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Carfentanil Withdrawal

President Donald Trump officially declared the opioid crisis a public health emergency in 2017. Provisional numbers from 2017 suggest there were nearly 50,000 overdose deaths involving opioids in the United States. With the introduction of fentanyl, carfentanil, and the newly FDA-approved opioid Dsuvia, the danger of overdoses and fatal overdoses are near certain.

Data from 2014 reveals almost 2 million people had an opioid use disorder relating to prescriptions and nearly 600,000 more people were struggling with heroin addiction.

The increasing rates of carfentanil use are leading to increasing overdose death rates, as well. Unfortunately, the numbers also show how few people actually get the help they need. Overall around less than 10% of the people needing treatment are able to benefit from quality detox followed by a long-term treatment program to address their substance use, as well as the underlying factors.

What Is Carfentanil?

Carfentanil is a synthetic opioid. Opioids refer to a class of drugs that when derived naturally, come from the opium poppy plant. In the early 1800s, morphine was isolated from opium and later in that century; heroin was derived from morphine. Heroin is considered a short-acting opioid.

Manufacturing and mass production of prescription opioids such as hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Percocet or Oxycontin) have increased the accessibility and lethality of these drugs.

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The recent crackdowns on “pill mills,” as well as overall restrictions on the number of days physicians are allowed to provide prescriptions for pain pills, have intended to curb the overdose deaths involved with opioids. However, it appears to be involved with the increase of the prevalence and availability of heroin. And with an increase in heroin use, there is also an increase of fentanyl and carfentanil use. In fact, carfentanil is more likely to result in an overdose death as the DEA issued a warning that it can be “up to 10,000 times more potent than morphine and 100 times more potent than fentanyl.”

Those individuals looking for the increased feeling of euphoria will also experience a more intense depressive effect, which is why overdose deaths may occur more frequently with carfentanil use. Alternatively, people often don’t even realize carfentanil is mixed with the heroin they are using, so their “usual dose” ends up being enough to kill them. Carfentanil and fentanyl also resemble powdered cocaine, at times.

The central nervous system (CNS) consists of the brain and the spinal cord. It is constantly communicating with cells and organs to ensure the body is functioning properly. The brain and the body are constantly seeking harmony in order to function well. The medical term is homeostasis, and it means that when anything disrupts the CNS, efforts must be made to return to a certain level of stability. For example, when the body becomes hot from exercise or being outside in the sun, we sweat in an effort to cool off or reach the previous level of homeostasis.

Over time, carfentanil use will interfere with the CNS’ ability to return to a balanced state.

How Carfentanil Affects the Brain

Everything we do affects our central nervous system. The foods we eat, how much sleep we get, the quality of the air and water we ingest, and even things like stress and unseen toxins in cleaning products will have some kind of an effect.

Carfentanil is a synthetic opioid and acts specifically on certain receptors that are keyed to respond to opioids, most notably the Mu receptors. These typically produce a feeling of euphoria as a result of the flood of dopamine in the brain that the carfentanil produces. Dopamine is the “feel good” neurotransmitter and is associated with motivation and the reward center in our brains.

The opioid receptors are located in areas of the brain that are involved with emotion (the amygdala), memory (the hippocampus), and the reward center of the brain (nucleus accumbens). Carfentanil also has a depressive effect on two important centers found in the brain stem: the respiratory center, which controls breathing, and the vomiting center, which also allows us to cough.

Additionally, carfentanil produces an analgesic effect. In other words, it relieves pain. And because it also addresses the negative emotional reactions (via the amygdala) to physical pain, carfentanil will not only take away the physical sensation of paint; it also allows you to forget how much you dislike the pain. This layered effect is just one of the reasons that carfentanil can prove to be very addictive in a short period of time.

What You Can Expect From Carfentanil Withdrawal

A Timeline of Withdrawal Symptoms

Carfentanil withdrawal, while not fatal, can be extremely uncomfortable and should not be undertaken alone. The extent and severity of the withdrawal symptoms will depend on the type, frequency and amount of carfentanil used by the individual. Typically the experience of withdrawal involves the opposite of the effect the drug produced.

For example, because we know opioids like carfentanil repress the vomiting center and slow digestion to create constipation, one might experience diarrhea or vomiting upon stopping their use.

Withdrawal symptoms can be acute or chronic.

Acute withdrawal symptoms usually begin within six to twelve hours after the last use and can include:

  • Restlessness, agitation, mood swings
  • Nausea or vomiting
  • Muscle aches, or cramps
  • Joint or bone pain
  • Sweating, chills, or going between the two extremes
  • Runny nose or watery eyes
  • Diarrhea
  • Yawning
  • Insomnia
  • Anxiety or depression
  • Gooseflesh skin
  • Pupil dilation

In extreme cases, chronic withdrawal symptoms can last 10-14 days after the last use and will often be a less severe experience of the symptoms that occurred during the acute phase. Chronic use can lead to a number of other health complications including, but not limited to: endocarditis, a swelling within the lining and valves of the heart; collapsed veins; abscesses at injection sites that can become infected, toxic and even need surgery, if untreated.

It is critical to get the help you need to successfully manage withdrawal symptoms and begin a life without the use of carfentanil. Long-term use can negatively affect respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.

When medically managed, most withdrawal symptoms are alleviated within seven days. However, it is important to note that treatment following a medically managed detox will result in a better success rate. Safely removing the carfentanil from the brain and body is only the first step. There are other psychological, emotional and behavioral issues to address that will set you up for continued sobriety.

Precipitated Withdrawal

Precipitated withdrawal can occur when an opioid antagonist is introduced in someone who is dependent, and enough of the opioids are still attached to the receptors in the brain. The antagonist will displace the opioids from their receptor sites, and it will feel like a magnified experience of the withdrawal symptoms outlined above. Unless treated, symptoms from precipitated withdrawal can last up to four days.

For example when a patient is not fully transparent about their last carfentanil use, to include the dose and the time, as well as frequency and usual use, and Suboxone (a medication used to manage withdrawal symptoms and cravings associated with opioid use) is administered too soon, the patient can go into precipitated withdrawal. This is an unfortunate event and can lead the patient to believe that buprenorphine is ineffective in treating their symptoms when the reality is the carfentanil still present in their system was to blame.

What Are the Carfentanil Withdrawal Treatment Steps?

When seeking treatment, it’s important to understand the difference between the various levels of care so you can get the most out of your treatment experience.

Medical detoxification, or simply detox, is a medically managed detoxification from carfentanil. Following a thorough history and physical examination, the medical staff will determine the best medication protocol to safely manage your withdrawal symptoms. A detox from carfentanil can take from three to 10 days, depending on the severity and extent of drug use and is up to the discretion of the medical providers.

Medical complications, using more than one substance, or a history of mental health diagnoses are all examples of when a detox may take longer than usual. Treatment centers will require you to successfully complete detox in order to safely and fully participate in their programs.

Detox can take place in a hospital setting if you have severe or unmanageable medical complications, or it can take place in a standalone detox facility. These standalone, privately run facilities must be staffed 24 hours a day with medical personnel, as well as support staff, to monitor your symptoms and ensure the safest, most comfortable experience possible. Specially trained staff will know how to observe your progress throughout the detox process and will be able to respond to any potentially life-threatening situations.

Residential treatment typically follows a successful detox and involves living on site and participating in a variety of therapy. Individual sessions with a trained therapist, as well as group and family therapy sessions, are some of what is required at each residential facility. It’s during this time you will be examining patterns of thoughts, emotions, and behaviors that may have contributed to your substance use. Residential treatment length of stay will vary depending on your needs, but can typically last from 30 – 90 days following the detox.

Outpatient treatment is intended for those individuals who are in a more stable position medically, physically, and emotionally. After the support from detox and residential care, the activities of daily living on your own are more manageable and you will remain involved with outpatient treatment to continue your journey of recovery.

You will continue to participate in therapy on a less frequent basis and maintain connections with your support system and therapist. This is an important part of your recovery, as it will allow you to transition to the next phase of your life with the support that played such a beneficial role.

Medication-Assisted Treatment, or MAT, is typically a form of outpatient care. It is intended to support those suffering from opioid or alcohol use disorders with a form of medication administered on a longer term basis than the typical medical detox. FDA-approved medications for the treatment of opioid use disorder are designed to manage withdrawal symptoms, reduce or eliminate cravings to use, and help prevent relapse.

For these reasons, some studies suggest there are better outcomes for those addicted to carfentanil and other opioids who participate in medication-assisted treatment following detox. Some form of therapy and medical supervision will still take place during MAT and your provider can assess whether this option is right for you.

Again, it is critical to note the best outcomes for the treatment of carfentanil addiction are associated with participating in the full spectrum of care. A detox treatment alone won’t give you the benefits or the support of a full continuum of therapy. There are many reasons that substance use may have grown into an addiction, but what’s most important is focusing on the resources and solutions that will help you find a new life free from carfentanil use.

If You’re Suffering from Carfentanil Addiction, We Can Help

If you or a loved one is struggling with carfentanil abuse or addiction, it is important that you treat it with the seriousness it requires and get help before it is too late.

At California Highlands Addiction Treatment, we offer quality detox as well as residential treatment and can provide the resources, support, and specialized treatment needed to get you or your loved one back on your feet and on the path to lasting sobriety.

Call 855-808-5454 now for a free and confidential consultation with one of our specialists, who are available around the clock to help you navigate your treatment options, verify insurance, and answer any questions you might have. Call now or contact us online for more information.

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Baldini, A., Von Korff, M., & Lin, E. H. (2012). A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner's Guide. The primary care companion for CNS disorders, 14(3), PCC.11m01326. from

Baylor, C. (2015, July 21). Medication-Assisted Treatment (MAT). from

DEA Issues Carfentanil Warning To Police And Public. (2016, September 22). U.S. Drug Enforcement Administration from

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Harrington, M. (2014, September 30). Substance Use Disorders. from

Jacob, A. (2018, August 27). President Trump Proclaims the Opioid Crisis a Public Health Emergency. from

National Institute on Drug Abuse. (2018, August 09). Overdose Death Rates. from

National Institute on Drug Abuse. (n.d.). 3: The reward pathway. from

Office of the Commissioner. (n.d.). Press Announcements – Statement from FDA Commissioner Scott Gottlieb, M.D., on agency's approval of Dsuvia and the FDA's future consideration of new opioids. from

The National Alliance of Advocates for Buprenorphine Treatment. (n.d.). from

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