As fentanyl’s deadly rampage continues, frontline physicians across the U.S. are seeing another profoundly troubling development.
Fentanyl creates a much more difficult withdrawal for patients treated with buprenorphine for opioid use disorder.
Why is that important? Because buprenorphine is one of just two drug therapies available to help patients manage what are often difficult opioid withdrawal symptoms.
The other drug is methadone, which is highly regulated, and only specialized clinics can administer it.
Many have questioned how fentanyl could have this effect. Part of the reason may lie in the fact that fentanyl stays in the body longer than other opioids.
Typically, a physician starts a patient on buprenorphine as they start to feel withdrawal symptoms. When treating someone without fentanyl in their system, buprenorphine helps them transition through withdrawal more comfortably.
Those going through withdrawal with fentanyl in their systems often have to wait longer to start buprenorphine and, even then, often find their symptoms worsen with treatment.
Many patients quit treatment prematurely. Worse still, some go back to taking fentanyl to relieve the pain of withdrawal.
How are physicians managing these challenges?
Approaches vary. Some rely on microdoses of buprenorphine, increasing dosages over time. Some are trying mega-doses of buprenorphine to overwhelm the effects of fentanyl. Others are using common drugs to treat individual symptoms of withdrawal.
What’s the best approach? No one is sure, leading specialists in the field to call for much more research on the problem.
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