This is a rapidly escalating problem in the mental health field and clinicians need to have increased awareness regarding the deadly potential of synthetic opioids. We need to educate patients regarding the risk of any drug they abuse (e.g. cannabis, cocaine, amphetamine, oxycontin) as synthetic opioids may be an adulterant and a deadly combination with psychiatric medications. We should be increasingly doing surprise urine drug screening as appearances are deceptive. Patients testing positive for drugs would benefit from enrollment in a dual diagnosis program where both substance abuse and mental health issues can be addressed. I suggest that we think of addiction in terms of a disease model (diabetes mellitus) and aim for a comprehensive treatment plan.
Opioids are substances that act on opioid receptors to produce morphine like effects. The broad classification of opioids includes natural opioids (e.g. morphine and codeine); semisynthetic opioids created from natural opiates or morphine esters (e.g. hydrocodone, oxycodone, hydromorphone, and buprenorphine); fully synthetic opioids (e.g. fentanyl, methadone, tramadol, dextropropoxyphene, heroin sold on the streets); endogenous opioid peptides found naturally in the body (e.g. endorphins and enkephalins).