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Fentanyl Detox Guide: Symptoms, Timeline, and Effects

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Hand holding vial of fentanyl

Fentanyl is a powerful synthetic opioid that is 50–100 times more potent than morphine.1 It is a Schedule II narcotic used to treat severe breakthrough pain. Doctors typically prescribe fentanyl to treat cancer pain, but it is sometimes given for chronic and post-surgical pain. Several pharmaceutical laboratories produce a variety of prescription fentanyl formulations, but it is also produced illicitly in clandestine drug labs.

In 2015, there were 6.5 million fentanyl prescriptions dispensed in the United States.1 Prescription fentanyl is available as a lozenge (Actiq), buccal tablet (Fentora), buccal film (Onsolis), sublingual tablet (Abstral), sublingual spray (Subsys), nasal spray (Lazanda), patches (Duragesic), and as an injectable solution. Like many prescription opioids, a portion of the pharmaceutical supply of fentanyl is ultimately misused, abused, or diverted to the illicit market. Some people abuse fentanyl patches by extracting the gel contents of the patches and injecting or taking it orally. Patches can also be frozen, cut into pieces, and placed under the tongue or on the inside of the cheek. Even used patches are appealing to fentanyl abusers because they still retain a significant amount of fentanyl after 3 days of use.1

Once someone is dependent on fentanyl and continues abusing the drug, they can develop an addiction.

According to a national survey, an estimated 3.8 million people were abusing prescription painkillers like fentanyl in 2015.2 When someone develops a dependence on a prescription opioid painkiller, they will likely experience withdrawal symptoms when they suddenly reduce or stop using. Although dependence does not necessarily constitute addiction, once someone is dependent on fentanyl and continues abusing the drug, they can develop an addiction. While dependence is a normal adaptation to the presence of the drug, addiction is a set of compulsive, drug-seeking behaviors in spite of negative consequences.

Painful withdrawal symptoms make quitting fentanyl on your own extremely difficult. Trying to quit cold turkey often leads to relapse, which further increases your risk of a fatal overdose. A professional fentanyl detox program can help you manage the symptoms of withdrawal in a safe and drug-free environment. Detox is an important first step on the road to recovery. A professional drug rehab center can also help you transition into long-term addiction treatment.

Are You Looking For the Right Detox ?

Stressed man looks at his phone, fictional concept of looking for rehabsWith the help of a detox program, the addict can pass through the withdrawal process with as little discomfort as possible while under medical supervision. This ensures addicts cannot get hold of drugs and also ensures the recovery is as safe as possible. Read More

The Short-term Effects of Fentanyl

People may begin to abuse fentanyl to achieve states of relaxation and euphoria, while paying little mind to the number of unwanted and potentially dangerous side effects that can negatively impact their mental and physical health.

Common short-term effects of fentanyl abuse include:4,11

  • Pupil constriction (or dilation, in the event of overdose).
  • Slurred speech.
  • Inattention.
  • Memory problems.
  • Euphoria followed by apathy.
  • Impaired judgment.
  • Feeling unsatisfied or unhappy with life.
  • Psychomotor retardation (slowed movements and thought).
  • Psychomotor agitation (repetitive movements, like fidgeting or pacing).
  • Slowed breathing.
  • Constipation.
  • Confusion.
  • Drowsiness.

Since fentanyl is far more potent than other opioids, users have a higher risk of overdosing on it. Fentanyl use can lead to profound respiratory depression, coma, and death. If you suspect that someone has overdosed, call 911 immediately and stay with the person until medical attention arrives.11

Consequences of Long-term Use

The longer you use fentanyl, the more likely it is that you will experience adverse effects. Chronic fentanyl abuse can lead to severe health problems and even death, which is why it’s so important to seek detox and addiction treatment sooner rather than later.

Potential effects of long-term fentanyl abuse include:4

  • Tolerance, which means that you need more fentanyl to achieve the desired effect.
  • Physical dependence, resulting in withdrawal symptoms when you attempt to quit.
  • Relationship problems, such as divorce and loss of friendships.
  • Legal issues, due to driving under the influence or illegal activities related to obtaining fentanyl.
  • Financial hardships.
  • Expulsion from school.
  • Termination from employment.
  • Increased risk of overdose and death.
  • Increased risk of injury resulting from accidents or violence.
  • Increased risk of HIV, hepatitis, tuberculosis, infection of the heart lining, track lines, and collapsed veins, if used intravenously or intramuscularly (injection routes).
  • Nose bleeds or perforation of the nasal septum, if used intranasally (snorted).
  • Difficulties in sexual functioning.
  • Irregular menses in women.

What Are the Signs of Fentanyl Addiction?

You may be unsure of whether you or a loved one has an addiction to fentanyl or other opioids, but there are many signs and symptoms of problematic fentanyl abuse to look out for. Signs and symptoms of a fentanyl addiction or opioid use disorder may include:3

  • Intense cravings for fentanyl or other opioids.
  • Inability to control or reduce use.
  • Continuing to use despite the problems it causes at home, work, or school.
  • Continuing to use in spite of social or interpersonal impairments.
  • Using larger amounts over time (tolerance).
  • Spending a lot of time obtaining and using fentanyl.
  • Experiencing withdrawal symptoms after stopping or reducing the dosage.

If you have experienced as few as two of these fentanyl addiction symptoms, you may already stand to benefit from the services of a professional fentanyl detoxification program to help you achieve sobriety.

Withdrawal Symptoms and Timeline

If you have a fentanyl addiction, then you will probably experience fentanyl withdrawal symptoms during detoxification. Fentanyl detoxification is the process during which your body eliminates the fentanyl from its system and adjusts to living without it.

Withdrawal symptoms typically worsen before dissipating.

Fentanyl withdrawal symptoms typically worsen before dissipating. For those abusing fentanyl, withdrawal symptoms will usually begin between 6 and 12 hours after last use, peak within 1 to 3 days, and subside within 5 to 7 days.4 In some cases, if a user has been abusing an extended-release fentanyl formula, withdrawal symptoms may be delayed, emerging within 12 to 48 hours after the most recent dose and dissipating within 10 to 20 days.5

The following is a list of withdrawal symptoms many people experience in the hours and days after their last dose:6

  • Anxiety.
  • Insomnia.
  • Muscle aches.
  • Increased tearing.
  • Runny nose.
  • Excessive sweating.
  • Increased yawning.
  • Abdominal cramping.
  • Diarrhea.
  • Nausea.
  • Vomiting.
  • Goose bumps.
  • Increased body temperature.
  • Rapid pulse.
  • High blood pressure.

After these acute symptoms resolve, a person in recovery from fentanyl addiction may experience post-acute withdrawal syndrome (PAWS).This group of withdrawal symptoms can last for additional weeks or months following acute withdrawal and can include symptoms like:7

  • Anxiety.
  • Depression.
  • Sleep problems.
  • Fatigue.
  • Emotional blunting.
  • Irritability.

Although fentanyl withdrawal is rarely life-threatening, it is best done under the supervision of a qualified physician. There are risks involved, such as extreme dehydration and electrolyte imbalance due to vomiting, not to mention the high likelihood of relapse to stave off the onset of the unpleasant withdrawal—it is better not to do it alone.

What Does Detox Entail?

Man in detox holds therapists handWhether you have been struggling with fentanyl abuse for months or years, the thought of detox has probably crossed your mind before. Maybe you have been putting it off for a more convenient time. Or maybe you just have no idea what to expect from an opioid detox program. If this is the case, the following information should answer some of your questions.

The goal of fentanyl detox is to help you get stable and sober so that you can transition into a comprehensive addiction treatment program. Detox is only the first step on the road to recovery, but it is an important one. A successful detox program will prepare you for the real work: maintaining sobriety. Detox programs typically last a few days to a couple weeks, but they provide the foundation for future treatment.

A substance abuse treatment program will increase your likelihood of success.When you arrive at a fentanyl detox facility, you will typically go through a three-step detox process, consisting of the following steps:8

  1. Evaluation: Doctors will interview you to learn about your unique needs and substance abuse history. They will perform a medical exam to look for health conditions that could complicate withdrawal. They will also evaluate mental health to identify any co-occurring psychiatric conditions.
  2. Stabilization: Doctors and nurses will help you reach a sober, medically stable state in which all substances are eliminated from the body. They may provide medications to ease some of the withdrawal symptoms and cravings.
  3. Referral: Your counselors will help you make a plan to transition into a fentanyl addiction treatment program, emphasizing the importance of receiving comprehensive care. They might give you information about different treatment options

Individuals who are withdrawing from multiple drugs or who have co-occurring mental health issues may also benefit from supervised detox programs. Detoxing from alcohol and sedatives like benzodiazepines and barbiturates can cause serious side effects that left untreated can result in fatalities.Anyone abusing multiple substances should consider entering a structured detox program. Mental health issues, including depression and anxiety, are common among opiate addicts. Detox may also cause an increase in symptoms such as anxiety. Supervised detox allows mental health symptoms to be monitored and may decrease the risk of relapse and other complications.

Detox gets you sober, but it doesn’t prepare you for the triggers you will face after the detoxification process. A thorough substance abuse treatment program will increase your likelihood of success by helping you deal with the issues that led you to addiction in the first place.

Effects of Fentanyl Detox

Many of the unpleasant fentanyl withdrawal symptoms resemble those associated with the flu. These effects of withdrawal will be extremely uncomfortable, but they are not usually life-threatening. Still, debilitating complications and needless suffering can occur if the symptoms are not effectively managed in a timely manner, which is why professional detox treatment is recommended for someone enduring fentanyl withdrawal.6

Additional risks associated with fentanyl withdrawal include:4,6,9

  • Dehydration and electrolyte imbalance: Vomiting, perspiration, and diarrhea can lead to a loss of fluids. It is vital to large amounts of water to counteract the effects.
  • Cardiac issues: People with preexisting heart problems may experience a worsening of symptoms due to changes in blood pressure and heart rate.
  • Anxiety symptoms: During withdrawal, symptoms of established anxiety disorders can return at higher than expected levels, leading to panic attacks.
  • Increased pain: Because fentanyl lowers the perceptions of pain, the absence of the drug will trigger increased sensitivity to pain.

These complications might be problematic, but restarting use can be the most dangerous behavior due to a possible overdose. According to the DEA, fentanyl overdoses nearly quadrupled from 2013 to 2014.1

What Fentanyl Detox Centers Are Available?

Detox occurs in many different settings. There is no single program that works best for everyone. Factors that might affect your decision about treatment include the cost, location, treatment approach, and amenities.

Common detox treatment settings include:

  • Hospital: People with pre-existing medical or psychological conditions or a severe fentanyl addiction may benefit from the resources of the acute care section of a hospital. Additionally, many people may enter a hospital detox program after being admitted for overdose complications.
  • Inpatient detox: Inpatient programs allow people to live at a facility where they are constantly supervised by professionals. They often provide medically assisted detox support.
  • Outpatient detox: Specialized detox programs are also available on an outpatient basis, meaning that you continue to live at home while visiting an outpatient detox center a few times per week. This can include methadone clinics.
  • Doctor’s office: This is on an outpatient basis but you won’t have access to group therapy sessions. Instead, your treatment will be based only on one-on-one sessions with your family physician or psychiatrist.

Addiction is hard, but finding beneficial detox treatment doesn’t have to be. You can search our directory to find detoxification centers in your area.

Detox Medications

Doctor gives female patient medication for detoxMany fentanyl detox programs offer medically assisted detox treatment. Fentanyl withdrawal medications can help you manage the uncomfortable symptoms of withdrawal. They can also help you maintain sobriety by reducing the intensity of cravings. Medically assisted fentanyl detox programs should always be followed by a formal addiction treatment program that uses behavioral therapy to treat the underlying causes of addiction and any associated mental health problems.

Fentanyl detox programs use medications like the following:9,10

  • Methadone: This is a slow-acting opioid that is taken orally once per day. It prevents withdrawal symptoms from developing. It is an opioid, but it does not produce a pronounced, pleasurable high when taken as directed. It is available only from approved outpatient treatment clinics.
  • Buprenorphine: This opioid medication is similar to methadone in that it relieves cravings without producing a high. Suboxone is a newer, combination medication that contains both buprenorphine and naloxone; the addition of naloxone prevents patients from misusing or abusing the medication to get high. It is FDA-approved, so physicians can prescribe it, eliminating the need for patients to travel to special treatment clinics.
  • Naltrexone: This is an opioid antagonist, which means it blocks the effects of opioids. It is not addictive or sedating and does not result in physical dependence. The FDA approved an injectable, long-acting form of naltrexone called Vivitrol that is only administered once per month, eliminating the need for daily dosing.
  • Clonidine: This is a blood pressure medication that can reduce some autonomic symptoms of withdrawal, such as rapid heart rate and sweating.

Post-Detox Rehab and Aftercare

After completing detox, it is important to find a fentanyl addiction treatment program that can help you maintain sobriety in the long run. Before you leave the detox program, your treatment team will help you create a recovery plan based on your addiction and unique needs. Whatever type of treatment you choose, it is important that you develop relapse prevention skills. Fentanyl relapse is common and can be dangerous in the event of an overdose. The skills you develop in rehab will help keep you safe and clean.

Common addiction treatment programs include:

  • Inpatient treatment: These are hospital or residential programs that provide 24-hour structured treatment, medication, individual counseling, group therapy, and medical care.
  • Outpatient treatment: A range of outpatient options allow participants to attend a treatment center while living at home and receiving behavioral counseling on both an individual and group level.
  • Community-based treatment: This includes non-12-step peer-to-peer programs, 12-step programs like Narcotics Anonymous, church groups, and other support programs.
  • Specialized treatment: This includes inpatient programs, outpatient facilities, and peer-to-peer programs for LGBT people, teens, and veterans, as well as gender-specific groups.
  • Luxury treatment: This includes inpatient programs that provide upscale residential facilities, including amenities like swimming pools and massage therapy at a higher cost.
  • Executive treatment: This residential program caters to high-profile business executives who wish to continue working while recovering from a fentanyl addiction. The center provides patients with access to high-speed internet and private work rooms, as well as upscale amenities, such as gourmet meals.
  • Holistic treatment: This includes alternative practices like yoga, acupuncture, or meditation.

Many people find it helpful to make a list of their top treatment priorities, such as insurance coverage, location, and duration. Do some research to see what might work best for you. There is no single treatment that works best for everyone, and each treatment has its own strengths and weaknesses, so the choice is up to you.

 Sources

  1. Drug Enforcement Administration. (2016). Fentanyl.
  2. Substance Abuse and Mental Health Services Administration. (2016). Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.
  3. Substance Abuse and Mental Health Services Administration. (2015). Substance Use Disorders.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
  6. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment.
  7. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
  8. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment: TIP 45.
  9. National Institute on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
  10. Stotts, A.L., Dodrill, C.L., Kosten, T.R. (2010). Opioid Dependence Treatment: Options in Pharmacotherapy. Expert opinion on pharmacotherapy, 10 (11), 1727-1740.
  11. National Institute on Drug Abuse. (2016). Fentanyl.
  12. Substance Abuse and Mental Health Services Administration. (2016). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health.
  13. Centers for Disease Control and Prevention. (2016). Synthetic Opioid Data.

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