Substance use disorder (SUD) and other conditions like chronic pain negatively impact millions of people across the world. As the Centers for Disease Control and Prevention (CDC) notes, an estimated 20.9% (51.6 million) and 6.9% (17.1 million) of adults in the U.S. experience chronic and high-impact chronic pain, respectively. The prevalence of pain conditions can be seen in the opioid crisis, like fentanyl misuse and opioid-related overdoses. In the U.S., opioids like fentanyl misuse have contributed to the epidemic, ravishing individuals and communities across the country.
As the CDC also notes, over 75% (nearly 107,000) of drug-related overdoses stemmed from opioids in 2021. Moreover, overdose deaths related to synthetic opioids like fentanyl increased by 22% in 2021 from the previous year. The rapid increase in deaths related to synthetic opioids highlights the need to understand fentanyl misuse. With a deeper understanding of your challenges with fentanyl misuse, you can build the tools you need to recover.
At Rancho Recovery, we believe in providing individualized care to ensure no one falls through the cracks. Too often, people are lost to narrow treatment practices in healthcare and addiction treatment fields. Thus, we offer small groups in a luxury drug rehab to meet you where you are. In a small group program, you can connect with clinicians and peers to uncover the impact of substances on well-being. Whether your opioid addiction started with fentanyl misuse from a prescription or other illicit avenues, there is a path to recovery for you.
Yet, you may still have questions about fentanyl misuse. What is fentanyl misuse? Is fentanyl misuse the same or different from opioid use disorder (OUD)?
What Is Fentanyl Misuse?
Opioids are, as the National Institute on Drug Abuse (NIDA) states, a class of drugs that can include legal prescriptions, synthetic opioids, and illicit opioids. As the CDC points out in “Opioid Basics,” opioids are a class of drugs traditionally used to reduce pain. Thus, understanding how opioids are accessed can give insight into the prevalence of fentanyl misuse:
- Prescription opioids like oxycodone, hydrocodone, codeine, and morphine are often prescribed for moderate-to-severe pain
- You may receive an opioid prescription following surgery, an injury, or for cancer-related pain
- Opioids have also increasingly been prescribed for other types of chronic pain like back pain and osteoarthritis
- In 2017, more than 191 million opioid prescriptions were prescribed to Americans
- 11.5 million Americans in 2016 reported misusing their opioid prescription
- Fentanyl is a synthetic opioid used legally to treat severe pain
- You may receive a fentanyl prescription to treat pain from advanced cancer
- Fentanyl has also been manufactured illegally for its heroin-like effect
- Illegally manufactured fentanyl has contributed to the rise of opioid-related overdoses and deaths
- Heroin is an illegal opioid used to create a euphoric effect followed by sedation and tranquility
- You may switch to heroin due to ease of access compared to prescription opioids or through other illicit substances
- In 2021, 25 people in the U.S. died each day due to a heroin overdose, which is over three times the rate in 2010
- Yet, the rate of heroin-related overdose deaths has decreased by nearly 32% between 2020 and 2021
- Despite the decrease in heroin-related deaths and only making up 11% of deaths in 2021, opioid misuse has risen
- Fewer people are initiating heroin use
- More people are opting to misuse and abuse fentanyl rather than heroin
Looking at the different ways opioids have been used legally and illegally highlights the significance of the opioid crisis. In particular, the prevalence of prescription opioid use speaks to the progression from use to misuse and abuse. Thus, you can initially start using fentanyl or other opioids from a prescription to deal with a legitimate health condition. Then, fentanyl misuse occurs when you start using your prescription in ways other than what was prescribed.
The abuse of a substance occurs when you intentionally improperly use a substance to achieve a specific effect. Typically, the abuse of a substance is an attempt to achieve a euphoric or psychotropic effect or cause self-harm. Further, non-suicidal abuse of substances often results in dependence. Dependence happens when you are unable to stop using substances despite physical, psychological, and relationship harm. In regards to opioids like fentanyl misuse, several risk factors can contribute to fentanyl misuse.
Some of the risk factors for opioids, like fentanyl misuse and dependence, include:
- Past or current challenges with substance use
- Polysubstance use: the use of one or more other substances
- Untreated mental health disorders
- Earlier exposure and initiation of use
- Adverse environments
Looking at some of the potential risk factors for challenges with fentanyl misuse showcases the importance of co-occurring disorders. Therefore, increased awareness of fentanyl misuse and its relationship to co-occurring conditions gives more insight into the roots of your challenges.
Substance Use Disorder and Co-Occurring Conditions
One category of conditions that commonly co-occur with SUD is other mental health disorders. As the NIDA notes, SUD and mental health disorders share a bidirectional relationship. On one hand, developing SUD can increase your risk of developing or exacerbating a mental health disorder. On the other hand, certain mental health disorders can contribute to the development of SUD. Moreover, certain mental health disorders have a higher rate of co-occurrence:
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Depression
- Attention-deficit/hyperactivity disorder (ADHD)
- Bipolar disorder
- Borderline personality disorder (BPD)
- Schizophrenia
- Antisocial personality disorder (ASPD)
On their own, unaddressed or untreated mental health disorders can lead to significant functional impairment in multiple areas of life. In addition, SUD on its own can also cause significant impairments in your home, work, and school life. Thus, together, SUD and mental health disorders can be exceptionally detrimental to your well-being and quality of life. Furthermore, co-occurring SUD and mental health disorders, especially when initiated in adolescence, can have a lasting impact on your life.
Misusing substances in childhood and adolescence can contribute to substance dependence and mental illness later in adulthood. In adolescence, important parts of the brain, like decision-making and impulse control, are still developing. Thus, the changes to the brain caused by substance use can increase vulnerability to mental impairments. In addition, unaddressed mental health challenges like ADHD, depression, and anxiety in childhood can contribute to SUD in adulthood. You may seek self-medicating with substances to alleviate or suppress the psychological distress of mental health challenges.
In regards to fentanyl misuse and co-occurring disorders, there is a strong correlation between misusing pain relief medication and other conditions. As the NIDA further notes, co-occurring SUD and mental health disorders increase the risk for the non-medical use of prescription opioids. In particular, research suggests that 43% of individuals in treatment for opioid challenges like fentanyl misuse have a mental health disorder like depression and anxiety. As a result, the prevalence of co-occurring opioid and mental health challenges showcases the importance of co-occurrence.
Fentanyl Misuse: The Relationship Between Opioids and Mental Health
When left unaddressed, co-occurring SUD and mental health disorders can have a profound impact on wellness. More specifically, there is a significant relationship between mental health challenges and the risk of an opioid overdose. According to Social Psychiatry and Psychiatric Epidemiology, the co-occurrence of opioid overdose and mental health disorders is influenced by SUD symptoms, psychiatric disorders, and medication side effects. Not only are you put at risk for overdose when psychiatric disorders are untreated, but exposure to opioids can further increase risk.
Through the common prescribing of opioids and other psychotropic medications for mental health challenges, the risk of overdose increases. Thus, with mental health difficulties, you have greater exposure to prescription opioids and the opportunity for fentanyl misuse and dependence. The presence of opioid exposure and co-occurring challenges highlights the importance of intersecting factors in opioid misuse and dependence. Specifically, looking at the relationship between fentanyl misuse and chronic pain can provide further insight.
Addressing the Co-Occurrence of Opioids and Chronic Pain
As noted by Julia Schaffer et al. in “Chronic Pain, Chronic Stress and Substance Use” in the U.S., chronic pain is a common reason why people seek medical care. Chronic pain can have a profound negative impact on every area of your life. Not only does chronic pain cause physical distress, but it also impairs other areas like emotional and mental well-being. The overlapping psychobiological impact of chronic pain can contribute to difficulties with other disorders and conditions. As stated by the NIDA, chronic physical health conditions often co-occur with SUD.
More specifically, chronic pain has a complex relationship with opioids and addiction, like fentanyl misuse and dependence. When you experience chronic pain, it is not surprising that it increases your emotional distress. The combination of physical and emotional distress can be overwhelming and disrupt functioning. Doing daily tasks, being productive at work and school, and maintaining relationships can be difficult. You may lose the desire to participate in activities you enjoy or spend time with loved ones.
The risk of chronic pain does not discriminate against any particular age. However, young people can be particularly vulnerable to prescription and illicit opioids. As the National Council for Mental Wellbeing notes in “What You Need to Know About Youth & Fentanyl,” in 2021, 77% of young people died from overdoses related to fentanyl misuse. The heightened risk for fentanyl misuse and overdose among young people is born out of greater opioid exposure.
For example, young people are more likely to be involved in sports and other physical activities that increase their risk for injury. Moreover, sports-related injuries often require surgery, and both injuries and surgery typically require pain relief medication like fentanyl. Therefore, young people may more frequently be exposed to opioids, which increases their risk for opioid misuse and OUD. In addition, the addictive nature of prescribed opioids coupled with other risk factors like comorbid mental health disorders further increases fentanyl misuse and other opioid use.
Thus, you may seek out substances or misuse your opioid prescription to alleviate your physical and psychological pain. Approximately 10% of individuals with chronic pain misuse prescription opioids, which speaks to the need to address fentanyl misuse to support whole-person recovery. Despite the prevalence of co-occurring fentanyl misuse and chronic pain, there are still barriers to care and recovery.
Barriers to Care: Understanding Stigma in Fentanyl Misuse
Challenges with SUD and or mental health disorders have always carried heavy public, self, and institutional stigma. There is a long history of people perceiving individuals with SUD as dangerous, violent, and weak in moral character. Often, individuals with SUD are blamed as the cause of their addiction, which leaves little space for understanding, compassion, and healing.
As the CDC notes in “Stigma Reduction,” there is not one single driving factor for the development of addiction. Addiction can be rooted in a variety of challenges like adverse childhood experiences (ACEs), trauma and stress, untreated mental illnesses, and poor coping skills. Further, fentanyl misuse faces unique stigmatization due to its relationship with prescription medication and treatment courses.
According to Substance Abuse and Rehabilitation, opioid-related stigma is complex and changes depending on the type of opioid. For example, fentanyl misuse attracts a high level of stigma that decreases treatment-seeking behavior, harms psychological well-being, and impedes access to effective support. Some of the stigma individuals face with fentanyl misuse and other opioids include:
- Media coverage: The narrative presents overdose deaths as the fault of the individual while de-emphasizing the role of healthcare systems and the pharmaceutical industry in the epidemic
- Misinformation: First responders are concerned about passive exposure to fentanyl and the behavior of individuals in crisis
- Results in slow and overly precautionary response to overdose calls
- Conceptualization of addiction: Prescription opioids are more often seen as a physical disease rather than a moral failing
- Still results in significant social exclusion and barriers that impede decision-making power
- Healthcare systems: Relies on ideology that reinforces the moral binary of good and bad
- There is good and bad opioid consumption and good and bad people who use opioids
- Intersectionality in stigma: Marginalization related to race, ethnicity, gender, sexual orientation, age, and socioeconomic status contributes to additional interrelated barriers to care
- Communities with high levels of poverty, income inequality, and poor access to social capital are disproportionately affected
- Criminal justice system: Misconceptions about opioid treatment programs lead to poor outcomes
- Not understanding the purpose and benefit of medication-based treatment programs
- Lack of availability and poor implementation of treatment programs in prison
- Reduces client self-efficacy and treatment engagement
- Not understanding the purpose and benefit of medication-based treatment programs
- Treatment course: Stigmatized beliefs about individuals engaged in medications for opioid use disorder (MOUD) treatment
- The belief that MOUD clients are still addicted and not truly in recovery
Looking at the types of stigma that form from fentanyl misuse and other opioids highlights the scope of its impact. The intersectional nature of stigma leads to various barriers to care at the macro, meso, and micro levels. Listed below are some of the fentanyl misuse and other opioid barriers to care:
- Macro level: Structural stigma from funding, service delivery, and policies and regulation
- Underfunded and inequitable allocation of resources
- Impedes development and access to evidence-based treatment
- Restrictive treatment policies and stigmatized language in government and organizational policies
- Implicitly label individuals seeking treatment as less worthy or undeserving of care
- Lack of coordination between SUD, physical health, and mental health services
- Fragmented care that increases poor health outcomes
- Underfunded and inequitable allocation of resources
- Meso level: Include stigma from providers, recovery peers, and the public
- Negative core beliefs from providers can lead to prejudice and discriminatory practices
- Exclusion from services
- Lack of support for public health policies that support access to treatment medications like naloxone
- The public has a narrow perception of who deserves to benefit from harm-reduction practices and services
- Negative core beliefs from providers can lead to prejudice and discriminatory practices
- Micro level: Self-stigma from perceived and experienced interactions with public and structural biases
- Delays in help-seeking behaviors
- Reinforces identity as a person with an addiction to increase shame and disempowerment
- Impedes recovery and reintegration
Despite explicit and implicit biases in treatment and policies, whole-person care can support dismantling stigma for lasting healing.
Whole Person Healing: Reducing Pain and Fentanyl Misuse at Rancho Recovery
At Rancho Recovery, we know how important understanding co-occurring conditions is for promoting lasting recovery. Thus, we offer dual diagnosis treatment and other holistic approaches to care to address your specific needs. No matter where you are on your recovery journey, our mission as a luxury rehab is to give you the space to discover or rediscover your sense of self. With a comprehensive care program, you can find the tools and support you need to heal the parts of your whole.
You can build a tailored treatment program from educational support like psychoeducational groups to individual counseling. True healing can begin when you have the space and support to address your specific experiences and needs. You deserve treatment, support, and recovery to lead a life with meaning and purpose. Together at Rancho Recovery, we provide the whole person care you need and deserve to empower you to thrive.
Public, self, and structural stigma for fentanyl misuse and other opioid-related disorders can contribute to negative self-perception and impair recovery. In particular, stigma can impede help-seeking behaviors and contribute to discriminatory policies and regulations that limit effective treatment. Moreover, when left untreated, the impact of co-occurring disorders like mental health disorders and chronic pain from opioid misuse and dependence can be devastating. However, access to holistic care can help you address your specific recovery needs. Thus, at Rancho Recovery, we are committed to providing comprehensive care like dual diagnosis and psychoeducational groups to dismantle stigma and give you the support you need to thrive. Call us at (877) 484-1447 to start healing today.