Fentanyl Has Upped The Stakes Of Substance Addiction Relapse

Substance addiction can be a “relapsing disease” where people who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives, according to the NIH (National Institute Of Health).  We have also learned that there are many stages of change those who struggle with substance addiction go through where prevention and treatment interventions can be implemented to help stem the tide of the progression of the disease of substance addiction.  And over the last several decades there has been great advances in reducing the stigma surrounding substance addiction and often present co-occurring mental health issues and increasing access to effective methods to treat it at all stages. 

The Problem:

Tragically, the advent of Fentanyl in the illicit drug supply on both coasts of the U.S. over the last several years has spiked overdose deaths across the country, making the stakes of relapse increasingly high.  At first it seemed these overdose deaths were from unintentional use of Fentanyl through other illicit drugs where it was cut into them like cocaine, methamphetamine or illegal online subscription pills like Xanax and Oxycodone, but it has recently also become the “drug of choice”  for many with chronic and acute substance addiction seeking to extend and augment the effects of their using.  The illicit drug supply has been flooded with illegally manufactured Fentanyl pills coming largely from drug cartels in Mexico, Central and South America with its core components being made available from China.

The deadly effects of Fentanyl overdoses when used intentionally or unintentionally can often be reversed with Naloxone (often administered through a nasal injector called Narcan) that can be life-saving.  Anyone can get Narcan now over the counter at a pharmacy due to new legislation eliminating the requirement of a prescription in 2023, which will go a long way to save the lives of those experiencing an opioid overdose. 

However, according to the NIH National Institute on Drug Abuse Narcan has started to become less effective because of Xylazine:

  • Xylazine, a non-opioid veterinary tranquilizer not approved for human use, has been linked to an increasing number of overdose deaths nationwide in the evolving drug addiction and overdose crisis. Studies show people exposed to xylazine often knowingly or unknowingly used it in combination with other drugs, particularly illicit Fentanyl.” 
  • NIDA goes on to say, “Research has shown xylazine is often added to illicit opioids, including fentanyl, and people report using xylazine-containing fentanyl to lengthen its euphoric effects. Most overdose deaths linked to both xylazine and fentanyl also involved additional substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids.”
  • And most tragically, NIDA concludes saying, “In the event of a suspected xylazine overdose, experts recommend giving the opioid overdose reversal medication Naloxone because xylazine is frequently combined with opioids. However, because xylazine is not an opioid, naloxone does not address the impact of xylazine on breathing. Because of this, experts are concerned that a growing prevalence of xylazine in the illicit opioid supply may render naloxone less effective for some overdoses. Emergency medical services should always be alerted to a suspected overdose.”

So, to sum up the problem, overdoses in the U.S. are increasing because of the prevalence of Fentanyl in the illicit drug supply and Xylazine has made reviving someone who has overdosed more difficult even with the use of Naloxone.  Together, this has completely changed the outlook of those with substance addiction relapsing and made mitigating the consequences more urgent than ever to stem the tide of deadly overdoses.

The Solutions:

For those who are in the stages of change of pre-contemplation, contemplation, preparation and action where an abstinence based path of recovery may not yet be sought as a solution or not successfully or consistently, interventions of harm reduction, like medically assisted treatment (“MAT”) can be helpful to reduce the odds of relapse and overdose, especially in consultation with a doctor, mental health clinician and other substance addiction professionals.  Additionally, at these stages, visits to the hospital emergency room, detoxification treatment, residential treatment, and/or various types of outpatient treatment may be needed to help stabilize substance addiction.  Peer support groups like 12-Step meetings, Smart Recovery, Refuge Recovery, religious group meetings, other spiritual groups, etc. can also help create a sense of connection and community that fosters substance addiction recovery through mentorship during these initial stages.

For those at the maintenance stage in the stages of change of substance addiction SAMHSA states, “This client needs help with relapse prevention.  A brief intervention could reassure, evaluate present actions, and redefine long-term sobriety maintenance plans.”  Many at this stage find success pursuing an abstinence-based approach where a profound change in thinking, feeling and action over time helps develop resilience, recovery capital and coping skills, and through consistent connection and community with their recovery support network to be able to sustain long-term substance addiction recovery.   Their recovery support network often includes peer support groups, mental health professionals, psychopharmacological support, spiritual support, family system and friend support, etc. working together to create an awakening to a new sustainable and productive life in recovery. If you need help with what you think might be substance addiction, you can reach out today through the national 988 Suicide and Crisis Hotline.  Help is always available for those that honestly seek it and you never have to pursue this help alone.  Over the last 36 years of my own recovery experiences, I’ve seen miracles happen for those that seemed the most hopeless, where through asking for help and bravely taking the next indicated actions over time they were able to transform their lives from hopeless to hopeful and begin their recovery journey.  I hope and pray you and your loved ones find the peace you seek.


  • David vandervelde

    Executive Director and Co-Founder

    Awakening Recovery

    David got clean and sober in 1988 at the age of 19, close to death from his own struggles with drug addiction and alcoholism. Now 35+ years clean and sober, he has been consistently active in his recovery community by mentoring others, serving on recovery and youth related non-profit Boards such as LifeWorks and the West Hollywood Recovery Center, and serving on panels at institutions speaking from his own experience about recovery.   In 2015, David chose to transition from a 25-year career in producing large-scale corporate events for the sports, entertainment and non-profit sectors, to co-founding Awakening Recovery, non-profit a sober living in Los Angeles, as its Executive Director and Board member, helping those looking for a long-term recovery solution regardless of access to funds.  Additionally, David has successfully completed his Certificate in Alcohol and Drug Abuse Counseling from UCLA.  He now devotes his personal and professional life to helping those that need it the most find a long-term recovery solution from chronic and acute drug addiction and alcoholism through the life-saving work at Awakening Recovery and in his recovery community at large.