Fentanyl is a extremely potent opioid used to treat moderate to severe pain. This drug is so powerful that it’s measured in micrograms rather than the usual milligrams, and it is considered to be 80-100 times more potent than morphine. For this reason, it’s highly controlled and typically only prescribed to the people with very intense pain, such as cancer patients.
Fentanyl often comes in patches that release tiny amounts of the drug into the skin for long-term relief. It can also be administered in dissolving tablets and lollipops that combine fast and long-lasting pain relief, as some of the drug is absorbed through the mucus membranes in the mouth, and the rest is swallowed for slower distribution through the digestive system.
By 2012, fentanyl was the most commonly used synthetic opioid in clinical practice. Even more methods of intake have been created, including nasal sprays and inhalers. Unfortunately, due to the extreme potency and fast-acting nature of this opioid, it’s highly addictive and can be incredibly dangerous.
The Specifics of Withdrawal
All opioids are considered to be physically addictive. This means that people both build up a tolerance to the drug and experience physical withdrawal symptoms if they stop taking it. Both of these phenomena occur because the brain adjusts to the frequent or constant presence of the drug. The brain produces its own natural opioids in response to certain stimuli, and when a person consumes additional opioids, the brain compensates for this overload by reducing production of its own. In this way, long-term drug abuse does physically alter the brain.
If an individual then stops taking an opioid like fentanyl, there’s a sudden severe lack of any opioids in the body. This is what causes withdrawal symptoms, which can be intensely unpleasant. Opioid withdrawal isn’t directly dangerous, but the pain, sick feeling, and cravings associated with the process are so strong that it can be a deterrent to addicted persons who want to get clean.
Fentanyl withdrawal symptoms can include:
- Watery eyes
- Runny nose
- Sweating
- Yawning
- Chills
- Fever
- Weight changes
- Muscle, joint, and/or back pain
- Restlessness
- Stomach cramps
- Weakness
- Nausea and vomiting
- Diarrhea
- Anxiety
- Depression
- Malaise
- Panic
- Hypertension
- Fast heartbeat
- Rapid breathing
According to the National Institute on Drug Abuse, 2.1 million Americans were suffering from a substance use disorder involving prescription painkillers in 2012. All of these people have to go through the withdrawal process in order to recover from addiction.
Withdrawal Timeline
Drug withdrawal looks different for each drug involved, and the timeline may be different for each individual depending on the severity of the addiction, how long the drug has been abused, and physical factors, such as body mass and overall health. However, most people follow a general timeline when detoxing from fentanyl.
- 6-36 hours: This is when withdrawal symptoms typically begin after the last dose of the drug has been taken. Addicted persons are likely to experience anxiety simply from anticipation as the physical symptoms begin to appear. Milder symptoms are likely to start first, including mild flu-like symptoms and some pain, especially if fentanyl was being used for pain management.
- 36-72 hours: This is when withdrawal tends to peak. Symptoms already being experienced, as well as cravings, intensify while hypertension, breathing issues, restlessness, and possibly panic attacks begin. This can be dangerous for people with heart problems or pre-existing high blood pressure.
- 72 hours to one week: Symptoms usually start to taper off after day three and fade over the rest of the week. Emotional symptoms and cravings tend to linger the longest.
- 1-4 weeks: Though an addicted person is mostly out of the woods after a week without fentanyl, cravings can persist or spontaneously reappear for a month or more after quitting. Depression may also continue and may need to be treated with medication until the individual’s life is back on track.
This timeline, however, is only for people who stop taking fentanyl all at once after becoming addicted. It’s not always necessary to quit “cold turkey” like this, and in fact, it is often discouraged by doctors and addiction specialists due to the difficulty of the process, the likelihood of relapse, and potential health complications that can arise. Alternative options can be both safer and much more comfortable for addicted individuals.
Fentanyl Detox Options
According to the National Institute on Drug Abuse, only 2.6 million of the 23.5 million people age 12 and older in the US with addiction disorders sought treatment for this problem in 2009. That means that 88.9 percent of addicted persons were left without any kind of professional treatment for this severe and debilitating illness. A large part of avoiding treatment is often due to a fear of withdrawal and a lack of education about treatment options.
Because fentanyl comes in so many different forms of intake, including slow-release patches, there are plenty of ways that a person addicted to this drug could be gradually weaned off it. However, it’s very important that this is only done under the supervision of a doctor. Trying to wean oneself off a potent opioid like fentanyl can have catastrophic consequences if relapse occurs. Even after a few days at a reduced dose, a person’s tolerance to fentanyl can be significantly reduced. If an addicted person goes right back to the dose being taken before the detox attempt, a dangerous overdose can be triggered.
A safer option is to use one of the opioid medications available for opioid addiction treatment. Medications like methadone and buprenorphine have helped millions of people with addiction disorders. Although they are opioids, they don’t produce nearly the same kind of high as drugs like fentanyl. For addicted persons with significant tolerance levels, these medications won’t cause a high, but they will reduce or eliminate cravings and withdrawal symptoms.
Once switched onto methadone or buprenorphine, individuals can then be weaned off the much safer drug without as much fear of relapse, as they are not so driven by cravings and unpleasant symptoms to chase their drug of choice. It’s still not an easy process, but it’s generally much easier than cold-turkey detox directly from fentanyl. According to the California Association of Addiction Medicine, addiction treatment with methadone boasts success rates of 60-90 percent.
Medication-assisted detox does make the timeline of detox much longer. Treatment with methadone or buprenorphine can take a few months to a year or more, depending on the severity of the addiction. During this time, individuals may experience minor withdrawal symptoms each time the dose of the medication is lowered – typically every couple weeks. However, these symptoms can be managed with nonaddictive anti-anxiety medications and over-the-counter flu remedies. Over time, even these symptoms may stop appearing until finally the person can stop taking the opioid altogether.
Opioid addiction is not an easy thing to overcome, especially due to the significant social stigma associated with the issue. However, it’s not hopeless, despite how it’s often portrayed. Addiction is classified as a mental illness or brain disease, and these issues are absolutely treatable. All it takes is education, professional care, and support. It’s important to seek out comprehensive rehabilitation programs in order to learn more about the disease and acquire the skills necessary to recover from it. Detox is an essential part of the recovery process but it must be followed by addiction therapy in order to achieve recovery.