Remifentanil Addiction and Abuse

Remifentanil is a potent opioid restricted to hospitals that nonetheless has been misused and can lead to addiction, overdose and death.

Remifentanil is the active ingredient in Ultiva, an intravenous (IV) opioid for pain. The drug is a highly potent narcotic that the Drug Enforcement Administration has listed as a Schedule II drug under the Controlled Substances Act. Although remifentanil is restricted to use in a hospital setting where it is less likely to be abused, it can be diverted or stolen and misused.

Remifentanil Addiction

Like all Schedule II opioids, remifentanil has a high potential for addiction. However, the drug has unique pharmacological properties that make it less likely to be misused. Although the onset of remifentanil is quick, around one minute, the drug’s effects completely wear off within 5 to 10 minutes. For this reason, remifentanil is less appealing than other opioids for recreational use and is rarely targeted by illicit drug dealers for distribution. However, the fentanyl from which remifentanil is derived is largely responsible for the current opioid overdose epidemic that has overtaken North America in the last three decades.

What is Remifentanil?

Remifentanil (sold under the brand name Ultiva) is a synthetic opioid administered as a pain reliever during and after surgical procedures with general anesthesia. It is not available from local pharmacies.

Remifentanil is as potent as fentanyl, which itself can be up to 100 times more powerful than morphine. The drug is intended for adults during surgery or immediately after that for those who are in intensive care units. Remifentanil should always be administered under the supervision of an anesthesia practitioner and the person should be on supplemental oxygen while taking the drug.

Common Side Effects & Symptoms of Misuse

People who begin treatment with Ultiva may notice side effects from the medication. Some of the most common side effects include nausea, low blood pressure, vomiting and muscle rigidity.

Misusing or abusing Ultiva can lead to opioid overdose. Symptoms of an overdose include:

• Slowed breathing
• Extreme sleepiness
• Coma
• Muscle weakness
• Cold and clammy skin
• Pinpoint pupils
• Slow heart rate
• Low blood pressure
• Atypical snoring
• Death

Overdose Risk

As with most opioids, the primary risk factor of remifentanil is severely slowed breathing, also known as respiratory depression. This risk occurs because remifentanil acts directly on the brainstem to suppress the body’s automatic urge to breathe.

When the brainstem is not under the effects of remifentanil or other opioids, the brainstem can accurately measure carbon dioxide levels in the blood. When carbon dioxide levels become too high, the brainstem triggers the lungs to breathe.

In the event of a remifentanil overdose, the brainstem can no longer perform this function, leading to oxygen deprivation and death. Because remifentanil is limited to hospitals, you should obtain help from a medical professional right away if you suspect an overdose. They will be able to assess the person and give an opioid reversal drug like naloxone if needed.

Remifentanil and Alcohol

Do not drink alcohol or consume any products containing alcohol while taking remifentanil or for 24 hours afterward. This rule should be followed regardless of whether you are in a hospital setting or outside a hospital. Because both alcohol and remifentanil are central nervous system depressants, combining the two may increase the risk of severe side effects like low blood pressure, slowed breathing, profound sedation, coma and death.

If you feel you cannot abstain from alcohol while being treated with remifentanil, talk to your doctor about alternative drugs to address your pain during your hospital stay.

Long-Term Consequences

The long-term effects of Ultiva have not been tested because this medication is intended only for short-term use in a hospital setting. However, because it is an opioid, if a person is misusing the medication, the long-term side effects can be similar to those of other opioids. In general, the longer opioids are used, the higher the chances of a physical and psychological substance abuse disorder.

Remifentanil Withdrawal

If you no longer want to be given remifentanil as part of your anesthesia, discuss this with your doctor. In most cases, the doctor will recommend the anesthesia practitioner to gradually lower your dose. This strategy, known as tapering off the medication, helps you avoid the worst of remifentanil withdrawal symptoms.

Remifentanil should never be abruptly stopped. Suddenly discontinuing this form of treatment may cause you to experience withdrawal symptoms.

Withdrawal Symptoms

Common withdrawal symptoms associated with opioids like remifentanil include:

• Restlessness
• Watery eyes
• Runny nose
• Yawning
• Sweating
• Chills
• Muscle pain, backaches and joint pain
• Dilated pupils
• Irritability
• Anxiety
• Weakness
• Abdominal cramps
• Insomnia
• Nausea and vomiting
• Loss of appetite
• Diarrhea
• High blood pressure
• Fast breathing
• Increased heart rate

Withdrawal Timeline

People who are going through withdrawal experience symptoms in different ways. For some, withdrawal symptoms may subside within a few days. For others, it may take much longer. This is because each person’s unique physiology contributes to how quickly substances are processed in the body and how long withdrawal will last. Factors that contribute to how your body processes remifentanil include your organ function, genetics, dose, and the frequency at which you are given remifentanil.

Remifentanil Addiction Treatment & Detox

The Recovery Village offers many rehabilitation programs and resources to those who may be struggling with remifentanil. Before beginning treatment with inpatient or outpatient programs, you will first need to safely detox from remifentanil. Once the drug is removed from your body, you may attend individual and group counseling sessions as well as recreational therapy activities during your time at The Recovery Village.

Inpatient Rehab
The first treatment option, which is particularly helpful for those with a severe addiction, is inpatient rehab. In this program, you are required to live on campus at one of The Recovery Village’s designated inpatient recovery centers. By living on campus, you can avoid distractions from your home life that may impede your recovery as you start life without remifentanil.

Outpatient Rehab
Once you complete inpatient rehab, you can enter an outpatient rehab program to support you as you navigate your remifentanil-free life. An outpatient program allows you to live at home while you attend scheduled treatment appointments at The Recovery Village. Those with a mild remifentanil addiction may choose to entirely skip the inpatient rehab program and begin recovery with outpatient rehab or online with teletherapy.

Choosing a Remifentanil Rehab Center

Choosing a rehab center is an important decision. If you are unsure which kind of center is right for you, set up a meeting with your doctor to discuss the treatment features you should seek. You may also want to consider how long you have been receiving remifentanil and your treatment schedule when making this important decision.

If you or someone you know is struggling with remifentanil, it’s not too late to stop the drug from taking over your life. The Recovery Village has professional addiction specialists ready to help. Contact us today to discuss treatment options that can help you start the journey to recovery.

Editor – Melissa Carmona

As the content manager at Advanced Recovery Systems, Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more