Do all doctors test for fentanyl?
When an addiction treatment doctor orders urine drug tests, there are various choices. The basic drug test will test for heroin, morphine, methadone, marijuana, cocaine and usually a few other drugs. For doctors who prescribe Suboxone, it is important to specially request drug test kits that include buprenorphine. Surprisingly, most drug test panels do not include fentanyl. In light of the current opioid crisis and rampant fentanyl abuse, this may change in the future. For the time being, doctors who treat opioid addiction may want to order a separate fentanyl test.
Fentanyl abuse is often unintentional.
It is actually not that common for an opioid addict to seek out fentanyl. Currently, we are finding that fentanyl is being added to street heroin. In fact, fentanyl is also being added to other drugs as well. Law enforcement officials and forensic scientists have confirmed that fentanyl can be found in cocaine and methamphetamine purchased on the streets. Even more ominous is that there are counterfeit oxycodone tablets being sold on the black market that are purely fentanyl as described in this article about Mexican oxy pills. One can imagine that other medicines, including Suboxone and Subutex, may be counterfeited and fentanyl-laced as well. Most drug users do not even know that they are taking fentanyl.
Fentanyl testing as harm reduction.
Interestingly, the addiction treatment clinic is not the only place where fentanyl tests may be beneficial. There are harm reduction sites, such as safe injection sites, where fentanyl tests can save lives. For example, if a heroin user goes to such a site to obtain clean needles and syringes, the attendant can offer to test their heroin. If the test is positive for fentanyl, the heroin user may decide to hold off on using that particular batch of tainted heroin.
Harm reduction saves lives.
If they do choose to use it, the attendant will be prepared with Narcan to reverse a potential opioid overdose. Some people believe that this sort of harm reduction site should not be allowed to exist. Why not just arrest the drug user on the spot and have them put into mandatory treatment? Many years of experience has taught us that harm reduction does more good than criminalization of the disease of opioid addiction.
Preventing the next overdose.
While Suboxone doctors usually do drug testing to enforce compliance with the program, surprisingly, many new patients specifically request to be tested for fentanyl. This is because the patient does not know if their heroin was fentanyl-laced or even purely just fentanyl. Interestingly, many patients believe that they are getting pure heroin. It is not uncommon to hear the story that a particular patient has the one good drug dealer who always gets the good stuff. They do not have to worry about fentanyl overdose like all of the other heroin users. Many of these patients are surprised to find out that they too were being given heroin with fentanyl added or even fentanyl with no heroin. This realization provides motivation to get clean once and for all. It shows that there is no way to know what poison is being sold out on the streets.
Naloxone is an important part of harm reduction.
Naloxone is the ingredient in Narcan. It is a potent opioid blocker that can quickly reverse a fentanyl overdose. While naloxone should be made available to all people who use opioids of any kind, it is especially important to have available to fentanyl users. Fentanyl abuse is highly dangerous and naloxone can be life-saving. The FDA is working to fast-track naloxone to be an over-the-counter drug.
Drug abuse and drug addiction can be successfully treated.
While fentanyl abuse and fentanyl addiction seem like problems that society would like to keep at arms length and sweep under the rug, the people who abuse these opioid drugs should not be discarded. People who fall into fentanyl use are often intelligent, creative people who have incredible potential for success in life. If they can just get help to overcome fentanyl addiction. All opioid-addicted people deserve to be helped. Fortunately, medical professionals have many treatment options to offer for fentanyl, heroin and opioid addiction.
Medication-Assisted Treatment (MAT) saves lives.
On a sinking ship, we are instructed to go straight to the life boats. How long do we stay in the life boat? As long as necessary to survive! Imagine if the crew and passengers fought over the benefits of swimming in freezing water over getting into a life boat. Some swimmers will survive, but the best chances are in the boat. Incredibly, this debate is happening every day as more people overdose and die from fentanyl overdose.
Abstinence-based treatment is not ideal for fentanyl addiction.
While there are some successes with abstinence-based addiction treatment, drugs such as buprenorphine, naltrexone and methadone provide the best possible chances of success. Of course, psychotherapy is also important as a part of MAT. Let us stop silly arguments over the fact that prescription buprenorphine is technically an opioid. It works to reduce overdose deaths. Side effects are usually not an issue. MAT medications can be safely taken for months and even many years without any problems.
Prevent an overdose with a fentanyl test.
Fentanyl is a very potent opioid, 80-100 times more potent than morphine. Carfentanil is even more potent, possibly 1000 times the potency of morphine. The street fentanyl-analogs are far more dangerous than the prescription fentanyl such as is found in fentanyl patches. First responders must be armed with Narcan, prepared for fentanyl overdose at all times. By making the fentanyl test more readily available at harm reduction sites and in doctors’ offices, we can help to reduce fentanyl use and prevent fentanyl overdoses.