Fentanyl is a synthetic opioid that’s commonly prescribed as an analgesic. Though it’s a short-acting opioid, it can quickly become addictive due to its strenuous withdrawal symptoms.
Patients undergoing fentanyl detox often require hospitalization, particularly those using high doses of the opioid. That’s because they might experience severe emotional symptoms, as well as life-threatening physiological changes.
Well, education is key when dealing with opioid abuse disorder. Not only do patients understand their symptoms better, but their families can also know what to look out for during withdrawal. Keep reading this guide to learn everything about fentanyl detox and know all the steps of opioid recovery.
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How Does Fentanyl Detox Work?
Fentanyl is one of the most addictive substances on earth. This opioid can be prescribed by medical professionals to treat severe pain. Unfortunately, patients can quickly become dependent on it, especially since the withdrawal symptoms are severe.
Accordingly, fentanyl abuse is incredibly common, with over 300,000 people experiencing dependence and abuse of the drug.
Fentanyl detox is a program designed to help individuals suffering from fentanyl addiction.
Instead of experiencing the uncomfortable side effects of fentanyl, the program aids them in undergoing withdrawal safely. It also provides the support and resources needed to prevent the risk of overdose.
While opioid use disorder patients can go through fentanyl withdrawal on their own terms, medical supervision makes the process safer and easier.
To explain, fentanyl detox in itself doesn’t pose a health risk. However, the withdrawal symptoms are severe and uncomfortable.
Furthermore, if a patient is dependent on a high dose of fentanyl, their withdrawal symptoms, such as diarrhea and vomiting, might be unbearable.
In turn, they might go through severe dehydration and electrolyte imbalance. If they have an underlying medical condition, this can be life-threatening.
Elements of Fentanyl Detox
Detoxing fentanyl is more than just getting rid of the drug in your system. Emotional dependency is just as painful as physical tolerance. For this reason, it’s crucial to get psychological help as well as physical support.
During fentanyl detox, patients receive the following:
Medication-Assisted Treatment
Medication-assisted treatment can greatly ease the recovery journey. Some of these medications simply alleviate the fentanyl withdrawal symptoms, while others prevent them by mimicking the physiological effect of fentanyl.
Opioid Aid Therapy (OAT)
The first-line treatment in fentanyl detox is opioid aid therapy (OAT). In this treatment, drugs such as methadone, an opioid agonist, and buprenorphine, a partial agonist, are used to keep the withdrawal symptoms at bay.
These medications act on the opioid receptors. However, they don’t elicit the same euphoric or high feelings as fentanyl, so they’re not psychologically addictive.
Typically, the patient starts a moderate methadone dose, gradually increasing it to stop the symptoms. Patients might continue methadone treatment indefinitely, or titrate the dose until no drugs remain in their system.
Not only do these medications provide comfort, but they also prevent fentanyl overdose in the case of a relapse.
Supportive Medication
Not all patients undergo OAT. That said, every substance abuse patient will require some form of supportive medication.
These pharmaceuticals are specific to the symptoms of withdrawal. For example, some patients benefit from using NSAIDs to relieve flu-like symptoms and muscle pains.
If a patient isn’t taking any opioid substitutions, they might benefit from clonidine therapy. This adrenergic agent alleviates abdominal cramps, nausea, anxiety, and insomnia.
That’s because clonidine produces similar physiological effects as opioids, yet it acts on different receptors. Accordingly, it shouldn’t be prescribed if the patient is still misusing fentanyl, or if they’re being administered OAT.
During fentanyl detox, vomiting is incredibly common, which leads to dehydration. For this reason, some patients might require I.V. hydration treatments as well as vitamins and electrolytes.
Physiological Monitoring
Patients exhibit numerous concerning symptoms when detoxing. That’s why hospitalization is crucial.
There are certain symptoms and side effects that only medical professionals can assess, such as heart rate and blood pressure.
Additionally, doctors need to ensure that the side effects are within normal range. Since many substance misuse patients have underlying medical conditions, the doses of their regular medications need to be adjusted, and their symptoms will require prompt treatment.
Physiological monitoring is also important to assess the patient’s withdrawal state. In particular, the Clinical Opiates Withdrawal Scale (COWS) determines the state of the patient and, thus, their level of dependence on fentanyl.
Emotional Support
Emotional support and therapy aren’t just indispensable in addiction recovery, they’re also essential elements during the early days of detox.
Patients need to be surrounded by their close friends and family, especially when the psychological symptoms kick in. This will help the opioid use disorder patient stay on track, and encourage them to brave through their journey.
Creating a soothing environment that’s free from triggers and temptations is significantly helpful. Additionally, relaxing activities and creative channels will ease the patient’s discomfort.
Symptoms of Fentanyl Withdrawal
To understand the symptoms of opioid withdrawal, learning how fentanyl affects the brain is crucial.
Fentanyl is an incredibly potent analgesic. It works by binding to the opioid receptors, the mu receptors, in the brain, preventing the sensation of pain.
However, this synthetic opioid also impacts other receptors, namely the delta and kappa opioid receptors, leading to the euphoric sensation.
Naturally, once the body is dependent on the activation of these receptors, the opioid withdrawal symptoms will be severe, including the following:
- Vomiting
- Diarrhea
- Anxiety
- Heart palpitations
- Hypertension
- Fever
- Sweating
- Chills
- Runny nose
- Muscle and bone pain
- Insomnia
- Restlessness
- Intense craving
Timeline of Fentanyl Detox
Fentanyl is a short-acting opioid, meaning that it takes about eight hours since the last dose for the withdrawal symptoms to start.
These symptoms start slowly and depend on the dose and frequency of fentanyl misuse. Usually, withdrawal consists of the following phases:
Early Withdrawal
The early stage of withdrawal is the easiest, typically starting within 12 hours of the last fentanyl dose, and lasting up to 48 hours.
During this phase, the fentanyl slowly begins to fade from the patient’s system. They’ll start feeling flu-like symptoms, such as sweating and chills.
Yet, some patients who are mildly dependent on opioids don’t feel significant symptoms. Instead, they’ll feel slightly irritated and experience cravings.
Peak Withdrawal
48 hours into fentanyl detox, patients experience the most distressing symptoms. That’s when the drug’s blood levels reach low levels, and almost all opioid receptors are empty.
This stage requires monitoring of physical symptoms, heart rate, and electrolyte level. The addict will suffer from diarrhea, vomiting, nausea, anger, and severe cravings.
Subsiding Withdrawal
After the acute phase of withdrawal subsides, some psychological and physical symptoms might persist.
However, these are most often a side effect of the withdrawal symptoms and not withdrawal symptoms in themselves. To explain, the vomiting might cause lingering gastrointestinal disturbances, unrelated to the absence of fentanyl.
Post-Acute Withdrawal
During this period, the patient’s physical well-being is restored. Their body no longer relies on opioids to function normally. Still, the psychological symptoms are in full effect.
Post-acute withdrawal syndrome (PAWS) can last weeks, or even months, after fentanyl detox. The substance abuse patient experiences anxiety, mood swings, insomnia, and a decline in their executive control functions.
Factors Affecting the Fentanyl Detox Process
Fentanyl detox programs are typically successful in reducing drug dependence and tolerance. That said, it’s crucial to understand that each patient has a different experience during detox.
Not only does the patient’s emotional and physical well-being affect how well their body reacts to withdrawal symptoms, but the severity of dependence also makes a difference.
Here are all the factors affecting fentanyl detox:
Dose of Fentanyl
Fentanyl is a short-acting opioid that has a high therapeutic index. It also produces tolerance rather quickly.
For this reason, opioid abuse patients feel the need to escalate the fentanyl dose to achieve the analgesic and euphoric effect of the drug.
If a patient is on exceptionally high doses of fentanyl, more opioid receptors will become saturated with the drug. In turn, the withdrawal symptoms will be more severe.
Frequency of Use
Similar to the dose of fentanyl, the frequency of use influences the severity of withdrawal. That’s because the less frequently a patient uses fentanyl, the less tolerant their body will be.
Accordingly, the side effects of abruptly stopping fentanyl will be less prominent in this case. In particular, many patients won’t exhibit intense cravings.
Other Drugs and Medical Conditions
Concomitant use of drugs and opioids is incredibly dangerous, especially central nervous system depressants such as benzodiazepines and alcohol.
These agents have a synergistic effect. So, even if an addict takes a small dose of fentanyl, the withdrawal will be difficult.
Moreover, patients with underlying mental conditions are more susceptible to substance abuse. These conditions exacerbate the psychological dependence and the cravings, making for a tricky recovery.
What to Expect After Fentanyl Detox
Fentanyl detox is only the first step toward recovery. While patients might no longer have any physical symptoms or cravings, triggers, and emotional turmoils might cause relapses.
Long-term recovery is achieved through continuous self-checking and life improvement. After all, it’s unrealistic for patients to spend their lives avoiding triggers. Instead, they should learn to manage their addiction through:
Therapy Sessions
Therapy sessions are indispensable in the recovery journey. For starters, therapy provides emotional support and coping mechanisms to deal with cravings.
This can be particularly helpful for patients with other mental disorders, or those with severe emotional dependence on opioids.
What’s more, addiction is a significantly traumatic experience. Addicts need to process their feelings of guilt, anxiety, and losing control in a healthy manner.
Substance use disorders might even trigger changes in brain chemistry, leading to the development of mental health conditions. In this case, therapy can identify these conditions, and help the patient deal with the long-term effects.
Intensive Outpatient Programs
Substance abuse patients might also benefit from intensive outpatient programs (IOPs), which provide more monitoring than traditional therapy sessions.
These addiction treatment programs are an option for patients who don’t require hospitalization but are in need of extra observance.
They consist of about nine hours a week of therapy sessions, group therapy, peer support, and complementary therapy. These help patients remain on track, gain inspiration from other patients, and find a healthy outlet.
Partial Hospitalization
Partial hospitalization programs are more intense forms of treatment. While patients can receive the same treatments as they would at in-patient centers, they can return to their homes at night.
These programs are useful to patients who are adjusting to return to their regular lives or those who don’t need monitoring.
The programs consist of the same elements as IOPs, except that there are more contact hours with the patient. Additionally, substance abuse patients can undergo medication-assisted treatment during partial hospitalization.
Sober Homes
Sober living homes are institutes where patients can get the proper support from other leaders in the community. These homes aid patients in creating healthy routines and establishing their sobriety and individual responsibility.
It’s important to understand that sober homes are different from in-patient treatment and halfway homes. This isn’t an environment where a patient gets medical support, nor do they have 24/7 monitoring.
Instead, sober homes provide a peaceful environment where substance abuse patients can stay away from triggers until they move on to the next step in their recovery.
Wrapping Up
There’s no denying that substance abuse treatment is a tricky journey, starting with detoxification to long-term recovery. Opioid misuse is particularly tough, as withdrawal can be a harrowing experience.
Still, there are certain auxiliary treatments that ease the fentanyl detox process. Opioid aid therapy provides the patient with opioid analogs that reduce the uncomfortable physical symptoms while ridding the body of fentanyl.
Additionally, medical health professionals monitor the patient during all detox stages to assess their condition. Some patients might require additional treatments, such as clonidine or hydration therapy.
Lastly, emotional support is key to preventing the intense cravings associated with fentanyl detox. Not only does a comfortable environment ease the psychological symptoms, but it also helps the patient deal with their substance abuse trauma.
Published on: 2023-11-22
Updated on: 2024-05-10