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.
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:
- Chills, goosebumps
- Stomach cramps
- Joint and muscle pain
- Nausea and vomiting
- Elevated heart rate, high blood pressure
- Depressed mood
- Runny nose
Fentanyl Withdrawal Symptoms Timeline
Because of fentanyl’s short half-life of 219 minutes, withdrawal symptoms usually begin within two to four hours of the last use. 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.
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:
- 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
- Previous attempts at detox
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.
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 successful recovery.
Medically Assisted Detox for Fentanyl Withdrawal
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
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.
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.
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.
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:
- Staff-to-patient ratio
Key Points: Understanding Fentanyl Withdrawal and Detox
Fentanyl addiction is a serious and potentially deadly substance use disorder, and people should arm themselves with facts when planning to break the drug use cycle. Here are some key points to remember about fentanyl withdrawal and detox:
- 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
When people detox from fentanyl at The Recovery Village Palm Beach at Baptist Health, our team of health care and addiction professionals help them do so in a safe, comfortable way in a supportive environment. If you wish to discuss fentanyl addiction in yourself or a loved one, contact us today for a confidential discussion with one of our intake counselors.
American Society of Addiction Medicine. “National practice guideline for the use of medications in the treatment of addiction involving opioid use.” June 1, 2015. Accessed July 15, 2019.
Centers for Disease Control and Prevention (CDC). “Drug overdose deaths involving fentanyl, 2011–2016.” March 21, 2019. Accessed July 15, 2019.
Chalana, Harsh; Kundal, Tanu; Gupta, Varun; et al. “Predictors of relapse after inpatient opioid detoxification during 1-year follow-up.” Journal of Addiction, April 7, 2016 Accessed July 15, 2019.
Diaper, Alison; Law, Fergus; Melichar, Jan. “Pharmacological strategies for detoxification.” British Journal of Clinical Pharmacology, February 2014. Accessed July 15, 2019.
Food and Drug Administration (FDA). “Fentanyl citrate injection, USP.” November 2012. Accessed July 15, 2019.
Frank, Joseph; Levy, Cari; Matlock, Daniel; et al. “Patients’ perspectives on tapering of chronic opioid therapy: A qualitative study.” Pain Medicine, October 2016. Accessed July 15, 2016.
Kleber, Herbert. “Pharmacologic treatments for opioid dependence: Detoxification and maintenance options.” Dialogues in Clinical Neuroscience, December 2007. Accessed July 15, 2019.
Substance Abuse and Mental Health Services Administration (SAMHSA). “Protracted withdrawal.” July 2010. Accessed July 15, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.