Fentanyl Patch Tolerance, Dependence, and Misuse
Fentanyl is an extremely potent opiate used in the treatment of moderate and severe pain. Fentanyl comes in many forms, but one of the most common is a transdermal patch, like Duragesic. Fentanyl patches can be used to effectively control pain, especially in cases where other opiates and interventions have not helped to relieve it.
While fentanyl patches are considered safe and effective when used as prescribed, fentanyl patch tolerance, dependence, and misuse are possible. Learn the difference between tolerance and dependence, and how these things can lead to fentanyl misuse and addiction, in this informational guide from the experts at Zinnia Health.
What Is Fentanyl?
Fentanyl works much like other opioid drugs. Opioids attach to neurons in the central nervous system (the brain and spinal cord) where they interact with neurotransmitters like endorphins, which are responsible for controlling things like stress, sleep, and pain. Dopamine and serotonin are just two examples of endorphins that fentanyl can affect.
Chemically, fentanyl and other opiates are very similar to certain neurotransmitters that occur naturally within the body. Some opiates occur naturally, as opium is naturally derived from the Asian poppy plant, while others are synthetically produced in a lab to mimic the structure. Opiates are effective for pain relief, but highly addictive, even to those who take them with a prescription.
Because of how addictive fentanyl can be, it’s under the strictest amount of control that any prescription drug can be, placing it on the Schedule II drugs list under the Drug Enforcement Administration (DEA). Substances on the Schedule II list represent a significant risk of misuse and physical dependence, whether a person is taking them for a legitimate reason (like pain management) or recreationally.
How Do Fentanyl Patches Work?
The fentanyl patch is given to individuals who have not found success with other opiate drugs. Most times, people who are using a fentanyl patch tend to have a high sensitivity to pain and they may also be experiencing emotional problems. These issues can make a person more likely to misuse a drug.
Fentanyl patches are designed to release the fentanyl at a slow rate. The amount of fentanyl released depends on the size of the patch. For instance, a 10.5-centimeter square patch will release about 25 micrograms of fentanyl each hour. Larger patches will release more fentanyl each hour.
The slow release of the fentanyl patch may make it sound safer, but extended-release formulations can actually increase the risk of negative side effects and overdose. For example, emotional issues can amplify the subjective experience of pain, and that can lead people to use patches more often than they are supposed to or apply more than one at a time.
Another aspect that makes fentanyl patches riskier is that they tend to feel less effective by the end of the dose. Most patches are prescribed to be worn for 72 hours at a time, but end dose effects are more subtle than those following the initial application of the patch. This perception often causes individuals to re-administer their patch earlier than they are supposed to.
A person who regularly uses fentanyl patches is likely to develop tolerance over time, but misuse, whether incidental or intentional, puts them at a higher risk of rapid tolerance development.
Understanding Fentanyl Patch Tolerance
Drug tolerance is common, especially when a person is taking a medication routinely and for a long period. For opiates like fentanyl, tolerance can develop rapidly. On its own, tolerance is not necessarily an issue, as long as a person is taking fentanyl under their doctor’s instructions. In reality, fentanyl patch tolerance is an expected outcome for long-term users.
Tolerance is marked by a dose becoming less effective over time. With a fentanyl patch, a person may no longer experience the same level of pain relief, for instance. When a person becomes tolerant to a prescription drug like a fentanyl patch, they simply need to tell their doctor, and their doctor will adjust their dose accordingly.
The Risks of Using Fentanyl Patches
Fentanyl patches are thought to be a safer alternative for certain groups, but researchers feel that most people who receive a fentanyl patch prescription have received them inappropriately. The lack of evaluation regarding prior opioid abuse is also lacking in most cases. A person with prior substance misuse should not be given strong medications like fentanyl.
Additionally, researchers assert that many physicians are unfamiliar with the proper protocol of a patch prescription and that may lead them to prescribe a fentanyl patch to someone who has not developed a tolerance to other opiates. A person without opiate tolerance is likely to develop rapid tolerance while using a fentanyl patch and this puts them at a greater risk of misuse.
Physicians also commonly prescribe too much or too little, both of which can lead to misuse. If a physician prescribes too little, patients may begin self-administering more and more. Meanwhile, being prescribed too much will allow tolerance to build very quickly, and make further increasing the dose to an effective amount that much riskier.
Furthermore, patients are not properly educated in many cases regarding the effects they should expect when being given a patch. This leads to patients often self-administering more of the patch when they find it is not effective for their pain, either because they were under-prescribed by the physician, “opiate-naive” and rapidly developed tolerance to their dose, or highly tolerant to opioids already.
Characterizing Misuse of Fentanyl Patches
Misuse can occur intentionally or accidentally, and misuse on its own does not mean that a person is addicted to fentanyl. In fact, when it comes to the fentanyl patch, misuse is extremely common because of the risks outlined above.
Misuse of a drug can come in the form of taking it more often than prescribed, taking it in a greater amount than prescribed, taking it for a reason other than prescribed or taking it without a prescription.
For example, someone who has been prescribed one patch every 72 hours and applies a new one after just 60 hours is misusing it. However, if they have applied a new patch for a legitimate reason, like to manage their pain, this would be characterized as accidental misuse—which seems innocent but is incredibly dangerous.
Fentanyl is extremely potent, and someone using a fentanyl patch can suffer from an overdose even when taking a relatively low dose. Tolerance amplifies the risk of an overdose because it can lead to a person self-administering more of the drug by changing their patch more often or wearing more than one, which can overwhelm their system even if they aren’t actively feeling pain relief or other effects from the patch.
Physical Dependence on the Fentanyl Patch
Just as tolerance is expected to form over time, dependence is also common with the long-term use of a fentanyl patch. Physical dependence actually results in a change in chemistry because a person’s body has become so accustomed to the presence of fentanyl. So, as the end of a dose comes around or a person misses a dose, their body begins to enter withdrawal.
Withdrawal symptoms can vary from agitation and anxiety to excessive sweating, muscle aches, and more. Most fentanyl patches are applied for three days at a time, and withdrawal symptoms can begin within hours of that 72-hour period ending if a person does not apply another patch.
How long it takes for a person to become dependent on the fentanyl patch varies. The amount a person is taking, their prior experience with opiates, and whether they’re misusing the drug all factor into how quickly physical dependence forms. However, it’s important to understand that physical dependence on its own does not represent an addiction.
Understanding Fentanyl Patch Addiction
Both tolerance and dependence are likely to form when someone is using fentanyl patches to manage pain in the long term. Tolerance and dependence on their own do not constitute an addiction, but they can contribute to the formation of an addiction.
Addiction, which is better referred to as a substance use disorder, forms over time and can only be officially diagnosed by a medical professional. A specialist will evaluate an individual for physical dependence, emotional dependence, and patterns of misuse to determine if they’re suffering from substance use disorder.
While fentanyl patches are rarely used by recreational users given the nature of the patch, people who have received a fentanyl patch prescription may find themselves addicted to them. Addiction could come in the form of routinely applying patches more often or in greater amounts than prescribed or combining the patch with other substances (like alcohol) to try to amplify its effects.
Those with an addiction to fentanyl will develop an emotional dependence alongside a physical dependence. Emotional dependence is marked by spending significant amounts of time thinking about, using, or getting more drugs; changes in behavior, like lack of interest in hobbies and social outings; and anxiety regarding drug supply and availability.
What makes addiction difficult to overcome is not only the development of physical dependence, which makes “quitting” severely uncomfortable, but the development of emotional dependence, which can make quitting feel impossible. In any case, no one should stop using fentanyl without the guidance of a professional.
Suddenly quitting a potent opiate like fentanyl will not only lead to severe physical withdrawal symptoms, but it can prove dangerous. The symptoms of fentanyl withdrawal also put a person at a major risk of relapse, which can heighten the risk of overdose. For all of these reasons, pursuing a medical detox and rehabilitation program is the best way forward.
Fentanyl Patch Detox and Rehabilitation
The fentanyl withdrawal process is uncomfortable, but it’s a necessary first step in overcoming fentanyl patch misuse and addiction. Fortunately, withdrawal is not an experience that you will have to go through on your own. By partnering with a research-backed recovery center like Zinnia Health, you’ll get the support and guidance you need to complete the detox process successfully.
For fentanyl users, the detox process generally lasts up to two weeks, but the worst symptoms tend to peak within the first few days. For those with severe emotional dependence, some symptoms (like drug cravings) can persist for weeks or even months after the initial detox. However, no individual will ever have to face these symptoms alone.
At the end of the detox process, a person will enter a rehabilitative program. Rehabilitative programs are based on medical science but tailored to fit the needs of the individual. Each person’s timeline is different, and the structured stage of rehabilitation might include a combination of talk therapy, peer support groups, and wellness classes.
During rehabilitation, we strive to help a person not only overcome their substance use disorder but get on the path to a fulfilling life after addiction. It’s our mission to not only aid recovery, but empower each individual to achieve their fullest potential, which is why we offer coaching in goal-setting and other crucial areas to motivate, inspire and enable success.
When structured rehabilitation ends, a person then enters the continuing care phase, which we consider to be the most exciting phase of all. Continuing care is all about supporting an individual as they go on to achieve the goals they laid out during treatment. For those who partnered with Zinnia Health, they’ll find that this phase is filled with caring support, guidance, and resources to help them stay on track.
Are you interested in learning more about how Zinnia Health can put you on the path to a better life after addiction? Contact us today to learn more.