Why fentanyl is different
The drug supply changed. Treatment works the same way.
Fentanyl is one of the dominant opioids in the illicit drug supply across the United States. It is 50 to 100 times more potent than morphine, which means dependence develops faster, withdrawal is more intense, and the risk of overdose is significant.
What this means for treatment
Buprenorphine can be effective for fentanyl dependence. It reduces withdrawal symptoms, helps control cravings, and provides a ceiling effect that can block fentanyl's effects while on medication. People on buprenorphine are significantly less likely to die from overdose — the evidence on this is consistent across multiple studies.
The current drug supply
Xylazine ("tranq") in the current drug supply.
Xylazine is a non-opioid sedative that has increasingly been identified in the illicit drug supply, often in combination with fentanyl. It does not act on opioid receptors and is not reversed by naloxone.
Because xylazine causes sedation and can contribute to respiratory depression when combined with opioids, its presence complicates overdose response and treatment.
Patients are often exposed without knowing it. The presence of xylazine reflects the broader shift toward more complex and less predictable drug mixtures.
Counterfeit pills
Counterfeit pills and fentanyl exposure.
Many pills sold as oxycodone or other prescription opioids are counterfeit and contain fentanyl instead. These pills are often referred to as "blues" or "pressed pills."
The appearance can resemble legitimate medications, but the contents are unpredictable. A pill may contain fentanyl, a fentanyl analog, or other substances entirely.
This has contributed to increased overdose risk, particularly among people who do not expect to be exposed to fentanyl.
Emerging substances
Emerging synthetic opioids.
In addition to fentanyl, other synthetic opioids — including compounds known as nitazenes — have been identified in the drug supply.
These substances can be highly potent and are not always detected on standard drug testing panels.
While less common than fentanyl, their presence reflects the changing and unpredictable nature of the illicit opioid supply.
Buprenorphine and fentanyl
A note on starting treatment.
Starting buprenorphine after fentanyl use requires some care. Because fentanyl stays in the body longer than other opioids, the timing of the first dose matters. Your physician will walk you through exactly what to expect and when to take your first dose — this conversation happens at the end of your first visit.
Many patients who have used fentanyl for extended periods do well on buprenorphine with appropriate dosing. Your physician will determine the right approach for your specific situation.
If you or someone you know is in immediate danger of overdose, call 911. Naloxone (Narcan) reverses fentanyl overdose and is available without a prescription at most pharmacies. Multiple doses may be needed for fentanyl — administer a second dose if the person does not respond within 2–3 minutes.
How we treat it
How fentanyl addiction treatment works here.
MyStreetHealth provides fentanyl addiction treatment through physician-led telehealth. You are evaluated by the same physician at every visit — not a rotating staff member or a platform-assigned provider.
Call or text to book
Same-day visits usually available. No insurance, no prior treatment records required.
Medical evaluation through online visits
A real clinical evaluation — your history, your use, your health. From your phone, tablet, or computer.
Prescription sent same day
If buprenorphine is appropriate, it is sent to the pharmacy of your choice the same day.
Ongoing care
Same physician, ongoing relationship. No arbitrary time limits on treatment.
Common questions
Things people ask about fentanyl treatment.
Does buprenorphine actually work for fentanyl?
Buprenorphine is FDA-approved for opioid use disorder and has been used successfully for fentanyl dependence. It reduces withdrawal, helps control cravings, and can block fentanyl's effects while on medication. It is one of the most evidence-supported treatments available for opioid use disorder.
I've heard it's harder to start buprenorphine when you're using fentanyl. Is that true?
There is more to manage with fentanyl because it stays in the body longer than other opioids. Starting too soon can cause precipitated withdrawal. Your physician will explain the timing precisely at the end of your first visit. This is a clinical conversation, not something you have to figure out on your own.
What if I've been using fentanyl for years?
Duration of use affects the approach but not the availability of treatment. Patients with long histories of fentanyl use can and do do well on buprenorphine. Your physician will tailor the approach to your situation.
Do I need to stop using before my visit?
No. Come to your visit honestly. Your physician needs an accurate picture of what you've been using and when in order to help you start treatment safely.
What does it cost?
$200 a month for most patients — visits are typically more frequent early in treatment and taper to monthly once you're stable. No insurance required.
Where do I start with fentanyl addiction treatment?
With a physician visit. The evaluation determines whether buprenorphine is appropriate, and if so, a prescription is often sent the same day.
Currently serving
Virginia · West Virginia · Maryland · Washington DC · Ohio
All visits are through online visits — phone, tablet, or computer. You do not need to leave home. Tennessee and Pennsylvania coming soon.
