How to Treat Actiq (Fentanyl) Addiction
[content-overview]Actiq is the brand name for an analgesic lozenge (on a stick like a lollipop) that contains the opioid drug fentanyl—a powerful synthetic opioid which, when rapidly absorbed through the oral mucosa (along with being slowly absorbed through the GI tract), helps to relieve breakthrough pain related to cancer that is not well managed by other opioid medications.1,2 [/content-overview]
In an ever-worsening opioid epidemic, fentanyl is playing a growing role. There were over 47,000 opioid overdose deaths among Americans in 2017, and about 59% of them involved fentanyl. This is a dramatic increase from 2010, where only about 14% of opioid overdose deaths involved fentanyl.2,13 Fentanyl is popping up in heroin and other drugs (often unbeknownst to users), some individuals seek out fentanyl because they have a raised tolerance to opioids and want a more potent drug, and overdoses due to fentanyl are on the rise.2,3,14 While a “lollipop” may seem relatively innocuous, Actiq is still fentanyl and the dangers and addictive potential exist like in any other form of this drug.
If you or someone you know is misusing Actiq, the stakes are high. Don’t wait to seek help. It could save your life or that of your loved one.
Can You Get Addicted to Actiq?
Yes. Actiq is very addictive. Fentanyl has a strong addiction potential because it is 50-100 times more potent than morphine, has a quick onset of action, and has a short duration of effects (so continued effect requires repeated doses).2,4
Repeated misuse can lead to addiction.
Like morphine, oxycodone, and other opioids, fentanyl works by attaching to opioid receptors and altering the brain's perception of pain. When the substance binds to opioid receptors in a certain part of the brain, it triggers a release of dopamine.5 It is thought that dopamine motivates individuals to repeat activities that were pleasurable, so these releases of dopamine encourage repeated misuse that can lead to addiction.15
What is Opioid Misuse?
It is estimated that, of people who are prescribed opioids for chronic pain, between 21 and 29 percent misuse them.13 Prescription opioid misuse is when a person uses them in a way that they are not meant to be used. Examples of how individuals may misuse prescription opioids (like Actiq) include:5
- Taking it through methods other than the prescribed method (such as snorting crushed pills).
- Using it more often than prescribed.
- Taking it in larger doses than prescribed.
- Using it for reasons other than the prescribed one(s).
- Using it without one’s own valid prescription.
- Taking it with alcohol, illicit drugs, or some other medications
Misuse of Actiq may increase the risk of side effects. Possible side effects include confusion, nausea, drowsiness, constipation, anxiety, problems breathing, and dizziness. Serious side effects may include respiratory depression, low blood pressure, impaired blood circulation, and shock. Actiq use can be deadly.1 Signs of an overdose can include sleepiness, confusion, dizziness, small pupils, slow and shallow breathing, and stopped breathing.16 If you think you or someone else may have overdosed on Actiq or another drug, call 911 immediately.
Individuals who regularly use Actiq, even if taking as prescribed, can develop tolerance and dependence.
Individuals who regularly use Actiq, even if taking as prescribed, can develop tolerance and dependence. Tolerance is when more of the drug is needed to get the same effect. Dependence is when stopping (or drastically decreasing) use of the drug causes withdrawal symptoms. Being dependent on opioids does not mean that person is addicted to opioids, but it can lead to addiction for some.2
Am I Addicted to Actiq?
Recognizing the signs of addiction in yourself can be much more complex than seeing the signs of addiction in others, especially when you’re holding a valid prescription for the drug. Individuals with addiction may have feelings of shame, fear, and anger, and addiction can distort a person’s judgment and decision making.6,7 This can make it challenging to be honest with yourself about whether you have a problem.
If you are addicted to Actiq, you may:7
- Keep using the drug despite it causing relationship problems.
- Be unable to maintain commitments at work, home, or school because of substance use.
- Use the drug more or in greater amounts than intended
- Try unsuccessfully, or want to try, to reduce or end use.
- Spend a large amount of time obtaining, using, or recovering from the substance.
- Have cravings for the drug
- Stop or decrease important activities because of substance use
- Keep using the drug despite knowing that it may be causing or worsening a physical or psychological problem
- Repeatedly use the drug despite it putting you in dangerous situations
- Develop a tolerance to the drug
- Have withdrawal symptoms if the drug is stopped
How to Approach a Loved One
Do you know someone who may be misusing Actiq? If so, deciding on a way to approach your loved one can be a confusing prospect. It can be challenging to know if they are using Actiq appropriately, if they are using the substance alone or in combination with other drugs, and/or if their changes are due in part to the presence of a mental health condition. The list provided in the previous section gives some signs a person may be addicted to Actiq. If you think your loved one may have an addiction, encourage him or her to see a medical provider for an evaluation.7
Before the actual conversation, you should consider:
- Building a thought-out plan of what you will say.
- Seeking advice from others.
- Arranging a convenient time to talk with them in a private place.
When speaking to your loved about their Actiq misuse, you should strive to:
- Frame things from your perspective using “I” statements (such as “I feel…” or “I worry that…”).
- Use calm body language and tone of voice.
- Distinguish your feelings for them as a person from your feelings about their actions.
- Ask if your loved one is willing to get professional treatment and, if they are, help them get it.
- Avoid unwanted behaviors like becoming overly emotional or threatening.
- Clearly explain any boundaries you are setting and any consequences that will happen if they do not seek treatment.
Some people struggle with what to do when their loved one has a problem with substance use. Fortunately, there is a method created to aid them called Community Reinforcement and Family Training (CRAFT). CRAFT is a skills-based approach that teaches concerned significant others (CSOs) how to help their drug-using loved one and to improve their own functioning and relationships. CRAFT-Support and Prevention (CRAFT-SP) is a CRAFT model that is modified to be used for group education in a treatment environment. Goals of CRAFT-SP include:9
- Promoting abstinence.
- Reducing the risk of violence.
- Minimizing stress and increasing healthy lifestyles for all people involved.
- Preparing the loved one to support the addicted individual in treatment (and to propose a return to treatment if relapse happens).
CRAFT is built around the idea that loved ones can play an active role in helping the individual struggling with substance use.9
Another approach, the formal intervention, involves having a group of loved ones provide the individual with a structured way to make some changes. It should be carefully planned and involve (at least through consultation) a treatment professional or interventionist. Loved ones use the meeting to discussing the negative impacts of the substance use, to urge him or her to seek treatment, and to state the consequences for not obtaining treatment.
Interventions can evoke strong feelings of resentment, anger and/or betrayal. Poorly prepared interventions can backfire and make the problem worse. A professional can help make an intervention effective.
When a person struggling with Actiq misuse agrees to seek help, professional evaluation and treatment is advised. No one treatment is best for everyone.11 Some treatment approaches that can be effective for individuals addicted to fentanyl include:2,12,18
- Medication-assisted treatment (MAT). MAT is an option to support the recovery process, reduce withdrawal symptoms, and minimize cravings for more Actiq or other opioid drugs. This involves taking a medication such as buprenorphine, methadone, or naltrexone.
- Cognitive-behavioral therapy (CBT). This approach explores the connections between thoughts, feelings, and behaviors. CBT can help a person to better manage triggers for substance use and stress and to alter their expectations and actions. CBT can address underlying mental health concerns as well.
- Motivational interviewing. MI strives to improve the person’s own motivation for change.
- Contingency management. CM dispenses rewards to encourage behaviors associated with a drug-free lifestyle.
Many people who misuse substances have mental health issues as well. A psychiatric evaluation should also assess for any comorbidities and any mental illnesses should be treated. Fortunately, multiple behavioral therapies can be used to treat mental health conditions and substance use issues simultaneously, and behavioral therapies can be used alone or in conjunction with medication(s).19
- U.S. Food and Drug Administration. (2011). Actiq.
- National Institute on Drug Abuse. (2019). Fentanyl.
- National Institute on Drug Abuse. (2018). Nearly half of opioid-related overdose deaths involve fentanyl.
- Drug Enforcement Administration. (2015). Fentanyl.
- National Institute on Drug Abuse for Teens. (2016). Prescription Pain Medications: Opioids.
- American Psychiatric Association. (2017). What Is Addiction?
- National Institute on Drug Abuse. (2016). What to Do If Your Adult Friend or Loved One Has a Problem with Drugs.
- Scruggs, S.M., Meyer, R, Kayo, R. (2014). Community Reinforcement and Family Training Support and Prevention.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2016). Drug Facts: Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- National Institute on Drug Abuse. (2019). Opioid Overdose Crisis.
- National Institute on Drug Abuse. (2017). Addressing America’s Fentanyl Crisis.
- National Institute on Drug Abuse. (2018). Drugs, Brains, and Behavior: The Science of Addiction.
- U.S. National Library of Medicine. (2019). MedlinePlus: Fentanyl.
- Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
- National Alliance on Mental Illness. (n.d.). Psychotherapy.
- National Institute on Drug Abuse. (2018). DrugFacts: Comorbidity: Substance Use Disorders and Other Mental Illnesses.