Fentanyl Detox & Withdrawal
Fentanyl, and its related narcotics like carfentanyl are the strongest legal or illegal opioids. Fentanyl is 100x stronger than morphine and 50x stronger than heroin. Carfentanyl is 100x stronger than fentanyl. Because it is so strong, fentanyl withdrawal can be difficult.
Fentanyl Withdrawal Symptoms:
- Low appetite
- Stomach pain and cramps
- Pain in muscles or joints
- Runny nose
- Watering eyes
- Trouble sleeping
- Dilated pupils
- Rapid breathing
- Shortness of breath
- Rapid heart rate
- Muscle weakness
- Body hair standing up
- Feeling restless
People in recovery often report that fentanyl withdrawal symptoms decrease within 1 week.
Fentanyl Withdrawal Timeline:
According to the Diagnostics Statistics Manual (DSM), Fentanyl withdrawal symptoms usually begin 12 hours after the last dose. With an extended release fentanyl patch (Duragesic), withdrawal symptoms usually begin 24 hours after removing the patch.
What is Fentanyl
Fentanyl is a synthetic opioid killer prescribed for pain. It is 50x stronger than heroin and 100x stronger than morhpine.
Fentanyl works by binding to opioid receptors in the gut and brain and blocking them from receiving other signals. In the brain, this limits the ability to feel physical and mental pain. In the gut, fentanyl limits the movement of the intestines which can lead to constipation.
Because fentanyl is powerful, overdoses are common. Starting in 2014, fentanyl overdoses began rising at an alarming rate. By 2015, the CDC announced that fentanyl had started the 3rd wave of the opioid epidemic.
When taken regularly, fentanyl causes changes in the brain. The brain stops making certain neurotransmitters that fentanyl provides. The shortage of these neurotransmitters is what leads to opioid withdrawal when someone stops taking fentanyl.
Diagnostic Quiz: ARE YOU ADDICTED TO FENTANYL?
Someone should never stop using fentanyl cold-turkey without professional supervision. By using a taper, or slowly removing fentanyl over time, withdrawal symptoms are manageable.
Quitting Fentanyl: Taper vs Cold Turkey
When someone abruptly stops using fentanyl it’s called quitting cold turkey. Quitting a drug as powerful as fentanyl cold-turkey can lead to a number of unsafe and uncomfortable side-effects since it triggers opioid withdrawal.
A much safer more manageable alternative is to wean off fentanyl using a taper. Tapering is a process used in medical detox where a person is given smaller and smaller amounts of a substance to allow their body and brain chemistry to adjust. Tapering has been shown to lead to fewer and less severe opioid withdrawal symptoms during fentanyl detox.
When tapering off of fentanyl, patients are switched to a different opioid. Usually either methadone or buprenorphine, which are less potent opioids. This is the first step in teaching the brain to function again without fentanyl. The next step of fentanyl detox is decreasing the amount of opioids a person needs until their dependence is manageable with over the counter medicines.
Every day for 3-5 days, a person’s opioid levels are decreased by 20-40%. After the 5th day most patients then decrease their opioid intake by about 5-15 mg every day.
The level that someone starts at is usually calculated by the severity of their fentanyl dependence. This also affects how long detox will take. But generally fentanyl detox takes 5-14 days.
Certain things can affect how long a person remains in detox:
- Their fentanyl dependence: How much fentanyl they need everyday will decide how high their starting dose is.
- Abusing other drugs: Tapering off multiple substances will require multiple tapers. Since some drugs can interact negatively, the process can take longer.
- Co-occurring mental health disorder: If someone requires medication for an existing mental health issue, it’s possible their medication may interact with standard opioid tapers. If this is the case they will need a different taper which may take longer.
Fentanyl Detox: The First Step
Physical dependence occurs when the brain can no longer function without fentanyl. If a dependent person tries to quit fentanyl they will experience fentanyl withdrawal symptoms like nausea, shakes, vomiting, etc.
The process of ending dependence is called detox. If a person is dependent on fentanyl then the first step of recovery is getting a medical detox.
Medical detox, sometimes called inpatient care or residential treatment, is required before any other recovery can begin. Depending on the needs of the patient, medical detox can last 5-30 days. Patients stay overnight in the facility as they detox and receive around the clock care, supervision, and vital sign monitoring.
Medical detox facilities are staffed with Medical Doctors and Nurses trained to manage medications and create tapers that best suit a person’s needs. Of course, these physicians may prescribe other medications as needed to help manage fentanyl detox symptoms.
After completing detox, will still have mental fentanyl cravings. That’s why detox is considered the first step to recovery. Without treatment, relapse rates after treatment can be as high as 91% in the first year .
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The Length of Fentanyl Detox:
Fentanyl detox can take up to 10 days for severe cases of fentanyl dependence. However most people can detox in 7 days or less. Certain factors can affect the length of fentanyl detox which is why patients undergo a thorough evaluation before beginning fentanyl detox.
Medications for Fentanyl Detox
Most if not all fentanyl detox patients receive a taper to help them slowly wean off of fentanyl. However detox centers do not provide people with more fentanyl. Instead they use less powerful opioids called partial-opioid agonists like buprenorphine, suboxone, or methadone.
As their name suggests, partial-opioid agonists affect the same brain receptors as fentanyl — but only partially. A helpful metaphor is to think of a sink or hose. Fentanyl would turn the sink/hose on full pressure. Whereas a partial agonist would only turn it to half pressure. These help curb cravings, allow the brain to adjust, and do not provide the euphoric high that fentanyl does.
During fentanyl detox other medications can also be prescribed. Frequent medications include anti-depressants for mood related symptoms of withdrawal, drowsiness-inducing antihistamines that help with insomnia. And of course medications that assist with nausea, vomiting, and other gastrointestinal issues created by fentanyl withdrawal.
No content on this website should ever be used as a substitution for direct medical care and advice from qualified physician-clinician.