Why is fentanyl withdrawal worse than heroin withdrawal?

Opioid withdrawal symptoms are difficult to tolerate. And in most cases, the symptoms are similar from one opioid to another.

Fentanyl withdrawal symptoms should be no different from heroin withdrawal symptoms. While this is true when comparing pharmaceutical fentanyl to heroin, street fentanyl is different.

When authorities report in the news that fentanyl is flooding the streets, it is not the same drug as the fentanyl used in hospitals. The drug that is sold by drug dealers, causing serious fentanyl addiction, is a different molecule.

Heroin addiction, and opiate addiction in general, was already a serious problem. Now, with the introduction of illicit fentanyl from China and Mexico, opioid use disorder is more difficult to treat.

Why is this synthetic opioid causing a different type of opioid withdrawal syndrome?

While illicit fentanyl analogs work the same on the opioid receptor, they appear to have different properties that affect how long they remain in the drug user’s system. After fentanyl use, the drug appears to linger, possibly being stored in the fat cells.

Hence, fentanyl withdrawal symptoms may seem more mild at first, because the drug takes much longer to wear off compared to heroin, or most opioid pain pills. After fentanyl abuse stops, it may take days to start feeling serious opiate withdrawal symptoms.
Another serious issue is the high potency of the drug. As a result, substance use can lead to unexpected fentanyl overdose.

This deadly new designer drug, masquerading as fentanyl has also made the detox process more difficult. Overcoming opioid addiction is a greater challenge than ever.

Why is medication assisted treatment more difficult with fentanyl detox?

Because of the unique fentanyl withdrawal timeline, patients attending substance abuse treatment are unable to start Suboxone easily. Suboxone, or Subutex, must be started after the patient’s system has eliminated most of the opioids.

For example, if a patient seeks addiction treatment for drug abuse with heroin or oxycodone, the doctor will ask them to wait about 18-24 hours. Then, they may take the first dose of Suboxone when they are in moderate withdrawal.

If Suboxone is taken too soon, the patient experiences precipitated withdrawal. In most cases, with typical short-acting opioids, this is not a major concern if the patient can wait through the 18-24 hour period.

However, fentanyl addiction treatment is more difficult, because precipitated withdrawal can occur more readily. Even if the patient waits for several days after taking the last dose of fentanyl, their first dose of Suboxone can cause a precipitated withdrawal reaction.

This medical detox issue occurs because illicit fentanyl lingers for so long. As a result, many patients refuse to try Suboxone again, and they may relapse. An opioid relapse puts the patient at high risk of overdose death.

How is fentanyl withdrawal a problem for drug users who do not use opioids?

Fentanyl is an opioid, and in most cases, only opioid users would seek out the drug. Unfortunately, since the streets have been flooded with this deadly synthetic opioid analog, it is now being found mixed in with other drugs.

Cocaine, for example, can be contaminated with fentanyl. Cocaine addiction treatment programs must now be prepared to deal with fentanyl withdrawal.

Marijuana may also be tainted with the deadly synthetic opiate. Additionally, authorities have identified many pills sold on the street as being fake pills, filled with fentanyl. Oxycodone and xanax tablets are likely the most commonly found fake pills.

The fentanyl found in fake pills and marijuana or cocaine laced with the drug is the same illicit drug that has a prolonged opioid withdrawal timeline. There are additional dangers for drug users who are opioid naive.

For example, if someone is benzodiazepine-dependent, and they buy Xanax bars on the streets, there is a double danger if they purchase fake Xanax pills. When they take a fake pill loaded with fentanyl, they can go into benzo-withdrawal and opioid overdose at the same time.

Emergency doctors have had to deal with such cases where a patient was having benzo withdrawal seizures and also respiratory depression caused by fentanyl overdose.

Should fentanyl users go for inpatient treatment instead of Suboxone treatment?

Inpatient treatment at a residential rehab can be useful for patients seeking behavioral therapy, such as cognitive behavioral therapy and dual diagnosis treatment. However, there is no significant advantage to rehab over outpatient therapy.

Suboxone doctors are learning new ways to perform a buprenorphine induction to avoid precipitated withdrawal. Drug addiction treatment is evolving to meet the needs of patients who are ready to give up fentanyl use.

In most cases, rehab is probably not necessary if the patient has access to an experienced Suboxone doctor. However, it is important that the doctor is experienced and dedicated to providing personalized care.

Patients who use certain online Suboxone programs may find that they are not able to speak to their provider easily after their brief online visit. Fentanyl withdrawal treatment is not easy. It is important to work with a doctor who is available to their patient at all times to help them through the difficult process of fentanyl detox.