Fentanyl is a prescription opioid drug designed to be potent. Doctors may prescribe fentanyl to those who have long term or life altering pain that’s caused them to build a tolerance to pain killers. Fentanyl can be a lozenge that goes under the tongue (brand name Aqtic), a shot that’s injected (Sublimaze), or as a patch for the skin (Duragesic). While fentanyl can effectively treat chronic pain, illegal fentanyl is responsible for more overdoses than any other narcotic.
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Fentanyl Crisis in North Carolina
Few states have been hit harder by fentanyl than North Carolina. Between 2015 and 2018, both overdose deaths and the percentage of overdose deaths caused by fentanyl doubled each year [4]. By 2018, the only state with more fatalities from fentanyl than North Carolina was Nebraska. At the end of 2021, 76.9% of overdose cases in North Carolina involved fentanyl [4] [5].
Fentanyl Crisis:
Fentanyl is 50 times more powerful than heroin. Fentanyl analogues like carfentanil (originally used to sedate elephants and other large mammals) are 100 times more powerful than fentanyl [1]. Beginning in 2014, illegal fentanyl and carfentanil began appearing on the streets. Not just for sale but also mixed into other illegal narcotics like cocaine, methamphetamines, and ecstasy [2].
In 2015, health officials announced that fentanyl had officially begun the 3rd wave of America’s ongoing opioid crisis. Fentanyl overdose rates doubled in the US every year between 2014 and 2018 [3]. However some parts of the US were hit harder by fentanyl than others.
Dealing with the Fentanyl Crisis :
Fentanyl Dependence:
One of the major problems causing the fentanyl overdose epidemic is that dealers mix fentanyl into other illicit drugs. Meaning people can be using fentanyl without realizing it. Taking fentanyl regularly can quickly create dependence.
Dependence, in simple terms, is when the brain not only expects the changes that fentanyl makes to brain chemistry but begins to rely on those changes to function properly. So when someone quits fentanyl, their brain chemistry is thrown off balance. The result is what we call withdrawal symptoms. With fentanyl, withdrawal symptoms are often flu like and are followed by mental symptoms later on.
Someone should never stop fentanyl “cold turkey” without medical help. Fentanyl withdrawal may sound intimidating, but withdrawal symptoms are very manageable when professionals slowly wean a person off fentanyl using a taper.
Fentanyl Withdrawal
Fentanyl withdrawal results from stopping fentanyl after a person has developed a tolerance. Fentanyl activates opioid receptors changing the way they function. After a time, these receptors become less sensitive to fentanyl and a person will require more to get the same effect. If a person continues using higher amounts their brain will come to rely on fentanyl and they will experience withdrawal if they stop.
Fentanyl Withdrawal Timeline:
According to the Diagnostics Statistics Manual (DSM), fentanyl withdrawal usually begins around 12 hours after the last dose. Fentanyl in patch form (Duragesic) works by extended release, so withdrawals may take longer to begin. Generally speaking, withdrawal may begin about a day after removing a Duragesic patch.
Fentanyl Withdrawal Symptoms:
According to the DSM, fentanyl withdrawal symptoms include:
- Pain
- Nausea
- Vomiting
- Muscle aches
- Runny Nose
- Dilated Pupils
- Sweating
- Diarrhea
- Yawning
- Fever
- Insomnia
- Bristling body hair
- Watery eyes
- Weakness
Withdrawals may not end after physical symptoms end. Heavy users of fentanyl are more likely to experience emotional withdrawal symptoms after detox such as depression and anxiety.
Fentanyl Addiction Quiz: Are you Addicted to Fentanyl?
Fentanyl Withdrawal: Tapering vs Cold Turkey
Stopping fentanyl all at once (known as “cold turkey”) can lead to painful withdrawal symptoms. A better option is to use a taper, which is a way to wean off fentanyl slowly. Medical professionals can set up a taper schedule that will slowly decrease the amount of opioids in someone’s system. That way withdrawal symptoms will be very minimal and manageable.
In many cases, tapering off fentanyl first means switching to another opioid like methadone, morphine, or Buprenorphine. These medications are then reduced by a certain percentage every day until the dose is small enough to quit cold turkey without withdrawal.
Fentanyl Detox Taper Schedules:
The most common taper schedule for getting off fentanyl is 8 to 11 days [6]. First, dosage is reduced by 15-33% everyday until a patient reaches 30 mg of morphine or 45 mg of methadone. After reaching this amount, the dosage is cut in half the following day. Once patients acclimate to this reduction, doctors will gradually reduce the dosage by a few milligrams everyday.
Tapering schedules can be affected by several things. Not everyone’s tapering schedule will be the same or similar. Several factors may influence the length or medications of someone’s taper like:
- Length of use: People who have used fentanyl for longer will likely have a more serious dependence and need a longer taper to avoid painful withdrawal
- Other medical issues: Certain health issues may affect which medications will be effective during a taper. To avoid drug interactions, it’s important to tell detox staff all medications you use.
- Abusing Multiple Substances: If you use substances other than fentanyl, your taper may require different medications.
Tapers are created by medical professionals who will collect your medical history before creating your schedule and choosing the best medications to help minimize fentanyl withdrawal.
Fentanyl Detox:
Fentanyl detox lets fentanyl safely leave your body while keeping physical withdrawals to a minimum. Detox should always occur at a medical facility like a hospital, clinic, or facility with professional medical supervision.
During detox, people receive 24 hour supervision, medication management, and meals while professionals monitor their vitals regularly. In addition, doctors help wean patients off fentanyl slowly so that physical withdrawals are manageable.
Length of Fentanyl Detox:
Many fentanyl detoxes last between 6 and 11 days with the third day normally being the most uncomfortable for physical withdrawals. However, the length of someone’s detox can vary depending on factors.
Medications for Fentanyl Detox
Fentanyl detox uses other opioids to help slowly wean someone off fentanyl so that they don’t experience physical withdrawals and cravings. The most common prescription is called Buprenorphine (brand name Belbuca, Probuphine, or Buprenex).
Buprenorphine acts similarly to opioids but is far less potent. It is a partial opioid agonist meaning that it does not fully activate opioid receptors in the brain like other pain killers. For an analogy imagine turning a faucet halfway on – it dispenses half as much water half as quickly. As a result, Buprenorphine helps decrease fentanyl withdrawal symptoms and cravings. Still, it does not produce the euphoric high like other opioids.
During fentanyl detox, Buprenorphine can be administered in many ways, such as a pill or tongue strip. Most medications that contain Buprenorphine also contain naloxone. By itself, naloxone is the opposite of an opioid and can be used to reverse opioid overdoses. However, the naloxone in medicines will stay dormant unless someone injects it.
Fentanyl Detox is Not Fentanyl Treatment
A common mistake is believing that treatment ends after fentanyl detox. Detox only removes your body’s physical dependence to fentanyl. It does nothing to treat any underlying addictions. With no treatment or aftercare plan, around 80% of people relapse on opioids in the first month after just detox [7].
If you or someone you care about is struggling with fentanyl we can help set up fentanyl detox. Just call us at 910-812-1728.
- https://www.dea.gov/press-releases/2016/09/22/dea-issues-carfentanil-warning-police-and-public
- https://www.cdc.gov/drugoverdose/epidemic/index.html
- https://www.ocme.dhhs.nc.gov/annreport/docs/FentanylandHeroinRelatedDeathsInNorthCarolina-081518.pdf
- https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- https://www.wect.com/story/38899928/fatal-drug-overdoses-rising-innc-faster-than-48-other-states-fentanyl-partly-to-blame/
- https://www.pbm.va.gov/AcademicDetailingService/Documents/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf
- https://www.lenus.ie/bitstream/handle/10147/110022/Article5260.pdf
- https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine
Author
Derek Swain: Addiction Writer