Key Points

  • A UCLA-led study estimated average daily fentanyl intake at approximately 8,887 morphine milligram equivalents (MME) among regular users in Los Angeles, roughly 60 times the 2 mg dose that can be lethal for a person with no opioid tolerance.
  • That level of tolerance means standard starting doses of methadone often provide little relief; updated regulations allow starting at 50 mg, but many patients with heavy fentanyl use still require rapid daily increases to manage withdrawal.
  • A nationally representative survey of U.S. middle and high schoolers found that 52% of eighth graders do not see a great risk in trying fentanyl once or twice, even though fentanyl is involved in at least 75% of adolescent overdose deaths.
  • Adolescents most often encounter fentanyl not by seeking it out but through counterfeit prescription pills made from or contaminated with fentanyl, meaning they may believe they are taking Xanax, Vicodin, or another familiar drug.
  • On July 6, SAMHSA announced more than $281 million across 15 grant programs under the Great American Recovery Initiative, with $68.2 million going toward medication-assisted treatment for opioid use disorder.
  • Naloxone is available without a prescription at most pharmacies, and knowing how to use it matters whether you are a teenager, a parent, or a friend.

Addiction News Weekly Episode 1.8

In This Episode:

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction, recovery, and public health. This week we go deep on fentanyl, three stories with three angles. First, what new research reveals about how much people who use it regularly are actually taking in and why that number matters for treatment. What a nationally representative survey of middle and high schoolers found about how teens actually perceive the risk, and where 281 million dollars in new federal funding is headed and what that means for access to care. Let’s get into it.

Fentanyl Tolerance: What UCLA Research Found About Daily Consumption

We start with a UCLA-led study that puts hard numbers behind something clinicians have been watching for years: the extraordinary tolerance that develops with regular illicit fentanyl use. The research, published in Drug and Alcohol Dependence, was led by Drug Checking Los Angeles, a research and public health program founded by Chelsea Shover, an associate professor at UCLA.1,2 The lead author, Morgan Godvin, drew on her own lived experience with an opioid use disorder to shape the questions behind the work.

The team combined purity results from more than 500 fentanyl samples tested between September 2023 and January 2026 with surveys of 47 people who regularly use fentanyl in Los Angeles. To make fentanyl’s potency comparable to other opioids, they used a standardized yardstick called morphine milligram equivalent, or MME. The estimated average daily intake came to about 8,887 MME.

To put that into context, the CDC considers just two milligrams of fentanyl potentially lethal for someone with no opioid tolerance. Shover’s team estimated that a typical regular user in Los Angeles takes in roughly 60 times that amount every day. One gram of the average purity fentanyl they tested carried a dose comparable to more than 1,200 hospital vials, or about 440 Percocet pills.

For the clinical read on what those numbers mean for treatment, here is Rehab.com Chief Medical Officer Dr. Sylvie Stacy. What these numbers translate to in the real world clinical setting really is a big shift in how we have to approach treatment. Most of our dosing guidelines and prescribing thresholds were built for an era where opioid tolerance looked very different than it does today. Today, patients are facing a physiological burden from regular fentanyl use that is just different than what we see with pain pill addiction and what we saw with heroin addictions.

Dr. Stacy sees this playing out regularly in her own practice. Since fentanyl took over the drug supply, the starting doses of methadone that used to work smoothly are really not enough for patients that have a high tolerance for fentanyl. She has had countless patients who feel little to no relief on what used to be a standard starting dose of methadone at around 30 milligrams, still in acute distress at that dose.

Regulations have finally updated in the past couple of years so that clinicians can start patients at a bit of a higher dose, at 50 milligrams, which does help. But even with that higher starting point, patients with heavy fentanyl use often need to continue to supplement with illicit fentanyl just to function in those first few days of treatment while their methadone dose gets titrated up. Clinicians often end up needing 10 milligram daily dose increases for the first several days just to reach a level where patients are not feeling sick throughout the day.

The physical aspects of fentanyl withdrawal are very intense as well. People often lose significant amounts of fluid from vomiting, diarrhea, sweating, and runny nose and watery eyes, and they are often too sick to drink enough to replenish those fluid losses. While opioid withdrawal itself is not typically considered life-threatening, Dr. Stacy has treated cases where the secondary complications, particularly from severe dehydration, required medical treatment and close monitoring.

Methadone and buprenorphine are still the gold standards for saving lives in opioid use disorder. But protocols and clinical procedures need to be as adaptive as possible to make sure that patients receive the care they need as the drug supply continues to shift.

How Adolescents Perceive the Risk of Fentanyl Use

Our second story is about who fentanyl is reaching and how little much of the youth understand about what it can do. Researchers reported in JAMA Network Open that a majority of eighth graders in the United States do not see a great risk in using fentanyl once or twice.3 The data comes from the 2025 Monitoring the Future study, an annual nationally representative survey of U.S. middle and high schoolers. Among close to 4,000 students who answered questions about fentanyl, only 48 percent of eighth graders said that there was a great risk of trying it once or twice. Among 10th graders it was 64 percent, and among 12th graders 70 percent, leaving roughly a third of older students and about half of the youngest ones not seeing fentanyl as highly dangerous. On top of that, 9 to 17 percent of students, depending on grade, said that they were not familiar enough with fentanyl to judge the risk at all.

The usual pattern in drug risk education is that occasional use is genuinely less dangerous than heavy use. Fentanyl does not follow that pattern. A single exposure can be fatal, and the most common way adolescents encounter it is not by seeking it out. Rather, it is through counterfeit prescription pills that are either contaminated with or made entirely out of fentanyl. A teenager who thinks that they are taking Xanax or Vicodin from a friend may actually be taking a pill containing fentanyl.

Drug poisonings and overdoses now rank third among leading causes of death for children and teenagers in the United States, and fentanyl is involved in at least 75 percent of those deaths among adolescents. For parents and caregivers, the takeaway is to have a specific conversation, not a general drugs-are-bad message, but rather one that explains what fentanyl is, where it actually shows up in the current drug supply, and why no pill that did not come from a pharmacy can be assumed to be what it looks like. Naloxone is available over the counter at pharmacies, and knowing how to use it is worth knowing whether you are a teenager, a parent, or a friend.

SAMHSA Awards $281 Million to Expand Treatment and Recovery

Our third story is the federal response. On July 6, SAMHSA announced more than $281 million in funding opportunities across 15 grant programs under the administration’s Great American Recovery Initiative.4 The largest single piece, $68.2 million, goes to medication-assisted treatment for prescription drug and opioid addiction, expanding access to medications for opioid use disorder. Other significant pieces include $55.7 million for Project AWARE, which builds school-based mental health services; $40.6 million for the National Child Traumatic Stress Initiative; and $34.7 million to train first responders to carry and administer opioid overdose reversal medication. The remaining roughly $59.8 million spreads across mental health awareness training, integrated primary and behavioral care, workforce development, suicide prevention, community treatment programs, and emergency department alternatives for opioids.

A point worth repeating: grant cycles do not lower the price of care overnight. What they do is influence which programs a community has a year from now, whether local providers can add capacity, and how many first responders are equipped to reverse an overdose. The fentanyl-focused funding, particularly the MAT expansion and first responder training, is a direct federal response to exactly the tolerance and access problems the first two stories this week described. For anyone comparing treatment options right now, this is a reason to ask providers directly about funding, sliding scale options, and whether they offer medication-assisted treatment for opioid use disorder.

Conclusion

Put these stories together and the picture is clear. Regular fentanyl use builds tolerance on a scale that standard treatment protocols were not designed for. Many of the young people most at risk do not yet have accurate information about how fentanyl works, and the federal government is moving significant funding toward medications and first responder training that close those treatment gaps. Fentanyl is not just another chapter in the opioid crisis. It is a different kind of challenge, one that asks more of treatment, more of education, and more of the systems meant to respond.

If you or someone you love is looking for treatment, Rehab.com lists thousands of verified centers across the country, and free confidential support is available at any time through the SAMHSA National Helpline at 1-800-662-4357. Naloxone is available without a prescription at most pharmacies, and knowing how to use it can save a life. And remember, if you are in a crisis, you can call or text 988 at any time.

Those are the top stories in the news. For more, visit Rehab.com. We will be back next week. I’m Kay, and thank you for listening.

You Might Also Like

  1. Fentanyl Addiction: Symptoms, Overdose, and Treatment Options — Comprehensive guide to fentanyl’s dangers, how tolerance and dependence develop, and treatment options
  2. What is Medication Assisted Treatment (MAT)? — Explains how methadone, buprenorphine, and naltrexone are used in whole-patient treatment for opioid and alcohol use disorders
  3. Methadone Medication-Assisted Treatment for Opioid Addiction — How methadone works as a long-acting opioid agonist, clinic structure, dosing considerations, and what to expect
  4. What Is Harm Reduction? Key Strategies and Why It Matters — Overview of harm reduction approaches including naloxone distribution and how these strategies save lives

Sources in This Episode

  1. Godvin M, Friedman JR, Molina CA, Koncsol AJ, Romero R, Juurlink DN, Shover CL. Estimating the Daily Milligrams of Morphine Equivalent of Illicit Fentanyl Use in Los Angeles: Clinical and Epidemiological Implications. Drug Alcohol Depend. 2026. doi:10.1016/j.drugalcdep.2026.113224. https://www.sciencedirect.com/science/article/pii/S037687162600205X Accessed July 21, 2026.
  2. UCLA Health. People who use illicit fentanyl consume daily doses equivalent to nearly 9,000 milligrams of morphine, UCLA-led research finds. Published June 10, 2026. https://www.uclahealth.org/news/release/people-who-use-illicit-fentanyl-consume-daily-doses Accessed July 21, 2026.
  3. Miech R, Patrick ME, Jager J, Jang JB. Perceived Risk of Fentanyl Use Among US Adolescents. JAMA Netw Open. 2026;9(7):e2622039. doi:10.1001/jamanetworkopen.2026.22039. https://pubmed.ncbi.nlm.nih.gov/42412427/ Accessed July 21, 2026.
  4. Substance Abuse and Mental Health Services Administration. SAMHSA Announces More Than $281 Million in Funding Opportunities to Address Addiction, Overdose, and Mental Illness and Promote Recovery. Published July 6, 2026. https://www.samhsa.gov/newsroom/press-announcements/20260706/samhsa-announces-more-than-281m-funding-address-addiction-overdose-mental-illness-promote-recovery Accessed July 21, 2026.
Dr. Sylvie Stacy
By Dr. Sylvie Stacy
Published on July 21, 2026
Sylvie Stacy, MD, MPH, Medical Officer at Rehab.com, is a board-certified addiction medicine specialist with over a decade of experience treating individuals with addictions in diverse clinical settings including residential treatment programs, detox centers, outpatient clinics, and correctional facilities.