Fentanyl is a potent and powerful prescription drug used for pain relief. It is similar to morphine in many ways; however, it is 50 to 100 times more potent depending on the unique biological activity of the patient who is prescribed the drug. It can be prescribed as a shot, a patch or a lozenge, which is to be placed under the tongue.
Most people who develop a dependence on fentanyl were prescribed this drug by a doctor. It’s incredibly effective at binding to the body’s opioid receptors. In fact, just one dose can cause an overdose. Due to this reason, fentanyl is one of the most dangerous prescription drugs on the market right now. It’s also commonly illegally manufactured and sold on the black market.
Unfortunately, due to the effectiveness and potency of this opiate, fentanyl is one of the most difficult drugs to get off of. The withdrawal symptoms are incredibly overwhelming, which leads to high relapse rates. This drug is also quite addictive, and just several doses can lead to dependence.
In order to prevent unwanted withdrawal symptoms, those who are physically dependent on this opioid should seek professional help and treatment from an inpatient addiction treatment facility. There, patients have access to around-the-clock medical supervision.
Fentanyl Withdrawal Symptoms
As fentanyl is one of the most potent opioids around, withdrawal symptoms will emerge within 12 to 30 hours of when users have taken their last dose. Some of the most common fentanyl withdrawal symptoms experienced include:
- Abdominal pain and stomach cramps
- Anxiety, irritability, and restlessness
- Backaches
- Chills
- Diarrhea
- Elevated heart rate and increased respiratory rate
- Hypertension
- Loss of appetite and weight loss
- Muscle or joint pain and weakness
- Profuse sweating
- Restlessness
- Runny nose
- Sleep problems like insomnia and nightmares
- Vomiting and nausea
In worst-case scenarios, the severity of the withdrawal symptoms can lead to hospitalization, coma and even death, which is why it is crucial that those who are withdrawing from fentanyl seek medical supervision and care. These withdrawal symptoms are notorious for being some of the most overbearing ones, which is why relapses are incredibly common.
Post-Acute Withdrawal Syndrome (PAWS)
Approximately 90% of recovering opioid users will experience a phenomenon known as post-acute withdrawal syndrome (PAWS). This is a unique syndrome that affects those who are dependent on alcohol or opioids and opiates. PAWS manifests through the following symptoms:
- Apathy or pessimism
- Difficulties sleeping
- Depression, irritability or anxiety
- Difficulties with cognitive tasks
- Obsessive-compulsive behaviors
PAWS will flare up when patients are faced with stressful events and can emerge even years after achieving complete recovery.
Fentanyl Withdrawal Timeline
Depending on the type of fentanyl and the dosage that is taken, the withdrawal symptoms will begin to emerge at different times. The patch form of fentanyl can last for about 12 to 24 hours and has a half-life of about 17 hours, so patients will usually begin to experience withdrawal symptoms a day after the last dose.
The withdrawal symptoms will usually start off pretty mild and manageable; however, they will peak within a couple of days. After that, the physical withdrawal symptoms will begin to subside, and within a week, the physical symptoms are usually a lot more manageable. Many patients will rely on some form of medical detox during this time to ease the intensity of the withdrawal symptoms and to curb cravings.
The psychological symptoms, however, can last for months if not years, which is why it’s incredibly difficult to wean off this drug. Many patients will continue to experience cravings and psychological symptoms, like anxiety, for a long time. Because of the complexity and longevity of psychological symptoms, many addiction treatment experts recommend getting admitted to a long-term inpatient rehab program for a better shot at recovery.
Treatment for Fentanyl Abuse
America has been facing an opioid and opiate epidemic for years now. Between 2013 to 2016, overdose deaths associated with fentanyl abuse increased by 540%! Those who are struggling with fentanyl dependence desperately need professional help. Fortunately, the increase in fentanyl usage and abuse have led to further research into which evidence-based modalities are best for treating this type of chemical dependence.
Fentanyl addiction treatment programs are quite comprehensive and require patients to treat not only their body, but also their mind. Most treatment programs will combine a variety of different modalities together, like a taper schedule with medication-assisted treatment and behavioral therapies. The type of treatment modalities that each patient goes for will vary based on their own preferences and what works.
It’s important to keep in mind that what works for one individual may not necessarily work for another individual. Due to this reason, most patients are under close supervision until they’ve reached sobriety. Treatment programs can take anywhere from several months to several years to complete.
A Taper Schedule
Due to the intense withdrawal symptoms associated with getting off fentanyl, patients should taper off this opioid instead of trying to quit cold turkey. In fact, quitting cold turkey can be dangerous, as the body will not be able to handle the sudden chemical changes.
Tapering off opioids is much more difficult than it sounds. Each patient will require their own customized taper schedule, and no single strategy will be the same. It will depend on the patient’s preferences, compliance, among many other factors.
In general, the goal is to reduce the dose from 10% to 50% every several days to 2 weeks. It all depends on the severity of the withdrawal symptoms that the patient experiences, as well as how their body is handling the taper. The taper should be as easy on the body as possible to minimize the chances of withdrawal symptoms flaring up.
Factors That Can Affect the Taper Schedule
The taper schedule will vary from one patient to another, as it is customized based on the patient’s physiological condition and mental health status. Some of the factors that will influence the taper schedule include:
- The length of the addiction. Those who have been abusing fentanyl for a longer period of time will usually be more dependent on this drug. They will have a much more difficult time tapering off of it and will need to go even slower.
- The individual’s physiological state. Everyone deals with addiction differently. Some people may be more addicted physically while others may be more addicted mentally. Regardless, the taper schedule will depend on how each patient responds to the taper. Once the medical professionals notice that a patient is struggling, they will often slow down the taper schedule even more in order to accommodate them.
- The presence of co-occurring mental health disorders. It is not unusual for substance use disorders (SUDs) to come hand-in-hand with co-occurring mental health disorders. Those who struggle with depression, anxiety and other types of co-occurring disorders may have a more difficult time weaning off fentanyl.
It can be difficult to guess how each patient will respond. Due to this reason, most medical professionals are open to modifying the taper schedule as the patient recovers. Those who are responding well to the treatment may be able to wean off fentanyl much more quickly.
Medication-Assisted Treatments for Fentanyl Abuse
Medication-assisted treatment (MAT) relies on the use of medications to ease withdrawal symptoms and curb cravings. The medications are approved by the Food and Drug Administration (FDA), and MAT is often used in combination with other types of evidence-based treatment modalities, like counseling and behavioral therapies.
Almost all fentanyl addiction treatment programs will include some type of MAT program, as MAT will:
- Improve recovery outcomes
- Increase treatment retention rates
- Decrease the risk of illicit opiate use or other types of substance abuse
- Improve birth outcomes for pregnant women struggling with fentanyl abuse
Most of the time, MAT is used when the patient no longer has any fentanyl in their system at all. The most common ones used for treating fentanyl abuse include methadone, Suboxone and Vivitrol. Each one works in a different way. We’ll look at these medications in more detail below.
Methadone
As methadone is one of the first MAT medications discovered, it is one of the most commonly used ones for treating fentanyl abuse. It’s also incredibly effective, as studies show that about 25% of patients who enroll in a methadone maintenance program will eventually become abstinent. Another 25% will continue to take the drug while the remaining 50% will go on and off methadone repeatedly.
Methadone is a full agonist, which means that it works by acting like fentanyl. It will attach to the same type of receptors in the brain that elicit the feelings of happiness and relaxation as fentanyl. Due to this reason, methadone has the potential to be quite addictive as well, so it needs to be prescribed under the close medical supervision of an addiction expert. This drug comes in either a pill or tablet form, and the dosage will be tailored to the patient’s height, weight, age, as well as many other factors.
Although methadone functions in the same way as fentanyl, it is not as dangerous. While only a speck of fentanyl can result in an overdose, methadone is much less deadly and potent. It can help curb cravings and ease withdrawal symptoms. Those who opt for methadone will need to take it on a long-term basis. Once they’ve successfully weaned off of fentanyl, they will also need to slowly taper off methadone as well.
This medication requires careful adherence to dosage guidelines, which is why it is crucial that patients are constantly supervised by a medical professional. One of the advantages of methadone is that patients don’t typically experience severe side effects when using this drug.
Suboxone
Suboxone, also known as buprenorphine, is a partial opioid agonist because it only partially stimulates the opioid receptors, unlike methadone. Unlike methadone, patients will not feel high when taking this medication because it is famous for having a “ceiling effect”. Once a specific dose is reached, any subsequent doses will fail to have any further effect on the body.
This feature of Suboxone has made it incredibly popular because it prevents substance abusers from abusing this medication. It is the ideal choice for those with addictive personalities since this MAT medication has a very low addictive potential. Because of this reason, it is also equally difficult to build tolerance or dependence.
Much like methadone, Suboxone is often prescribed in the form of a pill. Because it is less addictive, patients are usually prescribed longer doses each time, and the dose will vary based on each patient’s weight, age, height and more. Although Suboxone is more convenient, it does not have as high of a retention rate as methadone.
Vivitrol
Vivitrol is one of the latest MAT medications to grace the addiction industry. It is particularly useful for treating opioid and opiate withdrawal symptoms due to its convenience. Patients will be prescribed a single shot, and that shot will last an entire month. Patients only need to go back to the clinic to get a new shot every month. This increases the retention rate.
This drug works very differently from Suboxone and methadone. It’s not an agonist, but an antagonist, which means that it works by blocking the opioid receptors in the brain. After getting a shot of Vivitrol, those who are dependent on fentanyl will no longer feel the effects of this drug even if they take another dose. This will prevent many people from trying or from relapsing.
Unlike Suboxone and methadone, this drug is also quite unique in the sense that each patient will receive the same dose. This makes it a lot easier for medical professionals to dispense the drug, as they will not need to calculate the dosage based on the patient’s biological state and condition.
The only downside of Vivitrol is that it can only be administered once the patient has stopped taking any type of alcohol or opioids for at least 7 to 14 days.
Therapy and Counseling
Therapy and counseling is also an important part of recovery. Patients are encouraged to participate in both individual and group therapy. Both have their own advantages and drawbacks. Depending on the severity of the addiction, patients will take part in anywhere from several hours of therapy a day to several hours of therapy a month.
The key to recovery is finding the right type of evidence-based modality that suits each patient. Some common behavioral therapies that have shown promising results include:
- Cognitive Behavioral Therapy (CBT), which is based on changing thoughts, beliefs, physical sensations and emotions in order to transform negative behaviors into positive ones
- Acceptance and Commitment Therapy (ACT), which focuses on accepting negative thoughts without any judgment
- Dialectical Behavioral Therapy (DBT), which tries to identify and change negative behaviors and thoughts in order to replace them with positive ones
- Motivational Interviewing, which is a guided style of communication that empowers patients to change lifestyle habits by drawing out their own desire for change
- Eye Movement Desensitization and Reprocessing (EMDR), which is primarily used for treating post-traumatic stress disorder (PTSD) that may have led to the abuse of fentanyl
Patients are encouraged to try out different styles of therapy in order to figure out what works for them. It will take several sessions for patients to determine whether they are connecting with a certain evidence-based modality or not. Due to this reason, it can take some time for some patients to determine what modalities best suit their needs and personalities.
Additional Peer Support
Studies show that those who have reliable peer support are more likely to achieve sobriety. As a result, many addiction treatment programs actively promote group therapy and the 12-step program. Those who struggle with fentanyl dependence can seek comfort from other people who are in the same situation. By sharing their woes and struggles, they’re able to stay on the path to recovery without risking relapse.
Many addiction treatment programs also recommend finding a mentor. It’s super helpful to speak to someone whenever you’re feeling down or whenever you’re starting to experience cravings. Those who reach out are less likely to relapse.
Opioids vs. Opiates
Opioids and opiates are often used interchangeably, and both of these drugs are prescribed by medical professionals to help patients cope with pain. However, they’re not meant to describe the same thing.
While both of these drugs come from opium, only the naturally-occurring derivatives are known as opiates while synthetic ones are known as opioids. Fentanyl is made from a lab, so it’s an opioid and not an opiate. This opioid is one of the strongest ones out there and is usually only used in extreme situations to deal with severe pain.
The Difference Between Abuse and Addiction
There’s a fine line between abuse and addiction. Because of how potent fentanyl is, those who abuse this drug will quickly find that they are dependent on it. In general, abuse is termed as inappropriate use of the drug. This could be anything from taking larger doses than prescribed to taking the drug illegally.
Fentanyl abuse can cause some biological changes in the body. Some biological and behavioral signs of fentanyl abuse include:
- Taking fentanyl more frequently than prescribed
- Experiencing more anxiety and panic attacks
- Enjoying strong euphoric feelings
- Taking fentanyl for euphoric feelings rather than pain relief
- Experiencing instances of psychosis
- Feeling more confident after taking fentanyl
Since the transition between fentanyl abuse and addiction happens extremely quickly, it is crucial that those who are prescribed this drug monitor their own physical and mental state. If they suspect that they are becoming both physically and mentally reliant on the drug, they need to speak with a medical professional immediately.
A medical professional will weigh out the pros and cons of taking fentanyl. If the cons outweigh the pros, they may switch patients to another drug or take some other course of action. Fentanyl addiction is extremely difficult to treat, which is why it should be avoided at all costs.
Fentanyl Withdrawal Resources
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