Why Is Fentanyl So Addictive?
Opioids, in general, are highly addictive substances. Even when people begin using opioids as prescribed, they can become addicted. Fentanyl is much more powerful than morphine or even heroin, making it more addictive than these drugs.
When someone uses fentanyl, it activates opioid receptors found throughout the body and in particular the central nervous system. As these opioid receptors are activated, it can relieve pain and change the emotional response to pain.
It can also trigger dopamine to flood into the brain, creating a sense of euphoria or a pleasurable sense of well-being. Those pleasurable feelings trigger a reward cycle in the brain. The brain is conditioned and wired to want to keep seeking out the stimuli that provide these pleasurable feelings. In this case, that stimulus is fentanyl.
The Road To Addiction
Addiction is born when someone’s brain compulsively leads them to continue seeking out fentanyl and other opioids. Over time, with addiction to fentanyl, the structure and function of the brain changes, and effective addiction treatment needs to account for these changes.
Along with psychological addiction, fentanyl also leads to physical dependence. If a person is dependent on fentanyl and they attempt to stop using it, they will experience withdrawal symptoms. Fentanyl withdrawal can be severe and highly uncomfortable.
There are three terms related to fentanyl, and they’re often used interchangeably. These terms are abuse, dependence, and addiction. These terms don’t mean the same thing. Fentanyl abuse means someone is using the drug in any way other than how it’s prescribed. Substance abuse doesn’t mean someone is addicted or dependent on that substance, although abuse often leads to both.
Fentanyl dependence means a person’s brain and body are dependent on the presence of the drug to have a sense of “normalcy.” Drug dependence can occur with prescription opioids even if used exactly as a doctor indicates they should be. If someone is dependent on fentanyl, stopping suddenly or cold turkey can cause withdrawal symptoms.
Finally, there is the addiction. Addiction is a diagnosable disorder with a certain set of symptoms. Addiction can be diagnosed as mild, moderate or severe, depending on how many of the symptoms a person displays.
Fentanyl withdrawal occurs as the body attempts to stabilize after it’s no longer exposed to fentanyl. Drug withdrawal can be uncomfortable and in some cases, there can be severe or deadly consequences.
Even if someone is prescribed an opioid medication, their doctor will recommend they gradually taper down their dosage rather than stopping cold turkey. This can help minimize or reduce withdrawal symptoms.
Some of the symptoms of fentanyl withdrawal can include:
- Teary eyes
- Aches and cramps
- Joint and muscle pain
- Nausea and vomiting
- Rapid heart rate and increased breathing rate
- Sleep disturbances
- Dilated pupils
- Severe drug cravings
While the physical symptoms of fentanyl withdrawal can be difficult enough, the psychological symptoms are often the most challenging for people. When the brain is exposed to artificially high levels of dopamine, as it is with the use of fentanyl, to readjust without it can be psychologically difficult.
Many times as someone is going through opioid withdrawal, the neurotransmitters in their brain have a hard time naturally creating a sense of pleasure.
Psychological symptoms including anxiety and depression can persist for weeks or longer after someone stops using fentanyl.
Fentanyl Detoxification Timeline
People often wonder how long fentanyl withdrawal symptoms will last. The short answer is that it can depend. Some of the factors that play a role in how long fentanyl withdrawal lasts include a person’s individual body chemistry, how long they used fentanyl, the ways they used it, and the dosage they were using.
Withdrawal symptoms can begin anywhere from 12 to 30 hours after the last dose of fentanyl is taken. If someone regularly abuses extended-release versions of fentanyl, it can take longer for withdrawal symptoms to appear. The earliest symptoms of fentanyl withdrawal include sleep disturbances, aches and pains, and a runny nose.
Most people will experience the peak symptoms of fentanyl withdrawal within around four days after the last dose of the drug is used. For most people, the symptoms of withdrawal will start to subside in about a week although some may persist for longer.
Fentanyl Withdrawal and Overdose
One of the biggest risks of fentanyl withdrawal and detox is that someone will relapse. If a person goes through a period of withdrawal and fentanyl is eliminated from their system, a potential relapse can become much more dangerous.
When someone stops using fentanyl even for a short period of time, their tolerance goes down. When that happens and if they relapse and use the same dose as before, it’s much more likely they will suffer an overdose. That overdose can be fatal.
The fentanyl detox process is one where the drug leaves the system of the user. It’s essential for someone to go through a full fentanyl detox before beginning addiction treatment. The best option with a drug like fentanyl is a medically-managed detoxification program.
During a medically-managed detox from fentanyl, patients can be kept safe and comfortable. This minimizes the risk of complications and also relapse.
Many fentanyl rehab centers include a medically-managed detox as part of their program.
During a medical detox from fentanyl, the staff and medical professionals have an understanding of the patient’s mental and physical health history and their drug use. A medical detox may include monitoring, certain medications to reduce symptoms, and holistic support, such as the provision of nutritional meals.
Opioid Maintenance Medications
Due to the effects of the opioid epidemic, there has been an increased level of attention placed on certain maintenance medications. Opioid maintenance medications include buprenorphine and methadone, among others. The goal of these medicines is to help people stop using other stronger opioids like fentanyl.
Both buprenorphine and methadone are weaker opioids, and they fill the same receptors in the brain as fentanyl, without the more severe effects.
While opioid maintenance medicines have helped some people, the use of these medications can be controversial. There is the feeling that for many people, rather than helping them stop using opioids, these drugs just replace other opioids. Users may remain dependent on opioids for many years when they use a medication-assisted treatment like methadone.
Goals of Fentanyl Treatment
Fentanyl is one of the deadliest opioids available right now. There are prescription versions of fentanyl given to patients primarily with breakthrough cancer pain.
There are also illegal, black market versions of fentanyl that are made in labs. Regardless of the specifics of why someone is abusing fentanyl or addicted to it, seeking treatment is essential.
The goals of fentanyl treatment include:
- Fentanyl treatment should address the complexity of addiction. Addiction is multifaceted, and it isn’t just about drug use. It’s also about a person’s social life and their physical and psychological health. In order for treatment to be effective, all of the elements of addiction have to be fully addressed.
- Addiction treatment should help someone to not only stop using fentanyl but also learn how to live a life without relying on substances.
- Once someone completes an addiction treatment program, they should be able to return home and live their daily lives productively. They should also be prepared to be a thriving and productive member of society in general.
- Someone who participates in a fentanyl addiction treatment program will often learn how to manage their stress in the future without the use of any substances. This can include not only treatment with a focus on stress management, but also coping strategies.
- Fentanyl treatment can help someone understand and avoid triggers, and also learn how to cultivate a support network once they leave rehab.
- Most fentanyl treatment programs will also incorporate elements of family therapy to help people struggling with addiction to repair their relationships and learn how to function as a healthy spouse, parent or child.
In order to achieve these significant goals, fentanyl treatment needs to be highly individualized to the needs of the particular person. Treatment plans don’t remain static, either. Treatment plans change and evolve as the patient progresses.
Specific Types of Therapy and Treatment
Opioids are highly addictive and the addiction cycle is difficult to break. Fentanyl is one of the most potent opioids, and also one of the most addictive—even more so than heroin for many people. When someone goes to treatment for fentanyl addiction, the following are some of the types of therapy and treatment modalities that may be part of their plan.
There are many different types of counseling, and regardless of the style of counseling that’s used, it is the cornerstone of addiction treatment. Counseling helps people learn about themselves and their addiction. It can help them change their attitudes and consequently, their behaviors as well.
Individual and group counseling are often both included in addiction treatment programs. Each has benefits for someone who’s receiving fentanyl addiction treatment. During group therapy, there is a sense of support and shared experiences. Group therapy can help people feel challenged and more accountable for their actions and their dedication to remaining opioid-free.
Many programs that people participate in after rehab, such as 12-step programs are based on concepts of group therapy. When someone goes to rehab for fentanyl, and they participate in group therapy sessions, it prepares them to participate in support groups after rehab, which is essential for remaining abstinent from drugs.
Individual therapy has benefits as well, particularly when someone suffers from mental health conditions or trauma that play a significant role in their addiction. Dual diagnosis treatment, in particular, will focus on individual counseling and therapy. Someone can’t be treated for fentanyl addiction if they have an untreated mental health disorder such as bipolar disorder or depression.
Cognitive Behavioral Therapy
In treatment for fentanyl addiction and opioid addiction, cognitive behavioral therapy is the most commonly relied upon method. CBT is a way for people to learn how to recognize the triggers that could lead to drug cravings or a relapse.
With CBT, patients in treatment programs can learn how to avoid triggers that could lead them back to fentanyl. It is also a way for people to learn healthier ways to deal with their feelings and certain situations.
Contingency Management Therapy
Another form of treatment that could be used in fentanyl addiction treatment is contingency management therapy. Contingency management therapy helps people learn how to stay fentanyl-free by providing positive incentives.
However, there is controversy surrounding this method and its use in addiction treatment, since there aren’t always going to be positive incentives available. It may work in rehab, but not necessarily in the real world.
Motivational interviewing is a way for people to be open and honest about their use of fentanyl, but it’s not necessarily as confrontational as other forms of therapy.
Instead, therapists who use this technique try to understand what motivates the patient at the individual level, and they then use these naturally-occurring motivations as the basis for therapy.
When it’s an option, family therapy can be a critical component of addiction treatment for fentanyl and other substances. The family and loved ones of people who struggle with opioid addiction are severely impacted, and family therapy can help them along with helping their loved one abstain from opioids.
There is research showing integrating family members into addiction treatment can help improve long-term outcomes.
The 12-step model is used in support groups like Alcoholics Anonymous and Narcotics Anonymous. It’s also an important part of many rehab and treatment programs.
The 12-step model is based on the idea of surrendering to the idea that your life has become unmanageable, gaining a willingness to work on changing the problem, and identifying with the scenarios of other patients.
Evidence-Based Addiction Treatment
Before exploring the different types of fentanyl addiction treatment facilities, any center a person chooses should create recovery plans that are not just based on the individual but are evidence-based.
While addiction treatment needs to be compassionate, it also needs to be rooted in current research. This is the case with treatments for any other chronic disorder, and that’s what addiction is.
Evidence-based treatment can include medications and behavioral therapy.
For opioids, there are certain medications that can be given to help people. For example, methadone is a relatively weak synthetic opioid. Methadone is long-acting, and when it’s used, it’s also referred to as methadone maintenance treatment.
While methadone can help someone stop using other opioids including fentanyl, its use is controversial.
Methadone often creates a dependence of its own. Many people who start using methadone as a way to stop using fentanyl or other opioids, end up staying on it for years.
Buprenorphine is another type of opioid maintenance medication. It’s a partial opioid, and it also has the drug naloxone, which blocks opioids at receptor sites. This drug can help people stop using fentanyl, and it has a lower risk of abuse than methadone because of the naloxone component.
Not every fentanyl facility will offer these kinds of medications, however. Many rehab and treatment programs try to avoid the use of replacement and maintenance drugs like methadone and buprenorphine.
Behavioral therapy is really the focus of most opioid treatment centers. Behavioral therapy should help patients feel engaged and motivated during their time in treatment, and there should be incentives to remain in treatment and to continue to abstain from fentanyl.
Behavioral therapy for fentanyl addiction can also help people change their long-held attitudes and beliefs, shift their behavior, and learn to manage stress and triggers.
Choosing a Facility for Fentanyl Treatment
The following are some steps and tips to keep in mind when choosing a treatment facility for an addiction to fentanyl or other opioids:
- It’s important to first get an assessment by a medical professional or a licensed addiction treatment specialist. Before someone can determine the right type of treatment facility for their needs, they should have an understanding of their symptoms and the severity of their addiction. For example, someone with a mild addiction may opt for outpatient rehab, but this might not be an option for someone with a severe addiction disorder.
- Each person will have their own needs when it comes to addiction treatment, so it’s key to ensure a treatment facility will be able to address these. For example, if someone also struggles with depression, they will need to find a facility that offers dual diagnosis treatment.
- Not all fentanyl addiction treatment centers are going to use medication. This can be a benefit in the eyes of some patients or a downside to others, so it’s something to ask about and consider when choosing a facility
- Luxury doesn’t necessarily dictate the quality of care. A lower-cost rehab center can provide care that’s just as good as a luxury treatment center.
To learn more about the process to treat fentanyl addiction and dependence, or to ask questions about choosing a treatment facility, contact our team at Amethyst Recovery.