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Duragesic: Withdrawal Symptoms, Signs and Detoxification

Duragesic is the brand name version of a prescription pain medication containing fentanyl, a very powerful synthetic opioid substance. It is available as a transdermal patch, which is applied to the skin for several days at a time to help control constant, chronic pain that is caused by serious conditions like cancer.1 Duragesic, like other fentanyl products, is not intended as a first-line pain treatment. Instead, it is only used when other opioid painkillers are no longer effective.1

Duragesic offers many benefits to those who suffer from chronic pain because its high potency and fast-acting nature allows the medication to provide relief soon after the patch is applied. However, as such a potent opioid, its benefits are coupled with serious risks. As with other opioids, Duragesic use can result in the development of significant tolerance and physical dependence, even when used as prescribed.1

Abuse of fentanyl may easily result in addiction, and because it is so strong, any misuse may result in overdose.If you're abusing Duragesic, it's extremely important to find help to quit. Due to the intensity of withdrawal symptoms, you may need a program that incorporates medical detox to alleviate unnecessary pain and distress as you clear the substance from your body.

Abuse of fentanyl may easily result in addiction, and because it is so strong, any misuse may result in overdose.

How Dangerous Is It?

Prescription of fentanyl Duragesic is administered as an extended-release, transdermal film. As a sticky patch, it is applied to the shoulder, chest, back, or side and changed every 72 hours.1 At the end of the 3 days, the patch is to be removed, folded in half so that the sticky sides are touching, and flushed down the toilet.1 Duragesic patches range from 12 mcg/h to 100 mcg/h, with patch sizes that increase respective to dose.1

Even when used as prescribed, Duragesic may cause:1

  • Nausea, vomiting, and constipation.
  • Drowsiness and fatigue.
  • Dizziness.
  • Headache.
  • Itching.

Duragesic use can also negatively impact a person's mental health by triggering feelings of depression, anxiety, and, in rare cases, hallucinations.1

What Is Duragesic Abuse?

Risks of unwanted side effects and overdose will increase as people misuse Duragesic. People who abuse the drug may:

  • Use more of the drug than recommended by placing multiple patches on the body simultaneously to get more fentanyl into their system.
  • Use the drug to produce effects other than pain relief, such as:
    • A quick feeling of euphoria and well-being.
    • Relaxation.
    • Feelings of calm and drowsiness.
    • Change the way the drug is used, e.g.:
    • Scraping the gel from the patch and then injecting or eating the contents.2
    • Freezing the patch and then cutting it up so that the portion of the patch that contains the narcotic can be placed under the tongue or against the cheek where it is quickly absorbed into the bloodstream.2

Overdose

Commonly sought-out for its incredibly intense high, fentanyl can result in deadly overdose in minuscule amounts.2 In fact, the drug is much more potent than even heroin.2 While many overdoses involved illegally produced fentanyl, misuse of any fentanyl product is extremely risky.5

Someone overdosing on Duragesic may experience respiration depression that could progress to severely slowed or stopped breathing and death. Signs of Duragesic overdose may include:1

  • Cold and clammy skin.
  • Slow heart rate and low blood pressure.
  • Constricted pupils.
  • Unresponsiveness.

What Will Withdrawal Be Like?

The adaptation of the brain and body to the regular presence of an opioid like Duragesic is referred to as dependence. The brain and body function normally with the drug in the system and abnormally without it. When the level of fentanyl in the body begins to dip, serious discomfort and distress may arise, and this is referred to as withdrawal.1Some of the symptoms of Duragesic withdrawal are:1

  • Excessive yawning.
  • Increased tear production.
  • Runny nose.
  • Chills.
  • Sweating.
  • Insomnia.
  • Irritability.
  • Anxiety.
  • Backache
  • Joint and muscle pain.
  • Stomach cramps.

These symptoms of Duragesic withdrawal are a nuisance but aren't dangerous. Other effects of fentanyl withdrawal can be more distressing and may include:1,5

  • Nausea, vomiting, and diarrhea.
  • High blood pressure.
  • Increased heart rate.
  • Increased respiratory rate.

Cravings and relapse risk are very strong during the acute withdrawal period, as well.6 Relapsing after a significantly long period of abstinence can be very dangerous, since your tolerance will have decreased accordingly, and your normal dose may be more than you can now handle.5

Timeline of Duragesic Withdrawal

The timeline for Duragesic withdrawal will be impacted by a number of factors, but in general, the withdrawal symptoms will start around 12 hours after last use. The withdrawal symptoms will tend to peak between 1 and 3 days and gradually fade over the course of a week.7

Some long-lasting Duragesic withdrawal symptoms like anxiety, low mood, and insomnia may last for months after last use.7

What Are My Options for Detox?

Many withdrawal symptoms may be minimized with the help of medical detox. Detoxification is the specific set of interventions and strategies used to manage withdrawal symptoms, while increasing comfort and reducing any medical or mental health risks.Detox can occur in a number of treatment settings, with inpatient settings able to provide the highest level of care. Inpatient treatment options offer intensive observation, care, and support. Medically managed detox will focus on medical monitoring and intervention from physicians and nurses in an acute care hospital or standalone rehab center. "Social" detox programs will primarily focus on offering non-medical support within a safe inpatient environment.3

Patient with doctor in detox facilityDetox is separated into 3 stages:3

  • Evaluation – full assessment of current symptoms, past history, and any relevant medical information.
  • Treatment – implementation of detox strategies
  • Linkage to other services – connecting the person to further addiction treatment.

During detox, treatment medications are frequently used to mitigate withdrawal symptoms and help prevent relapse. Medications are used in about 80% of all drug detoxes.8

Can I Quit Duragesic Cold-Turkey?

Suddenly stopping any form of fentanyl, including Duragesic, can be problematic. Going “cold turkey” will bring out intense withdrawal symptoms, so this method is not frequently recommended.3Undergoing a taper will allow you to detox with less discomfort. Throughout the taper, the dose of fentanyl is slowly tapered down until the user is off of it completely.3 Weaning a patient off of the drug can take some time, especially for people using extremely high doses daily, so a longer weaning schedule may be required.

In some cases, the user is first transitioned from Duragesic to another opioid agonist medication, such as buprenorphine or methadone.3 By switching to one of these FDA-approved treatment drugs, the person can safely and legally manage their withdrawal symptoms while minimizing relapse risks.9

When used as prescribed, methadone and buprenorphine are helpful ways to reestablish a healthy lifestyle after an extended period of Duragesic abuse.

What Do I Do After Detox?

As mentioned, the final stage of detox is setting up the patient with additional treatment services. Continued treatment is necessary because detox only addresses the immediate health concerns related to withdrawal. It does little to treat the underlying causes of addiction.9 Longer periods of treatment that address these issues are related to longer periods of recovery, with the best outcomes associated with at least 90 days of treatment.9 Once detox is completed, the recovering person could move to a long-term or short-term residential program to continue receiving 24-hour care and support, or they could begin outpatient treatment that allows them to live at home, work, and tend to other responsibilities while undergoing treatment.9

Regardless of the specific treatment setting, professionals will use a combination of individual, group, and family sessions to discover triggers, develop new coping skills, and resolve lingering conflicts.

Types of behavioral therapies utilized for opioid recovery include:9

  • Cognitive behavioral therapy – to investigate maladaptive beliefs and develop healthier ones.
  • Motivational interviewing – to increase the individual’s internal motivation for recovery.
  • Contingency management – to provide tangible reinforcements for staying sober in the form of rewards like vouchers or money.

Along with professional addiction treatment, support groups like Narcotics Anonymous (NA) can help boost the benefit one gets from more formalized treatment options and offer the recovering individual the opportunity to build a supportive sober network.

Remember: no one is "cured" of addiction, and you aren't "finished" at the end of detox or rehab. You can slowly integrate back into society as a recovering person, but you must maintain your focus on sobriety. Doing what you can to consistently address your history with Duragesic addiction will put you in a better position to avoid future issues.

Duragesic Information at a Glance1,7
Medication Name, Costs Class of Medicine
  • Generic Name: : Fentanyl
  • Brand Name: Duragesic
  • Brand Name Variations: Actiq, Fentora, Sublimaze, Subsys
  • Cost/Price: Varies with supplier and prescription
  • Used to Treat Addiction? No
  • Used for: Treatment of severe pain
  • System: Opioid Analgesic
  • Duration of Action: Up to 72 hours
Form, Intake and Dosage Interactions and Complications
  • Drug Forms: Patch
  • Administration Routes: Transdermal
  • Dosage: 12-100 mcg/hour for 72 hours
  • Overdose: Varies with prescription and level of pain.
  • Alcohol Interaction: Interaction with alcohol may cause dangerous respiratory depression
  • Prescription Medications: Interactions with CNS depressants may cause fatal respiratory depression
  • Contraindications: People not currently tolerant to other opioids
Effects and Adverse Reactions Substance Abuse
  • Short-Term: Rash, sweating, dizziness, constipation
  • Long-Term: Tolerance, dependence, increased risk of overdose
  • Risk of Substance Abuse: Very high
Physiological Problem Signs and Symptoms Dependence and Addiction Issues
  • Withdrawal Syndrome Onset: 8 to 12 hours
  • Withdrawal Symptoms: Anxiety, cramps, fever, vomiting, insomnia, aches and pains
  • Tolerance: Users may develop tolerance
  • Cross Dependence: Heroin
  • Physical Dependence: High risk
Legal Schedules and Ratings
  • Controlled Substances Act Rating: Schedule II

Other Questions and Answers

How long does Duragesic withdrawal last?

The average timeline for the resolution of acute withdrawal symptoms can range from 5-7 days. Extended withdrawal symptoms may last several months.7 The length and severity of withdrawal symptoms depends on several factors including how the long the individual has used Duragesic.

What are popular slang or street names for Duragesic or fentanyl-laced heroin.10

  • Apache.
  • China girl.
  • China white.
  • Dance fever.
  • Friend.
  • Goodfella.
  • Jackpot.
  • Murder 8.
  • TNT.
  • Tango and Cash.

Are there any home remedies for getting clean safely?

There are no miracle remedies or alternative medicines approved for Duragesic withdrawal relief. You should seek professional help if you want to minimize withdrawal discomfort and best ensure a successful detox.

References:

  1. U.S. National Library of Medicine: DailyMed. (2017). Duragesic.
  2. Drug Enforcement Administration. (2016). Fentanyl.
  3. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  4. National Institute on Drug Abuse for Teens. (2017). Prescription Pain Medications: Opioids.
  5. National Institute on Drug Abuse. (2017). Research on the Use and Misuse of Fentanyl and Other Synthetic Opioids.
  6. Kosten, T., George, T. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science and Practical Perspectives, July 2002, 13-21.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  8. National Institute on Drug Abuse. (2018). DrugFacts: Treatment Approaches for Drug Addiction.
  9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
  10. National Institute on Drug Abuse. (2016). DrugFacts: Fentanyl.
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