President Donald Trump officially declared the opioid crisis a public health emergency in 2017. Provisional numbers from 2017 suggest there were nearly 50,000 overdose deaths involving opioids in the United States. With the introduction of fentanyl, carfentanil, and the newly FDA-approved opioid Dsuvia, the danger of overdoses and fatal overdoses are near certain.
Data from 2014 reveals almost 2 million people had an opioid use disorder relating to prescriptions, and nearly 600,000 more people were struggling with heroin addiction. The increasing rates of carfentanil use are leading to increasing overdose death rates, as well. Unfortunately, the numbers also show how few people actually get the help they need. Overall around less than 10% of the people needing treatment are able to benefit from quality detox followed by a long-term treatment program to address their substance use, as well as the underlying factors.
Carfentanil is a synthetic opioid. Opioids refer to a class of drugs that when derived naturally, come from the opium poppy plant. In the early 1800s, morphine was isolated from opium and later in that century; heroin was derived from morphine. Heroin is considered a short-acting opioid. Manufacturing and mass production of prescription opioids such as hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Percocet or Oxycontin) have increased the accessibility and lethality of these drugs.
The recent crackdowns on “pill mills,” as well as overall restrictions on the number of days physicians are allowed to provide prescriptions for pain pills, has intended to curb the overdose deaths involved with opioids. However, it appears to be involved with the increase of the prevalence and availability of heroin. And with an increase in heroin use, there is also an increase of fentanyl and carfentanil use.
In fact, carfentanil is more likely to result in an overdose death as the DEA issued a warning that it can be “up to 10,000 times more potent than morphine and 100 times more potent than fentanyl.”
Those individuals looking for the increased feeling of euphoria will also experience a more intense depressive effect, which is why overdose deaths may occur more frequently with carfentanil use.
Alternatively, people often don’t even realize carfentanil is mixed with the heroin they are using, so their “usual dose” ends up being enough to kill them. Carfentanil and fentanyl also resemble powdered cocaine, at times.
The brain and the body are constantly seeking harmony in order to function well. The medical term is homeostasis, and it means that when anything disrupts the CNS, efforts must be made to return to a certain level of stability. For example, when the body becomes hot from exercise or being outside in the sun, we sweat in an effort to cool off or reach the previous level of homeostasis.
Over time, carfentanil use will interfere with the CNS’ ability to return to a balanced state.
Everything we do affects our central nervous system. The foods we eat, how much sleep we get, the quality of the air and water we ingest, and even things like stress and unseen toxins in cleaning products will have some kind of an effect.
Carfentanil is a synthetic opioid and acts specifically on certain receptors that are keyed to respond to opioids, most notably the Mu receptors. These typically produce a feeling of euphoria as a result of the flood of dopamine in the brain that the carfentanil produces. Dopamine is the “feel-good” neurotransmitter and is associated with motivation and the reward center in our brains.
The opioid receptors are located in areas of the brain that are involved with emotion (the amygdala), memory (the hippocampus), and the reward center of the brain (nucleus accumbens). Carfentanil also has a depressive effect on two important centers found in the brain stem: the respiratory center, which controls breathing, and the vomiting center, which also allows us to cough.
Additionally, carfentanil produces an analgesic effect. In other words, it relieves pain. And because it also addresses the negative emotional reactions (via the amygdala) to physical pain, carfentanil will not only take away the physical sensation of paint; it also allows you to forget how much you dislike the pain. This layered effect is just one of the reasons that carfentanil can prove to be very addictive in a short period of time.
Carfentanil withdrawal, while not fatal, can be extremely uncomfortable and should not be undertaken alone. The extent and severity of the withdrawal symptoms will depend on the type, frequency, and amount of carfentanil used by the individual. Typically the experience of withdrawal involves the opposite of the effect the drug produced.
For example, because we know opioids like carfentanil repress the vomiting center and slow digestion to create constipation, one might experience diarrhea or vomiting upon stopping their use.
In extreme cases, chronic withdrawal symptoms can last 10-14 days after the last use and will often be a less severe experience of the symptoms that occurred during the acute phase.
Chronic use can lead to a number of other health complications including, but not limited to: endocarditis, a swelling within the lining and valves of the heart; collapsed veins; abscesses at injection sites that can become infected, toxic and even need surgery, if untreated.
It is critical to get the help you need to successfully manage withdrawal symptoms and begin a life without the use of carfentanil. Long-term use can negatively affect respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.
When medically managed, most withdrawal symptoms are alleviated within seven days. However, it is important to note that treatment following a medically managed detox will result in a better success rate. Safely removing the carfentanil from the brain and body is only the first step. There are other psychological, emotional, and behavioral issues to address that will set you up for continued sobriety.
Precipitated withdrawal can occur when an opioid antagonist is introduced in someone who is dependent, and enough of the opioids are still attached to the receptors in the brain. The antagonist will displace the opioids from their receptor sites, and it will feel like a magnified experience of the withdrawal symptoms outlined above. Unless treated, symptoms from precipitated withdrawal can last up to four days.
For example when a patient is not fully transparent about their last carfentanil use, to include the dose and the time, as well as frequency and usual use, and Suboxone (a medication used to manage withdrawal symptoms and cravings associated with opioid use) is administered too soon, the patient can go into precipitated withdrawal. This is an unfortunate event and can lead the patient to believe that buprenorphine is ineffective in treating their symptoms when the reality is the carfentanil still present in their system was to blame.
Another problem with abusing opioids like carfentanil is the risk of developing Post-Acute Withdrawal Syndrome (PAWS). It is a disorder characterized by prolonged opioid abuse and can occur for weeks or months after you’ve stopped using opiates. The condition is marked by symptoms found in mood disorders, such as insomnia, anxiety disorders, and increased levels of anxiety without any stimulus.
PAWS is extremely common in those who abuse opioids. Estimates point to nearly 90 percent of recovering opioid users will experience PAWS in some form or another. The reasoning behind this occurring is still unknown, but scientists point to brain changes that occur during substance abuse and increased tolerance to the drug for recurring symptoms.
When seeking treatment, it’s important to understand the difference between the various levels of care so you can get the most out of your treatment experience.
Medical detoxification, or simply detox, is a medically managed detoxification from carfentanil. Following a thorough history and physical examination, the medical staff will determine the best medication protocol to safely manage your withdrawal symptoms. A detox from carfentanil can take from three to 10 days, depending on the severity and extent of drug use and is up to the discretion of the medical providers.
Medical complications, using more than one substance, or a history of mental health diagnoses are all examples of when a detox may take longer than usual. Treatment centers will require you to successfully complete detox to safely and fully participate in their programs.
Detox can take place in a hospital setting if you have severe or unmanageable medical complications, or it can take place in a standalone detox facility. These standalone, privately run facilities must be staffed 24 hours a day with medical personnel, as well as support staff, to monitor your symptoms and ensure the safest, most comfortable experience possible. Specially trained staff will know how to observe your progress throughout the detox process and will be able to respond to any potentially life-threatening situations.
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Residential treatment typically follows a successful detox and involves living on-site and participating in a variety of therapy. Individual sessions with a trained therapist, as well as group and family therapy sessions, are some of what is required at each residential facility. It’s during this time; you will be examining patterns of thoughts, emotions, and behaviors that may have contributed to your substance use. Residential treatment length of stay will vary depending on your needs, but can typically last from 30 – 90 days following the detox.
Outpatient treatment is intended for those individuals who are in a more stable position medically, physically, and emotionally. After the support from detox and residential care, the activities of daily living on your own are more manageable, and you will remain involved with outpatient treatment to continue your journey of recovery.
You will continue to participate in therapy on a less frequent basis and maintain connections with your support system and therapist. This is an important part of your recovery, as it will allow you to transition to the next phase of your life with the support that played such a beneficial role.
Medication-Assisted Treatment, or MAT, is typically a form of outpatient care. It is intended to support those struggling with opioid or alcohol use disorders with a form of medication administered on a longer-term basis than the typical medical detox. FDA-approved medications for the treatment of opioid use disorder are designed to manage withdrawal symptoms, reduce or eliminate cravings to use, and help prevent relapse.
For these reasons, some studies suggest there are better outcomes for those addicted to carfentanil and other opioids who participate in medication-assisted treatment following detox. Some form of therapy and medical supervision will still take place during MAT, and your provider can assess whether this option is right for you.
Again, it is critical to note the best outcomes for the treatment of carfentanil addiction are associated with participating in the full spectrum of care. A detox treatment alone won’t give you the benefits or the support of a full continuum of therapy. There are many reasons that substance use may have grown into an addiction, but what’s most important is focusing on the resources and solutions that will help you find a new life free from carfentanil use.
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