Commonly Asked Questions about Addiction and Treatment
Facts about fentanyl
Fentanyl is a powerful synthetic opioid analgesic that has garnered significant attention in recent years due to its role in the opioid crisis. Here are some essential facts about fentanyl:
Potency: Fentanyl is estimated to be 50 to 100 times more potent than morphine and 25 to 50 times more potent than heroin. Due to its high potency, it is prescribed in micrograms (mcg) rather than the milligrams (mg) typically used for other opioids.
Medical use: Fentanyl is primarily used in medical settings to manage severe pain, such as chronic pain or breakthrough pain in cancer patients. It is also used as an anesthetic during surgical procedures. Fentanyl is available in various forms, including transdermal patches, lozenges, tablets, and injections.
Illicit use: Fentanyl has become a significant concern in the illicit drug market due to its potency and relatively low production cost. Illegal fentanyl is often mixed with other drugs, such as heroin, cocaine, or counterfeit prescription pills, increasing the risk of overdose for unsuspecting users.
Overdose risk: Fentanyl's potency makes it particularly dangerous, as even a small amount can cause an overdose. Signs of fentanyl overdose include slow or shallow breathing, unresponsiveness, pinpoint pupils, cold and clammy skin, and loss of consciousness. Fentanyl overdoses can be fatal if not promptly treated.
Naloxone: Naloxone, also known as Narcan, is an opioid antagonist that can rapidly reverse the effects of a fentanyl overdose by displacing the drug from the opioid receptors in the brain. Due to fentanyl's potency, multiple doses of naloxone may be necessary to reverse an overdose effectively.
Fentanyl analogs: There are numerous fentanyl analogs or derivatives, such as carfentanil, acetylfentanyl, and furanylfentanyl. These analogs can have varying potencies, often significantly stronger than fentanyl itself, which can further increase the risk of overdose and fatalities.
Legal classification: Fentanyl is a Schedule II controlled substance in the United States, indicating that it has a high potential for abuse and dependence but also has accepted medical uses. Illicit fentanyl and its analogs are often classified as Schedule I substances, indicating that they have no accepted medical use and a high potential for abuse.
Addiction and dependence: Fentanyl, like other opioids, carries a risk of addiction and physical dependence. Chronic use can lead to tolerance, requiring higher doses to achieve the same effect, and withdrawal symptoms if usage is reduced or stopped abruptly.
What is the most common substance abuse disorder?
The most common substance use disorder globally is alcohol use disorder (AUD). This disorder, often referred to as alcoholism, is characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.
Alcohol use disorder is defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of eleven criteria, within a 12-month period.
The criteria include issues like spending a lot of time drinking, or recovering from drinking, giving up important social or recreational activities in favor of drinking, developing a tolerance (needing to drink more to achieve the desired effect), experiencing withdrawal symptoms when not drinking, and continuing to drink even when it's causing physical or psychological problems.
It's important to note that substance use disorders can develop with the use of many different substances, including illicit drugs like cocaine or heroin, and legal substances like alcohol or prescription medications. The prevalence of these disorders can vary by region and demographic group.
Regardless of the substance involved, these disorders can have serious impacts on individuals' physical and mental health, relationships, and ability to work or study. Treatment can often help people with substance use disorders to recover and lead healthy lives. If you or someone you know is struggling with substance use, don't hesitate to seek professional help.
What is the purpose of drugs such as methadone, suboxone and subutex in the recovery process?
Methadone, Suboxone (a combination of buprenorphine and naloxone), and Subutex (buprenorphine) are medications used in Medication-Assisted Treatment (MAT) for opioid use disorders. Their primary purpose in the recovery process is to help manage withdrawal symptoms and reduce cravings, facilitating a safer, more comfortable transition to abstinence or long-term management of the disorder. Here's a more detailed look at how each of these medications function:
Methadone: Methadone is a long-acting opioid agonist, which means it activates the same receptors in the brain that other opioids like heroin, morphine, or prescription painkillers do. However, it does so more slowly and for a longer duration, without causing the intense euphoria associated with misuse of those drugs. This helps to mitigate withdrawal symptoms and cravings, enabling individuals to function more normally in daily life.
Suboxone: Suboxone contains two active ingredients: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, meaning it activates the opioid receptors in the brain, but to a lesser extent than full agonists like heroin or methadone. This can help manage cravings and withdrawal symptoms without producing the high associated with opioid misuse. Naloxone is an opioid antagonist, meaning it blocks the effects of opioids. It's included in Suboxone to discourage misuse of the medication; if someone tries to inject Suboxone, the naloxone will trigger withdrawal symptoms.
Subutex: Subutex is the brand name for buprenorphine alone. Like in Suboxone, buprenorphine in Subutex serves to lessen withdrawal symptoms and reduce cravings. It is typically used in the initial stages of treatment, while Suboxone is more commonly used for maintenance.
These medications are typically used as part of a comprehensive treatment plan that also includes counseling and behavioral therapies. It's important to note that while these medications can be highly effective in supporting recovery, they should be used under the guidance of a healthcare provider due to the risk of misuse and potential side effects. Each individual's treatment plan should be tailored to their unique needs and circumstances to ensure the best possible outcomes.