Fentanyl is a synthetic opioid that is 100 times more potent than morphine and 50 times stronger than heroin. Because it is so powerful, doctors typically only prescribe it for short periods of time, like to ease pain following a major surgery; however, even if individuals only take fentanyl as directed, they can still develop a dependence on it.

According to the Drug Enforcement Administration, there were more than 6.5 million prescriptions for fentanyl dispensed in the US in 2014. When an individual takes fentanyl for an extended period of time, the body builds up a tolerance to it. In order for the drug to continue having an effect, the individual must take larger doses of it more frequently, which eventually leads to dependence. People who have developed a physical dependence on fentanyl cannot stop taking it without experiencing withdrawal symptoms.

Fentanyl Detox Timeline

Early Withdrawal Symptoms

When the body is dependent on an opioid like fentanyl, it functions as if its presence in the system is normal, so when an individual suddenly stops taking it, painful withdrawal symptoms will occur. Withdrawal symptoms typically arise anywhere from 6 to 36 hours of the last dose, and their duration and severity depend on a variety of factors. The earliest withdrawal symptoms include:

  • Irritability
  • Sweating
  • Chills
  • Restlessness
  • Headache
  • Muscle pain or cramps

People who started taking fentanyl for legitimate medical reasons may also experience significant pain in the early stages of withdrawal, since they are no longer taking it to block pain receptors in the brain. Though withdrawal symptoms are not typically life-threatening, complications can arise. Individuals who try to quit fentanyl on their own are also more likely to relapse if symptoms get too painful simply because they have access to more fentanyl, whereas those in a detox program do not. However, clients in ambulatory detox do have access to other medications that can ease the worst of their withdrawal symptoms.

Later Withdrawal Symptoms

Symptoms of fentanyl withdrawal typically peak 1-2 days after the last dose. As the body starts flushing itself of the drug, individuals may experience:

  • Sweating
  • Nausea
  • Vomiting
  • Diarrhea
  • Confusion
  • Anxiety
  • Insomnia
  • Body aches
  • Loss of appetite
  • Tremors

For most people, the worst of the physical symptoms subside within a week to 10 days; however, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), protracted withdrawal, which is the presence of symptoms after the generally accepted withdrawal period has passed, can persist for weeks or even months following quitting.

Protracted Withdrawal Symptoms

Protracted withdrawal symptoms vary among individuals, and some people may not even experience them at all. For those who do, the most common protracted withdrawal symptoms that result from quitting opioids are:

  • Anxiety
  • Depression
  • Insomnia
  • Fatigue
  • Irritability

A study funded by the National Institutes of Health found that individuals with a history of opioid abuse may also struggle to focus on tasks more than those who had never used opioids.

Easing Withdrawal Symptoms

There are a variety of drugs that can make fentanyl withdrawal symptoms more manageable. In addition, individuals may taper off fentanyl under the guidance of a doctor in order to ease themselves into sobriety. The most effective quitting approach ultimately depends on the extent of the individual’s addiction.

Methadone is a popular medication that can ease fentanyl withdrawal symptoms because it binds to the same opioid receptors in the brain without producing the same intense high. According to a study originally published in The Canadian Journal of Hospital Pharmacy, administering methadone 1-2 days before tapering off fentanyl made it possible for subjects to discontinue their fentanyl use in just two days; however, it is important to keep in mind that methadone is an addictive drug itself, and it should only be used under the guidance of a trained healthcare professional.

Another popular medication for clients suffering from fentanyl withdrawal is buprenorphine. Buprenorphine is a partial opioid agonist. When given at the appropriate stage of fentanyl withdrawal and in the appropriate dose, it can diminish symptoms, decrease cravings, and ultimately help people remain in treatment.

fentanyl withdrawal and detox timeline

Naloxone is another effective medication for treating fentanyl withdrawal. According to the US Department of Health & Human Services, naloxone is a pure opioid antagonist, which means it can also be used to counter fentanyl overdoses.

Though naloxone can be effective at reversing an overdose, The New York Times reports that the number of deaths related to fentanyl is surpassing the number of fatal heroin overdoses. For example, fentanyl killed 158 people in New Hampshire in 2015, whereas heroin was responsible for 32 deaths across the state that same year.

Going through withdrawal might be painful, but doing so is a far better alternative than facing the risk of overdosing with every use. Luckily, in the right setting and with appropriate medication, fentanyl withdrawal symptoms are entirely manageable.

Physical Complications of Fentanyl Withdrawal

In an ambulatory detox setting, clients are monitored by healthcare staff who know how to respond if any complications arise. Individuals who try to quit fentanyl on their own do not have this same support structure in place, which is why experts recommend entering a detox program in order to quit fentanyl.

Because vomiting is a common withdrawal symptom, aspiration pneumonia is a potential complication. Aspiration pneumonia can occur when an individual vomits and then inhales the contents of the stomach. This can result in serious infection, respiratory failure, and even death.

Vomiting and diarrhea can also cause severe dehydration, which has serious complications of its own. Clients in a detox setting will be monitored for signs of dehydration and treated accordingly if any arise.

Another major complication associated with fentanyl withdrawal is relapse. Relapse during withdrawal is especially dangerous because the body has lost some of its tolerance for the drug during the detox period, but individuals do not always take that into account once they start using again, which can result in a fatal overdose.

Life after Withdrawal

There are a variety of treatment options that people can choose from following withdrawal. Individuals who have overcome withdrawal should feel proud because it is not an easy road, and they should give themselves every possible chance to succeed in recovery.

According to a study funded by the National Institute on Drug Abuse, an intensive outpatient treatment program can help a significant number of people enter recovery. Researchers found that 50 percent of subjects who received therapy and medication to taper off opioids in four weeks had remained opioid-free after 12 weeks, while just 20 percent of those who received a shorter tapering period were opioid-free after the same duration. Their results indicate that individuals who participate in treatment for longer and who have a strong support system in place beyond ambulatory detox may be the most likely to quit fentanyl for good. As a result, ongoing aftercare is critical to any comprehensive addiction treatment program.