Drugs Q & A

How Long Does Fentanyl Stay In Your System?

What is Fentanyl?

Fentanyl is a powerful synthetic opioid that is 80-100 times stronger than morphine. Pharmaceutical fentanyl was developed for pain management treatment of cancer patients, applied in a patch on the skin. Because of its powerful opioid properties, Fentanyl is also diverted for abuse.

Fentanyl is also made and used illegally by drug cartels who add it to fake prescription pills and other illicit drugs like heroin, cocaine, methamphetamine, and MDMA to increase its potency or be disguised as highly potent drugs. Many users believe that they are purchasing the actual drugs and actually don’t know that they are purchasing Fentanyl – which often results in overdose deaths. Clandestinely-produced fentanyl is primarily manufactured in Mexico and China.

Street names of Fentanyl include:

  • Apace
  • China Girl
  • China Town
  • China White
  • Dance Fever
  • Goodfellas
  • Great Bear
  • He-Man
  • Poison and Tango & Cash.

How is it used?

When prescribed by a doctor, Fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops. The illegally used fentanyl most often associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.

Prescription Fentanyl comes as a lozenge on a handle (Actiq), a sublingual (underneath the tongue) tablet (Abstral), a film (Onsolis), and a buccal (between the gum and cheek) tablet (Fentora) to dissolve in the mouth. Fentanyl is used as needed to treat breakthrough pain but not more often than four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

Your doctor will probably start you on a low dose of fentanyl and gradually increase your dose until you find the dose that will relieve your breakthrough pain. If you still have pain 30 minutes after using fentanyl films (Onsolis), your doctor may tell you to use another pain medication to relieve that pain and may increase your dose of fentanyl films (Onsolis) to treat your next episode of pain. Talk to your doctor about how well the medication is working and whether you are experiencing any side effects so that your doctor can decide whether your dose should be adjusted.

Do not use fentanyl more than four times a day. Call your doctor if you experience more than four episodes of breakthrough pain per day. Your doctor may need to adjust the dose of your other pain medication(s) to better control your pain.

Swallow the buccal tablet whole; do not split, chew, or crush. Also do not chew or bite the lozenge on a handle; only suck on this medication as directed.

Do not stop using fentanyl without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop using fentanyl, you may experience unpleasant withdrawal symptoms.

How does Fentanyl affect the body?

Similar to other opioid analgesics, Fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions. Its effects include extreme happiness, drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma, and death.

Fentanyl Metabolism

Fentanyl can be absorbed into the body via inhalation, oral exposure or ingestion, or skin contact. It is not known whether fentanyl can be absorbed systemically through the eye. Fentanyl can be administered intravenously (IV), intramuscularly (IM), or as a skin patch (transdermally).

Following oral administration, the onset of action is rapid (5 to 15 minutes). The Peak analgesic effect occurs within 20 to 30 minutes and the duration is approximately 2 hours. Of the total available dose, 25% is absorbed transmucosally over a 15-minute period, and an additional 25% is absorbed through the gastric mucosa during the next 90 minutes. In humans, fentanyl is mainly metabolized in the liver by CYP3A4 into norfentanyl through oxidative N-dealkylation at the piperidine ring by hepatic CYP3A4 and 3A5 isoenzymes.

How long does fentanyl stay in your system?

There are several factors that come into play when estimating how long Fentanyl will stay in your system because every patient has physiology unique to them. Here are some major factors you should consider when trying to understand how long Fentanyl will stay in your body:

•        Age: Typically, the younger you are, the more efficient your body functions are. The more efficient your body functions, the faster Fentanyl will be removed from your system.

•        Amount: The higher the dose of Fentanyl you have been taking, the longer Fentanyl will take to be removed from your system.

•        Genetics: Genes predispose people to different metabolic functions, which is a key factor in how your body processes medications like Fentanyl. For this reason, your genetic makeup comes into play when estimating how long Fentanyl will remain in your system.

•        Kidney and liver functions: The liver and kidneys eliminate everything you ingest, and Fentanyl is no exception. If your liver or kidneys are damaged, it will most likely take longer for your body to remove the Fentanyl from your system.

•        Metabolism: Your metabolism determines how quickly you process foods, liquids, and drugs such as Fentanyl. If your metabolism is slow, it will take longer for your body to process and eliminate Fentanyl from its system than someone with a fast metabolism.

•        Usage frequency: The longer you have been taking Fentanyl, the longer it will remain in your system. For example, it will take longer for someone who has taken Fentanyl for several years to remove Fentanyl from the body than someone who has only been taking Fentanyl for a few months.

The pharmacokinetics of fentanyl can be described as a three-compartment model, with a distribution time of 1.7 minutes, redistribution of 13 minutes, and a terminal elimination half-life of 3.65 hours. The half-life of a drug is the time it takes for the amount of a drug’s active substance in your body to reduce by half.

About 94 to 97% of a drug will have been eliminated after 4 to 5 half-lives. Thus, it follows that after 4 to 5 half-lives, the plasma concentrations of a given drug will be below a clinically relevant concentration and thus will be considered eliminated.

This means that fentanyl will clear out of a person’s system within 1 day (approximately 18 hours) after the last use but the elimination may vary based on multiple factors already stated above.

During drug testing, Fentanyl will usually show up on a blood test between 5-48 hours and on a urine test between 24-72 hours after last use. Hair tests can detect the drug for up to 3 months depending on the dose taken.

How to flush fentanyl out fast

A healthy diet plays a significant role in your recovery from fentanyl addiction. It restores the nutrients that were lost from substance abuse. Therefore, when eating your three meals a day, it is important to choose food that rebuilds your body’s tissue and boosts your energy levels. The right foods can accelerate your recovery, particularly during fentanyl detox.

During fentanyl detox, you should have access to nutritious fruits and vegetables that replenish vitamins and minerals. In many ways, a healthy diet can produce the same level of excitement and energy you felt when you were high with fentanyl. You can flush fentanyl faster from your system by:

Drinking Enough Water: The most basic and essential food that can speed up your recovery is actually water. Your body has suffered from a lack of hydration for a long time. Although water is a neutral element – it provides no nutrients but also doesn’t harm your body in any way – it is the most basic sustenance you can intake during detox. Hydrate as much as you can in the first few days and keep drinking water throughout fentanyl rehab. The oxygen in water heals your body and gives you a ton of energy.

Eating Energy-Boosting food: Fentanyl addiction can drain your body of much-needed energy. When you lack energy, you are not motivated to do anything. Important food in recovery that restores energy includes:

•          Healthy carbohydrates

•          Leafy vegetables

•          Peanuts

•          Pistachios

•          Almonds

These types of foods can also give you an extra kick of energy. Try to eat foods rich in iron, phosphorus, magnesium, calcium, potassium, and vitamins A, B, and E.

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Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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