Audrey was worried about "feeling normal" after a Fentanyl Detox. So the Coleman Institute provided her with tips that helped her navigate through Post-Acute Withdrawal Symptoms (PAWS) and get a restful night's sleep.

Audrey’s Fentanyl and Heroin Detox Story

Audrey and her cousin Jim showed up at the office without an appointment. They were concerned.

5 days earlier, Audrey had completed a heroin and fentanyl detox at the Coleman Institute, with a bit of Suboxone® that she added at the end of her use to help stave off horrible withdrawal symptoms.

She didn’t have the easiest detox I’ve ever seen, but she got through it and was able to have a naltrexone implant placed on day 6. She was also able to appear at her scheduled court date 48 hours after completion.

More like this: Live a Life Free From Fentanyl Addiction with Naltrexone

Audrey’s Support Person, Jim

Jim had been Audrey’s support person through her Fentanyl Detox. Jim himself has been off narcotic pain medication for about 8 years after developing a physical dependency that morphed into addictive behavior following a series of surgeries and treatment with various opioids.

Many of our patients have been prescribed pain medication such as Oxycontin®, Percocet®, Roxicet®, hydrocodone, morphine, tramadol, etc., and come to our offices for Accelerated Opioid Detox (AOD).

Based on this history, Jim had a good understanding of what Audrey was going through. Still, the truth was that he had never experienced fentanyl.

When Jim was still physically dependent on his drugs, he could get pills from people getting them from their doctors and pharmacies. Nowadays, most pills people buy on the street contain fentanyl. Fentanyl is 50 to 100 times stronger than morphine and much more challenging to stop using.

More like this: Suboxone® Alternatives to Detox Off Pain Medication and That Street Pill Might Be Fentanyl

Fentanyl Is Causing Longer Detoxes

14 years ago, we could do an Outpatient Heroin Detox or complete a detox for those taking 150mg to 200mg of pain medication in 3 days. With fentanyl, the minimum time for an Accelerated Detox is 5 days, and sometimes people do better with 6 or 7 days. Fentanyl is hard to quantify; so often, we find ourselves basing the length of the detox on how well our patient is doing. I don’t recall that anyone has gone longer than 8 days to get off fentanyl.




Post-Acute Withdrawal Symptoms (PAWS) for Fentanyl Detox

Audrey’s biggest short-term challenge was that she wasn’t sleeping. Jim said she hadn’t slept more than 2 hours a night for the last 5 days since completing our outpatient detox program. This was worrisome for Audrey because she ran her own hectic and successful company and had issues to deal with daily (if not hourly). Not to mention some looming legal problems.

One of the teaching points for our patients is to help them be ready for and expect some Post-Acute Withdrawal Symptoms (PAWS). Sometimes, when we prescribe our comfort meds at the start of the program, we add in extra, anticipating our patients will need some help for a little while once they go home.

Probably the 2 most difficult things people deal with during and after detoxes are trouble sleeping and lack of energy.

I’ve learned that when a drug is stopped, patients will experience the opposite effects of the drug. Opioids, which flood the brain with higher dopamine levels than the brain can compete with, give people bursts of energy. It is not a big surprise that insomnia, lethargy, and fatigue are the opposite effect.

Recently, I heard a podcast interview with Dr. Anna Lembke, a Stanford Addiction Psychiatrist. In her book, Dopamine Nation: Finding Balance in the Age of Indulgence, she reinforces everything we say to our patients: You will get through this. Promise.

More like this: What Is Dopamine & How Does It Keep Me Using Opioids?

Feeling Normal After Fentanyl Detox

I can’t provide an exact timeframe for everyone because of the type of drug, the amount and length of time a person has been taking it, and other medical or psychological conditions. But generally, we have seen that most patients begin to feel normal within 2 weeks to a month. In the severest cases, complete dopamine restoration can take several months.

The single most important thing our patients can do is commit to abstinence. Hence, the brain has a chance to return to its baseline, or homeostasis.

More like this: Is Recovery Possible For Fentanyl Addiction?

Post Detox Support with the Coleman Institute

Even though we know it may take several months for the brain to rebuild its dopamine supplies completely, it will happen. Patients who complete our Fentanyl Detox programs are routinely prescribed medication to help them get through this challenging period. In addition, our case managers have scheduled check-ins with our patients. They will be able to make sure they are doing okay and communicate with the clinical staff if intervention is needed.

It’s helpful for our patients to understand that the initial Post-acute Withdrawal Symptoms (PAWS) after a Fentanyl Detox can be uncomfortable. However, it’s not the intense discomfort of acute, cold-turkey withdrawal with debilitating gastrointestinal side effects and flu-like symptoms. Instead, PAWS is restlessness, insomnia, anxiety, and to a lesser extent, some stomach cramping or muscle aches.

This is an opportunity to practice some willingness to be uncomfortable.

This is also when help from friends in recovery, support groups, and counseling is invaluable.

More like this: Addiction Myths

Helping Audrey Sleep

Talking to Jim and Audrey, I learned that she had not been using any of the extra comfort meds we had prescribed since she returned home. Although she came to us because she was using heroin and fentanyl, she admitted that, ironically, she didn’t like to take pills. We discussed how a sleep aid could help in the short term, assuring her this was just a temporary situation. She was relieved.

We arranged for a phone follow-up in a few days to assess her sleep and discuss any other concerns. At the follow-up, some of Audrey’s PAWS were improving, but she was still struggling with only getting 4.5 to 5 hours of sleep.

I prescribed different sleep medications and took a thorough inventory of her sleep hygiene habits:

  • How much caffeine was she consuming?
  • Was she getting any physical exercise?
  • Was she completely blackening her room at bedtime?
  • How much was screen time happening at rest?
  • How close to bedtime was she eating?

We discussed some non-pharmaceutical tips to help her get better, more consistent sleep. She will follow up with her case manager in a few days, and I suspect things will be looking a lot different by then.

More like this: Healing the Brain After Opioid Detox and Withdrawal

Treating Fentanyl Addiction at the Coleman Institute

The artist Georgia O’Keefe once said, “To create one’s world takes courage.”

We provide a safe, more comfortable, and affordable detox in an outpatient setting. The Coleman Institute has specialized in using long-acting naltrexone to help people detox off of fentanyl or opioids for over 25 years.

Consider contacting the Coleman Institute if you are ready to ‘create your world’ and realize you have crossed the line into a physical dependence or addiction to opioids.

In the meantime, stay safe.

Joan R. Shepherd, FNP