For families watching a loved one start addiction treatment for fentanyl dependence, the expectation is that medically supervised treatment will be safe, managed, and effective. A study published in Drug and Alcohol Dependence is challenging one core element of that assumption: standard starting doses of the primary medication treatments for opioid use disorder — methadone and buprenorphine — may not be calibrated for the potency of the fentanyl that many patients are actually using.
The study examined patients with opioid use disorder in Los Angeles — one of the cities with the highest concentration of illicitly manufactured fentanyl — and found that standard dose protocols developed for patients dependent on heroin or pharmaceutical opioids were frequently inadequate for patients who had been using today's high-potency fentanyl. Those patients experienced inadequate symptom control at standard doses, increasing the risk of treatment dropout, return to use, and overdose during the treatment period.
