Fentanyl is a synthetic opiate drug in the same class of drugs like morphine, heroin, methadone, Vicodin, and OxyContin. According to the National Institute on Drug Abuse, all opioid drugs are derivatives of the poppy plant. The majority of these drugs are used in the treatment of chronic pain, and they also have medicinal uses as cough suppressants and treatments for chronic diarrhea.
Fentanyl is a synthetic opioid drug that is far more potent than morphine or heroin. It is marketed under a number of different brand names, including Durogesic and Duragesic. It is commonly used as a transdermal patch applied to the skin but also can be taken as a nasal spray or as a dissolvable lozenge.
The United States Drug Enforcement Administration lists fentanyl as a Schedule II controlled substance, indicating that the drug does have medicinal uses but also has a very strong potential for abuse and the development of physical and psychological dependence. Fentanyl can only legally be obtained with a prescription from a physician.
As fentanyl acts as an opioid agonist, it is believed to have an infinity to bind to built-in receptors in the human brain that are specialized for endogenous neurotransmitters, such as endorphins and enkephalins that naturally alter the subjective experience of pain. Opiate drugs naturally bind of these receptor sites to produce their effects. They also increase the production of dopamine in the brain, which adds to the euphoria and pleasant effects that the drugs produce. Fentanyl’s action makes it a strong candidate for abuse.
Abuse of Fentanyl
According to research from The Journal of Drug and Alcohol Dependence, the abuse of prescription drugs in college students appears to occur from one of three different possible routes. In the study:
- One group took drugs like fentanyl to control pain. This group most often used the particular drug according to its prescribed method of use and did not mix it with other drugs.
- A second group used narcotic drugs like fentanyl to achieve their psychoactive euphoric effects (recreational group). This group was more likely to use the narcotic drug in combination with other drugs and more likely to use it in ways inconsistent with its intended prescribed use, such as injecting or snorting it.
- A third group consisted of individuals who used narcotic medications for a number of different purposes, some not mentioned above. This group was term the mixed type.
- The researchers found that college students in the recreational and mixed type groups were far more likely to develop substance use disorders to narcotic medication and other prescription drugs than the group that self-medicated themselves with the drug. All of the subjects in the study were obtaining the drug without a prescription. These findings are consistent with other findings that suggest that people who use drugs for medicinal reasons and within the boundaries of their intended use are far less likely to develop substance use disorders than individuals who use them for their psychoactive effects and in manners inconsistent with their intended use.
All opiate drugs have the potential to cause physical dependence in anyone who uses them for lengthy periods of time. Even people who use the drugs medicinally can develop physical dependence on them, and individuals who abuse the drug are more likely to develop physical dependence because they use it in a manner inconsistent with safe use.
Physical dependence consists of exhibiting both the symptoms of tolerance (the need to use greater amounts of a drug to achieve effects that were once achieved at lower amounts) and withdrawal (a series of negative and often very unpleasant physical, emotional, and psychological effects that occur when one discontinues using the drug or drastically cuts down on the amount being used).
Withdrawal from Fentanyl
The withdrawal process from opioid drugs like fentanyl is generally well described; however, there can be quite a bit of individual variation associated with withdrawal from opioid drugs. Several factors affect the length of the withdrawal process and the severity of the symptoms that one will experience. According to the book Managing Patients with Chronic Pain and Opioid Addiction, these factors include:
- The length of time one use or abused the drug. Lengthier and more severe withdrawal symptoms are associated with using or abusing the drug for longer periods of time.
- The amount of the drug that was typically used: Individuals who typically took higher amounts of the drug will experience more severe and lengthier withdrawal syndromes.
- How the person stops taking the drug: Individuals who abruptly cease using the drug will experience more intense withdrawal symptoms, whereas individuals who are able to taper down the dosage over time will experience less severe withdrawal syndromes, though the overall withdrawal process will take longer.
- Developing physical dependence on multiple drugs at the same time: Individuals who have polydrug physical dependence will have more complicated withdrawal syndromes.
- Personal differences: Differences in metabolism and emotional or psychological stability will affect the withdrawal process.
The half-life of a drug refers to the amount of time that normal metabolism in most individuals is able to reduce the original concentration of the drug by half. The half-life of fentanyl is relatively long for the transdermal patch (20-27 hours) and much shorter for sublingual dosages (typically 5-6 hours). This is because the patches release the drugs slowly into the system. A good deal of the abuse of fentanyl occurs by individuals who obtain the patches and extract or use the fentanyl in them. Because the drug is taken in larger doses when abused, the half-life of fentanyl for individuals abusing the drug may typically be closer to 5-6 hours. This means that individuals who abuse fentanyl could potentially begin to experience withdrawal symptoms rather rapidly if they were taking significant amounts of the drug.
Even though the withdrawal process can be negotiated without serious aftereffects in most individuals, simply undergoing withdrawal from opioid drugs like fentanyl is not considered to be a method of treatment for a substance use disorder. Individuals with substance use disorders require active participation in a long-term treatment program following the withdrawal management process in order to ensure that they will not relapse.
In addition, individuals attempting to discontinue fentanyl will experience greater success initially if they become enrolled in a physician-assisted withdrawal management program (often referred to as medical detox).
During this process, an addiction medicine physician or psychiatrist trained in addiction medicine will administer a number of medications, including opioid replacement medication such as Suboxone, to the person as they negotiate withdrawal. These medications have the effect of significantly reducing or eliminating the symptoms of withdrawal, and the person can safely go through the process of normal detoxification without significant discomfort. The physician administers these medications on a tapering regime, such that at specific intervals, the dosage is decreased to allow the person to adjust to slowly eliminating the drug from their system. This process takes quite a bit longer than withdrawing from fentanyl without any assistance at all; however, it is much more comfortable, and there is significantly less risk involved. Individuals going through medical detox are at far less risk for relapse and the development of other complications.