Any opioid drug, from Vicodin to heroin to fentanyl, triggers several reactions when the chemical attaches to the opioid receptors in the brain. For prescription painkillers, the most important function is to stop or reduce intense pain symptoms, usually associated with injury, illness, or post-surgical pain. A medical professional will work with their patient to moderate the prescription, so it is at the lowest possible effective dose to reduce the risk of misuse and addiction. However, the opioid receptors also play a role in the involuntary process of breathing, sedation and cognition, and mood. When the drug binds to these receptors, and the dose is high, the person may experience a relaxing euphoria that can become addictive. If the person takes too much of an opioid substance or mixes it with other sedatives, they are at risk of depressing their breathing, so it is shallow, irregular, or stops altogether.
The body will eventually develop a tolerance to the painkilling and euphoric aspects of opioids. This is a dangerous point for those who misuse or abuse opioid drugs because they will take more of the drug or seek out more potent drugs, like heroin and fentanyl, to get the original high.
Detoxing safely from opioid drugs is extremely important. A doctor who has prescribed narcotic painkillers to their patient can help, and for people who abuse illicit narcotics, getting help from addiction specialists will be an important first step in overcoming this addiction. Attempting to quit “cold turkey” can lead to withdrawal symptoms as the drug leaves the body and is not replaced with another dose or a detox drug.
Length of Withdrawal
Without medical supervision, withdrawing from opioid drugs can cause various uncomfortable symptoms. Depending on the drug’s half-life, these may begin within a few hours to two days after the last dose. Fentanyl produced by a pharmaceutical company typically has a half-life of 3-7 hours, so withdrawal symptoms may begin within 24 hours. These will include:
- Muscle aches
- Watery eyes
- Runny nose
- Excessive sweating
- Trouble sleeping
- Other symptoms like having a cold or the flu
After the first two days, withdrawal symptoms will become more intense. Symptoms may include:
- Abdominal cramps
- Nausea and vomiting
- Dilated pupils
- Blurry vision
- High blood pressure
- Rapid heartrate and breathing
- Anxiety, restlessness, or mood swings
These symptoms will fade after the first week. Some psychological symptoms, especially depression, anxiety, and cravings, may continue for weeks after the physical withdrawal symptoms have gone away. These psychological symptoms can cause a relapse if the person has not received appropriate attention during detox and then entered a rehabilitation program.
Medication-Assisted Treatment to End Opioid Addiction
People who have a doctor overseeing their pain management can work with the physician on a tapering protocol to slowly reduce the dose. The CDC issued guidelines for physicians recommending a dose reduction of 10 percent per week to start. Those who have taken high-potency drugs for a long time, like fentanyl, may benefit from a slower tapering process, which could be as little as 10 percent per month.
Originally, methadone was the leading long-term detox drug to treat those dealing with heroin abuse.
In addiction treatment, removing the substance of abuse is the very first step in the detox process. Rather than reducing the dose of fentanyl, an addiction specialist will evaluate their patient for withdrawal symptoms. Among those who abuse fentanyl, heroin, or both, these symptoms are likely to feel intense. Medication-assisted treatment (MAT) can be an extremely important part of opioid detox and rehabilitation, so an addiction specialist is most likely to replace fentanyl with buprenorphine or methadone.
While some detox physicians may still prescribe methadone, the current preferred treatment is buprenorphine. It is a partial opioid agonist, attaching to the opioid receptors and easing withdrawal symptoms for up to two days, depending on the size of the dose. Once this drug has been prescribed, the physician will create a tapering schedule for buprenorphine, so the person eases off their physical dependence on all opioids.
Detox and Rehabilitation for Fentanyl Abuse
Detox is the first crucial step in overcoming an addiction to opioids and avoiding an overdose on these substances, including on fentanyl. After detox, the next step is to continue into a comprehensive rehabilitation program.
Many people who struggle with heroin or fentanyl abuse, especially for a long time, benefit from inpatient treatment because they are removed from triggers, friends who abuse drugs, and access to opioids. In some cases, outpatient treatment may be more appropriate. The decision on treatment type will be made in consultation with the intake physician.