Fentanyl Rehab - Abbeycare

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KEY TAKEAWAYS

Fentanyl Rehab provides:

A 7 – 14-day detox using 8 – 32mg Buprenorphine daily followed by CBT, grief counselling and mindfulness to manage cravings and overdose-related trauma
Take-home naloxone kits with family education about using naloxone to reverse fentanyl toxicity
Liaison with GPs, housing and legal services for ongoing support and relapse prevention

When Is Fentanyl Rehab Necessary?

The 163% increased risk of seizures and 282% increased risk of hypertension means fentanyl rehab is necessary as [1] [2]:

Cardiac Risk Management plans are developed to assess risk factors (e.g. family medical history), and ECGs are conducted during admission and after 30 days [3]
Serum electrolyte, urinalysis and BUN/creatinine tests are conducted, alongside blood pressure, heart rate, temperature and breathing rate checks at least 4 times daily [4]
5 – 60-minute brief interventions using the FRAMES approach educate patients about health status and personal risks associated with fentanyl use [5]

Cross tolerance means rehab is necessary as up to 93% of heroin users begin using fentanyl due to being 50 times stronger than heroin [6]:

Traumatic stress is addressed with weekly skills training and mindfulness exercises, as heroin users who experience or witness an overdose are 11 - 29% more likely to begin using fentanyl [6]
The "Social-Ecological Model of Trauma and Its Effects" is implemented to address unemployment in 48%, no education in 34% and previous incarceration in 79% of heroin and fentanyl users [6]

Non-fatal overdoses in 21% due to illicit fentanyl being cut with other substances means rehab is necessary as up to 65% consume fentanyl unintentionally [7]:

1-hour harm reduction interventions are provided with education about alternative methods for managing chronic pain with heat, stretching and non-opioid medications (e.g. NSAIDs) [5] [8]
4 – 16 hours of contact per week with an on-site psychiatrist is provided with ongoing mental status assessments (e.g. M.I.N.I, ASI), as 55% of unintentional fentanyl users have co-occurring psychiatric diagnoses [7] [9]

Fentanyl Rehab Process

Detox

Fentanyl detox is done by administering buprenorphine within 12 – 24 hours of fentanyl cessation and using FDA-approved medication to treat diarrhoea, vomiting and muscle pains for up to 2 weeks [10].

Therapy

Therapy in fentanyl rehab incorporates specialised therapy for overdose-related trauma and grief counselling, as 70 - 93% of fentanyl users have experienced or witnessed an overdose at least once [6]:

90-minute sessions of exposure therapy use imagery and real-life exposure to identify and process trauma-related memories (suicidality, death) and emotions (grief, anxiety) [11]
Grief counsellors provide patients with a ‘feelings’ journal to track emotions and numerically rate intensity to discuss during weekly individual or group sessions [11]
EMDR uses an 8-phase approach (e.g. reprocessing, body scan, closure) to address the trauma associated with witnessing an average of 4 deaths during active fentanyl use [6] [11]

Therapy in fentanyl rehab incorporates craving management techniques as cravings for fentanyl may persist for up to 90 days after the onset of withdrawal [3]:

10–minute mindfulness exercises use mental imagery and metaphors to help patients cope with cravings by referring to them as “ocean waves” or “leaves floating on a stream" [11]
1 -2 weeks of Buprenorphine treatment (8 - 24mg daily) and 16 weeks of CBT reduce fentanyl cravings by 54% [12]

Aftercare Planning

Aftercare planning in fentanyl rehab coordinates with external services to address homelessness in 43% and previous incarcerations in 79% of fentanyl users by [6] [7]:

Working with housing services to provide temporary (2 – 3 months), transitional (up to 3 years) or permanent accommodation after rehab treatment is complete [13]
Referring patients to vocational counsellors for weekly 90-minute skills training sessions with education about earning legal means of income during recovery
Liaising with financial, legal and social services to provide grants, probation and legal assistance for patients with pending legal matters (e.g. charges for possession with intent to sell/distribute)

Aftercare planning in fentanyl rehab provides naloxone kits to reverse fentanyl toxicity (e.g. pinpoint pupils, pulse rate <40 per minute) within 2 – 5 minutes using 0.4mg intramuscular or 2mg intranasal naloxone [10] [14].

Family members of fentanyl rehab patients are educated about how to identify/respond to signs of fentanyl toxicity (e.g. no breathing, call 999, perform CPR for up to 2 minutes and administer naloxone)[3].

Fentanyl Rehab Vs Other Opioids

	Fentanyl	Heroin	Oxycodone
Detox Timescale	7 – 14 days	10 - 14 days or 3 – 12+ months with MMT	7 – 10 days
Withdrawal Symptoms	Pupil Dilation Muscle/Bone Pain Diarrhoea/ Vomiting Insomnia	Sweating/ Fever Irritability Tremors and Shakes Anxiety/ Depression	Cravings Dysphoria Nausea Muscle Aches
Therapeutic Focus	Identifying/ processing trauma and grief + managing cravings	Developing coping skills + identifying triggers	Pain management and developing healthy coping mechanisms (e.g. exercise)
Behavioural Interventions	Integrated CBT, mindfulness, harm reduction	CBT with coping/ social skills training, REBT, DBT	CBT, Motivational Interviewing, Holistic Therapies (e.g. yoga)
Therapy Addressing Addiction From Prescribed Use?	No	No	Yes
Relapse Prevention Strategies	Coordinated care with housing programmes, vocational and legal services	Developing new social networks with sober friendships and hobbies	Enhancing coping skills for stress/ pain with mindfulness practices

	Morphine	Nitazenes
Detox Timescale	14 days	Symptoms peak around 72 hours after cessation
Withdrawal Symptoms	Abdominal Cramps Anxiety Restlessness Sweating	Fainting Panic Attacks Shaking Disorientation
Therapeutic Focus	Improving self-esteem, relationships and coping skills	Lifestyle changes (e.g. sleep habits), resilience building and stress reduction
Behavioural Interventions	CBT with relaxation techniques and cognitive restructuring	CBT, mindfulness, yoga, meditation
Therapy Addressing Addiction From Prescribed Use?	Yes	No
Relapse Prevention Strategies	Stress management techniques (e.g. deep breathing), trigger avoidance	Weekly check-ins + linkage with community resources for housing/ employment

Physiological And Genetic Factors Changing Fentanyl Rehab

High Lipophilicity And Rapid Receptor Binding

Fentanyl’s high lipophilicity (Log P values = 1.21 - 4.90) and rapid receptor binding, achieving equilibrium within 10 minutes, changes fentanyl treatment programmes due to [15] [16]:

Requirements for lipid profile tests during baseline laboratory examinations and cholesterol-rich foods (e.g. eggs) as fentanyl inhibits and decreases membrane cholesterol by up to 20% [10] [17]
Higher Buprenorphine doses (24mg vs 8mg) to effectively displace fentanyl from the mu receptor and stabilise withdrawal symptoms caused by a 61.8% decrease in cortical neuron activity [18]

Polymorphisms In Opioid Receptor Genes

The OPRM1 gene changes fentanyl rehabilitation because patients with GA and AA genotypes are 16 times more likely to consume higher doses (e.g. 59 vs 43 mg) of fentanyl compared to GG carriers, resulting in [19]:

25% higher buprenorphine doses are required 3 – 4 times daily to alleviate withdrawal symptoms due to a 4.3-fold increase in tolerance after using >50mg fentanyl daily for up to 10 years [20] [21]
Referrals to primary care pain specialists during or after treatment, as AA and GA carriers are 14 times more sensitive to pain (VAS scores >4) than GG carriers [19]
Administration of 10mg metoclopramide every 8 hours for up to 5 days and antihistamines or topical steroids due to increased nausea/vomiting (21.4 vs 7.7%) and pruritus (7.1% vs 3.8%) [22] [23]

Fentanyl-Induced Hyperalgesia

Fentanyl-induced hyperalgesia changes fentanyl addiction treatment by causing persistent pain for up to 6 months rather than 1 – 4 weeks after cessation due to a 30% reduction in the nociceptive threshold [24] [25]:

Patients receive ongoing coordinated care with GPs to develop and review pain management plans tailored to individual needs (e.g. 15 – 30 minutes of daily walking) [8]
Weekly 60-minute CBT sessions are adapted to focus primarily on maladaptive coping, developing strategies for accepting/managing pain and relapse prevention [26]
Some rehabs provide or arrange physical therapy, chiropractic care, acupuncture or transcutaneous electrical nerve stimulation for fentanyl patients with chronic pain (>3 months) [4]

Abbeycare's fentanyl rehab programme does not include complementary and alternative medicine practices (e.g. acupuncture, massage or chiropractic therapy).

Co-occurring Mental Health Disorders Changing Fentanyl Rehab

Psychological Treatment-Resistant Depression

Psychological treatment-resistant depression (TRD) changes fentanyl treatment programmes as patients typically experience less than a 25% reduction in depressive symptoms after receiving CBT [27]:

SSRIs or SNRIs (e.g. aripiprazole 5 - 20 mg/day), Lithium or Thyroid hormones (e.g. T3 = 25-50 μg/day) may be used alongside CBT to treat fentanyl patients with TRD [28]
Some rehabs offer 2 – 3 weekly sessions of electroconvulsive therapy as an alternative to CBT, to activate pyramidal cell firing by delivering high-frequency electrical pulses to the right hemisphere and vertex [29]
Some rehabs use 56 – 84mg esketamine nasal sprays 1 – 2 times weekly for up to 6 months to treat TRD patients that were unresponsive to 2 previous treatments (e.g. CBT, SSRIs) [30]

Dissociative Symptoms From Xylazine

Dissociative symptoms from xylazine in fentanyl change fentanyl rehab programmes because:

Less intensive treatment is required e.g. 30 – 60 minutes of group therapy rather than 3-hour group sessions 3 times weekly due to depersonalisation and derealisation [9]
The Dissociative Experiences Scale is administered, and metaphorical grounding techniques are used (e.g. walking out of a theatre, into daylight and the present environment) to recentre the patient [11]
Clinicians and counsellors require up to 240 hours of specialist trauma training to identify/manage dissociative symptoms (e.g. glazed eyes, monotone voice) during treatment [11]

Xylazine in fentanyl changes fentanyl addiction treatment because hospital care is required in some cases due to prolonged sedation (up to 81%), drowsiness in 85% and respiratory depression or coma in up to 43% [31]:

Patients with respirations <10 per minute and blood pressure <90/60 mmHg may require hemodynamic support (e.g. mechanical ventilation and inotrope/vasopressor infusion) [32]
Xylazine users are more likely to have skin ulcers or abscesses (38.5% vs 6.8%), requiring specialist nurses to treat infections daily to prevent amputation [31]

Fentanyl Rehab Outcomes

Fentanyl rehab abstinence rates are 55 – 93% after 6 months of receiving 13 – 20mg of Buprenorphine daily during treatment [33].

Fentanyl rehab improves emotional regulation by providing up to 16 weeks of CBT, mindfulness, and trauma/grief-focused counselling, alongside 8 – 24mg buprenorphine for 1 – 2 weeks [12].

45-minute weekly sessions of CBT and a 25% increase of dopamine after buprenorphine initiation reduces anxiety by 45% after 7 days and fentanyl cravings by 53.6% 18 weeks after fentanyl rehab [12] [34].

Fentanyl Rehab At Abbeycare

Fentanyl rehab at Abbeycare is a 28-day programme that addresses physical and psychological fentanyl dependence by:

Administering Buprenorphine to mitigate withdrawal symptoms (e.g. insomnia) during a 7 – 14-day detox
Providing weekly CBT, grief counselling and mindfulness exercises to address cravings, overdose-related trauma and co-occurring depression
Liaising with GPs, housing programmes and vocational services to provide ongoing support for chronic pain, homelessness and unemployment

Abbeycare provides fentanyl rehab patients with take-home naloxone kits when discharged from treatment, as naloxone prevents up to 20% of fentanyl overdose-related deaths [32].

References

[1] Wolfe, Caitlin E., et al. “Seizures as a Complication of Recreational Drug Use: Analysis of the Euro-DEN plus Data-Set.” NeuroToxicology, vol. 73, July 2019, pp. 183–87. Accessed 27 Jan. 2025.“There was a significant association between specific drugs and a higher seizure incidence, including fentanyl (odds ratio 2.63, 95% confidence interval 1.20–5.80).”
[2] Oh, Tak Kyu, et al. “Trends in Chronic Opioid Use and Association with Five-Year Survival in South Korea: A Population-Based Cohort Study.” British Journal of Anaesthesia, vol. 123, no. 5, Nov. 2019, pp. 655–63. Accessed 27 Jan. 2025.“Table 1.”
[3] SAMHSA. Medications for Opioid Use Disorder for Healthcare and Addiction Professionals, Policymakers, Patients, and Families TREATMENT IMPROVEMENT PROTOCOL TIP 63. 2021. Accessed 27 Jan. 2025.“Conduct an ECG for patients with significant risk factors at admission; repeat within 30 days.”
[4] SAMHSA. A Treatment Improvement Protocol TIP 45 Detoxification and Substance Abuse Treatment. 2006. Accessed 27 Jan. 2025. "Include serum electrolytes, urinalysis, BUN/creatinine, and an EKG in the detoxification unit’s, ... vital signs should be monitored at least four times daily.”
[5] SAMHSA. Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Brief Interventions and Brief Therapies for Substance Abuse Treatment Improvement Protocol (TIP) Series. 1999. Accessed 27 Jan. 2025.“Brief intervention that rarely requires more than several sessions, each lasting only 5 minutes to 1 hour.”
[6] Carroll, Jennifer J., et al. “Exposure to Fentanyl-Contaminated Heroin and Overdose Risk among Illicit Opioid Users in Rhode Island: A Mixed Methods Study.” International Journal of Drug Policy, vol. 46, Aug. 2017, pp. 136–45. Accessed 27 Jan. 2025.“The rate of regular (at least weekly) heroin use was significantly higher (93%) among those with known or suspected fentanyl exposure in the past year than those who reported no exposure (56%).”
[7] McKnight, Courtney, et al. “Understanding Intentionality of Fentanyl Use and Drug Overdose Risk: Findings from a Mixed Methods Study of People Who Inject Drugs in New York City.” International Journal of Drug Policy, vol. 118, Elsevier BV, June 2023, pp. 104063–63. Accessed 27 Jan. 2025.“Table 2.”
[8] SAMHSA. Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders TIP 54. 2011. Accessed 27 Jan. 2025.“Exhibit 2-1.”
[9] SAMHSA. Substance Use Disorder Treatment for People with Co-Occurring Disorders UPDATED 2020 TREATMENT IMPROVEMENT PROTOCOL TIP 42. 2020. Accessed 27 Jan. 2025.“Hire a psychiatrist part-time, even 4 to 16 hours per week, and that a significant number of clients can be seen that way.”
[10] SAMHSA. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. 2004. Accessed 27 Jan. 2025. “Before the initial buprenorphine induction dose is administered to a patient dependent on short-acting opioids, a minimum of 12–24 hours should have elapsed since the last use.”
[11] Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No.13-48. 2014. Accessed 27 Jan. 2025. “Clients must have ample time to process their memories and integrate cognition and affect, so some sessions can last for 1.5 hours or more.”
[12] Ling, Walter, et al. “Comparison of Behavioral Treatment Conditions in Buprenorphine Maintenance.” Addiction, vol. 108, no. 10, July 2013, pp. 1788–98. Accessed 28 Jan. 2025.“Table 2.”
[13] SAMHSA. Behavioral Health Services for People Who Are Homeless. Treatment Improvement Protocol (TIP) Series 55. 2013. Accessed 28 Jan. 2025. “Temporary housing services are generally limited to 2 or 3 months duration, ... Transitional housing is normally provided for periods of a few months to 2 or 3 years.”
[14] Lim, Jamie K., et al. “Prescribe to Prevent.” Journal of Addiction Medicine, vol. 10, no. 5, 2016, pp. 300–8. Accessed 28 Jan. 2025.“Table 1.”
[15] Schackmuth, Madison, and Sarah Kerrigan. “Lipophilicity of Fentalogs: Comparison of Experimental and Computationally Derived Data.” Journal of Forensic Sciences, vol. 68, no. 5, Sept. 2023, pp. 1542–54. Accessed 29 Jan. 2025.“Fentalogs with a wide variety of structural modifications were intentionally selected, yielding Log P values ranging from 1.21 to 4.90.”
[16] BOAS, R. A., and J. W. VILLIGER. “CLINICAL ACTIONS of FENTANYL and BUPRENORPHINE.” British Journal of Anaesthesia, vol. 57, no. 2, Feb. 1985, pp. 192–96. Accessed 29 Jan. 2025.“The receptor binding of fentanyl, which achieved rapid equilibrium (within 10 min) and dissociated equally rapidly (T 1/2 = 6.8 min).”
[17] Zheng, Hui, et al. “Cholesterol Level Influences Opioid Signaling in Cell Models and Analgesia in Mice and Humans.” Journal of Lipid Research, vol. 53, no. 6, Elsevier BV, June 2012, pp. 1153–62. Accessed 29 Jan. 2025.“There was a 20 ± 8% decrease in the membrane cholesterol in the hippocampal region and a 19 ± 10% decrease in the PAG region.”
[18] Taghizadehghalehjoughi, Ali, et al. “Effect of Fentanyl and Remifentanil on Neuron Damage and Oxidative Stress during Induction Neurotoxicity.” Journal of Cellular and Molecular Medicine, vol. 28, no. 4, Wiley-Blackwell, Feb. 2024. Accessed 29 Jan. 2025. “The highest neurotoxic dose of fentanyl and remifentanil was determined as 10 μg/mL, ... the rate of neuron cells in this dose has decreased by up to 61.80%.”
[19] Zhou, Yan, et al. “Is OPRM1 Genotype a Valuable Predictor of VAS in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer with Fentanyl?” BMC Anesthesiology, vol. 23, no. 1, BioMed Central, May 2023. Accessed 30 Jan. 2025.“The probability of GA and AA-type subjects receiving high-dose fentanyl was 15.90 times higher than that of GG-type subjects.”
[20] C Slorach. High Dose Buprenorphine a Guideline for the Peri-Operative Care of Opioid Dependent Patients Maintained on Buprenorphine, Including Acute Pain Service. May 2023. Accessed 30 Jan. 2025.“Temporary increase of daily buprenorphine dose by up to 25% and/or total dose divided and taken in three or four doses daily.”
[21] Algera, Marijke Hyke, et al. “Tolerance to Opioid‐Induced Respiratory Depression in Chronic High‐Dose Opioid Users: A Model‐Based Comparison with Opioid‐Naïve Individuals.” Clinical Pharmacology & Therapeutics, vol. 109, no. 3, Oct. 2020. Accessed 30 Jan. 2025.“Fentanyl was 4.3-fold less potent in chronic opioid users compared with opioid-naïve individuals.”
[22] Takemura, Miho, et al. “Comparison of the Effects of OPRM1 A118G Polymorphism Using Different Opioids: A Prospective Study.” Journal of Pain and Symptom Management, vol. 67, no. 1, Elsevier BV, Jan. 2024, pp. 39-49.e5. Accessed 30 Jan. 2025.“Table 4.”
[23] Department of Health . Drug Misuse and Dependence UK Guidelines on Clinical Management. July 2017. Accessed 30 Jan. 2025.”Nausea, vomiting, may also be useful for stomach cramps – metoclopramide 10mg eight-hourly (for a maximum of five days to minimise neurological and other adverse reactions)”
[24] Célèrier E et al. Long-Lasting Hyperalgesia Induced by Fentanyl in Rats: Preventive Effect of Ketamine. 1 Feb. 2000. Accessed 30 Jan. 2025.“Fentanyl administration exhibited a biphasic time-dependent effect, ... below the basal value (30% of decrease for the maximal effect) indicative of hyperalgesia.”
[25] Quinlan, Jane. Guidance for Opioid Reduction in Primary Care. 3 Oct. 2023. Accessed 30 Jan. 2025.“It can take 4-6 months after the cessation of opioids before patients feel back to normal, i.e. for the pain, anxiety and depression to reduce.”
[26] Ilgen, Mark A., et al. “Efficacy of a Psychosocial Pain Management Intervention for Men and Women with Substance Use Disorders and Chronic Pain.” JAMA Psychiatry, vol. 77, no. 12, July 2020. Accessed 30 Jan. 2025.“One-hour group-based sessions, ... highlight the link between pain and poor functioning as well as the potential use of substances as a maladaptive coping strategy for pain.”
[27] Professor Carmine Pariante. What Is Treatment-Resistant Depression? New Report Calls for Clearer Definition to Inform Research and Improve Treatment. 15 Dec. 2021. Accessed 30 Jan. 2025.“TRD when they experience a minimal reduction in symptoms (by 25% or less) after the use of at least two antidepressants, ... inclusive as possible in terms of other types of treatments, so that it does not exclude people who have failed psychotherapy.”
[28] Dawn F Ionescu et al. “Pharmacological Approaches to the Challenge of Treatment-Resistant Depression.” Treatment of Affective Dysfunction in Challenging Contexts, vol. 17, no. 2, June 2015, pp. 111–26. Accessed 30 Jan. 2025. “Current options consist of Switching therapies, Augmentation, Combination, and Optimization, ... Aripiprazole 5 mg to 20 mg/day, T3 augmentation (25-50 (μg/day).”
[29] Voineskos, Daphne, et al. “Management of Treatment-Resistant Depression: Challenges and Strategies.” Neuropsychiatric Disease and Treatment, vol. Volume 16, no. 16, Jan. 2020, pp. 221–34. Accessed 30 Jan. 2025.“ECT is applied 2–3 times per week, ... delivered as a series of high frequency electrical pulses to either the non-dominant right hemisphere and vertex.”
[30] NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Esketamine for Treating Treatment-Resistant Depression. Jan. 2020. Accessed 30 Jan. 2025.“Starting dose is 56 mg on day 1 with subsequent doses at 56 mg or 84 mg twice a week, ... SPC recommends continuing treatment for at least 6 months.”
[31] Advisory Council on the Misuse of Drugs. ACMD Advisory Council on the Misuse of Drugs ACMD Report -A Review of the Evidence on the Use and Harms of Xylazine, Medetomidine and Detomidine 2. 23 Feb. 2024. Accessed 31 Jan. 2025.“81% reported increased overdoses/passing out, ... drowsiness/lethargy in 43.8%.”
[32] Coffin, Phillip O., et al. “Modeling of Overdose and Naloxone Distribution in the Setting of Fentanyl Compared to Heroin.” Drug and Alcohol Dependence, vol. 236, July 2022, p. 109478. Accessed 31 Jan. 2025.“Overdose mortality increased just 4.1-fold with the transition to fentanyl, corresponding to prevention of 19.6% of overdose deaths from naloxone programming.”
[33] Wakeman, Sarah E., et al. “Impact of Fentanyl Use on Buprenorphine Treatment Retention and Opioid Abstinence.” Journal of Addiction Medicine, Dec. 2018, p. 1. Accessed 17 Feb. 2025.“Table 2.”
[34] Sharma, Anjalee, et al. “Examining the Severity and Progression of Illicitly Manufactured Fentanyl Withdrawal: A Quasi-Experimental Comparison.” Journal of Addiction Medicine, no. 5, American Academy of Orthopaedic Surgeons, Nov. 2024. Accessed 20 Jan. 2025.“Forty-three per cent and 19% of participants in the Fentanyl and Non-Fentanyl studies had >1 incidence of tachycardia during the evaluative period, P < 0.05.”

About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: July 20, 2025