Fentanyl’s Behavioral Impact on Individuals with Autism and Intellectual Disabilities

Over the last decade, fentanyl has changed from being a tool used to manage severe medical pain to a major catalyst of the opioid crisis. As many of us know, fentanyl is an extremely potent opioid that is far stronger than morphine or heroin, and it has been showing up not only in street drugs but also in counterfeit prescription medications. This has created new risks for vulnerable populations, including individuals with Autism Spectrum Disorder (ASD) and Intellectual and Developmental Disabilities (I/DD).

Even when used as prescribed, fentanyl can cause sedation, confusion, and impaired decision-making. For someone already experiencing difficulties with communication, regulation, or judgment, these effects can be increasingly destabilizing. This becomes even more concerning when fentanyl is encountered outside of medical care through contaminated pills or other substances such as street drugs. The margin for error is almost nonexistent, as just a tiny amount can be life-threatening.

There is various emerging evidence about fentanyl's impact on behavior and the brain. A 2019 study published in Translational Psychiatry (Zhang et al., 2019) found that young mice exposed to fentanyl developed lasting behavioral changes that resembled features often seen in autism spectrum disorder. These included increased anxiety, social withdrawal, and repetitive or rigid behaviors. While animal studies cannot be directly applied to people, they do highlight how opioids like fentanyl may disrupt brain systems involved in social processing and self-regulation. This resonates with what many clinicians observe…small disruptions in neurochemistry or environment can have major impacts on individuals who already face developmental and mental health challenges.

For clients with autism and I/DD, who often live with co-occurring conditions such as anxiety or depression, fentanyl exposure could easily complicate both assessment and treatment. A sudden increase in withdrawal, agitation, or repetitive behavior might be attributed to psychiatric symptoms, when in fact substance exposure is playing a role. This makes it all the more important for providers to keep the possibility of fentanyl in mind when new or unexpected behaviors emerge.

To support families and caregivers surrounding the fentanyl crisis, it's crucial to educate them about risks like fentanyl being hidden in counterfeit pills or street drugs. We should also promote safe medication storage and disposal, and make sure they know about harm-reduction tools such as naloxone and test strips. Many families find comfort in understanding that prevention is achievable and that they can take specific actions to lessen risks. We can also demonstrate calm, nonjudgmental communication about substance use, fostering a safer environment for clients to disclose any exposure.

Although fentanyl’s broader impact has been well-documented, its potential effects on people with autism and I/DD highlight a unique intersection of public health and developmental care. Our role as clinicians is not only to treat behavior as it arises, but also to understand the broader contexts (biological, psychological, social, etc.) that shape the lives of our clients. By staying informed and proactive, we can better protect those who are most vulnerable to the ripple effects of this ongoing crisis.

Author: Samantha Easton, LCSW, Miren Behavior Consultant

Article Link: https://www.nature.com/articles/s41398-019-0625-0.pdf

Citation:

Zhang, X., Wang, Y., Guo, N., Li, Y., Li, D., He, L., … & Ma, L. (2019). Fentanyl induces autism-like behaviours in mice by hypermethylation of the glutamate receptor gene Grin2b in the anterior cingulate cortex. Translational Psychiatry, 9, 322. https://doi.org/10.1038/s41398-019-0625-0