We see it almost daily. A patient comes in for a detox with us stating that they are buying pills, like opiates or benzodiazepines, on the street. They say their dealer is “trustworthy” and that the pills are “legit.” When we test their urine for substances, more often than not, there is no oxycodone, there are no benzos, but what is present is Fentanyl.

Street Drugs Are Not Always What They Claim They Are

It can be quite jarring and frightening for a patient to realize that what they thought they were buying was in fact not that at all and that they were taking something that they easily could have overdosed and died from.

We are familiar with the history of the opioid epidemic in the US. Among other reasons, Oxycontin® came on the market in the late 90s. It was very heavily promoted and prescribed as a safe, long acting, “non-addictive” opiate. Once it was discovered that this was not actually the case, the manufacturer reformulated it to make it harder to crush or melt and, ultimately, many doctors dialed back their prescribing of all types of opioids — but not before much damage had been done.

Millions of patients were now addicted or physically dependent on opioids and could not stop due to terrible withdrawals. For many people, this was the beginning of a long and sad history of addiction to opiates. Once the prescription opioids were no longer available, or got too expensive, people began to turn to heroin as a cheaper alternative. Cartels then began to mix Fentanyl into other drugs, including heroin, to make them more potent and addictive.

Why Fentanyl is So Prevalent in Street Drugs?

Fentanyl is a synthetic opioid, manufactured at low cost. It has, for the most part, replaced heroin on the streets because it is so cheap. It is now “pressed” into pills that people are buying thinking they are getting oxycodone, Percocet® or benzos. It reportedly has also been found on some occasions in marijuana.


Fentanyl is a short-acting and very potent drug, which was intended for use in severe pain as well as for surgeries and other procedures and administered by trained professionals such as anesthesiologists. Because of its extreme potency, it is very easy to overdose on. That is the primary reason that the opioid death rate has skyrocketed over the past few years. Source

Overdose Risk of Fentanyl

People who are dependent on it can begin to feel effects of withdrawal very quickly and thus it needs to be used frequently throughout the day in order to stave off withdrawal symptoms (aka getting “dopesick”). Each time one uses Fentanyl, there is a high risk of overdose.

Fentanyl also binds very tightly to the opiate or Mu receptors. It can make a detox more difficult. Despite this, the Coleman Institute for Addiction Medicine has a completion rate of 98% on our opiate detoxes, which includes getting patients started on long-acting naltrexone, a non-addictive opioid blocker that reduces craving and can block highs.

The Coleman Method, which has been continually refined over the past 20 years, is just as effective and safe with Fentanyl than it is with other opiates because of the relative level of comfort experienced by our patients and the support that our clinicians and case managers provide. Getting through withdrawal is just the first step in a person’s recovery journey, but it is a foundational one. If you have any questions, please schedule a callback with one of our Care Advocates. We are here to help.

Deborah Reich, MD