Different opioids have risen to popularity over the years. Today, the opioid of choice for many drug users is an extremely potent synthetic opioid called fentanyl. Fentanyl rose to notoriety in the last few years as illicit fentanyl pills proliferated across the United States. While legitimate fentanyl prescriptions do exist, most of the drugs on the street originate from an unregulated environment created by illicit drug manufacturers. In a medical setting, like most other opioids, fentanyl treats chronic pain. But most doctors prescribe opioids with extreme caution because the drugs carry high addiction potential. People also build tolerance quickly and require higher and higher doses to experience the same effect. Unfortunately due to its potency and cheap cost to manufacture, fentanyl has become incredibly common. It also has increased the occurrence of fentanyl withdrawal.
How is Fentanyl Different from Other Opioids?
Fentanyl has an initial period of euphoria that quickly fades due to its relatively short half life. This makes the drug even more dangerous because users must take it more frequently to maintain a high (or feeling of normalcy once tolerance develops) over an extended period of time. Fentanyl has a short half life because it was developed for specific medical use cases. An example is intubation that requires a rapid induction and recovery from sedation. The introduction of “fast-track” surgeries created a focus on earlier extubation, faster recovery, and expedited discharge from the hospital. In this case, a short half life offers the benefit of patients not leaving the hospital under the influence of opioids. But when not in a controlled hospital setting, this shorter half life creates dangerous problems, specifically for those struggling with opioid use disorder.
When looking at onset and elimination half-life, fentanyl is on the opposite end of the spectrum from maintenance medications such as methadone and buprenorphine. As a result, fentanyl’s rapid half life speeds up the onset of opioid withdrawal after use.
What Happens During Fentanyl Withdrawal?
Every individual goes through fentanyl withdrawal differently. But generally, symptoms of fentanyl withdrawal onset relatively quickly. They typically start between 12 to 24 hours after the last dose. Fentanyl withdrawal symptoms include:
- Intense cravings
- Restlessness or trouble sleeping
- Chills and/or goosebumps
- Irritability
- Stomach cramps
- Nausea and/or vomiting
- Runny nose
These fentanyl withdrawal symptoms typically last for several days. Fentanyl withdrawal, like other opioids, is known as being “dope sick.” But these physical symptoms eventually subside after a few days. Unfortunately, all opioids have a relatively high relapse rate. That is why many suffering with opioid use disorder choose medication-assisted treatment (MAT). They provide an extra layer of protection since many of them are partial opioid agonists, meaning they block the effect of other opioids.
How does Medication-Assisted Treatment (MAT) help alleviate opioid withdrawals?
Several medications assist with fentanyl withdrawal. They vary depending on the stage. In the beginning of opioid withdrawals (dope sickness), oral buprenorphine is typically the medication of choice. Clinical detox offers access to buprenorphine treatment in a safe and controlled environment. Addiction psychiatrists will prescribe a titration schedule with buprenorphine, since higher doses are initially needed to get through dope sickness. Once the titration concludes, several options exist for long term MAT.
Suboxone: Buprenorphine/Naloxone, Sublingual Film/Oral Tablet
One of the more popular medications people in recovery use is suboxone. Suboxone is a long-acting, high-affinity partial opioid agonist. It binds to the same receptors in the brain as other commonly abused opioids. For this reason, it also blocks/prevents the effects of those other opioids. Suboxone is prescribed because it has a very long half life and prevents opioid cravings. The most common Suboxone formulation is 4:1 buprenorphine to naloxone.
Subutex: Buprenorphine, Monthly Injection
Subutex offers the unique feature of being a monthly injection. This allows users to not have to worry about daily doses. Subutex does not contain naloxone but its main acting ingredient, buprenorphine, acts as a partial opioid agonist. So patients on Subutex will not feel the effects of additional opioids, as those receptors are being used by the weaker buprenorphine. This explains why physicians prescribe buprenorphine as an effective treatment for those recovering from fentanyl withdrawal and opioid use disorder.
Suboxone and Subutex both require prescriptions from a licensed physician. For those seeking treatment, treatment centers like our program at New Start Recovery provide individuals with the resources and access they need to move forward. If you or a loved one is seeking treatment for opioid use disorder, our addiction counselors are available 24/7 by phone: 714-455-3409