Opioid Addiction and Detox: Buprenorphine vs Methadone
Last week, I went over the history of opioids, and it really highlighted the trend of addiction that has always been linked with them. According to the World Health Organization, more than 15 million people are suffering from opioid dependence today. It’s clear that the opioid epidemic isn’t a new phenomenon; for as long as the opium poppy has been in existence, so has addiction. Historically speaking, what is relatively new is that physicians and pharma companies are recognizing the need for more effective ways to combat this epidemic, whether through prevention or treatment. As a result, we have some novel compounds that present different options for people who are addicted to these drugs; these include non-narcotic options for pain relief to prevent addiction, as well as medications to help addicted people on their road to recovery from opioid dependence. In a future blog, I’ll talk about a non-narcotic compound currently in patient trials that is showing a great deal of promise in the chronic pain arena. If you’re interested now, I posted a video on it on my YouTube channel, so check it out. But for today, I’m going to talk about the latter: two drugs, one relatively new and one not so much, that are being used to detox opioid addicts and give them a shot at a clean life. These two drugs are buprenorphine and methadone, and one of these is definitely not like the other. I’m going to compare and contrast them: the good, bad, and the ugly. By the end, you’ll not only know my opinion on the matter, but why I’m passionate about it.
What is Buprenorphine?
On the market for nearly twenty years, buprenorphine is a Schedule III drug used to help treat the physical ramifications of opioid withdrawal. Given as a simple medicine that dissolves under the tongue, buprenorphine satiates the opioid receptors that cause dependent people to crave opioids. It can be prescribed in its solo form, or as a branded compound product with naloxone, which is the familiar ‘resurrection’ drug Narcan. It is the most strictly regulated drug by DEA, and available only from physicians that have been specially certified in its use, a fact that has been the nexus of some controversy. Why? Some physicians and policy makers feel that the hoops that physicians must jump through in order to receive the ‘X Waiver’ required to prescribe it present a barrier to its use; that if certification requirements were relaxed or eliminated, more opioid-dependent people would have access to this option for detox. The objective of someone taking buprenorphine is to help them remain safe and comfortable as they go through detox from opioids so that they can focus on treatment and recovery. While some data claims that buprenorphine may create some feelings of well-being when a person takes it, it does not cause a euphoric high. It’s also worth noting that while it can be used safely long term, the duration of use of buprenorphine tends to be more short-term, which clearly verifies the absence of a high and it’s low potential for addiction. Buprenorphine’s binding action to opioid receptors in the brain blocks the narcotic effects of traditional opioids, so if a drug-dependent person takes buprenorphine and an opioid together, there’s still no “high,” thus eliminating the reason for taking said opioid. And, buprenorphine also has a ceiling effect, meaning that beyond a specific dose, its effects remain unchanged. This essentially does away with the “if one is good, four are better” phenomenon, so overdose is very rare.
What is Methadone?
Methadone is a drug that some physicians believe can be used to “help” opioid-dependent people as they try to stop using drugs. But that’s about where the similarities end. Old as the hills, methadone is a Schedule II opioid medication that’s been used for detox for 60 years. Methadone has a similar chemical structure to morphine; as such, methadone can, and does, make someone feel high. In theory, methadone doesn’t make people “as high” as some other opioids, and it can take longer for that high to occur, which proponents say translates into less potential for abuse. I say this is total bullshit. Why? Because we’re talking about drug-dependent people here, people! We’re dealing with people that, despite any good intentions they may have, their brains and bodies tell them they must get high. Remember that “if one is good, four are better” phenomenon I mentioned? Yeah. Bottom line is that methadone is a very strong opiate, so when a dependent person takes it, their addicted brain gets a taste of that high, and it’s like a tease…it tends to make them want more. Helllooo! There’s almost nothing that will stop a drug addicted brain from getting what it wants. There’s no blocking action and no ceiling with methadone, so overdoses are not unusual. Regardless, for over sixty years, methadone has been given as a “short-term” treatment to help people stop using opioids. That’s bad enough, but what’s worse is that it’s even more often used as a long-term maintenance drug for the “management” of opioid addiction. In reality, it’s replacing one bad drug with an even worse one. In fact, methadone is also known as “liquid handcuffs” by the people who have managed to successfully get off of their methadone “management” programs.
While the general objectives of buprenorphine and methadone use may be similar to one another, there are clearly many significant differences.
Methadone is almost exclusively dispensed by clinics on a per diem basis, meaning that people have to head to the clinic every day and line up to get their “medicine.” In contrast, a physician with an X waiver can write for a 30-day supply of buprenorphine. It is less problematic than methadone, largely because it’s less dangerous and less addictive than methadone, thanks to the ceiling effect precluding overdose, and the fact that it doesn’t cause a high. That said, people must keep in mind that buprenorphine is a powerful drug, and not one to be taken (or prescribed) lightly. Saying that it’s less dangerous than methadone, while absolutely true, is sort of like saying that rattlesnake bites are less dangerous than cobra bites. Me personally, I’d just rather not be bitten…but if I have to be bitten, bring on the freaking rattlesnake.
Buprenorphine vs. Methadone
It’s Science, People!
Both humans and animals have opioid receptors in the brain and spinal cord. Biologically speaking, these receptors facilitate the binding and effect of naturally produced pain-relieving chemicals. Externally sourced opioids like methadone belong to the opioid agonist class of drugs. They work by binding to these specific receptors in the brain and mimicking the effects of those naturally produced pain-relieving chemicals. As a result, the perception of pain is blocked, producing feelings of well-being and euphoria, but also side effects such as nausea, confusion, and drowsiness. While opioid drugs are often very effective in treating pain, people can eventually develop a tolerance, so they require higher doses to achieve the same effects. It’s a vicious cycle, so people become dependent, and will experience symptoms of withdrawal if they decrease or stop opioid dosing. That means that when it comes time to taper off of methadone, it’s intrinsically difficult, and withdrawal is unavoidable. Symptoms of opioid withdrawal can include anxiety, muscle aches, irritability, insomnia, runny nose, nausea, vomiting, and abdominal cramping. It’s seriously un-fun at best.
Buprenorphine belongs to the opioid agonist-antagonist class of drugs, and it is a partial opioid agonist. As such, it activates only a portion of an opioid receptor, so it only causes a portion of the effects of an opioid, specifically eliminating the euphoric effects of opioids like methadone. It has lower potential for causing respiratory depression than methadone, and that translates to little potential for overdose death. And it also effectively blocks the effects of other opioids, including heroin and prescription pain medications like fentanyl and oxycodone, so it’s much more likely to discourage relapse in recovering patients. Buprenorphine prescriptions can be filled and taken home, eliminating the need to go line up at a nasty clinic every single day. And because it’s much longer acting than methadone, buprenorphine doesn’t need to be taken every single day anyway, so patients aren’t tied to it; they have the freedom to spend more time doing activities that are more positive for their recovery. When it comes down to tapering off of buprenorphine, it’s far easier than methadone, with essentially zero physical withdrawal symptoms. All of these factors make a big difference, people.
Buprenorphine Pros vs Methadone
Newer, safer, more effective
Long acting, easy taper
Safe for use during pregnancy
Low overdose potential
Prevents opioid usage- blocks euphoria
Covered by most insurance carriers
Typically excluded from employment drug screening
Buprenorphine Cons vs Methadone
Can be more expensive out of pocket
Unpleasant taste sometimes reported
Requires specialized physician
In my practice, I treat a fair number of opioid addicted people, and I do not and will not ever use methadone to treat them…it makes zero sense, when there’s an alternative that is more effective, safer, and easier to use. Methadone doesn’t solve a problem, it creates a bigger one. If I have a new patient that is on methadone, I switch them to buprenorphine as a matter of course. It’s not easy on them, but I use every weapon available in my arsenal.
Methadone to Buprenorphine
In order to start taking buprenorphine, a patient must be in withdrawal, another un-fun fact. This is because buprenorphine is a bully. When you take it, it preferentially binds to those opioid receptors we talked about before. That means it kicks the true opioid off the receptor and replaces it. Doesn’t sound so horrible in theory, but it’s a very different thing in practice. The opioid addicted brain without its favorite thing- opioids- leads to a brain in withdrawal, which leads to a body in physical withdrawal…shakes, sweats, nausea, vomiting, diarrhea, muscle aches, and joint pain, just to name a few of the symptoms to be expected.
The patient must be in a state of withdrawal for a proscribed amount of time before you can dose them with buprenorphine, because it can be dangerous to give it sooner. The longer they can tolerate that withdrawal prior to dosing buprenorphine, the better the buprenorphine will work and the easier the process will be. The length of the ideal withdrawal time is based on the half-life of the opioid the patient is addicted to. The half-life of a drug is roughly the amount of time it takes for half of the drug to be metabolized by the body, ie that 50% of it is left. For most opioids, 24 to 36 hours is the ideal withdrawal time. But methadone’s half-life is crazy long; in some people, it can be between 88 and 59 hours. But wait…it gets worse. That’s just for half of the drug to be metabolized. It generally takes six or seven half-lives to fully metabolize out a drug so it is no longer biologically active, so in methadone you need to have ten days off before you can safely introduce buprenorphine. Again, this is because that buprenorphine is a bully, and if you introduce it too soon, when methadone is still parked on the opioid receptors, it’s going to kick that buprenorphine off and throw the person into instant, severe withdrawal, which is not only dangerous, but intolerable to patients. Coming off of methadone requires high doses of buprenorphine for the first 24 to 48 hours, even after waiting for it to metabolize out. Otherwise, you can precipitate major withdrawal where that person starts kicking their legs uncontrollably, sweating, flinging sheets off the bed, and having terrible muscle spasms and cramping- it’s a horror to watch, let alone experience. I had a new patient that had become addicted to strong opioids secondary to chronic, severe pelvic pain and a series of several consecutive pelvic surgeries for ovarian tumors. The whole thing lasted for years and culminated in a hysterectomy. Immediately upon release from the hospital after the hysterectomy, she checked herself in to rehab to detox, and they put her on buprenorphine way too soon. Her withdrawals were very severe, to the point where she vomited so hard that she tore 19 of her abdominal sutures open and had to be taken back to the operating room emergently. Needless to say, she wasn’t too keen on the possibility of that ever happening again.
So what’s a guy like me to do when a methadone-addicted patient comes in? If they’re committed, there are a couple of ways to handle it. Neither is fun nor risk free. One, you can step down from methadone to another opioid substitute like oxycodone in an incremental ratio for three days or so, stop the substitute for 24 hours, and then start buprenorphine. Or two, stop the methadone, wait as long as you can, which is usually two days, three max, of total misery, while using ancillary drugs like clonidine, benzodiazepines (like Klonopin, Ativan, and Xanax), muscle relaxants like Robaxin, and Mirtazapine to sleep. Basically using every drug possible to make the patient more comfortable, hold off on the methadone for as long as possible, and let the methadone metabolize out. Then put them on high dose buprenorphine for 48 hours, then drop to moderate dose for whatever time period is required.
In addition, there are some dietary type changes that are helpful. Taking high-dose vitamin C acidifies the urine, enhancing the secretion of methadone out of the system. Taking 1000 mg of vitamin C twice a day, drinking slightly less water if possible, and eating a lot of protein will help further acidify the body and constipate the system, which sounds like hell, but is actually a good thing for withdrawal.
The best way to deal with the situation is not to, meaning avoid becoming addicted in the first place. But, if you do find yourself addicted, do not choose a methadone detox, and definitely do not choose a methadone maintenance program. There’s just zero reason to do that when we have buprenorphine fairly readily available.
The clear consensus is that buprenorphine is the gold standard treatment for patients suffering from opioid addiction. As a provider, I’ve had the privilege of seeing patients reclaim their lives with the help of a buprenorphine detox regimen; it allows them to focus on their jobs, their families, and their own well-being, instead of physically, mentally, and emotionally battling their addiction every minute of every day, to the exclusion of all happiness.
So boys and girls, the moral of the story is…
Coming off methadone is not fun, and I have had patients who are still depressed, anxious, and unable to sleep- six months, eight months, even a year- after transitioning from methadone to buprenorphine, to the point where they still require medications to deal with it. Xanax and methadone are my two least favorite pharmaceuticals in the entire world, each for their own specific reasons. Clearly, for patients looking to switch from methadone to buprenorphine, it’s a tough row to hoe; the symptoms can be excruciating, especially if mismanaged, but don’t let that stop you from making the switch. My first and best advice is to avoid becoming an addict, but if you do become one, never go on methadone, for any length of time, ever. It’s a trap, pure and simple.
I hope you enjoyed this blog and found it educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Opioids: History, Use, Abuse, Addiction
How Did We Get Here?
Anchored in the history, culture, religion, mythology, biology, genetics, and psychology of the earliest civilizations to the societies of present day, humans have long tried to balance the positive medicinal properties of opioids with the euphoric effects that have so often led to their use and abuse.
Before we get into their history, first a quick fyi lesson in the semantics of the terms opiates vs opioids vs narcotics. While the terms are often used interchangeably, they are technically different things.
The term opiate refers to any drug that is derived from a naturally occurring substance, ie from opium alkaloid compounds found in the poppy plant. Types of opiate drugs include opium, codeine, and morphine. The term opioid is broader, and refers to any synthetic or partially synthetic drug created from an opiate. Examples of opioid drugs include heroin, methadone, oxycodone, and hydrocodone. Narcotics is an older term that originally referred to any mind altering compound with sleep-inducing properties.
For the general public, only the term opioid is really necessary, as it includes all opi- substances. In my practice and in my blogs, I sometimes make a distiction between the terms, but if you’re looking for a safe bet, or maybe a trivia win, the term opioid is the best and most accurate choice. Regardless of the word used, one is not any safer than the other; any opiate or opioid has the potential to treat pain, to be abused, and to cause dependence.
Following are some of the most common opioids and their generic names, listed in order of increasing strength.
Hydrocodone (Vicodin, Hycodan)
Morphine (MS Contin, Kadian)
Oxycodone (Oxycontin, Percocet)
History of Opiates
A long, long time ago, opiate use began with Papaver somniferum, otherwise known as the opium poppy. Native to the Mediterranean, it grew well in subtropical and tropical regions fairly easily, a fact that contributed to its historical popularity. Unripe poppy seed pods were cut, and the milky fluid that seeped from the cuts was scraped off, air-dried, and treated to produce opium.
In case you’re wondering… today, legal growing of opium poppies for medicinal use primarily takes place in India, Turkey, and Australia. Two thousand tons of opium are produced annually, and this supplies the entire world with the raw material needed to make the medicinal components. Papaver somniferum plants grow from the very same legal and widely available poppy seeds found in today’s many seed catalogues. But, planting these seeds is less legal, with the DEA classifying them as a Schedule II drug, meaning that technically, they can press charges against anyone growing this poppy variety in their backyard. You can ask this one dude in North Carolina about it, as he was busted for having one acre of these big blooming beauties behind his house. At about 9 feet tall and topped with big red blooms, they’re not exactly inconspicuous. Another grow was discovered after an Oregon state patrol officer stopped to look at a field of beautiful “wildflowers,” wanting to cut a bouquet for his wife… a story that I personally find totally hilarious. Evidently, when he cut the first one, he was surprised by the sap that got all over his hands, so instead of taking some home to his wife, he took one to a fellow cop friend that was big on horticulture, and she enlightened him on what it was. Good thing too, because he had even thought about how cool it would be to dry the “wildflowers” to seed and plant them in his side yard! You just can’t make this stuff up.
Archaeologists have found 8,000 year-old Sumerian clay tablets that were really the earliest “prescriptions” for opium. The Sumerians called the opium poppy “Hul Gil,” meaning the “Joy Plant,” which was regularly smoked in opium dens. Around 460-357 B.C. Hippocrates, known as the “Father of Medicine” acknowledged opium’s usefulness as a narcotic, and prescribed drinking the juice of the poppy mixed with nettle seed. Alexander the Great took opium with him as he expanded his empire- it’s surprising that he was so great, because some accounts seem to suggest that he was a raging addict. Arabs, Greeks, and Romans commonly used opium as a sedative, presumably for treating psychiatric disorders. In the 15th and 16th centuries, Arabic traders brought opium to the Far East. From there, opium made its way to Europe, where it was used as a panacea for every malady under the sun, from physical ailments to a wide variety of psych issues. Biblical and literary references, and opium’s use by known and respected writers, leaders, and thinkers throughout history, including Homer, Franklin, Napoleon, Coleridge, Poe, Shelly, Quincy, and many more, made opium use perfectly acceptable, even fashionable.
19th Century Opiates to Opioids
There was a lot of unrest and violence around the globe throughout the 1800’s. Wounded soldiers from the American Civil War, British Crimean War, and the Prussian French War were basically allowed to abuse opium. And sure enough, beginning in the 1830’s, one-third of all lethal poisoning cases were due to opium and its opiate derivatives, and this really marked the first time that a “medicinal” substance was recognized as a social evil. Yet, most places around the world still really turned a blind eye to opium and opiate use. But, so many soldiers developed a dependency on opiates that the post-war addiction state was commonly known as “soldier’s disease.”
In 1806, German alkaloid chemist Friedrich Wilhelm Adam Sertürner isolated a substance from opium that he named “morphine,” after the god of dreams, Morpheus. The prevailing wisdom for creating morphine was to maintain the useful medicinal properties of opium while also reducing its addictive properties. Uh huh, sure. In the United States, morphine soon became the mainstay of doctors for treating pain, anxiety, and respiratory problems, as well as consumption and “female ailments,”
(that’s old-timey for tuberculosis and menstrual moodiness/ cramps) In 1853, the hypodermic needle was invented, upon which point morphine began to be used in minor surgical procedures to treat neuralgia (old timey for nerve pain). The combination of morphine and hypodermic needles gave rise to the medicalization of opiates.
Well, morphine turned out to be more addictive than opium, wouldn’t ya know it. So, as with the opium before it, the morphine problem was “solved” by a novel “non-addictive” substitute. Of course… I mean, what could possibly go wrong? Your first clue is that this novel compound was the first opioid, and was called heroin. See where this is going? First manufactured in 1898 by the Bayer Pharmaceutical Company of Germany, heroin was marketed as a cough suppressant, a treatment for tuberculosis, and a remedy for morphine addiction. Well, as you can probably guess, that worked great, until heroin proved to be far more addictive than morphine ever thought of being. So what to do? Hmmm… what…to…do… I know! Let’s make a “non-addictive” substitute for the heroin! That’s the best plan, definitely.
20th Century: Opiates to Opioids
By the dawning of the 20th century, the United States focused on ending the non-medicinal use of opium. In 1909, Congress finally passed the “Opium Exclusion Act” which barred the importation of opium for purposes of smoking. This legislation is considered by many to be the original and official start of the war on drugs in the United States. Take that, Nancy Reagan! In a similar manner, the “Harrison Narcotics Tax Act of 1914” placed a nominal tax on opiates and required physician and pharmacist registration for its distribution. Effectively, this was a de-facto prohibition of the drug, the first of its kind.
In 1916, a few years after Bayer stopped the mass production of heroin due to the dependence it created, German scientists at the University of Frankfurt developed oxycodone with the hope that it would retain the analgesic effects of morphine and heroin, but with less physical dependence. Of course they did, because this worked out so swimmingly before. What could possibly go wrong?
Well, we know how this story turns out.
First developed in 1937 by German scientists searching for a surgical painkiller, what we know today as methadone was exported to the U.S. and given the trade name “Dolophine” in 1947. Later renamed methadone, the drug was soon being widely used as a treatment for heroin addiction. But shocker… unfortunately, it too proved to be even more addictive than its predecessor heroin. Captain Obvious says he’s sensing a trend here.
In the 1990’s, pharmaceutical companies developed some new and especially powerful prescription opioid pain relievers. They then created some equally powerful marketing campaigns that assured the medical community that patients would not become addicted to these drugs. Gleefully, docs started writing for them, and as a result, this class of medications quickly became the most prescribed class in the United States- even exceeding antibiotics and heart medications- an astounding statistic. Well, we now know that the pharma co’s were full of crap: opioids were (and still are) the most addictive class of pharmaceuticals on the planet… and so in the late 90’s, the opioid crisis was born.
Opioids: True and Freaky Facts
The real fact is that 20% to 30% of all patients who were/ are prescribed opioids for chronic pain will misuse them. Further, studies on heroin addicts report that 80% of them actually began their addiction by first misusing prescription opioids. That’s a big number people, but I think it’s actually higher. Food for thought for all the pill poppers out there saying ‘I’ll never use a street drug like heroin.’ And speaking of that, by the turn of the 21st century, the mortality rate of heroin addicts was estimated to be as high as twenty times greater than the rest of the population. Twenty times, people.
Opioid Addiction and Overdose
Opioids produce a sense of wellbeing or euphoria that can be addictive to some people. Opioids are often regularly and legitimately prescribed by excellent, well-meaning physicians when treating patients for severe pain. The problem is that even when taken properly, many people develop tolerance to these opioids, meaning they need more and more to get the same effect and relieve their pain. That’s just one factor that makes them so insidious. In addition, we cannot predict who will go down this tolerance and potential addiction path, because it can happen to anyone who takes opioids. However, there are some factors that make people more susceptible to addiction, such as the presence/ prevalence of mood disorder(s) and especially a genetic/ familial history of addiction, which contributes to nearly 50% of abuse cases.
When people become addicted to opioids, they begin to obsessively think about ways they can obtain more, and in some cases they engage in illegal activities, such as doctor shopping, stealing prescriptions from friends and family, and/ or procuring them on the street.
Another insidious facet of tolerance is that the tolerance to the euphoric effect of opioids develops faster than the tolerance to the dangerous physical effects of taking them. This often leads people to accidentally overdose as they chase the high they once felt. In this attempt to get high, they take too much and overdose, dying of cardiac or respiratory arrest. Drug overdose is the leading cause of accidental death in the United States, and there are more drug overdose deaths in America every year than deaths due to guns and car accidents combined. According to the CDC, 2019 drug overdose deaths in the United States went up 4.6% from the previous year, with a total of 70,980 overdose deaths, 50,042 of which were due to opioids.
There’s a kahuna in Opioidland that’s so big and so bad that it bears a special mention… fentanyl. Referencing the above statistics, of the more than 50,000 opioid overdoses, fentanyl is specifically indicated in more than 20,000 of those fatalities. Again, I think it’s way higher than that. Regardless, I think we can all agree that it’s deadly. Fentanyl is so crazy dangerous because it is 50 to 100 times more potent than morphine, so it takes the teeny tiniest amount to overdose. A lethal dose of fentanyl for adults is about two milligrams- that’s the equivalent of six or seven grains of salt people!
Obvi, there are tons of chilling statistics about fentanyl, but here’s another one for you: in one-third of fentanyl overdoses, the individual died within seconds of taking it. Get this- they died so quickly that their body didn’t have enough time to even begin to metabolize the drug, so no metabolites of fentanyl were found on toxicology screens at the time of autopsy. The moment you ingest or inject any drug/ pharmaceutical, the body immediately begins to break it down into components called metabolites. After a certain period of time (which varies according to many different factors) the drug is completely metabolized by the body, so a toxicology screen will pick up those metabolites rather than the complete molecule(s) of the drug. Every drug has a known rate of metabolism, so tox tests can tell how long ago a drug was used or ingested. This data is saying that in one-third (33%) of fentanyl overdose deaths, tox screens pick up zero metabolites, because the body had no time to even begin to start the process of making them. The screens detected the presence of the full complete molecule(s), but no breakdown products. It’s a very significant and scary hallmark of fentanyl use/ abuse/ overdose: the fact that you may not live long enough to regret using it.
How did fentanyl become such a big part of the opioid epidemic? Around 2010, docs were getting smart to the use and abuse of opioids and the ensuing crisis, and many stopped prescribing them. This left a lot of addicted people, including many who legitimately required relief from pain, unable to get prescriptions and SOL. At the same time, buying prescription drugs on the street was crazy expensive due to increased demand and decreased supply. But also, heroin had became so abundant that it suddenly became cheaper than most other drugs, so addicts started to switch to heroin. In one survey, 94% of people in treatment for opioid addiction said they used heroin only because prescription opioids became much more expensive and harder to obtain.
Next, to make things exponentially worse, drug cartels discovered how to make fentanyl very cheaply, so huge quantities of fentanyl started flooding the market. Because fentanyl is easier to make, more powerful, and more addictive than heroin, drug dealers recognized the opportunity, and began to lace their heroin with fentanyl. People taking fentanyl-laced heroin are more likely to overdose, because they often don’t know they’re taking a much more powerful drug. Fentanyl can be manufactured in powder or liquid forms, and it can be found in many illicit drugs, including cocaine, crack, and methamphetamine. And let’s face it folks, the people making this garbage aren’t exactly rocket scientists, so all of these drugs can (and usually do) contain toxic contaminants and/ or have different levels of fentanyl in each batch, or even varying levels within the same batch. These facts just add to the lethal potential of this stuff.
Now fentanyl has found its way onto the street in yet another form: pills. When fentanyl pills are created for the street, they’re pressed and dyed to look like oxycodone. Talk about insidious! If you go looking to buy oxy’s on the street and the dealer is selling them dirt cheap because they don’t know any better, or care is probably more accurate, you’ll probably think ‘Wow- these oxy’s are cheap! Let me get those!’ If your body is accustomed to using real oxy’s and you unknowingly take fentanyl, you will absolutely overdose. Like see ya later, bye overdose.
But believe it or not, it gets worse… A new variation of fentanyl is finding its way into the drug trade. Carfentanil is 100 times stronger than fenatanyl, which makes it 10,000 times more potent than morphine. While it was originally developed as an elephant tranquilizer (hel-looo??!!) the powdered form of carfentanil is now commonly used as a cutting agent in illicit drugs like heroin, cocaine, and methamphetamine.
Opioid withdrawal can be extremely uncomfortable. But an important thing to remember is that opioid withdrawal is not generally life threatening if you are withdrawing only from opioids and not a combination of drugs. This is because each drug class is pharmacologically different, so withdrawal is different for each one. FYI, the most dangerous withdrawls are from benzodiazepines (Valium, Xanax, etc) and alcohol, even though alcohol isn’t technically a drug, it reacts, is metabolized, and physically withdraws from the body like any drug. Individually, either can be lethal in withdrawl and require medical supervision.
Opioid Withdrawal Symptoms
Withdrawal typically includes the following symptoms to varying degrees:
Hot and cold sweats
Muscle aches and pains
Stages of Opioid Withdrawal
-The first phase (called acute withdrawal) begins about 12 hours after the last opioid use. It peaks at around 3 – 5 days, and lasts for approximately 1 – 4 weeks. This acute stage has mostly physical symptoms.
-The second phase (post-acute withdrawal) can last for a long time, with some references documenting up to two years. The symptoms during this phase are mostly emotional, and while they are considered less severe, they last longer.
Symptoms include mood swings, anxiety, variable energy, low enthusiasm, variable concentration, and disturbed sleep.
But, don’t let concern over withdrawl symptoms keep you from getting off of opioids. There are medications that can significantly decrease all of these. Two of the most common are methadone and buprenorphine. Being that drug detox is one of my specialties, in next week’s blog, I’ll outline both of these and tell you my reccommendations.
Now that we’ve covered the history and background on opioids, if you think you might have an opioid addiction, I have a separate quiz that will bring some clarity to you on that question. I will upload a more detailed assessment as a separate blog, but for now, here’s a short generalized screen to take first.
Do You Have an Opioid Addiction?
Answer yes or no to each of the following questions. If you answer yes to at least three of these questions, then you are likely addicted to opioids and should definitely take the detailed addiction self-assessment test which follows. I also suggest that you print the assessment and answers and take them with you for a professional evaluation.
Addiction: Basic Screen1) Has your use of opioids increased over time?2) Do you experience withdrawal symptoms when you stop using?3) Do you use more than you would like, or more than is prescribed?4) Have you experienced negative consequences to your using?5) Have you put off doing things because of your drug use?6) Do you find yourself thinking obsessively about getting or using your drug?7) Have you made unsuccessful attempts at cutting down your drug use?
Again, if you answered yes to at least three of these questions, then you are likely addicted to opioids and should take the detailed addiction self-assessment test which follows as a separate blog. Be sure to print both with you for a professional evaluation.
I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!