What Are Synthetic Opioids?

The rise of illegally produced synthetic opioids presents several challenges for health professionals and policymakers:

1. Rapid Proliferation: New synthetic opioids are constantly introduced, complicating efforts in drug policy, forensic science research, and law enforcement.
2. Contaminated Drug Supply: Synthetic opioids are often added to illicit drugs without the user’s knowledge, making every dose potentially fatal.
3. Accessibility: Counterfeit pills resembling legitimate medicatSynthetic opioids have become a defining element of the ongoing opioid epidemic. Highly potent and often deadly, these substances have flooded both the medical and illicit drug markets, dramatically increasing the number of opioid overdose deaths across the globe.

But what are synthetic opioids exactly? How do they differ from other opioid drugs like morphine or codeine? And why have they become so central to the overdose crisis?

This article offers a comprehensive, yet accessible explanation of synthetic opioids, their uses, risks, and their role in the growing public health emergency.

Defining Synthetic Opioids

Synthetic opioids are man-made narcotic drugs that bind to opioid receptors in the brain and body to reduce the perception of pain. Unlike natural opioids such as morphine, which are derived directly from the opium poppy plant, synthetic opioids are chemically manufactured in laboratories. Some are legally prescribed for chronic pain, severe pain, or cough suppression, while others are illegally produced synthetic opioids that have flooded the illicit drug supply.

Common examples of synthetic opioids include:

• Fentanyl (prescription and illicit)
• Methadone
• Tramadol
• Carfentanil (extremely potent and intended for veterinary use)
  

These substances are part of a broader category that includes semi-synthetic opioids like oxycodone and hydrocodone, which are synthesized from natural opiates.

Potency and Risk Factors

Potent synthetic opioids like fentanyl are up to 50 to 100 times stronger than morphine.[1] Even small high doses—equivalent to a few grains of salt—can result in respiratory depression, shallow breathing, or slow breathing, leading to death.

Because of their chemical structure, synthetic opioids can vary widely in potency. Designer drugs and emerging drugs like isotonitazene are created to mimic opioid effects but often evade regulation. These substances are increasingly found in counterfeit pills, nasal sprays, and other drugs like cocaine, methamphetamine, and counterfeit benzodiazepines, often without the user’s knowledge.

Prescription Use vs. Illicit Production

Medical Use

Some synthetic opioids are prescription opioids used under medical supervision to treat acute or moderate to severe pain, especially post-surgery or in cancer care. These pain relievers are also prescribed for pain management in chronic pain conditions.

When used properly and under the guidance of health professionals, prescription opioids can be effective tools. However, repeated use—even when medically prescribed—can lead to opioid use, opioid misuse, and opioid use disorder (OUD).

Illicit Synthetic Opioids

Illicit fentanyl and its analogs are the primary drivers of the overdose crisis today. Produced in clandestine laboratories, often overseas, these illicit drugs are sold as powders, pills, or liquids and are frequently mixed into the recreational drug supply.

This unregulated mixing dramatically increases the risk of overdose, especially when users are unaware they are consuming synthetic opioids.

The Overdose Crisis: Shocking Statistics

The synthetic opioid crisis has had devastating consequences. According to the Centers for Disease Control and Prevention (CDC):[2,3,4]

• In 2022, synthetic opioids (excluding methadone) were involved in over 70,000 drug overdose deaths in the United States alone, a sharp increase from previous years
• Fentanyl is now the leading cause of death for Americans aged 18 to 45.
• A total of 69,893 synthetic opioid-involved overdose deaths among U.S. residents aged 15–64 years were identified, 53.6% of which also involved either psychostimulants or cocaine

The Department of Health and Human Services (HHS) continues to classify this as a public health emergency and has launched multiple initiatives to mitigate the epidemic.

Mechanism of Action: How Do Synthetic Opioids Work?

All opioids, synthetic or otherwise, act on opioid receptors located in the brain, spinal cord, and other organs. These receptors regulate pain, emotion, and respiratory function. When opioids bind to these receptors, they block pain signals and release large amounts of dopamine, causing a sense of euphoria.

This euphoric effect is partly why synthetic opioids are highly addictive. Over time, repeated use leads to tolerance, requiring higher doses to achieve the same effect—thereby increasing the risk of dependency, overdose, and death.

Opioid Use Disorder and Withdrawal

Substance use disorder (SUD) involving synthetic opioids is challenging to treat due to the intensity of physical and psychological withdrawal symptoms. These may include:[5]

• Muscle aches
• Anxiety
• Insomnia
• Nausea and vomiting
• Intense cravings
  

Abrupt discontinuation without medical oversight can be life-threatening. Medically-assisted treatments such as methadone, buprenorphine, and naltrexone are used to stabilize patients and reduce the risk of relapse.

What Are the Signs of Synthetic Opioid Addiction?

Recognizing the signs of synthetic opioid addiction can be the first step toward getting help—whether for yourself or a loved one. Because synthetic opioids like fentanyl are extremely potent and fast-acting, addiction can develop quickly, even with short-term or prescription use. Many individuals begin with legitimate pain relief medications and gradually develop a dependency due to repeated use, increasing tolerance, or opioid misuse.

Here are the most common physical, behavioral, and psychological symptoms that may indicate an opioid use disorder involving synthetic opioids:

1. Physical Signs

The physical symptoms of opioid addiction include:

• Drowsiness or sedation: Appearing unusually sleepy or “nodding off,” even during conversations.
• Constricted pupils: Pinpoint pupils are a telltale sign of opioid use.
• Shallow or slow breathing: This may escalate to respiratory depression, especially with high doses.
• Frequent flu-like symptoms: Nausea, vomiting, sweating, and muscle aches—often signs of withdrawal symptoms between doses.
• Weight loss and poor hygiene: Long-term users often neglect personal care and nutrition.
• Track marks or nasal irritation: Depending on the method of use (injection, snorting, or nasal sprays).

2. Behavioral Signs

The behavioral signs of opioid addiction include:

• Compulsive drug-seeking: Going to great lengths to find or purchase opioid drugs, often from illegal sources.
• Doctor shopping: Visiting multiple healthcare providers to obtain new prescription opioids.
• Neglecting responsibilities: Missing work, school, or family obligations due to drug use.
• Social withdrawal: Isolating from friends, family, or previously enjoyed activities.
• Financial problems: Frequently borrowing money or stealing to support the addiction.

3. Psychological Signs

The psychological symptoms of opioid addiction include:

• Mood swings: Sudden changes in mood, irritability, or agitation, especially between doses.
• Anxiety or depression: Common co-occurring conditions in people with substance use disorder.
• Cravings: Intense, uncontrollable urges to use synthetic opioids.
• Impaired judgment: Engaging in risky behaviors such as driving under the influence or using illicit drugs like counterfeit pills.

4. Tolerance and Withdrawal

The main indicators that you or someone you love is addicted to synthetic opioids are tolerance and withdrawal:

• Increasing tolerance: Needing higher doses of the drug to achieve the same effect—a major warning sign of developing dependency.
• Withdrawal symptoms: When use is stopped or reduced, symptoms like chills, restlessness, insomnia, diarrhea, and muscle pain may occur. These symptoms often lead to continued use to avoid discomfort, fueling the cycle of addiction.

When to Seek Help

If you or someone you know is experiencing several of these symptoms, it may indicate a developing or severe opioid addiction. Early intervention is critical. Health professionals can provide medical assessments, detox support, and long-term treatment plans, including medication-assisted treatment (MAT) and behavioral therapy.

Understanding these signs and acting early can dramatically reduce the risk of opioid overdose, overdose deaths, and other long-term consequences of addiction.

Public Health Challenges

1. ions are sold online and in street markets, increasing the chances of accidental overdose.
2. Limited Public Awareness: Many people remain unaware of the risks associated with illicit fentanyl and other synthetic opioids.

The Role of Public Health and Research

Public agencies and journals such as Int J Drug Policy, Drug Alcohol Depend, and Forensic Science Research are vital in providing evidence-based strategies to combat the opioid epidemic. Research is focused on:

• Identifying psychoactive substances in the drug supply
• Tracking drug overdose patterns
• Evaluating the effectiveness of treatment programs
• Understanding correlations between drug use, hepatitis C, and other infectious diseases
  

Agencies like the National Institute on Drug Abuse (NIDA) and the National Center for Health Statistics collaborate with local governments to deliver prevention and treatment programs.

Prevention and Harm Reduction

While tackling the opioid epidemic requires a multifaceted approach, several harm reduction strategies have shown promise:

• Naloxone (Narcan) distribution: This life-saving medication reverses the effects of opioid overdose and is now widely available in schools, libraries, and pharmacies.
• Safe injection sites and drug-checking services: These reduce drug overdose deaths by ensuring safer use and monitoring illicit drugs for contamination.
• Public education campaigns: Raising awareness about the dangers of synthetic opioids and how to recognize overdose symptoms like shallow breathing and sedative effects.
• Monitoring programs: Prescription Drug Monitoring Programs (PDMPs) track opioid prescriptions to reduce opioid misuse.

How to Recover from Synthetic Opioid Addiction

Recovering from synthetic opioid addiction is challenging but entirely possible with the right combination of medical care, psychological support, and long-term treatment. Because potent synthetic opioids like fentanyl and other illicit opioids are highly addictive and carry a greater risk of overdose deaths, professional help is crucial for safe and lasting recovery.

Treatment for opioid use disorder typically involves a multi-phase approach that includes medical detox, inpatient rehabilitation, and outpatient treatment. Each phase targets different aspects of addiction—physical dependency, psychological health, and long-term relapse prevention.

Medical Detoxification

Medical detox is often the first step in recovering from synthetic opioid use. It involves supervised withdrawal in a controlled medical setting to safely manage withdrawal symptoms that can be severe and potentially life-threatening. 

Because synthetic opioids can cause high doses of dependence, detoxing without professional help increases the risk of relapse, drug overdose, and complications like respiratory depression.

During detox, medical staff may use medications for opioid use disorder (MOUD) such as:

• Methadone – a long-acting opioid agonist that reduces cravings and withdrawal
• Buprenorphine – a partial opioid agonist that eases symptoms and reduces misuse risk
• Clonidine – to reduce symptoms like anxiety, sweating, and agitation
  

These treatments can stabilize the patient before entering the next phase of recovery.

Inpatient Rehabilitation

Following detox, many individuals benefit from inpatient rehab—a structured, residential treatment environment. This option is especially important for those who:

• Have experienced multiple relapses
• Are abusing multiple illicit drugs
• Have co-occurring mental health conditions like depression or anxiety
• Lacks a stable or supportive home environment
  

Inpatient rehab programs typically last 30 to 90 days and provide:

• 24/7 medical supervision and support
• Individual and group therapy
• Relapse prevention strategies
• Education about drug addiction and its effects
• Family therapy and support systems
  

The immersive setting removes the individual from daily triggers, such as access to illegal drugs, stressors, and people associated with substance use.

Outpatient Treatment

After completing detox and/or inpatient care, outpatient treatment helps maintain recovery while reintegrating into daily life. These programs allow patients to live at home and continue working or attending school, while still receiving regular treatment.

There are varying levels of outpatient care:

• Partial Hospitalization Programs (PHPs) – Intensive day programs providing several hours of therapy daily
• Intensive Outpatient Programs (IOPs) – Fewer hours per week, but still structured and therapy-focused
• Standard Outpatient Therapy – Weekly sessions for counseling, support groups, and relapse monitoring
  

Outpatient care is best for individuals who have already developed coping strategies and have a supportive, substance-free living situation.

Ongoing use of medications for addiction treatment, such as naltrexone (an opioid antagonist that blocks the euphoric effects of opioids), is often continued in outpatient settings. Many programs also integrate cognitive-behavioral therapy (CBT), motivational interviewing, and peer recovery groups.

The Importance of Long-Term Support

Recovery from opioid addiction doesn’t end with treatment. It is a chronic condition—much like diabetes or hypertension—that requires ongoing management. Long-term strategies include:

• Regular follow-ups with health professionals
• Attending support groups like Narcotics Anonymous (NA)
• Continuing individual and group therapy for substance use disorder and co-occurring mental health conditions
• Accessing harm reduction tools such as naloxone for overdose prevention

Get Connected to Treatment for Opioid Addiction 

Understanding what synthetic opioids are is essential to confronting the urgent public health crisis they represent. While these drugs have legitimate uses in treating pain, their high potency and prevalence in the illicit drug supply have led to an alarming rise in overdose deaths.

Efforts from health professionals, public health agencies, and communities are crucial in addressing opioid use disorder, reducing drug addiction, and saving lives. With ongoing research and widespread education, society can take meaningful steps toward ending the overdose crisis driven by synthetic opioids.

If you or a loved one is addicted to synthetic opioids, it’s time to seek professional help. At Eleve Behavioral Health, we provide the tools and support you need to achieve long-term sobriety. Contact us today for more information on our opioid addiction treatment center. 

Frequently Asked Questions (FAQ)

1. How are synthetic opioids different from natural or semi-synthetic opioids?

Synthetic opioids are fully man-made in laboratories and do not require any components from the opium poppy plant, whereas natural opioids (like morphine and codeine) are directly derived from it. Semi-synthetic opioids—such as oxycodone and hydrocodone—are chemically modified versions of natural opiates. Synthetic opioids tend to be more potent and faster-acting, which increases their risk profile for overdose and addiction.

2. Can synthetic opioids be detected in standard drug tests?

Yes, but not always. Some synthetic opioids, especially newer or designer drugs, may not show up in standard drug panels. Specialized toxicology screenings or forensic science research methods may be required to detect them, particularly in cases involving illicit fentanyl analogs or emerging drugs. Healthcare providers may request expanded panels if synthetic opioid use is suspected.

3. Why is fentanyl being added to other illegal drugs?

Illicit fentanyl is cheap to manufacture, extremely potent, and easy to transport, making it profitable for drug traffickers. It’s often mixed—intentionally or unintentionally—into illicit drugs like cocaine, heroin, methamphetamine, and counterfeit pills to intensify effects or mimic prescription medications. This greatly increases the risk of accidental overdose, especially for users who are unaware they’re consuming potent synthetic opioids.

4. Are synthetic opioids used outside of human medicine?

Yes. Certain synthetic opioids, like carfentanil, are approved for veterinary use in large animals such as elephants and bears. These substances are not safe for humans under any circumstances and are deadly even in microgram quantities. Carfentanil’s appearance in the recreational drug supply has led to numerous fatal overdoses due to its extreme potency.

5. Can over-the-counter medications contain synthetic opioids?

No. Synthetic opioids are controlled substances and are not available over the counter. Any pills claiming to contain opioids and sold without a prescription—especially online—are likely to be counterfeit pills and may contain illicit fentanyl or other dangerous psychoactive substances. Always obtain medications from licensed pharmacies and avoid purchasing drugs from unverified sources.

6. What should I do if I suspect someone is overdosing on a synthetic opioid?

Act immediately. Call emergency services (911) and, if available, administer naloxone (Narcan)—a medication that can reverse the effects of an opioid overdose. Common signs include slow or shallow breathing, loss of consciousness, and blue lips or fingertips. Stay with the person until help arrives and provide rescue breathing if trained. A prompt response can save a life.

References:

1. City of San Francisco: About Fentanyl
2. The Centers for Disease Control and Prevention (CDC): About Overdose Prevention
3. Get Smart About Drugs: DEA Administrator on Record Fentanyl Overdose Deaths
4. CDC: Synthetic Opioid and Stimulant Co-Involved Overdose Deaths by Occupation and Industry — United States, 2022
5. The National Library of Medicine (NLM): Opioid Withdrawal