Fentanyl Withdrawal Symptoms, Timeline & Detox

Written by Jonathan Strum

& Medically Reviewed by Dr. Andrew Proulx, MD

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Last Updated - 12/28/2022

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Updated 12/28/2022

Key Takeaways

  • Fentanyl is America’s deadliest drug and the most common drug involved in overdose deaths
  • Fentanyl’s ultra-high potency and very short half-life cause particularly severe withdrawal symptoms
  • Fear of withdrawal and inability to endure withdrawal are major barriers to successful recovery
  • Medical detox greatly reduces fentanyl withdrawal, making the experience safer and more comfortable
  • Inpatient detox at a detox facility offers the best chances of success
  • Successful detox from fentanyl is not a treatment for the addiction, and it should be viewed only as the necessary lead-in to treatment

Fentanyl, America’s deadliest drug, has made recovery from substance addiction more urgent than ever before. Here are the facts about withdrawal and detox from fentanyl.

Fentanyl Withdrawal Symptoms

Fentanyl withdrawal symptoms can make people very sick, and their cravings to use fentanyl again may worsen as they become desperate to stop the withdrawal. Fortunately, the withdrawal symptoms can be avoided or greatly reduced for those who accept help at a detox program.

Fentanyl withdrawal symptoms in the acute phase (the initial period after stopping the drug) tend to be more physical in nature, and psychological symptoms become more prominent after this phase. Symptoms include:

Physical Withdrawal Symptoms

Runny nose Watery eyes Yawning Sweating Chills Nausea/vomiting Diarrhea Muscle cramps or spasms Insomnia

Psychological Withdrawal Symptoms

Dysphoria (a general state of unease/discontent) Anhedonia (inability to experience pleasure) Depression Anxiety Cravings Restlessness

Fentanyl Withdrawal Timeline

Because of fentanyl’s short half-life of 219 minutes, withdrawal symptoms usually begin within two to four hours of the last use.

  • 2 – 4 hours: Withdrawal symptoms begin
  • 1 – 2 days: Peak symptom severity
  • 2 – 10 days: symptoms will gradually resolve

This can be longer in people who were using the fentanyl patch, which is a slow-release delivery system. In this case, withdrawal symptoms usually start within 24 to 36 hours of removing the patch.

Some people may develop symptoms that last well beyond the acute withdrawal phase. These are known as protracted withdrawal symptoms and may last weeks to months.

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FAQs About Fentanyl Withdrawal

What is fentanyl withdrawal?

Fentanyl, a synthetic opioid, has made recovery from substance addiction more urgent than ever before. Now known as America’s deadliest drug, fentanyl has overtaken heroin and oxycodone as the leading cause of drug overdose deaths. When treating addiction to the drug through a fentanyl detox, the body experiences withdrawal as the brain and body react to the shock of the drug’s removal. Because of fentanyl’s ultra-high potency and short half-life, its withdrawal symptoms can be particularly severe. Fear of withdrawal can be a barrier to recovery for many people, but fentanyl withdrawal does not have to be a difficult and frightening experience. Medically assisted fentanyl detox can help people to stop their drug use safely and comfortably.

How can I cope with fentanyl withdrawal symptoms?

Fentanyl withdrawal can be profoundly uncomfortable, especially for people who quit “cold turkey” without medical support. There are no shortcuts or easy fentanyl withdrawal remedies that can prevent symptoms. However, people who participate in supervised medical detox programs have access to 24/7 medical professionals who can address concerns as they arise and, if appropriate, administer pharmacotherapies to mitigate the severity of withdrawal symptoms. Fentanyl withdrawal is best addressed in a professional rehab setting that includes medical detox. At the very least, someone facing fentanyl detox and withdrawal should seek professional assistance to obtain an appropriate tapering regimen.

How long does fentanyl stay in your system?

The fentanyl half-life varies quite a bit, depending on the formulation and the route of administration. There are three types of fentanyl: Pharmaceutical fentanyl, derivatives of pharmaceutical fentanyl and non-pharmaceutical (illicit) fentanyl, which all have different half-lives. Broadly speaking, intravenously administered pharmaceutical fentanyl has an average half-life of 7 hours, but the range spans from 3-12 hours. Transdermal fentanyl patches administer fentanyl through the skin, slowing the metabolic half-life to 20-27 hours. Derivatives and illicit fentanyl have shorter half-lives than pharmaceutical fentanyl.

How long does it take to detox from fentanyl?

It is difficult to predict how long fentanyl withdrawal will last in a particular individual, but withdrawal symptoms taper off and end after four to 10 days in most people. The fentanyl withdrawal timeline usually follows a general pattern, but there are specific factors that affect each person’s level of withdrawal. These factors include age, gender, general health, liver and kidney health, genetic and biological make-up, concurrent use of other drugs, co-occurring mental health disorders, use of medically assisted detox, and previous attempts at detox.

Can I detox from fentanyl at home?

Fentanyl dependence is a consequence of the brain becoming adapted to its presence. When someone who has become dependent on fentanyl quits abruptly, their brain will attempt to rapidly restore normal functionality. Unfortunately, this is not always a smooth process and, as brain chemistry rapidly changes, the result can include dangerous physical and psychological symptoms like seizures and hallucinations. For these reasons, quitting abruptly is never recommended for people who have developed a fentanyl dependence. It is strongly suggested that someone with a fentanyl use disorder consult with their doctor or an addiction specialist before they attempt to quit. People who choose to detox without medical supervision should prepare ahead of time. Enlist a trusted friend or family member who can be a cheerleader, errand runner, and motivational speaker. Discuss with them why recovery is important and what the short and long-term goals are. It can be very helpful if someone struggling to resist relapse is reminded of why they are pursuing sobriety. In addition, make sure the refrigerator is full of healthy food and water. Many people find that a quality multivitamin may help their symptoms.

What is medication-assisted treatment for opioid addiction?

Quitting cold turkey is rarely the most effective approach to overcoming substance use disorders and fentanyl is no exception. In milder cases of fentanyl dependence, a tapering protocol is a highly effective strategy for managing withdrawal symptoms, but in severe cases of dependence, opioid replacement therapy in the form of medication-assisted treatment (MAT) may be more appropriate. MAT is a strategy that replaces fentanyl with other opioids that have longer half-lives and that do not deliver the euphoria that is associated with fentanyl abuse. The goal of MAT is to provide the brain with a substance that can mimic the chemical effects of fentanyl in the brain without delivering the sense of euphoria that perpetuates addiction. In other words, MAT tricks the brain into believing that it is receiving the drug it has become accustomed to without continuing to reinforce the pleasure that is associated with fentanyl use. There are several drugs that are valuable MAT options for people recovering from a fentanyl use disorder, including methadone, buprenorphine, Suboxone and naltrexone.

Professional vs At Home Detox

Fentanyl detox treatment can be beneficial in helping someone break free from fentanyl addiction. One medical paper describes fentanyl withdrawal as a mountain of effort where the brain is driven to go around the mountain by relapsing. However, it describes medical detox as a molehill, which the brain does not need to find a way around.

Detoxing at Home

When making the decision to attempt fentanyl detox at home, individuals should do so in conjunction with their physician or an addiction professional. They should also be honest about the extent of their drug use. It is also important to involve loved ones in the process and heed the advice that is given by medical professionals. Addiction to fentanyl is a consuming and deadly substance use disorder. People who wish to end their drug use should take the endeavor very seriously to give themselves the best chance of success. Detoxing off fentanyl at home may not provide the best recipe for success, as the cravings to relapse and relieve the withdrawal may be overwhelming. As a minimum, people who plan to detox at home should have certain supporting factors in place: – A short period of drug use at lower doses
– A stable and supportive home environment
– A safe, drug-free home that is removed from negative influences such as dealers or people who use drugs
– They should not live alone, and the people at home should be aware of the detox situation
– They should be highly motivated to recover Detox does not in any way constitute treatment for fentanyl addiction. People should make arrangements in advance for some kind of treatment to address the reasons behind the substance use. Treatment also helps people heal from the mental and physical damage caused by drug use. This is the purpose of addiction treatment programs.

Quitting Cold Turkey

Stopping fentanyl “cold-turkey” results in a rapid onset of withdrawal symptoms, usually severe. The risk of relapse during such a stark withdrawal is high, as the craving to use fentanyl in order to stop the symptoms can be overwhelming. Going through fentanyl withdrawal cold turkey is not recommended, as it is the most difficult way to stop fentanyl use and is a major driver of relapse. Rather, medically supervised detox using medications, counseling support, and symptom management make the experience much easier, safer, and more likely to result in a successful recovery.

Tapering off Fentanyl

People often overestimate their ability to self-taper off their opioids and stop the drug use on their own. People who wish to avoid withdrawal symptoms by doing an opioid taper should discuss opioid replacement therapy with an addiction professional as part of an overall plan for treatment and recovery. People who use the fentanyl patch also need to taper off the drug, even if they are using it for legitimate purposes by prescription. Although the effects will be delayed, they can suffer significant withdrawal effects if they suddenly stop using their patch. They should discuss how to taper off the fentanyl patch with their prescriber.

Medically Assisted Detox

Medically assisted detox offers much more than the option of using opioid replacement therapy to prevent or reduce withdrawal. It also provides: – A safe place to detox, away from distractions, temptations and triggers
– Immediate help if any complications arise
– Proper non-opioid management of side effects, such as insomnia, high blood pressure or diarrhea
– The ability to connect with other motivated people who are detoxing
– The ability to connect with counselors and begin working out an individualized plan of success for treatment and long-term recovery
– Access to proper, medically accurate information and facts
– The ability to demonstrate to loved ones that the individual is serious about recovery

Medication-Assisted Treatment (MAT)

Some medications that form the mainstay of withdrawal management from fentanyl are:

Buprenorphine is a long-acting synthetic opioid used for opioid replacement therapy. It is given in a controlled manner to people in recovery, which helps facilitate a slow, controlled taper off of opioids and avert withdrawal effects. It also helps reduce cravings to use during early recovery.

Buprenorphine appears to work as well as the other FDA-approved opioid replacement agent, methadone. In addition, it has some chemical properties that give it a more favorable side-effect profile than methadone, and it can be tapered off more quickly.

A popular commercially available buprenorphine formulation for opioid addiction is Suboxone. Besides buprenorphine, Suboxone also contains naloxone, which blocks any attempts at misuse. One drawback of Suboxone is that it is a more expensive drug than methadone.

Methadone is a synthetic long-acting opioid that is used for treating serious cancer-related pain and for opioid replacement therapy. The drug is taken once a day, usually in the morning, as an oral liquid suspension.

If people try using opioids while undergoing methadone therapy, methadone will block the “high” of the opioids, thereby acting as a deterrent to relapse.

Clonidine is an older type of blood pressure medication that has been found to reduce some withdrawal symptoms. However, it also has some severe side effects. Most notably, it can cause low blood pressure and slow heart rate, sedation and insomnia. When its use is stopped, clonidine can cause rebound high blood pressure and rapid heart rate. As such, clonidine is used with great care and usually only on an inpatient basis.

Related Topic: Clonidine dosage for withdrawal

Naltrexone removes opioids from their receptors in the brain and blocks further opioids from attaching to their receptors. As such, it reverses the effects of opioids, which makes it a life-saving drug for treating overdose. It also prevents a high when people take opioids. Naltrexone itself is non-addictive and gives no high.

Because naltrexone can precipitate withdrawal symptoms by removing opioids from their brain receptors, naltrexone should only be initiated when the individual is at least partly detoxed from fentanyl use.

Finding a Fentanyl Detox Center

Undergoing medically-assisted detox at an accredited facility is the safest and most effective way to rid the body of fentanyl and other substances. This detox also helps them to transition smoothly into treatment and recovery. Some factors to consider when selecting a detox program include:

  • Location
  • Cost
  • Effectiveness
  • Staff-to-patient ratio

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