What is Fentanyl?
Fentanyl addiction is a serious condition that affects more Americans than one would think. Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. According to the National Institute on Drug Abuse, in 2017, 59.8 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.
How long does fentanyl stay in your system? Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It is a prescription drug that is also made and used illegally. Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery.
It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.
When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops.
The illegally used fentanyl associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.
Some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose.
Fentanyl Withdrawal Timeline and Symptoms
Fentanyl withdrawal usually begins within 12-30 hours of the last dose of the drug, the National Library of Medicine (NLM) reports. Fentanyl, in patch form, is an extended-release medication with effects that may continue to increase for the first 12-24 hours of wearing it, lasting up to 72 hours total, according to the labeling information provided by the U.S.
Food and Drug Administration (FDA) for Duragesic. With a half-life of around 17 hours after removal of the patch, withdrawal likely begins around a day or so of taking it off. The FDA reports the following as potential side effects of the opioid withdrawal syndrome that occurs when Duragesic (fentanyl) leaves the bloodstream:
- Tearing up
- Runny nose
- Stomach cramps
- Pain in joints and/or muscles
- Body hair standing on end, or bristling
- Muscle weakness
- Nausea and/or vomiting
- Elevated heart rate
- Increased respiratory rate
- Pupil dilation
Fentanyl withdrawal syndrome likely peaks in the first few days and levels off within a week or so.
Fentanyl Withdrawal: Cold Turkey vs. Weaning
As sudden discontinuation of the drug may induce fentanyl withdrawal, individuals may instead choose to slowly taper off the drug. Tapering is the slow removal of fentanyl over a set period of time, and it is also called weaning off the drug. This must be performed under the direction and watchful eye of a medical professional who can set up a tapering schedule that may be able to keep fentanyl withdrawal symptoms from manifesting by keeping some of the opioid drugs in the system. By slowly removing the drug and not stopping “cold turkey,” Fentanyl withdrawal may be managed.
To taper off fentanyl, a person may be first switched to another opioid, such as long-acting morphine or methadone, as reported in the Tapering and Discontinuation of Opioids published by the U.S. Department of Defense (DoD) and the Department of Veterans Affairs (VA). After a person is switched over, these opioids are reduced by about 20-50 percent each day until the dosage reaches 30 mg/day for methadone or 45 mg/day for morphine. At this point, the dosage can be reduced by 15 mg every 2-5 days for morphine and by 5 mg every 3-5 days down to 10 mg/day. It can then be reduced by 2.5 mg every 3-5 days down to 0 for methadone.
Tapering may not be the same for everyone, and different schedules may need to be adopted. There are several factors that may require the schedule to be modified, such as:
- Level of dependence on fentanyl: The more significant the dependence, the slower the taper may need to be.
- Addiction to or abuse of fentanyl: Someone using fentanyl for nonmedical purposes, or who suffers from compulsive drug-using behaviors, may benefit best from a residential detox program where substance abuse and addiction are addressed in tandem with withdrawal.
- Co-occurring disorders: Someone suffering from a medical or mental health disorder may take medications that need to be properly managed during a tapering schedule.
- Length of time taking fentanyl: Typically, the longer someone has been taking an opioid like fentanyl, the slower the taper may need to be to manage withdrawal.
- Abuse of other drugs or alcohol: Other mind-altering substances can interact with fentanyl and may increase the level of dependence to both substances and/or create a cross-tolerance that may need to managed differently than usual.
A doctor, substance abuse professional, or another medical professional can help people to set up an individualized tapering schedule to wean off fentanyl safely while minimizing withdrawal symptoms.
Fentanyl Withdrawal: Medical Detox Treatment
The method of removing fentanyl from the body safely is called detox, which is the removal of toxic substances from the bloodstream.
This process is usually performed in a specialized substance abuse treatment center. Detox can be part of either an outpatient or a residential program, depending on the specific needs of the individual. Typically, residential detox is called medical detox, as it includes medical and mental health support provided by highly trained professionals around the clock. Vital signs are monitored to ensure each individual’s safety, and medications are also often used to manage physical and emotional withdrawal symptoms. A residential detox is usually recommended for fentanyl withdrawal as it is such a powerful opioid.
Fentanyl Withdrawal: How Long Is Detox?
Detox typically lasts about 5-7 days, though it can extend up to 10 or more days if needed. Some people may need more or less time, as detox is unique for each individual. A thorough evaluation during intake can help determine the optimal length of time for the detox process.
Fentanyl Withdrawal: Medications Used in Detox
In some instances, fentanyl may be replaced with a different opioid agonist during detox. Buprenorphine products are commonly used to aid in opioid withdrawal. Buprenorphine is a partial opioid agonist that is FDA-approved to treat opioid dependence. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the brand names Bunavail, Suboxone, and Zubsolv all contain buprenorphine as well as the opioid antagonist naloxone, and buprenorphine can be found in transmucosal products like Subutex.
Buprenorphine acts on opioid receptors in the brain like other opioids but to a much lesser degree. This action can help reduce withdrawal symptoms without producing the euphoric “high” that opioid narcotics like fentanyl are known to produce. Naloxone, on the other hand, has the opposite effect and blocks opioid receptors from receiving opioids. The naloxone component of these opioid dependency medications remains dormant unless they are altered or abused, and then, if activated, can cause withdrawal to come on full force. Combination medications may be reserved for post detox after fentanyl and other opioids are completely out of the system.
Adjunct, or supplementary, medications are helpful during medical detox too. Antidepressants can help with depressive symptoms; antihistamines can assist with insomnia or restlessness; medications to ease gastrointestinal distress can address nausea, vomiting, cramps, and diarrhea; and nonsteroidal anti-inflammatory agents can soothe muscle aches, Pain Treatment Topics reports. The blood pressure medication clonidine is also a popular adjunct medication used off-label to treat opioid withdrawal symptoms, as it can help regulate heart rate, blood pressure, and body temperature.
Medical detox can be highly beneficial in helping to safely and smoothly remove fentanyl from the body and achieve a healthy physical balance. When it is followed with a substance abuse treatment program that uses both therapeutic and pharmaceutical tools, cravings and other negative psychological and behavioral symptoms of substance abuse and addiction can be improved and managed on a long-term basis.
Reclaim Your Life From Fentanyl Withdrawal
Fentanyl addiction is a condition that can cause major health problems such as an overdose. We Level Up California can provide you, or someone you love, the tools to recover from this with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition and give you clarity about issues like the fentanyl withdrawal symptoms. Our specialists know what you are going through. Please know that each call is private and confidential.