Much of what we hear about fentanyl revolves around overdoses, but addiction to the drug is becoming a major problem for doctors and nurses.
In 2021, 108,000 people died from a drug overdose in the United States, according to CDC data, and upwards of 70% of those overdoses involved fentanyl.
“There was one time after I started using intravenous heroin that I did come across the fentanyl that came over the border—the powdered form—and I was scared, so I chose to smoke it rather than to use it intravenously and I [overdosed] on it and if somebody didn’t find me in 15 minutes, I would’ve died,” recalled Sean Kavanagh, a 31-year-old former addict who lives in Dallas.
The incident led Kavanagh to rehab, but he quickly fell out like he had so many times before, because fentanyl is proving to become harder to quit than other opioids according to experts.
“A lot of times I left treatment because either the withdrawal got uncomfortable or I’d get through the physical withdrawal, but then, I was still dealing with the mental aspect," said Kavanagh.
Doctors are calling it precipitated withdrawal, or withdrawal brought on by the very drugs meant to ease them.
Right now, opioid addiction is treated by two main drugs: buprenorphine and methadone. They are known as partial agonists or drugs that bind to the same receptors as opioids. Think of them as placeholders so you do not get a high, but you also do not get the withdrawal.
Traditionally, these agonists are administered once the original drug, say heroin or morphine, has left the system.
The thing about fentanyl is it breaks down in the body a lot slower than naturally occurring opiates, so where a withdrawal from heroin might last 24 hours, a withdrawal from fentanyl might last 72 hours.
“Trying to treat fentanyl as if it is the same as any other opioid is playing into the cycle of addiction,” said Eve Sandler, the clinical director at Gallus Medical Detox, a facility that helps wean people off drugs.
Sandler says the prolonged discomfort of the withdrawal only worsens the fentanyl epidemic as it scares people away from help.
“I think it prevents a lot of people from seeking treatment to begin with,” she said. “No one wants to think they’re going to suffer inside a facility outside their comfort zone for days and days and not be appropriately treated, and it makes it challenging to get people to seek help.”
“When you’re still coming to, there’s still the addict mind in you that says, 'I still want to go get high again,'” added Kavanagh.
Kavanagh is clean now and has started working for a treatment center but knows how tempting it can be to use again to ease the pain
Doctors are still trying to find best practices to overcome this challenge of precipitated withdrawal, for they know the longer it persists, the fewer stories like Kavanagh's will prevail.
“Recovery is a beautiful thing,” said Kavanagh. “Today, I have a beautiful fiancé, a beautiful 4-year-old daughter. I get to be present in their lives. I get to love them, serve them, which is a spiritual high in and of itself.”