Fentanyl Addiction Treatment
What Is Fentanyl?
Fentanyl (Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT and Tango and Cash) is a synthetic opioid analgesic. Its chemical name is N-phenyl-N-[1-(2 phenylethyl)-4-piperidinyl] monohydrochloride. Fentanyl was formulated originally during the 1950s and synthesized by Janssen Pharmaceuticals in 1960. At the time, it was thought to be a safer and more effective alternative to the painkillers morphine and meperidine. The reality is the drug is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin. According to research published in the journal Annals of Pharmacotherapy, a fentanyl dosage of as little as .25 mg can be fatal. To put that in perspective, a standard aspirin tablet is 325 mg. Like other opioid drugs, fentanyl works by binding to the body’s opioid receptors, found in areas of the brain controlling pain and emotions.1,2,3
Fentora, the first brand of fentanyl pills, was approved by the U.S. Food and Drug Administration (FDA) in September 2006. Types of currently prescribed, FDA-approved fentanyl include:
- Fentora, a tablet placed between the gum and cheek
- Duragesic, a transdermal patch placed on the skin
- Actiq, a lozenge on a stick (lollipop)
- Abstral, a sublingual tablet placed under the tongue
- Onsolis, a film applied to the inner lining of the cheek or lip
- Lazanda, a nasal spray
- Subsys, a sublingual spray4
Many drug addicts use fentanyl because it provides a more powerful high than heroin, albeit of shorter duration. Like other opioids, fentanyl is highly addictive and users often take it or other opioids to avoid withdrawal symptoms. Some users unsuspectingly shoot up a potentially lethal combination of heroin or cocaine laced with fentanyl, which significantly increases its potency and danger. Illicit fentanyl is produced in clandestine laboratories primarily in Mexico and China as a powder, spiked on blotter paper or manufactured in tablets resembling less potent opioids. In the latter case, users believe they are buying prescription pain pills like oxycodone or hydrocodone, both of which are far less potent than fentanyl. In fact, pills found in the Minnesota home of Prince were reportedly marked hydrocodone, although testing revealed they contained fentanyl. Subsequent toxicology reports attributed the death of Prince to fentanyl.1,3,5,6
Naloxone (Narcon) is a lifesaving emergency intervention used to help prevent opioid-related overdose deaths, but it does not address the underlying dependency. Due to its powerful and addictive effects, professionally supervised detox and rehab is the only safe and efficacious treatment method for people addicted to fentanyl.2,3
Fentanyl Addiction and Abuse
Fentanyl abuse has become rampant, with news reports of overdose spikes in cities across the U.S. Nearly half of all unintentional drug overdose deaths in New York City from July to December 2016 involved fentanyl. In Nassau and Suffolk counties in Long Island, New York, America’s most densely populated suburban region, fentanyl killed more than 220 people in 2016. In Long Island, fentanyl surpassed heroin as the most commonly detected drug in fatal opioid overdoses in 2016.7
In June 2016, in less than two days, 17 people presented at emergency rooms in New Haven, Connecticut, for undetermined drug overdoses. Of the 14 victims who survived, all of them said they believed they were buying cocaine. While most were current cocaine users, the absence of other opioids such as heroin, methadone or oxycodone indicated the majority of these individuals were not habitual opioid users. Testing by the DEA showed these individuals took pure fentanyl.8,9
Fentanyl causes elevated dopamine levels in the brain’s reward areas, thereby producing a state of euphoria and relaxation. A person with chronic pain can develop a tolerance to legally prescribed fentanyl and take escalating doses in order to obtain relief. In some instances, a legal prescription may run out, causing an individual who is already hooked on the drug to buy it on the street. Others abuse the drug strictly for its euphoric effects. Treatment for fentanyl addiction, whether through inpatient rehab or an intensive outpatient program, is already challenging, but it becomes more so with the co-occurring use of other illicit and prescription drugs, whether intentional or unintentional.2
Stats and Facts
- From 2013 to 2014, the number of fentanyl submissions and synthetic opioid deaths in the U.S. increased by 426% and 79%, respectively. Among the 27 analyzed states, increases in fentanyl submissions were strongly associated with the rising number of synthetic opioid deaths.10
- From 2014 to 2015, the death rate from synthetic opioids other than methadone, including fentanyl, increased by 72.2%.11
- The 15.6% increase in opioid-related deaths from 2014 to 2015 was attributed primarily to illicitly manufactured fentanyl and heroin. The cases involving illegal fentanyl were concentrated in eight of 27 states examined.11
- From 2014 to 2015, states with more than 70% increases in death rates from synthetic opioids other than methadone were Connecticut, Illinois, Maine, Massachusetts, New Hampshire, New York, Ohio, Tennessee and West Virginia.12
Even after successful treatment, few opioid users are able to maintain continuous abstinence during the first year of recovery. The first two weeks after the end of treatment are associated with the highest incidence of overdose, because tolerance is low and new patterns of healthy behavior have not yet been established. Like other opioids, buprenorphine and Suboxone are administered during inpatient detox to help decrease withdrawal symptoms and the incidence of relapse in addicted individuals.13
- What Is Fentanyl? The Drug That Killed Prince Has Killed Thousands of Others. NBC News website. http://www.nbcnews.com/news/us-news/what-fentanyl-drug-killed-prince-has-killed-thousands-others-n584961 Published June 3, 2016. Accessed February 10, 2017.
- What is Fentanyl? National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugfacts/fentanyl Updated June 2016. Accessed February 10, 2017.
- Fentanyl Abuse. Drug Abuse website. http://drugabuse.com/library/fentanyl-abuse/ Accessed February 10, 2017.
- What Is Fentanyl (Duragesic)? Everyday Health website. http://www.everydayhealth.com/drugs/fentanyl Accessed February 10, 2017.
- Drugs website. https://www.drugs.com/fentora.html Updated November 3, 2016. Accessed February 10, 2017.
- CNN website. Prince’s death and the growing fear of the ‘kill pill’. http://www.cnn.com/2016/08/26/health/prince-minnesota-fentanyl-counterfeit-pills/ Published September 1, 2016. Accessed February 10, 2017.
- Kevin Deutsch. Fentanyl Outpaces Heroin as the Deadliest Drug on Long Island. The New York Times. December 28, 2016. https://www.nytimes.com/2016/12/28/nyregion/fentanyl-epidemic-long-island.html?_r=2 Accessed February 10, 2017.
- Nicholas Rondinone. Three Arrested In Wake Of Fatal New Haven Fentanyl Overdoses. Hartford Courant. June 28, 2016. http://www.courant.com/health/heroin/hc-new-haven-overdose-update-0628-20160627-story.html Accessed February 10, 2017.
- Tomassoni AJ, Hawk KF, Jubanyik K, et al. Multiple Fentanyl Overdoses – New Haven, Connecticut, June 23, 2016. MMWR Morb Mortal Wkly Rep. 2017;66:107-111. doi http://dx.doi.org/10.15585/mm6604a4.
- Gladden RM, Martinez P, Seth P. Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid-Involved Overdose Deaths – 27 States, 2013–2014. MMWR Morb Mortal Wkly Rep. 2016;65:837–843. doi: http://dx.doi.org/10.15585/mmwr.mm6533a2.
- Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths – United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445-1452. doi: http://dx.doi.org/10.15585/mmwr.mm655051e1.
- Synthetic Opioid Data. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/data/fentanyl.html Updated December 16, 2016. Accessed February 10, 2017.
- Buprenorphine: Long-term Efficacy for Opioid Dependence. Medscape website. http://www.medscape.com/viewarticle/863801 Published May 25, 2016. Accessed February 10 2017.