As the opioid crisis rages on, claiming more lives every year, many have pointed to a potent morphine analog as the cause of the ever-rising rates. Fentanyl, a powerful synthetic opioid that is similar to morphine, is said to be 50 to 100 times more potent than that naturally occurring substance. According to data cited by the U.S. Centers for Disease Control and Prevention, much of the increase in synthetic opioid overdoses may be traced to illegally or illicitly made fentanyl.

Fentanyl that is in its purest form appears as a white powder or in grains that are about the size of grains of salt. In medical situations, the Schedule II drug is typically used for rapid onset of severe pain relief in serious medical situations. Doctors prefer it in cases where they are trying to combat specific pain, for instance in epidurals for women in labor or pain that accompanies advanced cancer. It first came into use in the 1960s.

However, outside the bounds of medicine, illegally made fentanyl is a highly dangerous street drug. It’s cheaper and easier to make and buy than its cousin heroin, and it’s far more powerful. Plus, dealers can easily disguise it as heroin and use it to stretch profits or provide a bigger kick. According to the Drug Enforcement Administration, illegal fentanyl is often made in secret laboratories before it is trafficked or transported across the U.S. southwest border or shipped via mail. Mexico and China have been identified as countries that are major sources for fentanyl and fentanyl-related compounds.

As with other opioid drugs, fentanyl is a drug that affects the central nervous system. It binds to the body’s opioid receptors and floods the brain’s reward areas with high levels of dopamine, giving users a rush of euphoria and relaxation. In addition to these effects, users also can experience nausea, confusion, constipation, and sedation. Regular, frequent use can result in a high drug tolerance that leads to addiction.

Street fentanyl can be sold as a powder, as tablets that appear to be less potent opioid medications, or as a spiked substance on blotter paper. On the illegal drug market, it, along with fentanyl-laced heroin, is also known as:

  • Apache
  • Butter
  • China Girl
  • China White
  • Crazy
  • Dance Fever
  • Dragon’s Breath
  • Facebook (fentanyl-heroin mix in pill form)
  • Friend
  • Goodfella
  • Jackpot
  • Lollipop
  • Murder 8
  • Shoes
  • TNT
  • Tango and Cash

Users can take swallow, inject, snort, or dissolve the drug onto their tongues using the blotter paper approach. The drug also can be mixed with heroin or cocaine. In many cases, it is sold to users who think they’re getting just cocaine or just heroin, not a combination drug that can kill them.

“The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains fentanyl,” writes the National Institute on Drug Abuse (NIDA).

Fentanyl is considered to have a very high dependence liability because it is highly addictive. Signs of fentanyl addiction include concentration difficulties, depressed or elevated mood, anxiety, and confusion.  If you have higher than average risk factors for addiction, you may become dependent even in some medical treatment situations. Since it is active at five to 12 micrograms and can be absorbed through the skin, illicit fentanyl use carries a high risk for overdose. But if you build up an opioid tolerance and become addicted, it also can come with painfully unpleasant withdrawal symptoms.

Chronic fentanyl users are strongly advised to avoid quitting the drug abruptly to end their fentanyl dependence. If they do just suddenly stop using, they risk experiencing extreme withdrawal symptoms that are so uncomfortable that they could make one go back to using just to avoid the discomfort. If you or someone you know wants to stop fentanyl dependence, it is best to seek medical help from a licensed drug rehabilitation center to safely withdraw from the drug.

What are the Fentanyl Withdrawal Symptoms?

Fentanyl withdrawal follows the same patterns of withdrawal from other opioids such as heroin and prescription painkillers. However, since fentanyl is so much more powerful, its withdrawal symptoms may be more pronounced. Early signs of opioid withdrawal may mimic common cold symptoms, and as you get closer to peak symptoms, they may grow to feel more like a full-blown flu. However, people who have gone through fentanyl withdrawal report extreme symptoms that go beyond standard sickness.

Fentanyl withdrawal symptoms include:

  • Rapid heartbeat
  • Chills
  • Excessive yawning
  • Fatigue
  • Goosebumps
  • Headache
  • Increased tearing
  • Runny nose
  • Insomnia
  • Nausea
  • Vomiting
  • Diarrhea
  • Muscles aches
  • Joint pain
  • Weakness
  • Stomach cramps
  • Sweating
  • Anxiety
  • Agitation, irritability

Opioid withdrawal is not known to be life-threatening, especially when compared to other addictive substances such as alcohol. However, the extreme symptoms of fentanyl withdrawal can lead to medical complications in some cases. The most common effect of withdrawal will be an intense craving for fentanyl that may be difficult to resist on your own.

What are the Stages of the Fentanyl Withdrawal Timeline?

The timeline in which you feel symptoms is affected by several factors including the amount of time you took opioids, the dosage of fentanyl you were used to, and the amount at your last dose. Since a small dose of fentanyl is a large dose by the standards of most other opioids, you may start feeling withdrawal symptoms a bit sooner than you would if you were taking heroin or morphine.

You may start to experience opioid withdrawal symptoms 12 hours after your last dose. If your last dose was large, you might not experience your first symptoms until 30 hours later. Fentanyl can be absorbed through the skin with about 92 percent of the same bioavailability (the amount of the chemical that makes it into your system) as intravenous injection. Because of this, extended release transdermal patches are available that extend the action of the drug. This method of taking fentanyl will prolong the period before symptoms start.

Symptoms will peak around two to four days. You might be able to identify the peak by the presence of gastrointestinal distress like cramps, nausea, diarrhea, and vomiting. After a week from your last dose, symptoms will begin to dissipate.

Why Should I Detox?

Fentanyl withdrawal, as with other opioids, does not carry a significant risk of fatality. However, extreme withdrawal symptoms, such as vomiting and diarrhea, can lead to complications including dehydration and aspiration of vomit. Through medical detox, a team of medical professionals who specialize in addiction can help alleviate your withdrawal symptoms. They also can respond to or help avoid any serious complications caused by withdrawal symptoms. Medications used in fentanyl detox include  buprenorphine, Naltrexone, Suboxone, and methadone. Non-pain medications may also be used to manage other chronic health conditions such as diabetes and high blood pressure.

Opioids are notoriously difficult to quit without professional help. Uncomfortable symptoms combined with strong drug cravings make relapse during withdrawal compelling. Through medical detox, your clinicians will not only help ease your discomfort, but they will also keep you from using to satiate cravings during weak moments. Clinicians also may help you find the best treatment program for your needs following your completion of detox. Since fentanyl is one of the leading causes of rising overdose death rates, continued treatment is essential for relapse prevention.

What is the Next Treatment Step?

Although addiction is a chronic disease for which there is no known cure, it is treatable to the point where you can live a normal life and manage cravings and triggers. Still, your road to recovery doesn’t end when you complete a medically monitored detox, which is typically the first step of professional drug treatment.

Man grabbing his backbecause of discomfort

Addiction is a disease that primarily affects the brain by training your reward center to seek out drugs like it would seek out food and water. Even after the last of the drug’s chemical presence has left your body, your brain may respond to stress and triggers with compelling cravings.

A full continuum of care is the best way to combat these cravings and avoid relapse. Starting with professional addiction treatment, you can learn to manage stress and triggers that can potentially cause a relapse. You also will be able to take a closer look at the underlying factors that may have lead to addiction. Studies show that a large portion of addiction cases occur alongside other mental disorders.

Through a range of therapy options you can participate in individualized treatment that works best for you and your needs.

Before a treatment program is planned, recovering fentanyl users will undergo an evaluation that reviews factors such as the severity of the addiction and if other health issues are present. In the case that a mental health disorder is discovered, a treatment plan that includes therapies for co-occurring disorders, such as anxiety, depression, and post-traumatic stress disorder among others, will be recommended.

According to NIDA, addiction is a complex but treatable disease that affects brain function and behavior. The disease also can leave result in brain changes that last long after substance abuse has stopped, which is why users are vulnerable to relapse. While it is treatable with the appropriate programs, research shows that at least three months (90 days) or more are needed to properly treat substance addiction.

After treatment, alumni programs can connect you to support groups and 12-step programs that can help connect you to people who share your goals, so they can help avoid relapse for years to come.

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