- Generic Name or Active Ingridient: Fentanyl Citrate
- Abdominal Cramping
- Fever, Runny Nose or Sneezing
- Goose Bumps and Abnormal Skin Sensations
- Hot Sweats and Cold Sweats
- Low Energy Level
- Muscle Aches or Pains
- Nausea or Vomiting
- Rapid Heartbeat
- Rigid Muscles
- Runny Nose
- Shivering, Tremors
- Teary Eyes
- Poor concentration
- Social isolation
Withdrawal is a normal response to a sudden decrease in Fentora levels after an individual's body has become physically dependent on this opioid. Physical dependence to Fentora means the body has learned to rely on this drug to feel normal; a drastic reduction of Fentora levels causes an imbalance in body chemistry. Withdrawal symptoms are the physical manifestation of the individual's body trying to regain chemical balance.
Doctors diagnose a person as being physically dependent on fentanyl, the active ingredient in Fentora, if he suffers withdrawal symptoms when the level of the opioid decreases suddenly.
Fentanyl, the active ingredient in Fentora, is 80 to 100 times stronger than morphine. This medication is only for those patients who are already tolerant to opioids and who are currently taking other opioids to control breakthrough cancer pain. Individuals who are not already opioid tolerant may suffer dangerous or fatal overdose or toxicity from taking Fentora.
It takes several weeks of continued Fentora use to develop physical dependence.
Fentora is only legally available to those enrolled in a federal program designed to reduce the potential for abuse. Fentora poses a special risk for abuse, misuse, addiction and overdose. To overcome this, this medication is only available through a restricted program called TIRF REMS, or Transmucosal Immediate Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) Access Program.
Under the guidelines of this program, outpatients and their associated physicians, pharmacies, clinics and distributors must enroll in TIRF REMS. Essentially, this program require professionals to be trained to look for signs of Fentora abuse and dependence while patients must learn the associated risk for abuse and sign a waiver stating they accept this risk. Inpatients and the healthcare providers who treat them are not required to enroll in TIRF REMS.
The severity of these withdrawal symptoms depends upon how much Fentora the individual has been taking, the length and the route of administration. While the symptoms of opioid withdrawal are extremely unpleasant, they are usually not life threatening. Nonetheless, opiate withdrawal can worsen other conditions or cause complications; is always best to undergo withdrawal under a doctor's supervision.
Fentanyl is secreted in breast milk and passes from a mother taking Fentora to her nursing child. These Infants may exhibit symptoms of Fentora withdrawal if they suddenly stop nursing.
Complications associated with Fentora withdrawal include dehydration from excessive vomiting and diarrhea. Additionally, a person may inhale stomach contents into the lungs after vomiting, a dangerous condition known as aspiration. Without medical intervention, dehydration and aspiration could cause harm.
A sudden drop in the level of fentanyl causes withdrawal symptoms in opioid-dependent individuals. This abrupt decrease of fentanyl levels are caused by either sudden cessation, like when a patient misses a dose, or after administration of drugs that lower fentanyl levels rapidly. Drugs that lower fentanyl levels and subsequently cause withdrawal symptoms include naloxone, nalmefene, or mixed agonist/antagonist analgesics, such as pentazocine, butorphanol, buprenorphine and nalbuphine. This drastic reduction in fentanyl causes unpleasant flu-like symptoms of withdrawal as the body tries to stabilize its chemistry.
Symptoms of Fentora withdrawal appear within hours of the last dose. These withdrawal symptoms can last five or more days and may increase to intolerable levels. The most intense symptoms usually appear around the fourth day. Specially trained professionals administer drugs to shorten the duration and ease the intensity of withdrawal symptoms. Withdrawal symptoms, when left untreated or poorly treated, can drive even the most determined individuals back to Fentora use.
Withdrawal from Fentora is an uncomfortable, even physically grueling experience. Physical symptoms of Fentora withdrawal may be protracted and overpowering.
Physical symptoms of Fentora withdrawal include:
Withdrawal from Fentora also causes psychological symptoms that can be just as difficult to overcome as the physical manifestation of Fentora withdrawal. These psychological symptoms can impede rehabilitation, in that these symptoms instill a sense of shame or hopelessness on top of the physical challenges of withdrawal.
Psychological symptoms of withdrawal include:
Patients who used Fentora to treat cancer pain and then became physically dependent to it may fear the return of overwhelming pain once they quit taking this opioid.
Complications of opioid withdrawal include vomiting and then breathing the stomach contents into the lungs, a process known as aspiration. Aspiration is a dangerous complication that may result in infection. Extreme vomiting and diarrhea may result in dehydration.
Fear of withdrawal symptoms prevents many people from seeking rehabilitative care. Some individuals try to quit Fentora without the help of medicine to reduce withdrawal symptoms. Medical professionals call this self-detoxification, but the average person calls it "going cold turkey," a reference to the cold, clammy, pale and bumpy appearance of an individual's skin as he experiences withdrawal. Without medicine to reduce Fentora withdrawal symptoms, self-detoxification is uncomfortable, emotionally demoralizing and ineffective.
Some individuals devise a plan to reduce withdrawal symptoms, mixing prescription drugs and over-the-counter remedies. One such concoction is The Thomas Recipe, which calls for Xanax or other medication to reduce anxiety and induce sleep, anti-diarrhea drugs, vitamins and supplements to ease muscle aches and increase energy levels.
Withdrawal symptoms from opioids such as Fentora can last from five days to two months, depending on the duration of abuse and the amount of fentanyl consumed. Overpowering physical and psychological symptoms drive many back to Fentora abuse. The cycle of abuse, withdrawal and relapse has a profound emotional and social effect on the individual suffering Fentora withdrawal and everyone around him.
The greatest complication associated with Fentora withdrawal is the return to opioid abuse. There is a greater potential for overdose in individuals who have recently gone through detoxification because the detoxification process reduces a person's tolerance, or ability to handle Fentora. A person who has just completed detox can overdose on a much smaller dose of Fentora than they used to take, unaware of his reduced tolerance to this powerful opioid.
Emergency treatment for Fentora overdose will cause withdrawal symptoms in individuals dependent on fentanyl. An overdose means there is a toxic level of fentanyl in an individual's bloodstream; this is a life-threatening emergency, requiring emergency medical care. Emergency department personnel administer medications to reverse the effects of Fentora, secure an airway to help the patient breathe, start an IV to administer fluids and medications and decontaminate the gastrointestinal tract to wash away any remnants of the opioid.
During emergency treatment, the physician focuses on saving the patient's life and, as such, not necessarily on reducing withdrawal symptoms or providing counseling. Individuals in stable condition can participate in inpatient or outpatient therapy programs that include detoxification, withdrawal and behavior modification.
Drug replacement therapy is a detoxification program where the individual takes replacement drugs that reduce withdrawal symptoms while he participates in an outpatient behavior modification program. In this type of therapy, physicians replace Fentora with a longer-acting drug that causes less euphoria, such as Methadone, Suboxone or buprenorphine. The patient then weans himself from this medication later on. Supporters of drug replacement therapy point out participants do not have to spend time away from work or families; opponents fear it merely replaces one addiction for another.
During inpatient medical detoxification, specially trained physicians administer medications to decrease fentanyl levels and drugs to ease the symptoms of Fentora withdrawal. The benefit of inpatient medical detoxification is that withdrawal is less uncomfortable and progresses faster than going cold turkey. The patient will not have to wean himself from a replacement drug. Additionally, physicians monitor the patient's condition and address complications, such as aspiration or dehydration, as they arise.
The most humane detoxification process is rapid detox. During rapid detox, board certified anesthesiologists administer the standard anti-withdrawal and detoxification medications, along with sedatives and anesthesia. The patient rests comfortably in a "twilight sleep" while their bodies regain chemical stability. The patient awakens a few hours later, unaware of the unpleasant symptoms of Fentora withdrawal. Spared from the uncomfortable and demoralizing withdrawal process, she is ready to participate in meaningful rehabilitation.
The American Society of Addictive Medicine says that recovery from addiction is "best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals." Rehabilitation often includes behavior modification along with individual, group and family counseling. Rehabilitation helps the individual address issues that contributed to or were a result of physical dependence on Fentora. This rehabilitation may be done as an outpatient, or in an inpatient program lasting from 28 days to six months or one year.