The fentanyl patch, also known by the brand name Duragesic, is designed to give around-the-clock pain relief to people experiencing chronic and severe pain. It is an extended-release format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72-hour period.
The American Journal of Emergency Medicine warns that fentanyl patches are commonly abused by inhalation, injection, and ingestion. The gel from the patch may be scraped off and then injected or smoked. Patches may be frozen and cut up into squares and then sucked on, or inserted into the rectum.
Fentanyl is a highly potent opioid drug that is 50 to 100 times stronger than morphine and 25 to 50 times stronger than heroin, Forbes explains. It is deadly in much smaller amounts as well—as tiny as the size of a pinpoint. The skin can absorb it on contact, so the risk of overdose is immense.
The U.S. Centers for Disease Control and Prevention (CDC) reports that overdoses involving fentanyl have skyrocketed in recent years, which is an indicator of abuse trends. Between 2013 and 2014, overdose death rates for synthetic opioids (not including methadone) jumped up 80 percent in the United States, and the driving force behind these fatalities was fentanyl.
The high potency of fentanyl, and the speed at which it crosses the barrier between the blood and the brain and binds to opioid receptors in the body, increases the risk for a potentially life-threatening overdose. It also raises the rate at which the drug can become habit-forming. Use and abuse of the fentanyl patch can quickly cause the brain to become dependent on the drug, which can lead to significant withdrawal symptoms when the drug processes out of the body.
Fentanyl is typically a rapidly acting opioid drug that takes effect quickly after entering the bloodstream. The fentanyl patch is designed to keep the drug working in the body for up to three days after putting it on. The medication is often prescribed to people who suffer from significant pain that is continuous, as they need a powerful drug to control that pain.
Opioid drugs work to block pain sensations by attaching to opioid receptors in the brain; this then slows down functions of the central nervous system. Blood pressure, respiration rate, body temperature, heart rate, movement functions, and moods are affected.
With repeated use of the fentanyl patch over time, a person can become tolerant to the dosage. The amount that worked to control pain before is no longer effective, and a higher dosage will be needed. This is drug tolerance.
As a person increases their dosage of fentanyl, the odds for physical dependence also rises. When someone is physically dependent on fentanyl, levels of brain chemistry are affected. The brain now expects fentanyl to keep its chemical levels regulated, and it will struggle to maintain balance without the drug. When fentanyl wears off, the brain can experience a kind of shock. Drug cravings and withdrawal symptoms usually develop at this point.
When someone takes a fentanyl patch off, it can take close to a day for the drug to fully process out of the body. The prescribing information for Duragesic warns that the drug should not be stopped suddenly because of the significance of the withdrawal symptoms.
The fentanyl patch has a half-life of about 17 hours, which means the drug starts to wear off at about that point. Fentanyl withdrawal can be influenced by biological factors, such as gender, metabolism, race, and age, as well as environmental ones, including stress levels and stability. The more significant the level of dependence on fentanyl is, the higher the intensity of withdrawal.
Physical dependence is determined by the length of time using the drug, dosage amounts, genetic and biological components, the presence of a medical and/or mental health disorder, the method by which the drug was used, and any concurrent use of other drugs and/or alcohol. Combining fentanyl with other substances can complicate and exacerbate withdrawal. Also, fentanyl patch abuse can increase the rate of dependence, thereby affecting the withdrawal timeline and significance of the symptoms.
The National Library of Medicine (NLM) estimates that withdrawal typically begins within 12 to 30 hours of the last dose of an opioid drug. Acute withdrawal symptoms generally last about four to 10 days, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Withdrawal symptoms usually peak within two to three days and then begin to taper off. Some of the emotional withdrawal symptoms may continue for longer, which is called prolonged withdrawal; this condition can be managed through therapeutic and supportive treatment methods.
While individual experiences vary somewhat, there is an average timeline to expect with fentanyl withdrawal.
Within 24 hours after taking off the patch (or the last dose), one may experience:
About two to three days later, a user may have:
Three to five days after the last dose of fentanyl, these effects may be present:
Five to 10 days later:
One week to several months after stopping fentanyl patch use:
Side effects of fentanyl patch withdrawal are not typically considered to be life-threatening; however, the level of discomfort can be significant enough to warrant medical treatment and intervention. In addition, a high level of support is needed to avoid relapse during withdrawal, and that can be provided through a medical detox program.
A medical detox program can help to make a person more comfortable during withdrawal from the fentanyl patch, and it also can serve to shorten the withdrawal process. Withdrawal symptoms can be managed, both through supportive measures and medical means.
Fentanyl and opioid drugs powerfully interact with the brain’s chemistry, so medical professionals do not recommend stopping them cold turkey. During medical detox, the dosage can be tapered through a slow and controlled schedule, which can help to dull the brunt of the withdrawal symptoms.
Fentanyl may also be replaced with another opioid drug that stays in the body longer and is less potent, such as methadone or buprenorphine. Medications like the blood pressure drug clonidine (Catapres) are sometimes used off-label to control opioid cravings and minimize some of the hyperactivity of the central nervous system functions during withdrawal. The FDA has recently approved a new medication for opioid withdrawal, lofexidine (Lucemyra), that the National Institute on Drug Abuse (NIDA) explains can alleviate withdrawal symptoms.
During medical detox, vital signs can be continuously monitored, and medications can be managed to ensure the safety and physical stability. Mood stabilizers, sleep aids, nonsteroidal pain medications, and medications to address stomach and gastrointestinal issues can all target certain symptoms of fentanyl patch withdrawal. Co-occurring mental health and medical issues can also be addressed.
Medical detox provides a stable and calm environment, which can allow the brain to recover and healing to begin. Emotional support is a key part of this process. Mental health providers give ongoing encouragement as well as tools for combating stress and preventing relapse. Through medical detox, a person can become physically stable, readying them to move into a treatment program that can provide further emotional support and skills for recovery.
A complete addiction treatment program should follow detox. Comprehensive addiction treatment programs provide continued support, encouragement, educational programs, holistic methods, and therapeutic measures to promote a sustained recovery while helping to minimize relapse and enhance healing.
Through therapy and counseling sessions, individuals can learn coping mechanisms and life skills to improve overall functioning and wellness. Behavioral therapies, support groups, holistic methods, medication management, and educational programs can all round out a complete treatment program. NIDA recommends at least 90 days in a specialized treatment program for drug addiction. Each person is different, so treatment plans will, therefore, vary from person to person. Ultimately, the treatment provider will determine the best plan for the specific individual and their family. SAMHSA’s Behavioral Health Treatment Services Locator can help individuals to locate local programs. The tool also provides details on the type of programs and their offerings. Programs offering peer support through 12-step programming and local meetings such as Narcotics Anonymous (NA) can be good resources for long-term recovery.
Fentanyl patch withdrawal is optimally managed through a medical detox program that is followed immediately with an individualized drug addiction treatment program.
(2011). American Journal of Emergency Medicine. from https://www.ajemjournal.com/article/S0735-6757(10)00037-9/pdf
(August 2016). Centers for Disease Control and Prevention. from https://www.cdc.gov/mmwr/volumes/65/wr/mm6533a2.htm
(March 2017). Janssen Pharmaceuticals. from http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/DURAGESIC-pi.pdf
(August 2018). National Library of Medicine. from https://medlineplus.gov/ency/article/000949.htm
(2010). Substance Abuse and Mental Health Services Administration. from https://store.samhsa.gov/shin/content/SMA10-4554/SMA10-4554.pdf
(May 2018). National Institute on Drug Abuse. from https://www.drugabuse.gov/news-events/news-releases/2018/05/fda-approves-first-medication-to-reduce-opioid-withdrawal-symptoms
Substance Abuse and Mental Health Services Administration. from https://findtreatment.samhsa.gov/
Narcotics Anonymous. from https://www.na.org/