.
It appears that fentanyl affects the amygdala, a portion of the brain involved in emotional responses, like fear and anxiety. When a person goes into withdrawal, it activates the fear and anxiety responses controlled by the amygdala and creates a negative association with the experience of being without fentanyl. This negative reinforcement can make a person feel uncomfortable with even the idea of quitting fentanyl, which leads to further mental health issues and inhibits recovery.
Treatment for fentanyl misuse
Luckily, there are a number of treatments that have proven effective in treating opioid use disorder in the long term, but the process is still challenging. Under close supervision of trained medical professionals who specialize in addiction treatment, medications like buprenorphine and naloxone (sold under the brand name Suboxone) can help mitigate the effects of withdrawal while staving off opioid cravings.
With the right program and the right support, it’s possible to stay stable and avoid misusing opioids over long periods. These programs are also often coupled with various types of mental therapy, should the patient want to receive them, and the combination helps patients maintain good habits and good mental health, as well as good overall brain health.
If you’re awaiting treatment, it’s a good idea to learn how to administer naloxone, a life-saving opioid reversal drug, or educate family members to create a safe support system.
Navigating fentanyl use
At Ophelia, our team of medical experts provides comprehensive opioid use disorder (OUD) and fentanyl treatment to help patients lead healthy lives. Our clinicians craft personalized treatment plans to meet each patient’s needs, including directing patients where to order fentanyl testing strips to quickly and easily test any supply of opioids for this substance.
We work with a growing number of insurance providers, including Medicaid, to help provide treatment without barriers. Our enrollment team can help you navigate costs and coverage options, so get in touch with us today to learn more about our options.
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