Duragesic Withdrawal

Generic Name or Active Ingridient: Fentanyl.

Duragesic is the brand name skin patch that contains the powerful opioid pain reliever, fentanyl. This medication is 80 to 100 times more powerful than morphine, making it an attractive drug for recreational use.

Definition

Medical professionals recognize physical dependence and subsequent withdrawal as a normal, predictable outcome of taking high doses of Duragesic or using this drug for a long time. Withdrawal is the period immediately after an individual stops taking Duragesic; depending on the severity of his dependence on Duragesic, he may experience physical and emotional symptoms for several days or weeks as his body tries to regain chemical stability.

Facts

The severity of these withdrawal symptoms depends upon how much Duragesic the individual has been taking, the duration and the route of administration. While the symptoms of opioid withdrawal are very uncomfortable, they are not life threatening. Nonetheless, opiate withdrawal can exacerbate other conditions or cause complications, therefore it is always best to seek the help of a trained professional to guide you through withdrawal and monitor your condition.

Causes

A sudden reduction in the level of Duragesic in the system causes withdrawal syndrome that manifests itself through uncomfortable symptoms. A person might bring about this sudden reduction by abruptly discontinuing Duragesic or by taking another drug, such as Naloxone.

Symptoms

Symptoms of Duragesic withdrawal appear within hours of the last dose. The fear of unpleasant withdrawal symptoms perpetuates drug use in some individuals, while the strength and duration of withdrawal symptoms drive some of the most determined individuals back to Duragesic abuse. These symptoms may be physically overpowering or psychologically demoralizing.

Physical

When an individual takes high doses of certain medications such as opioids, or uses them for a long time, her body adapts to the presence of these drugs and adjusts her body chemistry accordingly. She may become physically dependent on the drug, which means she needs to continue taking the drug to maintain her stable body chemistry and feel normal. When the level of Duragesic drops, she must take more drugs or suffer withdrawal symptoms. These withdrawal symptoms are the physical manifestation of her system trying to stabilize its body chemistry.

Physical symptoms of withdrawal include:

  • Abdominal Cramping
  • Diarrhea
  • Fever, Runny Nose or Sneezing
  • Goose Bumps and Abnormal Skin Sensations
  • Hot Sweats and Cold Sweats
  • Insomnia
  • Low Energy Level
  • Muscle Aches or Pains
  • Nausea or Vomiting
  • Pain
  • Rapid Heartbeat
  • Rigid Muscles
  • Runny Nose
  • Shivering, Tremors
  • Teary Eyes
  • Yawning

Psychological

An individual who is physically or emotionally dependent on Duragesic can experience psychological symptoms of withdrawal if the level of this powerful opioid drops below a tolerable level. A person who uses Duragesic to treat chronic or severe pain may be especially fearful as he suffers both the discomfort of withdrawal and the return of pain from his chronic or serious condition.

Psychological symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Depression
  • Hallucinations
  • Irritability
  • Poor concentration
  • Restlessness
  • Social isolation

Possible Complications

Complications of withdrawal from Duragesic include vomiting and then breathing the stomach contents into the lungs, known as aspiration. Aspiration is a dangerous condition that can result in aspiration pneumonia or lung infection. Extreme vomiting and diarrhea, if left unchecked, can result in dangerous dehydration.

A significant complication associated with Duragesic withdrawal is the return to opioid abuse. Additionally, there is a greater risk for overdose in individuals who have recently gone through detoxification because detox reduces tolerance to Duragesic; a person who has just completed detox is not as tolerant of opioids as they were before detoxification and can overdose on a much smaller dose than they previously used.

Treatment options

Treatment comes in two phases: detoxification and rehabilitation. Detoxification, or detox, is most closely associated with the symptoms of withdrawal. Detoxification stabilizes body chemistry during the withdrawal stage while rehabilitation focuses on behavior modification to reduce the risk for relapse. A person must stop using Duragesic before he can engage in meaningful rehabilitation.

Fear of withdrawal symptoms prevents many people from seeking rehabilitative care. Others worry about the social ramifications of admitting to substance abuse; some cannot afford time away from work or family obligations. Choosing the best method to overcome Duragesic withdrawal is a very personal and difficult choice.

Some individuals try to quit Duragesic without the help of medicine to reduce withdrawal symptoms. This is sometimes called "going cold turkey," referring to pale, cold, clammy and bumpy appearance a person's skin takes on while going through withdrawal. Quitting cold turkey is not effective because of overpowering withdrawal symptoms. These individuals suffer increased risk for aspiration and dehydration without qualified professionals to monitor their condition.

Other individuals who choose self-detoxification may draw up a treatment plan for themselves, using medication to reduce withdrawal symptoms. One such plan is The Thomas Recipe, which outlines various medications to ease the symptoms of withdrawal. The Thomas Recipe calls for valium, Xanax or some other medication to reduce anxiety and induce sleep, medicine to treat diarrhea, vitamins and mineral supplements along with medications to increase energy levels and reduce overwhelming malaise associated with Duragesic withdrawal. While The Thomas Recipe reduces withdrawal symptoms, it does not reduce the risk for complications or relapse.

Individuals who attempt self-detox are at greater risk for overdose upon relapse because they are unaware of the danger posed by lowered tolerance or because they cannot correctly estimate their new tolerance level. Overdose is a serious, life threatening condition that requires immediate medical care. Emergency room personnel administer Naloxone to counter the side effects of Duragesic; this brings out withdrawal symptoms immediately. Doctors and nurses administer medication to stabilize blood chemistry, monitor the patient for complications, give fluids intravenously and provide other procedures, such as stomach pumping, or life-saving measures as necessary. Once medically stabilized, these patients may progress to rehabilitation.

A person who is dependent upon Duragesic, but is otherwise medically stable, may participate in drug replacement therapy as an outpatient. During drug replacement therapy, an individual stops taking Duragesic and begins taking methadone, Suboxone or buprenorphine instead. These drugs reduce withdrawal symptoms, enabling the person to continue his normal life while engaging in behavior modification. Eventually, the patient weans himself from the replacement drug. Drug replacement therapy is beneficial for those unable to spend weeks or months in rehabilitation but opponents of the treatment fear it is merely trading one addiction for another. Additionally, outpatient care relies heavily on patient compliance and self-determination.

Inpatient care offers individuals a safe and effective mode of treatment for Duragesic dependence. During inpatient care, doctors prescribe medications to induce detoxification and drugs to reduce withdrawal symptoms while nurses monitor patients for complications. Medical detoxification reduces the severity and duration of withdrawal symptoms, making it easier for individuals to complete the difficult detoxification process. Highly trained medical professionals also address the psychological aspects of withdrawal, including associated demoralization and anxiety.

Rapid detox is a humane treatment for Duragesic withdrawal. During rapid detox, board certified anesthesiologists administer anesthesia and sedatives alongside the standard anti-withdrawal medication. Patients awaken from pleasant "twilight sleep," unaware of unpleasant symptoms of withdrawal. These individuals suffer from less demoralization and anxiety than patients who undergo self-detox or standard medical detoxification procedures.

After successful detoxification or drug replacement therapy, patients may participate in drug rehabilitation including behavior modification to change the behaviors or improve the environmental factors that led to the initial dependence on drugs and reduce the risk for relapse. Rehabilitation may be inpatient or outpatient, and programs can be as short as 28 days or as long as 6 months or a year.

Long-term recovery from Duragesic withdrawal depends on success during both the detoxification and rehabilitation phases. A significant number of individuals suffer relapse, especially those who engage in self-detoxification or do not participate in rehabilitation.

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