Fentanyl Addiction Treatment for Opioid Use Disorders

The opioid epidemic has ravaged the country for years. The U.S. government has thrown billions of dollars at it, but there is no sign of the problem slowing down. In fact, opioid overdose deaths have increased dramatically in the last few years alone. This increase has a lot to do with a powerful synthetic opioid called fentanyl. Though the drug has been around since the 1970s, availability has grown significantly in the past few years. Both pharmaceutical fentanyl and illicitly produced fentanyl have increased in manufacturing, prescription, and trafficking.

Drug users that cross paths with fentanyl usually weren’t looking for it specifically. In many cases, it makes its way into heroin and counterfeit pills without the user knowing. In several cases, this results in an overdose. Most users aren’t prepared for the potency of fentanyl. If the dose is small enough and the user has built up a tolerance, fentanyl will deliver an intense high with a host of side effects. Fentanyl addiction can be extremely difficult to break, especially without help.

If you are worried that you may come into contact with fentanyl or if someone you know is struggling with opioid or fentanyl addiction, the following information will help shed light on the potent drug and how addiction can be treated.

What is Fentanyl?

Fentanyl is a synthetic opioid that produces effects similar to morphine with much more potency. It’s used as a medicinal pain reliever in hospital settings, especially in epidurals. The drug causes the user to feel quick analgesia, comfort, and euphoria. It’s fast-acting, even when compared to other opioids, which makes it helpful in unpredictable medical settings. It’s often used in epidurals to treat labor pains, because, unlike other medicines used in epidurals, it works within minutes. Since labor and the birthing process can begin quickly, a fast-acting pain reliever is ideal.

Fentanyl is often injected intravenously, but it may also be delivered via transdermal patches. Unlike other medications, fentanyl has an incredibly efficient transdermal bioavailability, a term which means how well a chemical can make it into the bloodstream when absorbed through the skin. Fentanyl can be absorbed through the skin and into the blood with 92 percent efficiency. For comparison, intravenous bioavailability is 100 percent; therefore, it’s only eight percent more effective to inject the drug straight into a vein than to get it on your skin.

Fentanyl was first synthesized in 1960 and quickly became widely used as a general anesthetic. It was originally used through intravenous injection through the 60s until the patch was introduced in the 1990s.

Today, cases of fatal opioid overdose have dramatically increased and it is largely due to the growing fentanyl availability. Not only has it grown in medical use, it’s also illegally produced in laboratories in Mexico, South America, and China. The drug makes its way over the border through smuggling and through the mail. Because it is so potent in small amounts, significant shipments can be sent in small packages, like iPhone cases, that are difficult for law enforcement to detect.

According to the Drug Enforcement Administration, the Sinaloa Cartel, headquartered in Mexico, is the primary source of fentanyl trafficking and importation into the U.S. The DEA has also identified China as another significant source of fentanyl.

How Dangerous is Fentanyl?

Fentanyl is stronger than known naturally occurring opiates like morphine and heroin. In fact, it’s 100 times more potent than morphine and 50 times more powerful than heroin. It’s so powerful that it’s effective at the microgram level. Which means that the effective dose is smaller than a single gram; visually it’s about the size of a grain of salt. The lethal dose for a person with no tolerance is about 20 micrograms which is almost three times lighter than the weight of an eyelash. Heavy users can take as much as 100 micrograms.

Because it can be absorbed through the skin, it’s believed that it could be dangerous to even handle. The CDC issued a warning to police officers seizing the drug that exposure could be deadly; however, 92 percent transdermal bioavailability in medical patches doesn’t necessarily apply to lose fentanyl powder. Still, the loose powder can be inhaled and its general potency makes it dangerous to handle.

Fentanyl Abuse Statistics

  • Over 20,000 people have died because of fentanyl overdose. While the opioid epidemic has steadily risen for the past decade, the sharpest increase has occurred in the past few years and fentanyl is largely to blame.
  • Fentanyl is 100 times more powerful than morphine and it’s mixed into heroin and other street drugs. Even hardened opioid users can overdose when fentanyl unexpectedly makes it into drugs.
  • Death from synthetic opioids including fentanyl has increased by 72 percent in just a year, between 2014 and 2015.
  • The opioid has costed the US $504 billion dollars to date, and the problem continues to grow exponentially, largely due to the ubiquity of fentanyl.

Adverse Effects

Fentanyl comes with a variety of side effects in illicit and medical use. In medical use, side effects will be mild and limited for most people. In fact, it has even been shown to produce less nausea and itchiness than the less powerful morphine. Illicit use of the drug can be unpredictable because it’s dosage and the presence of adulterants is unknown. In regular use, common adverse effects are similar to other opioids and can include:

  • Nausea
  • Constipation
  • Dry Mouth
  • Confusion
  • Muscle weakness
  • Sweating
  • Abdominal pain
  • Headache
  • Fatigue
  • Anorexia
  • Weight loss
  • Dizziness
  • Drowsiness
  • Nervousness
  • Hallucinations
  • Depression
  • Anxiety

Fentanyl Addiction Withdrawal

Fentanyl addiction withdrawal typically mimics flu-like symptoms and can be extremely uncomfortable. Some users report feeling the worst flu symptoms they had ever experienced. Though withdrawal is extremely unpleasant, it’s typically not fatal unless you have other medical complications. However, if a fentanyl overdose occurs, it can cause more serious symptoms. The most common, deadly symptom in most opioid overdoses is respiratory depression. And fentanyl produces longer episodes of respiratory depression than other opioids.

The specific reason that fentanyl and other opioids slow breathing and cause shortness of breath or complete respiratory shutdown is unknown. However, it is believed that it hinders your brain’s ability to cause carbon dioxide levels in the body so your breathing slows as a result. This hindering of the autonomic nervous system can cause a dangerous lack of oxygen that ends in apnea, hypoxia, and death.

Unknown Ingredient

Most people who are addicted to opioids either start with prescription pain relievers (86 percent) or they go straight to heroin, which is an emerging trend. Very few, if any, seek out fentanyl intentionally. However, fentanyl has caused a spike in U.S. opioid overdose deaths. The reason is that it can show up in other drugs without the user knowing it.

Fentanyl is extremely cheap and easy to make. Mixing a tiny amount into other drugs can make even diluted product feel intense. People who use heroin may not be able to tell the difference when the buy the drug cut with fentanyl and the dose would be much more powerful than they are able to handle. People who use pills may not be safe from fentanyl contamination either. Pills acquired illicitly may actually be pressed fentanyl or a mixture including fentanyl, according to the CDC.

In the last few years, fentanyl has even affected celebrities, having been found as a potential cause of accidental overdose in the deaths of Prince, Tom Petty, and Lil Peep.

Fentanyl Addiction Treatment

Fentanyl addiction treatment follows the same general treatment levels as other opioids. However, the specifics of a treatment plan should always be tailored to the individual. Studies show that the most effective treatment follows a continuum of care, or continual care that responds to your current needs. The following is the path the continuum of care might take for opioid or fentanyl addiction:

  • Detox – Fentanyl addiction withdrawal can come with intense symptoms. If you are able, starting with medical detoxification is preferred. However, because opioid withdrawal isn’t typically medically dangerous, some insurance companies won’t cover medical detox
  • Inpatient – This refers to treatment with 24/7 medical monitoring. It’s not as medically intensive as detox, but if there is an instance of medical complication, medical professionals will be available at all times. This is especially common for people who have other health risks like a heart condition or a simultaneous alcohol abuse disorder.
  • Intensive outpatient or outpatient – In this level of care, you will no longer live in a medically monitored setting. In intensive outpatient treatment, you will have some independence but you will spend more than nine hours per week in fentanyl addiction treatment programs. In outpatient treatment, you will spend less than nine hours in therapies.
  • Aftercare – Aftercare programs start once you’ve completed fentanyl addiction treatment. Here is where you put the relapse prevention skills you learned into practice, with the help of support groups or 12-step communities.
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