Many communities around the United States are reporting an increase in fentanyl use, fatalities, and arrests. Fentanyl is often produced illegally to serve as a counterfeit of other opioids, such as oxycontin, and other drugs, such as methamphetamine. It may also be used in combination with other drugs.
U.S. officials respond to drug trafficking
The Biden administration recently announced broader efforts to target and disrupt illicit trafficking of fentanyl and related substances. These efforts include working with the United Nations’ Commission on Narcotic Drugs, collaborating more closely with domestic intelligence and law enforcement agencies, and targeting financial sources of drug trafficking. The administration also has asked Congress to provide $46.1 billion for National Drug Control Program agencies, overseen by the White House Office of National Drug Control Policy.
Recently officials have been seizing xylazine, a powerful tranquilizer used in large animals such as cattle and horses. The U.S. Drug Enforcement Administration has issued a public safety alert regarding this substance.
Xylazine has been used in combination with opioids, including fentanyl. When misused, this drug can severely slow respiration, blood pressure, heart rate, and body temperature. However, because xylazine is not an opioid, opioid agonists like naloxone will not reverse its effects.
Federal changes to opioid misuse treatment
In an attempt to reduce fatalities associated with the misuse of fentanyl and other opioids, the FDA has approved the over-the-counter (OTC) use of Narcan, 4 milligram naloxone hydrochloride nasal spray. This is the first naloxone product to be approved for non-prescription use.
This means that Narcan can be sold directly to consumers in places like grocery stores and gas stations. However, there is not yet a timeline for how soon it will be available OTC, or how much it will cost for consumers to purchase.
Meanwhile, the Substance Abuse and Mental Health Services Administration has proposed a change that would make it easier for physicians to prescribe higher doses of methadone for patients with opioid use disorder (OUD). Current federal regulations allow patients to start only on 30 milligrams of methadone.
However, experts say that a dose that small is not enough help a behavioral health client transition from a potent opioid like fentanyl without experiencing significant discomfort. The proposed changes would permit larger doses and make explicit providers’ ability to provide even higher doses, under their discretion.
Starting buprenorphine for patients using fentanyl
Buprenorphine is another treatment for OUD, and new research indicates that it can be safely begun in the emergency department. Even for patients who use substances as strong as fentanyl, less than 1 percent experienced withdrawal when starting buprenorphine treatment in the ER. This new research has been published in JAMA Network Open. This could lead to new options for starting buprenorphine treatment in patients who use fentanyl.
As more communities face the challenges of fentanyl use and recovery, behavioral health clinicians and addiction treatment providers must be prepared. You can help your clients, while experiencing less frustration and lower costs, with an EHR solution like BestNotes, which was designed with behavioral health in mind, from admission to outcome tracking. Contact us today to learn more!