Fentanyl is a powerful synthetic opioid painkiller listed as a Schedule II medication by the Drug Enforcement Administration (DEA). Although fentanyl has medical applications to ease serious pain, it can be highly addictive. Opioid painkillers are distantly related to heroin, since they are both synthesized from the opium poppy and can therefore cause a euphoric high that may lead to addiction, tolerance, and dependence.

Fentanyl withdrawal

Fentanyl, in particular, is used to treat patients with severe pain who either have difficult-to-control pain, chronic pain, or who have developed a tolerance to other pain medications. In smaller doses, fentanyl is used to help control breakthrough pain in cancer patients who are already taking another opioid painkiller, such as OxyContin, that isn’t as effective for them. The medication can also help patients who have difficulty swallowing pills or liquids due to illness. This medication can be administered in a transdermal patch, intravenously, via a nasal spray, or in a lozenge. The medication binds to opioid receptors in the brain and spinal cord very quickly, so pain relief begins within minutes of administration.

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Fentanyl Abuse

However, the potency and fast-acting nature of fentanyl has made it a prime target for illicit use. Fentanyl is 50–100 times more powerful than morphine, and it creates effects similar to heroin, so it can be just as addictive for some people. Fentanyl abuse was first reported in the 1970s, and now there are 17 fentanyl analogues that have been catalogued by law enforcement on the illegal substances market in the U.S.

In fact, recently, fentanyl has been found in heroin and cocaine as a way to increase the potency of these drugs. Lacing street drugs with fentanyl has also increased the number of overdoses and drug-related deaths. Non-medical fentanyl, called acetyl fentanyl, was created in illicit laboratories and sold illegally to appeal to the market for the drug in greater numbers.

When a person is addicted to an opioid and moves to fentanyl abuse because of the drug’s potency, comprehensive addiction treatment is needed. The first step in ending an addiction is to detox from the substance, which produces withdrawal symptoms and, therefore, requires medical supervision.

Causes and Symptoms of Fentanyl Withdrawal

A person might experience withdrawal symptoms when they stop using opioid painkillers if they are physically dependent or addicted to the drugs. Although addiction and dependence are correlated, they are not exactly the same thing. Addiction is a disease of the brain, which causes a person to compulsively use a substance or continually perform a behavior despite the negative consequences. Abusing fentanyl to get high and being unable to stop even when you want to is one symptom of an addiction.

Physical dependence can occur with consistent use of a substance, whether it is due to legitimate medical use or recreational abuse. People who take potent opioid painkillers like fentanyl can develop a dependence on the medication, since it changes their brain chemistry, without necessarily developing an addiction to it. However, people who struggle with addiction to substances like fentanyl typically take more than the prescribed dose or alter the substance, and this can lead to physical dependence.

When a person struggles with addiction to fentanyl or no longer needs their prescription but has developed a physical dependence, they will experience withdrawal symptoms when they try to stop taking the drug. Withdrawal symptoms may include:

  • Sweating.
  • Runny nose.
  • Watery eyes.
  • Coughing.
  • Chills, fever, or goosebumps.
  • Excessive yawning.
  • Exhaustion and fatigue.
  • Cognitive issues, difficulty focusing, or memory problems.
  • Restlessness and anxiety.
  • Trouble sleeping, up to insomnia.
  • Physical weakness.
  • Muscle aches or bone pain
  • Abdominal cramps.
  • Diarrhea
  • Nausea or vomiting.
  • Irritation or mood swings.
  • Cravings or obsession about the substance.

More On Withdrawal Timelines:

Fentanyl Withdrawal Timeline: What to Expect

Withdrawal symptoms occur because the brain is attempting to reach equilibrium without the influence of an outside chemical on its neurotransmitters. Similar to other opioid medications, withdrawing from fentanyl can be very uncomfortable, but it is not physically dangerous. However, discomfort, mood swings, and cravings for fentanyl can lead you to relapse in an effort to avoid feeling these symptoms, which can make you more susceptible to overdose, especially with a substance as powerful as fentanyl. It is important to seek medical help when detoxing from an opioid, especially fentanyl.

The withdrawal process can vary from person to person, depending on individual factors. If you have taken fentanyl as prescribed and you no longer need it, you are less likely to experience intense or protracted withdrawal symptoms, although you may still experience a few days of feeling down or like you have the flu. If you used fentanyl non-medically and subsequently became addicted to it, you are more likely to experience both physical and psychological withdrawal symptoms and they may feel the effects of detoxing longer.

Fentanyl detox occurs in 3 basic stages:

  • Early stage: Fentanyl is a slow-acting narcotic, so it can take several hours for the body to begin to experience withdrawal after you’ve taken your last dose. Mild symptoms typically begin anywhere between 12 and 30 hours after the final fentanyl dose, depending on how large the dose was, and whether it involved time-release properties such as those found in the transdermal patch. The first stage lasts 2–3 days, and peaks with symptoms such as agitation, muscle aches, insomnia, sweating, and runny nose.
  • Peak: On days 3–5, the worst physical symptoms will feel the most intense. These include nausea, diarrhea, vomiting, muscle and bone pain, increased tearing and runny nose. Psychological symptoms can also feel intense during this time too, including mood swings, depression, and anxiety. However, after day 5, symptoms will begin to decrease, and you may start to feel better because the brain is relearning how to function without fentanyl in its system.
  • Long-term: Withdrawal symptoms typically clear up after 1–2 weeks. Physical symptoms of withdrawal will subside after this time frame, although some psychological symptoms, such as cravings and depression, can linger for a few days and may lead to relapse during this time, so it is important to have medical oversight help you through this time drug-free.
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PAWS and Fentanyl Detox

PAWS and Fentanyl Detox
Post-acute withdrawal syndrome, or PAWS, occurs in people who struggle with addiction to alcohol, benzodiazepines, or opioids for a long period of time. This syndrome is an intensification and protraction of withdrawal symptoms—especially psychological symptoms—for weeks or months. Some people in recovery from fentanyl addiction state that they have experienced PAWS for years. Unfortunately, feeling this level of discomfort can make relapse difficult to avoid.

PAWS can also lead to the intensification of symptoms like depression, which can lead to suicidal ideation. In rare cases, people experiencing PAWS may suffer seizures. This is, of course, dangerous and another reason why it is important to find a doctor or professional treatment program to help with the detox process and with continued care for months afterward.

The Necessity of Medical Detox

Medical detox is the safest method of withdrawing from substances like fentanyl. A doctor can prescribe psychiatric medications like antidepressants or anti-anxiety medications, which can ease psychological symptoms as necessary. Over-the-counter pain medications in small doses, such as ibuprofen or acetaminophen, can ease physical aches and pains too. A doctor’s oversight helps prevent abuse of these substances while you try to withdraw from fentanyl.

Buprenorphine is becoming a popular opioid replacement therapy, to ease the symptoms associated with opioid withdrawal. It is a partial opioid agonist, so it binds to opioid receptors and releases the same neurotransmitters, without creating the same high as drugs like fentanyl, morphine, or heroin. With a doctor’s help, you can taper off buprenorphine over time, after you’ve successfully detoxed from fentanyl.

Tapering the drug itself can be another method of overcoming fentanyl addiction. A doctor will work with you to come up with a tailored tapering schedule, typically a 25-50% reduction per week until complete detox is achieved. This eases withdrawal symptoms, because the body receives some of the drug it has become dependent on.

However, it also slowly teaches the brain to release neurotransmitters on its own. A tapered approach does not work well without direct medical supervision since you might be much more likely to relapse.

Medication-assisted detox can take more time than just quitting cold turkey, but it is much safer. Completely quitting a drug like fentanyl without any help typically takes 2 weeks; however, without medical and social support, relapse is much more likely. Although tapering or replacement therapy can mean detox takes longer, it could be effective for maintaining sobriety in the long-term for certain people.

Detox is also not the same as overcoming an addiction. It is an important first step, but finding an appropriate rehabilitation program should be the next step in a complete treatment plan. These programs provide medical and social support through individual and group therapy and medical supervision that lasts well after the initial detox phase.

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