Detoxing From Fentanyl
Fentanyl is a dangerous drug, and withdrawing from it can result in severe side effects. Fortunately, detox treatment programs are available and effective. This article provides a general overview of fentanyl detox programs so that you can know what to expect and minimize your concerns.
How Long Does It Take to Detox From Fentanyl?
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Fentanyl is a synthetic opiate pain medication prescribed to treat post-surgical discomfort or cancer pain.2 It comes in the form of a pill, lozenge, nasal spray, skin patch or film that dissolves in your mouth. It can also be administered intravenously at a healthcare facility.2
Prescription names for fentanyl include Duragesic, Actiq and Sublimaze,2 and street names include jackpot, TNT, murder 8, China white, China girl, friend, goodfella and Tango and Cash.3
Fentanyl acts similarly to other opiates. But it is 100 times more potent than morphine and 50 times more potent than heroin. 2 Each time you use fentanyl, your brain releases a chemical called dopamine, resulting in a state of euphoria and tranquility. After repeated use, both physical and psychological dependence may quickly develop.2
Fentanyl detoxification is the process of allowing your body to remove the drug from your system and overcoming the physical addiction to the drug.4 It is a necessary first step on your path to recovery. The goal of medically assisted detox is to help you get through the withdrawal symptoms as safely and as comfortably as possible.
Fentanyl Withdrawal Symptoms and Timeline
If you have been using fentanyl on a regular basis over a lengthy period of time, you will most likely experience withdrawal symptoms when you stop using it. Withdrawal symptoms can be very unpleasant but can be made more tolerable if detoxification takes place under medical supervision.
Withdrawal symptoms begin to appear 3 to 5 hours after fentanyl use, with the most uncomfortable symptoms appearing within 8 to 12 hours. 2 If fentanyl is the only substance you were using, your withdrawal symptoms should resolve within 4 to 5 days.6 If you combined fentanyl with another opiate drug like heroin, your withdrawal may last 7 to 10 days.6
If you have been using the fentanyl patch, symptoms may not appear for 16 to 24 hours due to the continued absorption of the medication through your skin. 2
Early symptoms of fentanyl withdrawal include:
- Muscle aches.
- Runny nose.
- Yawning. 4
Late-occurring symptoms of fentanyl withdrawal include:
- Abdominal cramping.
- Dilated pupils.
- Vomiting. 4
Less acute withdrawal symptoms can last for weeks or months and may include anxiety, dysphoria, anhedonia and insomnia. 9
Detox Treatment Settings
Fentanyl detoxification can occur in detox centers or in inpatient, partial hospitalization or outpatient treatment settings. 4 You and your healthcare provider will decide together what is best for you.
Detox centers and drug recovery programs are safe, clean and comfortable places. They are staffed with healthcare providers including nurses, social workers and psychotherapists, all of whom are specially trained for and experienced in addressing your addiction recovery needs. Your team will help you begin your journey to recovery.
A detox center focuses on managing the withdrawal process. A physician may provide medications to help manage the discomforts of withdrawal. You will be supervised throughout detoxification to ensure rapid management of any medical complications or severe discomfort that may arise. Some programs may provide therapy or counseling. You generally only stay as long as it takes to detox from the drug. A detox center may be a good choice for people who need urgent recovery assistance, as well as for those who are unable to commit to a longer, more expensive treatment program. It’s highly recommended, however, that during the span of a detox program, additional plans for more long-term, ongoing treatment be made for each person. Successfully completing a detox program does not guarantee lasting recovery.
Inpatient removes you from day-to-day temptations.
Inpatient facilities provide a more immersive treatment environment and around-the-clock supervision for the duration of your treatment. During the day, you will participate in activities with other people in recovery. This setting can be advantageous for those who have been using fentanyl for a long period of time. Inpatient detox has an additional benefit of helping to remove you from your day-to-day temptations and break old habits before returning home. Inpatient detoxification is usually the most expensive of the detox programs, but it can be effective for people with severe substance abuse issues.4
Partial hospitalization refers to a program where you receive on-site treatment for part of the day and then return home at night. These programs are structured and therapeutically intensive. They are meant for people who may need medical services and, potentially, require a more structured treatment approach than that found in an outpatient program but less than what is required for inpatient care. During these programs, you will meet with your medical team for a portion of the day and participate in daily group activities.4
Outpatient detox allows you to follow a detoxification regimen while receiving treatment and regular daily monitoring for a short period of time. This type of detox approach can be conducted by a substance abuse treatment practitioner out of their clinic or office, and it is suitable for those with relatively mild addictions. Some may choose outpatient detox because the programs allow them to maintain their employment or fulfill school obligations. Generally, outpatient treatment is less expensive than treatment obtained in other settings. But it may not minimize the risks of relapse as efficiently as inpatient programs.4
How to Choose a Detox Setting
When choosing the best fentanyl detox setting, you may want to ask a few questions to find out more about the program and whether it’s a good fit. Consider the following:
- What amenities does the facility have?
- Does the facility allow cigarette smoking?
- Will you be allowed to bring your cell phone or computer?
- What services does your insurance cover?
- Does the facility allow visitors, and, if so, when and how often?
- Where is the facility, and how far a drive is it for you and your family?
- Does the detox center accommodate any special dietary needs?
How Fentanyl Detox Programs Work
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When you enter a detox program, you’ll undergo a medical exam. During your exam, a medical provider will ask you which substances you have been using, how much you have been taking and how often. Be honest so that your provider can create the best detox plan for you.
Diagnosis and Treatment Plan
The medical provider will give you a diagnosis based on the medical exam. The diagnosis comes from the Diagnostic and Statistical Manual of Mental Disorders 5th Edition and will likely be opioid use disorder. 5 The purpose of a diagnosis is to define the condition and create a specific treatment plan. Your provider will offer you different detox options based on how much fentanyl you’ve been using, how often you’ve been using it and the length of time that you’ve been taking it.
The Detox Process
Detoxification from fentanyl may initially involve either tapering the fentanyl dose or using another stabilizing opiate medication such as buprenorphine or methadone to help wean your body off the more powerful fentanyl. 6 How you were using fentanyl can impact the detox process. For example, if you were using the skin patch, the process may start more slowly and take longer as your body rids itself of the toxins.
Your healthcare provider may also prescribe additional medications to manage the symptoms of your withdrawal. For example, clonidine may be used to manage anxiety, high blood pressure, sweating and restlessness. 6 During this time, it will be especially important for you to stay hydrated by drinking plenty of water. To prevent dehydration, your healthcare provider may prescribe intravenous fluids as well.
What Happens After Detox?
After finishing your medical detox, you will be ready to begin the next phase of treatment: psychosocial interventions. Being dedicated to this phase of treatment is imperative to your overall success with recovery.7
During this phase, you may receive individual counseling in the form of cognitive behavioral therapy, motivational interviewing and contingency management. You may also begin attending 12-step meetings as part of a program such as Narcotics Anonymous and/or seek comprehensive substance abuse treatment care offered from a residential treatment facility.
- Inpatient or residential treatment. These settings are generally long-term programs where you live with a group of recovering substance abusers and professional support staff. Programs usually last anywhere from 30 days to 60 days to 90 days. While in a residential setting, you participate in individual and group therapy in order to build new coping skills before returning home.7
- Outpatient treatment: Outpatient programs also offer individual and group therapy. But you are not required to live at the treatment facility. You come to the facility on certain days of the week for certain hours at a time. These programs may be a good choice for people with a less severe fentanyl addiction.
- Cognitive behavioral therapy: Also called CBT, this type of therapy aims to help you identify automatic negative thoughts you may have about yourself or your addiction that may be leading you to use. Your therapist will also teach you behavioral strategies to cope with cravings and identify relapse triggers.7
- Motivational interviewing: Motivational interviewing is a counseling technique that helps you discuss and resolve your ambivalence toward substance addiction. During this process, your therapist will express empathy by listening and identifying discrepancies between your values and your actions. Motivational interviewing has been thoroughly researched, and it is widely accepted as an effective treatment for those suffering from substance abuse. 8
- Contingency management: Also called voucher-based therapy, contingency management uses behavior modification to reinforce positive actions and eliminate drug-seeking actions. During this type of therapy, you receive a voucher, privilege, prize or financial incentive for remaining abstinent. Research has demonstrated that contingency management therapy can be effective, but there are relatively few trained practitioners, so it may be difficult for you to engage in this form of treatment.7
- 12-step programs: These programs include groups such as Narcotics Anonymous that aim to offer social support using a self-help philosophy. These programs bring together groups of people who struggle with addiction to form tight social bonds and community support networks.7
Fentanyl Detox at Home
Seeking detox under medical supervision will ensure your safety and comfort.
Detoxing from fentanyl at home is rarely life-threatening. But depending on the amount, duration and method of use, detoxing alone can be scary and painful, leaving you vulnerable to relapse. Additionally, the byproducts of a difficult withdrawal may give rise to acute health challenges such as severe dehydration. As your body rids itself of toxins, you may also experience profound depression and anxiety.
If you have thoughts of suicide, you should tell someone immediately. You should also never detox alone if you have certain serious medical conditions such as heart or liver disease.
Find Fentanyl Detox Centers
Fentanyl addiction is an escalating problem with serious consequences. Illicit use of fentanyl is potentially lethal, even in very small doses, and it becomes extremely dangerous when mixed with other drugs such as heroin. 1
. Drug Enforcement Administration. (2012). Fentanyl.
. Chisholm-Burns, S., Schwinghammer, T., Wells, B., Malone, P., & DiPiro, J. (2013). Pharmacotherapy principles and practice (3rd ed.). New York, NY: McGraw-Hill Medical.
. National Institute on Drug Abuse. (2012). Fentanyl.
. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
. Gabbard, G. O. (2014). Gabbard’s treatments of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Association.
. Jhanjee, S. (2014). Evidence based psychosocial interventions in substance abuse. Indian Journal of Psychological Medicine, 36(2), 112-118. doi: 10.4103/0253-7176.130960
. Hettema, J., Steele, J., & Miller, W.R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111.
. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA American Psychiatric Publishing, 2013.