Polysubstance Use and the Path to Fentanyl Addiction: Understanding the Risks and the Road to Recovery

By: An Addiction Specialist

Polysubstance use—mixing or alternating between multiple substances—is one of the most dangerous patterns I see in addiction work. Many people don’t start with fentanyl. They begin with alcohol, cannabis, cocaine, benzodiazepines, or prescription opioids. Over time, tolerance grows, the brain adapts, and the search for a stronger or more reliable high begins.

This is often where fentanyl enters the picture—sometimes intentionally, sometimes without the person even knowing. And once fentanyl becomes part of the cycle, the risks escalate dramatically.

How Polysubstance Use Leads to Fentanyl Addiction

Polysubstance use creates the perfect storm for fentanyl exposure and dependence. Here’s how:

1. Increased Tolerance

Using multiple substances—especially depressants and stimulants—pushes the brain’s reward system to its limits. As tolerance rises, people seek stronger effects, making fentanyl’s potency appealing or inevitable.

2. Contaminated Drug Supply

Many street drugs are now cut with fentanyl:

• Cocaine

• MDMA

• Methamphetamine

• Counterfeit pills

• Heroin

People often ingest fentanyl without knowing it, leading to accidental dependence.

3. Chasing Balance

Some people use stimulants to counteract depressants, or depressants to come down from stimulants. This “chemical balancing act” increases the likelihood of encountering fentanyl in the supply.

4. Emotional Escape

Polysubstance users often rely on substances to manage stress, trauma, or emotional pain. Fentanyl’s intense numbing effect can become a powerful—yet deadly—escape.

Why Fentanyl Is So Dangerous

Fentanyl is 50–100 times stronger than morphine. A few grains can cause overdose. Once dependence forms, withdrawal becomes severe and frightening, making quitting extremely difficult without support.

Common risks include:

• Respiratory depression

• Blackouts

• Memory loss

• Overdose (even in small amounts)

• Rapid physical dependence

• High relapse risk

This is why fentanyl addiction requires a specialized, compassionate, and structured approach.

Solutions: How to Safely Come Off Fentanyl

Recovery from fentanyl is absolutely possible—but it must be done safely and strategically.

1. Harm Reduction: Staying Alive While Seeking Change

Harm reduction is not “giving up.” It’s about keeping people alive long enough to recover.

Key harm reduction tools include:

• Naloxone kits (life‑saving overdose reversal)

• Fentanyl test strips to check drug supply

• Never using alone

• Supervised consumption sites

• Safe supply programs

• Education on mixing substances

These strategies reduce death, disease, and trauma while a person works toward stability.

2. Medication‑Assisted Treatment (MAT): Including Sublocade

Medication‑assisted treatment is one of the most effective and evidence‑based approaches for fentanyl addiction. These medications stabilize the brain, reduce cravings, and dramatically lower the risk of overdose.

Common MAT options include:

• Buprenorphine/Suboxone – Reduces withdrawal and cravings.

• Methadone – Provides stability for people with severe opioid dependence.

• Slow‑Release Oral Morphine (SROM) – Used when other treatments are not effective.

 Sublocade: A Major Advancement in Harm Reduction

Sublocade is a long‑acting injectable form of buprenorphine given once a month. It has become a powerful tool in helping people stabilize from fentanyl addiction.

Why Sublocade is so impactful:

• Steady medication levels – No daily dosing, no missed doses, no morning withdrawal.

• Reduced relapse risk – Removes the temptation to skip or misuse medication.

• Blocks fentanyl’s effects – Occupies opioid receptors, making fentanyl less rewarding and reducing overdose risk.

• Supports long‑term stability – Helps people rebuild routines, work, and relationships.

• Harm reduction at its core – Even if someone is not ready for full abstinence, Sublocade dramatically lowers the risk of fatal overdose.

Sublocade is not a quick fix, but it is one of the strongest tools we have to keep people alive and stable while they work toward recovery.

3. Therapy and Behavioral Support

Medication alone is not enough. Recovery requires emotional and psychological healing.

Effective approaches include:

• Cognitive Behavioral Therapy (CBT)

• Trauma‑informed therapy

• Motivational interviewing

• Relapse prevention planning

• Family therapy

Therapy helps people understand their triggers, build coping skills, and repair relationships.

4. Community and Peer Support

Connection is one of the strongest predictors of recovery.

Options include:

• SMART Recovery

• Narcotics Anonymous

• Peer support workers

• Recovery coaching

• Cultural or spiritual communities

No one recovers alone.

5. Structured Environments

For some, a higher level of care is needed:

• Detox programs

• Residential treatment

• Intensive outpatient programs

These provide stability, routine, and safety during early recovery.

Final Thoughts

Polysubstance use often opens the door to fentanyl addiction—not because someone chooses fentanyl, but because the drug supply is unpredictable, tolerance grows, and emotional pain drives people toward stronger relief.

But fentanyl addiction is treatable. With harm reduction, medication‑assisted treatment (including Sublocade), therapy, and community support, people can and do recover.

The goal is not perfection—it’s survival, stability, and eventually, freedom.