That Street Pill Might Be Fentanyl

That Pill You Bought On The Street Might Be Fentanyl

We see it happen every week. A person comes to our office to start our treatment program, confident that they’ve been getting “legit” prescription pills from their dealer–whether opiates or benzos. They are certain that their dealer is “on the level and that they are getting what they are paying for. However, when we test their urine, we often discover that there isn’t any of the drugs they thought they were getting — benzodiazepines, oxycodone, or whatever — but there is Fentanyl. 

Your Street Drugs Are Likely Cut with Fentanyl

It is often shocking for our patients to realize how what they were taking is from what they had imagined. It also emphasizes how much greater an overdose risk they were facing.

By now most of us have read something about how the US Opioid Epidemic emerged. A key factor was the arrival of Oxycontin® in the late 90’s, supported by an impressive marketing campaign to convince doctors that it was a safer, longer-acting, or “non-addictive” opioid formulation. Once people realized that this wasn’t the case, the manufacturer released a new version that made it harder to melt or crush and, ultimately, prescribers became more knowledgeable about the risks of opioids and sharply changed their prescribing habits. 

Unfortunately, too much damage had already been set in motion. Thousands of people had become dependent on opioids that they couldn’t easily stop taking, since doing so threw them into terrible withdrawal symptoms. For many people this kicked off a tough downward spiral.  As their doctor stopped prescribing them opioids or it became too expensive to buy them legally, many people shifted over to heroin as a cheaper alternative. At the same time, cartels had started to cut heroin with Fentanyl, making it more potent and desirable to users, albeit much more dangerous.  

Why Fentanyl is So Prevalent in Street Drugs?

Fentanyl is a potent synthetic opioid that can be made much more cheaply than heroin, since there is no need to guard or water large fields of poppies.  To a great extent, it has replaced heroin on the streets since it is so inexpensive. It can be “pressed” into pills that people purchase under the mistaken impression that they are prescription medications like oxycodone or branded benzodiazepines.  

Fentanyl is a short-acting agent that was created to treat severe pain under the supervision of medical professionals. Because of its high potency—50 to 100 times greater than morphine—the overdose risk is remarkably high. This is a primary reason that the opiate overdose death rate has massively increased in the past few years. Source

Overdose Risk of Fentanyl

Because it delivers such a fast, powerful rush, people’s brains can quickly become dependent on fentanyl.  Withdrawal symptoms can set in soon afterward, driving users to seek more at frequent intervals to stop withdrawals from setting in.  Unfortunately, the margin of error in dosage is so low that every use of street Fentanyl entails material risk of overdose.

Fentanyl binds so tightly to the brain’s Mu or opioid receptors that a “cold turkey” detox is extremely difficult and most people cannot tolerate it.  By contrast, the Coleman Method, which has been constantly refined over the past 20 years, is as safe and effective with Fentanyl as it has been with other opioids.  

We’ve been able to get 98% of our patients successfully through their detox and inducted onto long-acting naltrexone, a non-addictive opioid blocker that reduces cravings and blocks the highs from opioids.  Part of the reason for this high completion rate is the accelerated detox timeline and relative comfort that our patients experience at Coleman Addiction Medicine, as well as the nonjudgmental support that our medical professionals and case managers provide. If you have any questions, please schedule a callback with one of our Care Advocates. We are here to help.

Deborah Reich, MD

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