Fentanyl: Treatment and rehabilitation

Last modified: Sunday, 31. May 2009 - 3:34 pm

Most hospitals in the United States today are aware of the trend of abuse among anesthesiologists. In recent years, hospitals have stepped up efforts to help personnel realize when coworkers might be abusing various drugs, including fentanyl. Due to necessity, anesthesiology staffers have become especially adept at observing signs of addiction in their coworkers. Assistance is covered under most hospital healthcare insurance plans. This is due to the high number of addicts within the hospital community and the harm that can come to patients if a doctor’s addiction is left untreated.
Addiction requires a user to get help from professionals. A person is considered an addict if they continue using a drug despite adverse consequences or if they cannot go without the drug. There are numerous opiate detoxification programs in the United States that can treat abusers, though their methods vary. The traditional method for treating opiate addiction is by detoxification. This means clearing the body of the drug and giving small amounts of methadone to help curb some of the desire for the drug. When the desire is diminished to abuse drugs and the withdrawal symptoms have subsided, the person can be released. This is a very long and tenuous process. Some have questioned its success rate as many “rehabilitated users” return to abuse.
There are a small but growing number of institutions that are beginning to use an ultra-rapid opiate detoxification program. It is still considered an experimental practice with techniques varying from site to site. However, there are three main differences between traditional and ultra-rapid opiate detoxification. In traditional programs, a patient attempts to function normally while fighting the heavy withdrawal symptoms. In ultra-rapid detoxification, the user is put under anesthesia and is thus able to sleep through the pains of withdrawal. The amount of time varies between institutions, but usually lasts a day or two. A drug called naltrexone is given, which accelerates the onset of withdrawal. Some doctors believe that naltrexone only be given to a patient who has been free of opiates for seven days, which means that a user still must face severe withdrawals. Opiate Mockers are given upon release of the program, which has been found to suppress both desire for the drug as well as some lingering withdrawal symptoms.
The first three days of the treatment are the most difficult for the abuser due to the highly intensive withdrawal pains. During this time approximately 30% of opiate-dependent abusers in a traditional detoxification program quit the program. Some of the withdrawal symptoms the user faces include runny nose, tearing, sneezing, insomnia, loss of appetite, depression, irritability, severe abdominal cramps, pain in the muscles and bones of the back, sweating, nausea, tremors, increased heart rate and blood pressure, and weight loss due to dehydration.
Removing the drug from the user’s system is only the first step in an ongoing process regardless of which technique is used. For an addict, the drug has become a part of his or her lifestyle. That lifestyle must change in order for that person to remain clean. Twelve-step programs such as Narcotics Anonymous have proven very helpful to many in the everyday battle to avoid relapse.
This creates a very difficult situation for anesthesiologists who are recovering from an addiction to fentanyl. Since it is used so often in their work, they must handle and administer the drug that they have abused. This is why the risk of relapse is especially high among opiate-addicted anesthesiologists who decide to return to their profession. Among those who do have a relapse, the incidence of death from overdose is high.
In a May 2001 newsletter, the American Society of Anesthesiologists offers seven questions that an anesthesiologist who is a recovering fentanyl addict should ask themselves before trying to return to their jobs. An abbreviated list follows: If you were a freshman in college and could choose any profession with the wisdom you have now, what would you consider pursuing? If you could not be in anesthesiology, what other possibilities would you consider? What are some positives and negatives of practicing anesthesia? What is stressful for you in the practice of anesthesia? Since the relapse rate is so high, why would you put yourself and your patients at risk? How does your significant other feel about the risk you would be talking returning to anesthesiology? What safeguards would you put in place to avoid a relapse?
Depending on recovering addict’s honest answers to these questions, it is often suggested that they find a different field. However, former abusers are allowed to return as long as they are not currently using.

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