Do I Need Residential Treatment in a Drug Rehab for Fentanyl Addiction?

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If you receive a diagnosis for opioid use disorder (OUD), you may also receive a referral from a physician for residential treatment, but if you have a fentanyl addiction, there’s no guarantee that a residential treatment program is the best choice.


Because the gold-standard treatment for opioid use disorder (OUD) is medication-assisted treatment (MAT) with one of three medications for opioid use disorder (MOUD): buprenorphine, naltrexone, and methadone, and the most effective medication for fentanyl among those three is methadone.

However, many residential programs treat patients with a hardline abstinence model, and that approach means they will not provide medication-assisted treatment (MAT) with methadone or buprenorphine.


Because from their point of view, using a full opioid agonist like methadone or a partial opioid agonist like buprenorphine during treatment defeats the point of treatment: their opinion is that recovery requires full abstinence, and that a person using a MOUD is not abstinent.

But there’s a problem with that stance: programs that require full abstinence and prohibit the use of MOUDs are far less effective for opioid use disorder (OUD) – and specifically far less effective for fentanyl addiction – when compared to programs that utilize MOUDs as part of a comprehensive treatment plan for opioid use disorder.

If that’s the case, then that begs a question:

If MAT with methadone is the gold-standard treatment for people with fentanyl addiction, why do some treatment centers require full abstinence, and prohibit MAT with MOUDs?

To be perfectly honest, we understand where they’re coming from, theoretically, but practically speaking, we don’t understand why an addiction treatment center wouldn’t provide the best available treatment for a specific medical condition.

Therefore, the question posed in the title of this article has at least two valid answers:

  1. If a residential treatment center for fentanyl addiction doesn’t offer MAT with MOUD, the answer may be clear and simple “No.”
  2. If a residential treatment center for fentanyl addiction does offer MAT with MOUD, the answer may be clear and simple “Yes” if you’re okay with using MAT with MOUD as part of your treatment plan.

The Medical Model of Addiction

Let’s back up and explain why this is even a debate in the first place.

The language we use above to describe buprenorphine and methadone – partial and full opioid agonist(s) – mean that those medications occupy the same receptors in the human brain and nervous system that opioids like heroin, fentanyl, and others occupy, but without causing the extreme euphoria and opioid high associated with disordered or recreational use of drugs like heroin or fentanyl.

Providers that adhere to the hardline abstinence-only model of treatment assert the MAT approach is simply replacing one addiction with another. However, addiction science has moved past this relatively narrow view of treatment and recovery, which has its origins in programs such as Alcoholics Anonymous (AA) and a treatment philosophy developed almost a hundred years ago.

In 2024, we understand two things we didn’t in the 20th century: the medical model of addiction and the harm reduction approach to addiction treatment. The medical model of addiction means that addiction, which we now call substance use disorder (SUD) is a disease with genetic, environmental, biological, and neurological causes that responds well to evidence-based treatment that includes therapy/counseling, lifestyle changes, and – for some diagnoses and disorders – medication. In this way, addiction is remarkably similar to other chronic diseases such as diabetes or hypertension.

If a person diagnosed with one of those conditions stops taking their medication, risk of relapse increases dramatically. In other words, discontinuing medication can force them out of remission and into relapse. That’s the same with OUD during MAT: if a person discontinues medication, it may force their disease out of remission, and their chances of relapse to opioid use increase.

Addiction and Physical Dependence: An Important Distinction

According to our latest understanding of addiction science, there’s a difference between opioid use disorder (OUD) and physical dependence on medication for opioid use disorder (MOUD). The Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5) places OUD under the overall category of substance use disorder (SUD), which is characterized by:

  • Compulsion to use opioids
  • Cravings for opioids
  • Tolerance to opioids
  • Loss of control over opioid use
  • Withdrawal when discontinuing use
  • Continuing use despite significant negative consequences

The authors of the DSM-V separate physical dependence on MOUD from OUD by identifying these differences:

  • Tolerance to FDA-approved MOUD does not count as a criterion for OUD
  • Withdrawal from FDA-approved MOUD does not count as a criterion for OUD
  • A person in treatment with MOUD who shows tolerance, withdrawal, and cravings – but no other criteria for OUD – is considered in remission on medication

Understanding this distinction is critical for people considering MAT with methadone for fentanyl addiction.

Therefore, when someone asks:

“Isn’t someone on methadone (or buprenorphine) just addicted to a different drug?”

The correct, medically accurate answer – following DSM-V criteria – is this:

“No. A person physically dependent on a MOUD is in recovery, and in medical terms, in remission from OUD.”

Methadone: The Most Effective Medication for Fentanyl Addiction

Residential treatment for fentanyl addiction can be effective without MOUD, but denying access to a gold standard medication for a medical condition does not align with the harm reduction approach to addiction treatment we embrace at Pinnacle Treatment Centers. We take an all-of-the-above approach to treating OUD, and in some cases, methadone is part of that approach.

Evidence shows that of the medications available for OUD, methadone is the most effective for fentanyl addiction. There are three reasons for this:

  1. According to the DEA, fentanyl is far more powerful than other opioid medications: it’s 100 times more potent than morphine and 50 times more potent than heroin.
  2. Methadone is a full opioid agonist, meaning it attaches completely to opioid receptors in the brain, whereas buprenorphine is a partial agonist, meaning it only partially attaches to the opioid receptors in the brain.
  3. Because it’s a full agonist, methadone is more effective than buprenorphine in reducing cravings, mitigating withdrawal symptoms, and normalizing brain chemistry for a person addicted to fentanyl, compared to a person addicted to a less potent/powerful opioid.

Methadone is currently available at specialized treatment facilities called Opioid Treatment Programs (OTPs). To locate a Pinnacle facility that prescribes methadone as part of a comprehensive treatment plan including counseling, social support, and other treatment modalities, please navigate to this page:

Where We Are: Methadone Locations

Expanding access to methadone is essential in our nationwide efforts to mitigate the harm caused by the opioid crisis, and a key component in addressing fentanyl addiction and overdose.

Fentanyl and the Opioid Crisis

In the report “STREET DEA: State and Territory Report on Enduring and Emerging Threats,” published in January 2024, Drug Enforcement Agency (DEA) officials explain that fentanyl is a significant danger to our national health and wellbeing due to its ongoing role as the primary driver behind the ongoing opioid overdose crisis in the U.S. The Centers for Disease Control and Prevention (CDC) reports the following overdose data for 2022:

  • 109,413 total drug overdose deaths
  • 82,075 opioid-related overdose deaths
  • 74,829 fentanyl-related overdose deaths

That data tells us fentanyl was involved in approximately 68 percent of drug poisoning deaths. In addition, the DEA indicates:

  • Fentanyl seizures by the DEA have increased steadily since the mid-2010s
  • Rates of fentanyl overdose increased alongside the increase in DEA seizures:
    • 2015: 9,367 fentanyl-related overdose deaths
    • 2022: 74,829 fentanyl-related overdose deaths

That’s an increase of 698 percent.

This data makes increasing access to methadone treatment more important than ever before: in plain language, evidence shows medication is the most effective approach to reducing the negative consequences of fentanyl addiction. MAT with methadone can:

  • Decrease opioid use
  • Increase time-in-treatment
  • Normalize brain chemistry
  • Improve social and family functioning
  • Improve academic and vocational achievement
  • Reduce criminal behavior
  • Decrease risk of relapse
  • Reduce opioid-related mortality
  • Reduce fatal overdose

If you or someone you love is considering residential treatment for fentanyl addiction, please understand that the best available treatment for fentanyl addiction is with the MOUD methadone. While residential treatment plays an important role in the big picture effort to support people with substance use disorder in their long-term recovery journey, it’s critical for people to understand that evidence shows methadone – as part of a comprehensive treatment plan – is the gold standard treatment for OUD, and the most effective known treatment for fentanyl addiction.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.