What is Fentanyl?
A synthetic pharmaceutical drug, fentanyl is an opioid pain reliever (OPR) more than 50 to 100 times stronger than morphine. It is used to relieve severe pain, such as after surgery or during cancer treatment, and breakthrough pain (flare-ups of intense pain despite round-the-clock narcotic treatment).
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Some brand names and forms for fentanyl include:
- Actiq—This form of fentanyl comes as a lozenge on a plastic stick administered under the tongue like a lollipop. It is used for patients already on pain-relieving medications and has some military applications.
- Duragesic—The fentanyl patch was introduced in the 1990s. It is prescribed to treat moderate to severe pain and its effects can last for up to 3 days.
- Sublimaze—Generally administered in hospitals, sometimes alongside anesthetics, Sublimaze is the injectible form of fentanyl. It is used to manage pain before and after surgeries.
- Subsys—Subsys is a sublingual spray administered under a patient’s tongue to deliver immediate pain relief. Its purpose is to treat breakthrough cancer pain.
- Abstral—Also used for opioid-tolerant patients with breakthrough cancer pain, Abstral is the quick-dissolve tablet version of fentanyl and is placed under the tongue for immediate relief.
- Lazanda—Lazanda is a fentanyl nasal spray administered in the same manner as a common nasal decongestant spray. It is predominantly used to treat pain in cancer patients.
Fentanyl works by blocking pain receptors in the brain and increasing production of the happiness-inducing chemical dopamine. Street names for fentanyl include apache, China girl, China white, dance fever, TNT and crush.
Fentanyl Abuse and Side Effects
Like other potent OPRs, fentanyl harbors massive risk for addiction and abuse regardless of its prescription form.
Those ingesting fentanyl at unprescribed levels experience an intense euphoria and sense of relaxation similar to a heroin “high.”
Outward symptoms of fentanyl abuse might include:
Nausea and vomiting
Fentanyl abuse is especially dangerous to those without a tolerance to opioids. The substance’s already elevated risk of overdose is multiplied when someone without a tolerance abuses it.
Mixing fentanyl with illicit narcotics like heroin or stimulants like cocaine amplify the drug’s damaging side effects. Whether taken as prescribed or abused recreationally, fentanyl is a volatile and potentially lethal drug.
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Signs of a Fentanyl Addiction
Since many patients don’t believe OPRs like fentanyl harbor significant addictive potential like heroin or other street drugs, it has a higher likelihood for accidental and intentional abuse.
Fentanyl impacts the central nervous system to a significant degree, causing excess amounts of dopamine to flood and chemically alter the brain over time. Due to these neurochemical changes, someone prescribed fentanyl might become dependent on the drug and turn to illegal methods of getting it after exhausting their prescribed amount.
Once someone develops a tolerance to fentanyl’s narcotic properties, he or she will depend on it to feel “normal,” requiring more of the drug to reach the previous sensations.
OPRs like fentanyl can escalate from abuse to full-blown addiction rapidly. Thanks to the Diagnostic and Statistical Manual of Mental Disorders’ criteria for diagnosing substance use disorder, healthcare professionals can pinpoint problematic behavior like building a tolerance or suffering withdrawal symptoms.
Fentanyl Withdrawal Symptoms
When someone takes an opiate like fentanyl for a long time, his or her body starts depending on the drug to function normally. It can take less than a month to develop a dependence on fentanyl.
With continued fentanyl use, larger doses are required to get the desired effects. A reduction in dose causes a chemical imbalance in the brain that results in withdrawal.
Fentanyl takes over normal brain processes that provide stability and well-being. When an addicted person stops taking fentanyl, the brain has to correct the imbalance caused by the drug. A variety physical and psychological symptoms start during this time.
Some of the most common withdrawal symptoms are:
- Nausea and vomiting
- Fast breathing
- Muscle aches
- Runny nose
- Joint pain
- Stomach cramps
Fentanyl Withdrawal Timeline
|First 6-8 hrs.||Withdrawal starts anywhere from 6-8 hours after the last use of the drug. The beginning of withdrawal is similar to the flu. The initial symptoms that develop tend to be chills, muscle aches, cramps, nausea, vomiting and diarrhea. Those in withdrawal may also feel unusually tired at first.|
|First week||Acute symptoms of withdrawal hit their peak within a day or two, adding heavy sweating, nausea, loss of appetite and mood swings. It typically becomes difficult sleep after the first day of withdrawal, and this insomnia usually persists throughout the first week. Fever is also common during the first week.|
|Weeks 2-4||Withdrawal becomes less intense over the second week. Symptoms of restlessness, fever and loss of appetite may still be strong, but become more manageable through weeks three and four. Episodes of depression, isolation and irritability are common during this time, but not completely associated with withdrawal from fentanyl.|
|PAWS||Post-acute withdrawal (PAWS) is a common phenomenon for those who abused potent drugs like fentanyl. PAWS is the return of withdrawal symptoms long after the initial withdrawal period is over. Bouts of irritiability and pain can arise months later, but typically only last a few days.|
Fentanyl detox is the process of getting the drug out of the body. Detoxing from fentanyl under medical supervision is the safest way to work through withdrawal. Doctors can also lessen the severity of withdrawal symptoms.
Those with a severe fentanyl addiction often start detox by tapering their dose. This allows the body to gradually adjust to working without fentanyl and minimizes cravings. A doctor might also switch addicted people to less potent painkillers like hydrocodone or tramadol to reduce the shock of withdrawal.
Other medications prescribed during fentanyl detox may include:
- Clonidine. This is a non-opiate drugs that relieves a variety of symptoms, such as anxiety, cramping, muscle aches, sweating and runny nose. Although clonidine doesn’t satisfy cravings, it can ease the severity of withdrawal from fentanyl.
- Buprenorphine. This is a synthetic opiate drug that acts on the same brain receptors as fentanyl. By acting on those receptors, buprenorphine can reduce cravings and withdrawal symptoms. This drug is often used for long-term maintenance of recovery, and usually isn’t recommended for those with a severe addiction.
Depending on the individual, a psychiatrist may prescribe medication for mental conditions brought on by fentanyl addiction or withdrawal.
In 2015, the U.S. Drug Enforcement Agency responded to an upswing in fentanyl abuse with a nationwide alert about the dangers of fentanyl and other substances frequently combined with fentanyl. The illicit and unsupervised use of fentanyl is highly dangerous — even doses as small as 0.25 mg can be fatal.
An overdose on fentanyl can cause varied side effects, ranging from extremely slow breathing to seizures and even death. The number of fentanyl-induced seizures in the United States increased by more than 640 percent between 2012 and 2014.
“The more [fentanyl] you take, the less your body has an urge to breathe. And it makes sense that a lot of people are overdosing on it because they aren’t sure how much to take.”
Fentanyl Addiction Treatment
Although rarely life-threatening, cutting out fentanyl “cold turkey” can be a miserable process. Those shouldering a fentanyl addiction have likely developed physical dependence on the substance, with ensuing withdrawals taking a painful toll. Specialized treatment centers offer inpatient and outpatient resources to help those addicted quit fentanyl.
Despite the typically non-lethal nature of fentanyl withdrawal, users are still vulnerable to potential relapse. Professional medical supervision during detoxification can ease the cleansing process and curb the odds of relapse.
Regaining Control is a Phone Call Away
A fentanyl addiction can be arduous to overcome, but despite the difficulties, winning this struggle is possible. Support groups exist in communities across the country to lend a helping hand or ear.