Fentanyl Prescriptions: Uses, Types, and Safety

Fentanyl is a strong opioid medication used to treat pain. It is one of the most potent opioid medications, which means it comes with a high risk of misuse and overdose. In fact, fentanyl and other opioids are the most common drugs involved in overdose deaths in the U.S. 

But even though fentanyl is often used illegally, prescription fentanyl is still a helpful medication for people who need it. And when used correctly, prescription fentanyl is much safer than illegal versions of fentanyl.  

What is prescription fentanyl used for?

Fentanyl is mainly used as a pain medication. In the hospital environment, it is usually used for pain related to surgery. Fentanyl is a very strong pain medication, but it only lasts for a short time. 

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Your provider is able to give you a little fentanyl at a time and monitor your response to it. Healthcare providers commonly use fentanyl for injuries that cause severe pain. 

When providers prescribe fentanyl for use at home, it’s usually for chronic pain. Some examples include:

• Cancer pain

• Chronic back pain

• Pelvic pain, related to an issue with your uterus or bladder

• Bone or joint pain from arthritis or fibromyalgia

Fentanyl may also be used when someone with chronic pain builds a tolerance to other opioids. Tolerance is when your body gets used to the opioid medication, and you need a higher dose to get the same desired effect. 

Fentanyl can be used when tolerance develops to other opioids, like hydromorphone and oxycodone. But it’s important to note that fentanyl can also cause tolerance after time.

What are the different forms of prescription fentanyl?

When someone receives fentanyl in the hospital, it is often in IV (intravenous) form. But prescription fentanyl comes in several different forms. And many of these are designed to have a slower release of fentanyl into the body compared to IV fentanyl. 

Forms of prescription fentanyl include:

• Subsys: an oral spray

• Lazanda: a nasal spray

• Fentora: dissolvable tablets that go inside your cheek or under your tongue (also known as buccal fentanyl)

• Actiq: a lozenge or lollipop you suck on 

• Duragesic: a patch placed on the skin

Is prescription fentanyl safe?

Prescription fentanyl presents a high risk for opioid use disorder and deadly drug overdoses. But prescription fentanyl is much safer when used as prescribed by your provider. Here’s how to reduce the risk of potential harm: 

• Use prescription fentanyl in the correct way. This means only using the amount and frequency your provider has prescribed to you. 

• Do not change or increase your dosage of fentanyl without the guidance of an experienced provider. 

• Do not combine fentanyl with other medications or substances that have not been cleared by your provider.

• Call 911 immediately at the first sign of a possible overdose.

Side effects

Fentanyl, just like any other strong medication, comes with some side effects. And it’s important to be aware of these side effects, because some can lead to serious health complications. 

Fentanyl’s side effects in the body include:

• Drowsiness and sedation

• Constipation

• Slowed breathing

• Nausea

• Confusion

• Unconsciousness

Overdose

A fentanyl overdose looks the same as an overdose from heroin or other opioids. Opioid overdoses can be deadly because they cause you to stop breathing. 

The symptoms of a fentanyl overdose (or other opioids) include:

• Slowed breathing, shallow breathing, or periods of no breathing

• Small, pinpoint pupils

• Unconsciousness, or difficult to arouse

• Vomiting, or a gurgling sound in the throat

• A pulse that is weak and hard to feel

• Skin that is pale or cool

• Lips and fingernails that look blue or gray

Naloxone (Narcan) is a lifesaving medication that can reverse the effects of opioid overdose. Naloxone blocks the effects of opioids, and it can quickly help restore someone’s breathing after using too much fentanyl or any other opioid. 

Oftentimes, a provider will prescribe naloxone to anyone with a fentanyl or other opioid prescription as a safety precaution. But now Narcan is available over the counter without a prescription.

Opioid use disorder

Opioid use disorder is when someone develops a habit of misusing opioid medications. Other terms for this are “opioid addiction” or “opioid dependence.” When someone has opioid use disorder, it means their opioid use is interfering with their daily life. 

A hallmark sign of opioid dependence is if you develop withdrawal symptoms when you stop taking fentanyl. Withdrawal symptoms from fentanyl include:

• Cravings for fentanyl

• Restless leg movements

• Diarrhea and vomiting

• Anxiousness 

• Difficulty sleeping

• Sweating

Healthcare providers use the Diagnostic and Statistical Manual of Mental Disorders to diagnose mental health disorders. It defines opioid use disorder as “a problematic pattern of opioid use leading to problems or distress.” 

For someone to be diagnosed with an opioid use disorder, at least two of the following must apply to them within a 12-month period:

• You take more opioids over time, or you take more than you mean to.

• You feel like you need to stop or lower your opioid use, but you can’t.

• You spend a lot of time getting or using opioids or recovering from the effects of opioids.

• You crave opioids, or have a strong desire to use them.

• You have a tough time meeting your responsibilities at work, school, or home.

• You stop doing certain activities, or you do them less, because of opioid use.

• You use opioids in risky situations, like when driving.

• You keep using opioids even though they cause or worsen physical or mental problems for you.

• You have a tolerance for opioids.

• You have withdrawal symptoms, or you take opioids to avoid these symptoms.

The treatment for opioid use disorders is typically a combination of psychotherapy and medications. If you’re concerned you or a loved one is dealing with opioid use disorder, call 911 or reach out to a provider for help. 

How is illicit fentanyl different from prescription fentanyl?

Fentanyl is one of the main reasons for increasing rates of drug overdoses and deaths. And this includes both prescription fentanyl and illegal versions.

Prescription fentanyl can be addictive and misused. This may cause an unpredictable response or higher absorption of fentanyl, resulting in life-threatening side effects. 

Illegal versions of fentanyl are even more dangerous because it’s impossible for someone to know what dose they’re getting. It can also be combined with other illegal drugs. So some people may not know the drug they’re taking has fentanyl in it. This increases the risk of an accidental overdose. 

If you or someone you know has access to fentanyl — prescription or illegal versions — it’s important to have quick access to naloxone (Narcan) at all times. It is safe to give to anyone, whether or not there’s fentanyl in their system. Give Narcan and call 911 at any sign of an overdose.

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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