Fentanyl is a Schedule II synthetic opioid that has extremely powerful effects on the brain and the body. Other names for this drug are Actiq, Fentora or Duragesic. This potent drug is used to manage pain after surgeries, or it is used for those who are suffering from severe pain. When used properly, this drug can be a successful and comprehensive treatment for chronic pain management for those with cancer. Pharmaceutical fentanyl comes in several forms, such as:
- Lozenge or “lollipop”
- Transdermal patch
- Nasal spray
As for illicit fentanyl, it can be found mixed with other drugs, in powder form, as tablets, or as a small amount placed on blotter paper. Illicit fentanyl can either be swallowed, snorted, or injected. Blotter paper can be placed on the tongue where the drug is absorbed into the mucous membranes.
Fentanyl was first introduced in the 1960s as Sublimaze, an intravenous anesthetic. Overuse of this drug was first seen in the mid-70s and has risen over the past four decades. To note, the far-reaching fatal effects of this drug are seen in the over 81,000 drug overdoses from fentanyl which were recorded in a 12-month period (ending in May 2020). The reasons for the overuse of fentanyl include:
- Reduces pain sensation
- Causes dizziness or a sense of euphoria
- Elevates pleasure and relaxation (in the short term)
- Can cause drowsiness or unconsciousness
- Is cheaper and easier to obtain than other drugs like heroin
- Is fast-acting and causes an initial, very intense rush
How Long Does Fentanyl Stay in the System?
The effects of fentanyl are generally only felt for a few hours after use. However, the drug can be detected in the system from 24 hours up to three months depending on the test used. The amount of time that the drug stays in the system depends on how much is taken, the type, a person’s weight, the metabolism, and other factors. Testing for fentanyl can be done via urine, blood, or hair.
About Fentanyl Testing
Fentanyl testing is done for a variety of reasons, including:
- Employers – to monitor drug use periodically
- Legal situations – used in court cases where someone may be ordered to be tested due to a crime or traffic accident he or she is responsible for
- Healthcare setting – to ensure proper levels are being adhered to for an effective pain management program
As mentioned above, fentanyl is tested through urine, blood, or hair. Although saliva is used to test for other drugs in a person’s system, fentanyl cannot be detected consistently via this mode of testing. Here are some details about each mode of testing:
- Urine tests – Fentanyl can be detected in urine for up to 72 hours from last use. Urine testing is one of the most common testing methods for fentanyl because it is quick, noninvasive, easy to administer, and less expensive. To note, norfentanyl, a metabolite that comes from the breakdown process in the body, can be detected up to 96 hours from last use.
- Blood test – Although this method of testing is more expensive, it is capable of detecting fentanyl within five hours post use. The window of detection spans up to two days from last use.
- Hair test – Hair tests for fentanyl will be able to detect fentanyl up to three months post use. Hair testing is usually done for those that have been using the drug over a longer period of time.
Best Practices for Fentanyl Use and Detection
Both pharmaceutical and illicit fentanyl overdoses are on the rise.
Fentanyl is regularly mixed into illicit drugs like heroin, cocaine, and methamphetamine. This combination means that fentanyl is also linked to many indirect overdoses. To combat indirect overdoses for those who use other illicit drugs, rapid test strips for detecting fentanyl are recommended. Fentanyl testing strips (FTS) are used for personal use and are considered a harm reduction intervention for reducing overdoses among those who use illicit drugs.
When taking pharmaceutical fentanyl, we suggest:
- Fentanyl’s potency should be taken very seriously when combined with other prescribed medications. Speaking and listening to your doctor about your medication profile and drug interactions is imperative when starting fentanyl.
- Operating and driving machinery and drinking alcohol is prohibited.
- If overdose is suspected or has occurred, call 911 immediately. If naloxone is present, administer it immediately.
- Children and pets should never have access to any type of medications. All medications should be stored up and out of reach. For more information, read the CDC’s Up and Away program.
- Never share your medications with anyone. Even the smallest dose of fentanyl can cause overdose or death.
- If you should have any unused fentanyl, it must be disposed properly. You can turn your medication into your healthcare provider, or you can visit the FDA or DEA sites to learn more.
How Does It Affect the Brain?
Like other opioid drugs, fentanyl binds the body’s opioid receptors. These receptors are found in the brain where pain and emotions are controlled. After the body and brain adapt to having the drug in the system regularly, sensitivity is diminished. The effects of fentanyl are:
- Drowsiness, sedation, unconsciousness
- Extreme happiness
- Breathing problems
Fentanyl Use Disorder
Fentanyl use can lead to addiction, overdose, and possibly death. Once physical dependency occurs with the drug, it is hard to stop because it is extremely addictive. Stopping the medication will involve a detox program and medication-assisted treatment. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency. Withdrawal symptoms, listed below, will need to be managed to successfully recover from fentanyl use disorder.
- Trouble sleeping
- Diarrhea, nausea or both
- Loss of appetite
- Pain and muscle weakness
- Watery eyes and runny nose
- Increased heart rates/blood pressure
- Feeling depressed
Symptoms of withdrawal can occur within 12 hours of last use and last up to a week. The first three days of detox can be difficult; therefore, it is important to be in a detox program and to have support. When fentanyl overdose is suspected or has occurred, the following side effects will likely be present:
- Respiratory problems or breathing stops
- Blue, cold, or clammy skin and lips
- Constricted pupils
- Confusion or stupor
- Loss of consciousness
If overdose occurs, medical help should be sought immediately so that the person can be administered an opioid receptor blocker (Naloxone). This “antidote” will reverse the effects of the opioids via injection.
For those who use pharmaceutical fentanyl on a regular basis, medical providers may provide naloxone to the patient. Since a patient cannot administer naloxone in case of an overdose, it is necessary that family or care providers know where the naloxone is kept so it can be given if needed.
Fentanyl is extremely addictive and dangerous. Treatment options for fentanyl use disorder can include:
- Detox program
- Medication assisted treatment
- Evidence-based treatment program
- Aftercare program
Detoxification is generally the first step in confronting addiction. Going through detox, a patient will face both physical and mental withdrawal symptoms when stopping the use of a drug. Detox can take place in a variety of settings, such as:
- Medical detox facility
- In combination with residential care
- A center that specializes in medical detox
Detox location will be determined based on the level of care needed (sub-acute or acute). Sub-acute care is for non-emergency detox whereas acute detox is for those who have overdosed or who are in need of life-saving care.
Medication-Assisted Treatment Program (MAT)
Medication-assisted treatment, or MAT, is supervised medical treatment. It is best for those who are trying to recover from heroin or fentanyl. By way of medicines that are FDA approved, patients will receive care to manage themselves through recovery. Some of the drugs used in medication-assisted treatments are methadone, suboxone, and Vivitrol.
Methadone is used as an agonist because of its ability to connect with receptors and to create the effect the brain needs while experiencing withdrawal. It will also help to block the feelings a person has when using opioids like fentanyl. This helps to manage cravings and the need to take fentanyl. This drug will be administered carefully through liquid form once a day. The initial dosing is small to help your body adapt. In large doses, methadone can be dangerous if abused.
Suboxone medication is considered a partial agonist because the connection to the receptors is not as strong. It is only used when needed and has similar effects to methadone. Suboxone helps to fight cravings and is a combination of naloxone and buprenorphine. Naloxone counteracts the opioids, so if taken with an opioid, it will create a negative effect.
Sometimes called naltrexone, Vivitrol is an injection administered once a month. It also helps to fight cravings and to lessen symptoms. Vivitrol will help fight against overdosing. This shot will not be given unless it has been 14 days since a person’s last use.
Evidence-Based Treatment Program
In addition to MAT, there is also EBT, an evidence-based treatment. This type of treatment is integrated with a comprehensive 12-step curriculum. The purpose of EBT is to teach evidence-based therapies like cognitive behavioral therapy and dialectical behavioral therapy. These therapies help with changing thought patterns and teaching coping strategies to handle future triggers and issues when they arise. EBT may also include therapies such as trauma, grief, and loss therapy.
Counseling and Aftercare Programs
Counseling can be done either alone or in a group setting, and it will be utilized before, during, and after treatment. When going through counseling, problems are discussed, and you are taught different tools that aid in helping you to process and to handle your life situations better. Whether done alone or in a group, counseling provides comfort and a safe place for you to be heard and understood. Coupled with an aftercare program, counseling will help you achieve a successful recovery.
Granite Recovery Center
For over a decade, Granite Recovery Center has been helping those with substance use recover and live their lives free of addiction. Granite Recovery Center is located in the New England area and is committed to helping those who are alcohol and drug dependent. A few of our treatment programs include:
- Medical detox program
- Drug rehabilitation
- Inpatient and outpatient treatment
- Men and women’s Specific treatment
- Uniformed professionals treatment
- Mental health program
Depending on your goals and circumstances, we will help you find the best option of treatment. Our very experienced professionals are passionate about helping you find recovery and live free of drugs and alcohol. At Granite Recovery Center, our alumni will be happy to tell you how we have helped them not only save their lives but transform them as well.