An August 7 story by NBC news entitled “Once feared, illicit fentanyl is now a drug of choice for many opioid users,” focused on the need for higher doses of opioid agonists to treat these patients, as well as higher doses of naloxone to reverse overdoses. Fentanyl is a very potent opioid, and illicit opioid even more so. At first, when illicit fentanyl was found in street drugs, it was viewed as a contaminant. Nobody wanted to die from an overdose. But now, more drug users are seeking out the powerful opioid, particularly for smoking, which can be more easily titrated.
The article quotes several sources as calling for higher doses of medications to treat opioid use disorder and for higher doses of naloxone. Recently we wrote about a new 8-milligram dose of naloxone, Kloxxado (https://atforum.com/2022/05/8-milligrams-naloxone-given-opioid-ods-stat-fentanyl/). The medical experts interviewed cautioned against first giving a lower dose of the rescue medication to “see if it works,” noting that if it doesn’t, there could be damage from lack of oxygen. The main argument against giving a high dose of naloxone from the harm reduction community is that it could result in “unintended consequences” of severe withdrawal symptoms. But as the medical experts in our article said, at least these patients are alive and without permanent brain or other damage.
To be fair, some patients don’t appreciate these severe withdrawal symptoms, and have complained about them. Here’s one study saying that it’s unnecessary to give high-dose naloxone (https://pubmed.ncbi.nlm.nih.gov/34560623/).
And here’s the link to the NBC News story, which came out August 7: https://www.nbcnews.com/health/health-news/feared-illicit-fentanyl-now-drug-choice-many-opioids-users-rcna40418.