Fentanyl Comes Crashing: Surviving the Third Wave of the Opioid Epidemic

At the lowest point of her fentanyl addiction, Jo would pop just enough pills to survive the workday without throwing up — and then go “balls to the wall” after exiting the office.

“I’d stop at a store or a gas station bathroom because I didn’t want to be seen,” recalls Jo, 37 who worked as an administrative assistant. “I would crush them and snort until my nose bled, and then I’d switch sides.”

“I was such a zombie,” Jo adds. “But I didn’t realize it.”

Fentanyl, a synthetic opioid up to 50 times more potent than heroin and 100 times more potent than morphine, has created a large population of what Jo calls “zombies” — folks who did not even know, at first, they were taking the drug yet quickly became addicted to the point of incapacitation. Or death.

In 2016, fentanyl surpassed heroin as the opioid most often linked to overdose deaths; the following year, synthetic opioids such as fentanyl were linked to more than 28,000 deaths.

Fentanyl first hit the East Coast, where about 10% of Ideal Option patients now test positive for the drug. In the west, where fentanyl abuse was unheard of a few years ago, it’s showing up in about 6% of drug screens.

“I am highly alarmed,” says Ken Egli, M.D., medical director at Ideal Option, where Jo is receiving treatment for her addiction. “Because fentanyl is more potent than other opioids, people become addicted faster and the potential for death is higher.”

For illegal drug manufacturers, fentanyl is a cheap additive. Made in China and mailed to the U.S. or smuggled through Mexico, it’s cut into heroin, meth, and cocaine and “stomped” into counterfeit Percocet or Xanax pills.

Pharmaceutical fentanyl is typically limited to cancer and surgery patients in excruciating pain. But the street version has found its way to partying teenagers and people with opioid use disorder (OUD) who seek out illicit pills.

Especially popular are “Perc 30s,” blue pills that resemble prescription 30-mg Percocet (a combination of oxycodone and acetaminophen) but may be pure fentanyl.

Ben Rae, a nurse practitioner at Ideal Option, says that while bogus pills are becoming commonplace, knowledge of their dangers is not.

“People taking ‘Perc 30s’ are not necessarily aware they’re ingesting this scarier substance. They’re presented with the pills and say, ‘Sure, why not?’” 

That’s what Jo told herself.

Before long she was spending “every penny” on fentanyl, falling behind on bills and dealing pills to friends to fund her own supply. At her job, she began to make mistakes and miss deadlines.

Fearing she’d get fired, as she had from her previous job, Jo took a voluntary layoff but didn’t tell her longtime boyfriend. She’d leave the house in the morning, pretending to go to work. Behind on her bills, she’d intercept late notices before her boyfriend could see them.

“I was lying to him about everything,” Jo says, “and it got to the point where I couldn’t remember what I lied about.”

Fentanyl: A Higher High, A Deadlier Crash

In many ways, fentanyl is like heroin and prescription painkillers: It binds to the brain’s opioid receptors and floods the brain with dopamine, far more than the body can produce naturally. Over time, the brain sprouts additional receptors to accommodate the flood and demands ever more opioids to stave off vomiting, anxiety, body aches, and other withdrawal symptoms.

But fentanyl doesn’t just cause a dopamine flood; it sets off a tsunami.

The high is more intense and the devastation more extreme. Withdrawal — triggered when opioid receptors go unfilled — can begin within 2 to 4 hours, so users are driven to pop pills all day long.

“I always felt like: I need it RIGHT NOW, and if I don’t get it, I’m going to start throwing up,” recalls Randy, 35, another Ideal Option patient recovering from fentanyl addiction.

Randy’s opioid addiction began in his twenties, after surgery to repair a hip shattered when he was hit by a truck. “They had to put my hip back together like puzzle pieces,” says Randy, who was hospitalized for four months.

Upon discharge, he was prescribed painkillers. When his prescription ran out, he bought pills on the street.

“By that time I didn’t have pain in my hip anymore,” he says. “I was just searching for a high.”

He thought he was buying half Percocet and half fentanyl but later learned the pills were pure fentanyl.

“I lost two friends who overdosed after taking just one pill,” Randy says. “My mind is blown that I didn’t overdose, because I was taking 6 to 10 a day.”

If he didn’t take the pills, he says, he couldn’t get out of bed, let alone drive his delivery truck.

“I’d be like a hobbit and want to sleep all day,” Randy says. “I just felt like crap. People would always ask: ‘Are you sick?’ and I’d tell them I had the flu.’”

For a while, Randy earned enough money to support his $250-a-day addiction, and he scored free pills by referring friends to his dealer.

But he lost his job after co-workers reported him for being high at work, and he lost his car when he couldn’t make the payments.

He also lost interest in his three children. Every once in a while, he’d take his teenage son, who lived with his mom, to the movies. “But mostly I wanted to spend my money on pills rather than on my kids,” he says.

Eventually, Randy’s girlfriend caught on to his drug abuse and lies and left home with their two daughters. “I was like, Damn, I’m going to lose my family. I felt like I was losing everything important to me.”

Recovering from Fentanyl Addiction

Both Jo and Randy knew their lives were spiraling out of control and tried, unsuccessfully, to quit fentanyl on their own.

Randy would ask himself, “Why am I doing this?”

Jo would tell herself: This isn’t me.

But like Randy, Jo found withdrawal impossible to endure.

“I’d be sweating, shaking, and puking,” she recalls. “My whole body would ache. I’d feel nauseous and stressed, and I’d have diarrhea. That would last a couple days before I couldn’t stand it anymore.”

Eventually, Jo buckled under the weight of the lies she was telling her boyfriend and confessed.

“I felt so bad,” she says. “I loved him so much, but l loved the drugs more.”

To Jo’s surprise, her boyfriend was understanding. “He said, ‘I want to help you, but I wish you would have told me sooner.’”

If there’s a bright side to fentanyl addiction, it’s that the disorder is just as treatable as addiction to heroin or prescription painkillers.

Yes, fentanyl is more potent and addictive than other opioids, but the drug rewires brain chemistry in fundamentally the same way. So, the medications shown to successfully treat addiction to other opioids — buprenorphine and methadone — are effective for fentanyl addiction as well.

“Opioid addiction is opioid addiction,” says Dr. Egli.

While some fentanyl users prefer methadone, many choose buprenorphine, which is commonly prescribed as Suboxone (a combination of buprenorphine and naloxone). Whereas methadone patients must visit a clinic every day, Suboxone patients can pick up their medication at a pharmacy and ultimately check in with a clinic every two to four weeks.

“Suboxone works really well for fentanyl, but patients need significantly higher doses than with other opioids,” says Ideal Option provider Ben Rae.

To prescribe the correct dose, Rae notes, providers must know if a patient has been taking fentanyl. Because counterfeit pills are so common, many patients don’t realize what they’ve taken.

“The substance may not show up in preliminary drug screenings,” Rae says. “It can take 2 to 5 days to run a definitive drug screen.”

Randy, of course, did know he was taking fentanyl and told his providers at Ideal Option. Since he began Suboxone treatment a year ago, his life has turned around completely. His girlfriend and daughters, ages 7 and 11, moved back in with him, and he landed a job as a fireplace installer.

“I feel better than ever,” he says. “Instead of feeling high and having energy, I feel sober and have energy. I go to work every day, and I’m not late on my bills. I feel like a part of society.”

He takes his girls to the park and the movies, and he adopted a cat. He also spends time with his son, now 14.

“We play basketball and videogames, and we throw the football around,” Randy says. “We’ve done paintballing. I teach him how to cook.”

Jo, too, says her life has rebounded since she began treatment with Suboxone.

“I don’t think about drugs anymore. I have no desire to do it.”

Jo went back to school and is now working in the healthcare field. She also works in real estate and relaxes by spending time outdoors with her animals. 

“It’s like a total 180,” Jo says.

During her addiction, Jo says, fentanyl stole her confidence, her personality, and her emotions. “I would just sit there in a daze all the time. A friend died and I wasn’t even upset.”

Now, she says, she has her personality back, along with her capacity to feel and to care for others.

“People tell me: ‘You’re a completely different person. Before, you were depressed and negative and withdrawn. Now you’re always smiling.’ It makes me feel cared for.”

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