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 at a Glance:

• Remifentanil is a potent opioid used for pain during and immediately after surgeries.
• As a Schedule II narcotic, it carries a high risk of addiction and dependence.
• Common side effects include nausea, low blood pressure, vomiting and rigid muscles.
• If you struggle with remifentanil, medical detox and rehab can help you start an opioid-free life.

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 can be up to 100 times more powerful than morphine. The drug is intended for adults during surgery or immediately after that for those 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.

Remifentanil Addiction

Like all Schedule II opioids, remifentanil (Ultiva) has a high potential for addiction. However, the drug has unique pharmacological properties, making it less likely to be misused. Although the onset of remifentanil is quick, around one minute, the drug’s effects completely wear off within 5–10 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.

Ultiva Overdose

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, it can accurately measure carbon dioxide levels in the blood. When carbon dioxide levels become too high, the brainstem triggers the lungs to breathe.

In 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 can assess the person and give an opioid reversal drug like naloxone if needed.

Pinpoint pupils are another primary sign of Ultiva overdose. This symptom is common in nearly all opioid overdose cases. As the patient’s condition deteriorates, the pupils eventually transition to maximal dilation due to oxygen deprivation.

Mixing Ultiva 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 or out of a hospital setting. Because 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. Side effects from mixing alcohol with Ultiva can be lethal, so it’s essential you do not combine the two.

Can I Take Remifentanil (Ultiva) While Pregnant?

Little is known about the safety of remifentanil in pregnancy. Because of this, doctors may hesitate to prescribe the drug unless needed. Sometimes, the drug may be given to a pregnant woman by a medical professional before a procedure or during childbirth. In this case, the doctor and medical team will evaluate the risks and benefits of using Ultiva during pregnancy and decide whether it is safe. 

On the other hand, if a woman uses Ultiva for non-medical reasons and becomes pregnant, she may be worried about the risks to her baby. Generally speaking, Ultiva should not be used during pregnancy unless under the supervision of a doctor.

How Does Ultiva Affect Your Baby?

Using opioids during pregnancy can increase the risk of congenital disabilities in babies. Studies have shown that opioids can cause neural tube defects in the unborn fetus. While taking Ultiva while pregnant doesn’t necessarily mean that the baby will be born with congenital disabilities, using any opioid during pregnancy increases the risk of complications.

Babies Born Addicted to Remifentanil

There is also the potential for a baby to be born dependent on Ultiva. Ultiva passes through the placenta if it’s used during pregnancy. If it or any other opioid is regularly used, the baby may become addicted and dependent on it. Babies born with a dependence on Ultiva will likely go through neonatal abstinence syndrome (NAS). Symptoms of NAS can be severe, and typically, a baby will require NICU treatment. Symptoms of NAS related to opioids can include problems with feeding and eating. Babies with NAS often have trouble gaining weight and may be diagnosed with failure to thrive. Other symptoms of NAS can include irritability and excessive crying, fever, sweating and tremors.

Signs of Remifentanil Addiction

When a person struggles with remifentanil addiction, signs and symptoms of addiction often emerge. Friends, colleagues and loved ones may notice changes in the addicted person. These signs can be behavioral, physical or psychological.

Behavioral Signs

Behavioral signs of a remifentanil addiction include:

• Inability to stop taking remifentanil, even if you want to cut back or stop
• Anxiety about where to find another dose of remifentanil
• Cravings for remifentanil 
• Spending a lot of time getting, taking or recovering from remifentanil 
• Neglecting responsibilities at work, school or home because of remifentanil 
• Interpersonal problems linked to remifentanil 
• Spending less time with family, friends and activities to take remifentanil 
• Taking remifentanil, even when doing so is risky
• Taking remifentanil, even though you know doing so is harmful
• Needing increasing quantities of remifentanil to achieve the same effects as before
• Withdrawal symptoms when you try to stop remifentanil 
• Keeping your remifentanil use a secret
• Sudden changes in your activities
• Lying about how much remifentanil you take
• Losing energy or motivation
• Neglecting your appearance
• Stealing to afford remifentanil 

Physical Signs

Physical signs of remifentanil addiction can go hand in hand with the behavioral signs. These signs may be similar to the drug’s side effects and can include:

• Glazed eyes
• Slurred speech
• Rambling speech
• Slowed movement
• Weight loss
• Changes in sleep patterns

Psychological Signs

Psychological signs of remifentanil addiction are common and include:

• Inability to control your remifentanil intake, even if you want to
• Urges to take remifentanil
• Changes in mood
• Problems relating to other people

Side Effects of Ultiva Abuse and Addiction

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:

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

Long-Term Consequences of Remifentanil

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 misuses 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 and Detox

Discuss with your doctor if you no longer want remifentanil as part of your anesthesia. In most cases, the doctor will recommend that the anesthesia practitioner lower your dose gradually. This strategy, known as tapering off the medication, helps you avoid the worst remifentanil withdrawal symptoms.

Remifentanil should never be abruptly stopped. Discontinuing this form of treatment suddenly may cause withdrawal symptoms.

Ultiva Withdrawal Symptoms

Common withdrawal symptoms associated with opioids like remifentanil include:

• Muscle aches 
• Insomnia
• Runny eyes
• Runny nose
• Sweating
• Yawning
• Enlarged pupils 
• Abdominal cramps
• Anxiety
• Goosebumps
• Nausea and vomiting
• Diarrhea
• Agitation

Remifentanil Withdrawal Timeline

People going through withdrawal experience symptoms differently. 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.

How Long Does Ultiva Stay In Your System?

Ultiva will stay in your system for a few hours after your last dose. The exact time that Ultiva will remain in your system will vary, depending on several factors, including:

• Age
• Gender
• Other medications being taken
• Liver function
• Kidney function 
• Dosage

Half-Life of Ultiva

A medication’s half-life is how long it takes the drug’s effectiveness to be cut in half after a person stops taking the last dose. The half-life of Ultiva is 8–40 minutes. Because it takes around five half-lives to rid a drug from your system completely, this means that Ultiva can stay in your system for up to 200 minutes.

How Long Does Ultiva Stay In Your Urine, Hair and Blood?

Ultiva is a type of medication that can appear in a drug test. If you are taking Ultiva or have taken it recently, it’s important to inform your drug test administrator. However, Ultiva is typically used only in hospitals, and it’s unlikely that you will be tested for it. For this reason, little information is available on how long the drug stays in your body.

Remifentanil Addiction Detox and Treatment

The Recovery Village offers many rehabilitation programs and resources to those struggling with remifentanil. Before beginning treatment with inpatient or outpatient programs, you must safely detox from remifentanil in a medical detoxification program. Once the drug is removed from your body, you may attend individual and group counseling sessions and recreational therapy activities at The Recovery Village.

Inpatient Rehab

The first treatment option particularly helpful for those with a severe addiction is inpatient rehab. In this program, you must live on campus at one of The Recovery Village’s designated inpatient recovery centers. Living on campus prevents distractions from your home life that may impede your recovery as you start life without Ultiva.

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 skip the inpatient rehab program and begin recovery with outpatient rehab or online with teletherapy.

Get Help for Remifentanil Addiction Today

Choosing a rehab center is an important decision. If you are unsure which center is right for you, meet with your doctor to discuss the treatment features you should seek. When making this decision, you may also want to consider how long you have received remifentanil and your treatment schedule.If you or someone you know is struggling with remifentanil addiction, 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 a Recovery Advocate today to discuss treatment options to help you start the journey to recovery from Ultiva right away.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. 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