What is Fentanyl?
Fentanyl is a synthetic opioid– this means it is an opioid that is synthesized in a lab. Fentanyl is an extremely potent opioid. This means that compared to other opioid drugs, a relatively small amount is needed to be effective– increasing the risk of fentanyl overdose.
Fentanyl acts on the same opioid receptors as other opioids. Because it is highly potent, overdose occurs particularly often in people who abuse fentanyl, and overdose deaths are common in people who abuse fentanyl.
Fentanyl is fat soluble, which means it stays in the body for longer than other opioids. Because it is fat soluble, it takes the body longer to eliminate fentanyl, and fentanyl remains detectable in the urine for longer than many other opioids, including longer than other synthetic opioids. This creates particular challenges for fentanyl “detox,” and starting effective treatment.
Street Fentanyl
Many (if not most) of the “prescription drugs” sold on the street are actually fentanyl that has been pressed into a pill form and often made to look like other prescription opioids.
This means that when buying and selling opioid medications on the street, many people are actually taking fentanyl, even if they think it is something else.
The fact that it is relatively easy to obtain fentanyl has worsened the opioid epidemic and made opioid overdose deaths more common.
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Medical Use of Fentanyl
Fentanyl is commonly used in the hospital for pain relief. It is also a common part of sedation for inpatient and outpatient procedures (such as colonoscopies).
Prescription fentanyl has a role in outpatient medicine and can be used as part of the treatment of severe pain, especially for cancer patients. For patients undergoing cancer treatment with severe pain, fentanyl nasal spray is sometimes prescribed for the treatment of severe pain.
However, these nasal sprays are used sparingly. These uses should not be confused with fentanyl addiction.
What is Fentanyl Addiction?
Because fentanyl is highly potent, it is easy to develop physical dependence. Once a person has become dependent, he or she experiences withdrawal symptoms when trying to stop.
The symptoms of fentanyl withdrawal are similar to other opiates and include body aches, severe cravings, abdominal pain, nausea, vomiting, sweating, and insomnia, among others.
Fentanyl addiction is similar to any other drug addiction and involves substance use that is getting in the way of life– interfering with relationships with family members, work, friends, and life obligations.
Unique Challenges With Fentanyl Addiction Treatment
The fact that fentanyl is more potent than many other opioids means that the opioid receptors in the brain have gotten used to a higher dose of opioids, relative to patients taking opioid medications, for example.
This creates some unique challenges in managing the severe pain and withdrawal symptoms that come with fentanyl addiction.
The fact that fentanyl is fat soluble, and so stays in the body longer than some other drugs in the opioid class, also creates some unique challenges in helping patients get started on fentanyl addiction treatment.
Fentanyl Addiction Treatment is Effective
While drug abuse can leave people feeling stuck and hopeless, safe and effective treatment is available. Treatment for fentanyl abuse starts with an assessment.
At this initial assessment, we work to understand the history of substance abuse (including the use of other drugs), duration, and treatments tried before (it is common that our patients have already been to many treatment centers).
We then discuss if there are prescription medications that could help. While the unique characteristics of fentanyl present some challenges for starting a treatment program, the long-term treatment options for fentanyl abuse are similar to the treatment options for other forms of opioid use disorder.
We know that using medication (medication assisted treatment, or MAT) dramatically increases the chances of successful treatment.
Outpatient Treatment For Fentanyl Abuse
Most patients with opioid addiction, including patients who use fentanyl, enter treatment on an outpatient basis.
Initially, treatment is directed toward managing withdrawal symptoms and getting patients transitioned to not taking fentanyl. Once a person has been stabilized, we work to rebuild– re-establishing routines (for example, not spending time around drug dealers), and building support. Each individual’s treatment is unique, and the recovery process needs to be tailored to the individual.
Our fentanyl addiction treatment program is not one-size-fits-all but is an ongoing conversation between the patient and the treatment provider. For some people who have been abusing fentanyl, individual treatment programs including family therapy, individual therapy, or group therapy sessions are a part of feeling better.
However, there is no requirement to attend therapy sessions. For some people, the road to overcoming substance abuse means also treating mental illnesses, or treating other co-occurring disorders. The core of our treatment program is flexibility— the patient must be at the center of the recovery process.
Residential Addiction Treatment Centers
Some people feel that the only way to get fentanyl addiction treatment is at an inpatient rehab center. This is a great option for some people who are suffering from a substance use disorder and can be a good way to start recovery.
For people that have been to residential treatment, we can start seeing you after discharge, to provide ongoing support for your recovery.
Fentanyl addiction treatment is not a short-term process but requires ongoing care and support to be successful. All opioid use disorder patients are at high risk of relapse.
The goal of recovery is not just to stop using drug abuse, but to live a life that is healthy, happy, and meaningful. If we believe that opiate use disorder (including fentanyl abuse) is a chronic disease, the long-term goal is good disease control.
Our standard of care is to take care and support our patients how we would want someone to care for and support our family members if they were struggling with addiction.
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We Are An Outpatient Addiction Treatment Center
Not everyone wants or needs inpatient rehab centers. When a stay at an inpatient treatment center is not the right path, we work with patients to transition directly off of fentanyl without staying at a residential rehab center.
At the initial appointment, we work with our patients to develop an individualized treatment plan.
We review treatment options and decide together how to manage sometimes painful withdrawal symptoms— usually by prescribing short-term medications. Once fentanyl misuse has stopped, we transition to building a plan for stabilization and recovery.
Substance abuse treatment is not a short-term proposition: the goal is not just to get stop drug abuse, but to stay off. We believe that substance abuse is a chronic disease— like diabetes or hypertension. Given that, we are interested in how to establish long-term disease control.
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Evaluating and Treating
Mental Illnesses
Many patients who suffer from substance abuse disorders also struggle with mental illness. However, understanding and accurately diagnosing mental illness in the context of an active substance use disorder is nearly impossible.
When a person is actively abusing fentanyl (or having a lot of withdrawal symptoms), it is difficult to distinguish symptoms of mental illness from symptoms of drug use.
However, as people begin to stabilize and move away from an active substance use disorder, co-occurring mental illnesses become easier to diagnose and treat. It is at this time that individual therapy sessions start to become more useful as well.
We are an addiction treatment center, which means sometimes our patients’ psychiatric diagnoses exceed our ability to effectively treat them; in these cases, we will involve other experts in the community to help our patients get the care they need.