Fentanyl Withdrawal: Symptoms, Causes, and Timeline

Fentanyl withdrawal refers to a set of symptoms that occur when an individual fully stops the consumption of fentanyl after a heavy prolonged use. The human body becomes dependent on fentanyl due to prolonged use and has a hard time adjusting to its absence, which causes challenging symptoms.

The main symptoms of fentanyl withdrawal include muscle pain, sweating, chills, nausea, anxiety, depression, cravings for fentanyl, insomnia, fever, diarrhea, nausea or vomiting, and dysphoria.

Table Of Contents:

• What is Fentanyl Withdrawal?
• What are the Symptoms of Fentanyl Withdrawal?
• What are the Causes of Fentanyl Withdrawal?
• What is the Fentanyl Withdrawal Timeline?
• What are the Treatment Options for Fentanyl Withdrawal?
• What are the Best Medications for Fentanyl Withdrawal?
• What are the Coping Strategies for Fentanyl Withdrawal?
• What is Fentanyl?

The causes of fentanyl withdrawal are physical dependence, and the impact of prolonged use on the brain and body.

The treatment options for fentanyl withdrawal are detoxification, therapy and counseling, inpatient and outpatient treatment programs, medication treatment, and the use of coping strategies.

What is Fentanyl Withdrawal?

Fentanyl withdrawal is the set of physical and psychological symptoms that occur after a person who is dependent on the consumption of fentanyl completely stops or severely reduces its usage.

Fentanyl is a highly potent synthetic opioid that is 50-100 times more potent than morphine. This potency increases the severity of its withdrawal symptoms, as fentanyl alters the brain’s opioid receptors way more than other opioids.

Fentanyl is a highly lipophilic mu-opioid receptor agonist, increasingly found in heroin and other drug supplies, that is contributing to marked increases in opioid-related overdose and may be complicating treatment of opioid use disorder (OUD), according to a research titled: “Fentanyl withdrawal: Understanding symptom severity and exploring the role of body mass index on withdrawal symptoms and clearance” by Rachel Luba.

What are the Symptoms of Fentanyl Withdrawal?

The symptoms of fentanyl withdrawal are muscle pain, sweating, chills, nausea, anxiety, depression, cravings for fentanyl, insomnia, fever, diarrhea, nausea or vomiting, and dysphoria.

These symptoms are listed below.

• Muscle Pain: Muscle pain like aches and spasms occurs due to disruption in pain regulation when the body reacts to the absence of fentanyl. Muscle spasms/twitching is a common opioid withdrawal symptom, according to a research titled: “Fentanyl withdrawal: Understanding symptom severity and exploring the role of body mass index on withdrawal symptoms and clearance” by Rachel Luba.
• Sweating: Sweating occurs when the autonomic nervous system fails or struggles to work properly due to withdrawal from fentanyl use. The heavy sweating leads to other problems like skin irritation and severe dehydration if not managed on time.
• Chills: Chills and intense shivering are associated with fentanyl withdrawal as the body’s temperature control system is dependent on fentanyl and becomes dysregulated due to its absence. It also causes alternating hot flashes.
• Nausea: Nausea occurs when the body’s gastrointestinal system becomes overactive due to opioid withdrawal. Opioid withdrawal can cause random feelings of sickness and vomiting. Nausea/Vomiting is included in the list of signs and symptoms of opioid withdrawal, according to “The Diagnostic and Statistical Manual of Mental Disorders (DSM–5)”.
• Anxiety: Anxiety occurs during fentanyl withdrawal as the brain’s stress-response systems cause hyperactivity and tension which used to be suppressed by fentanyl use. Anxiety or irritability is a common symptom of opioid withdrawal, according to a research titled: “Fentanyl withdrawal: Understanding symptom severity and exploring the role of body mass index on withdrawal symptoms and clearance” by Rachel Luba.
• Depression: Depression occurs as fentanyl withdrawal causes a sudden decline in dopamine and serotonin levels in the neurotransmitters that manage mood regulation. Co-occurring opioid withdrawal symptoms include depressed mood, persistent depressive disorder (dysthymia), and opioid-induced depressive disorder, according to a research titled: “Opioid Withdrawal” by Mansi Shah.
• Cravings for Fentanyl: Cravings for fentanyl become intense as the brain rewards system is fully used to the euphoria and soothingness provided by fentanyl and tries to seek it again. These cravings lead individuals to use fentanyl again which further causes more severe symptoms.
• Insomnia: Insomnia occurs due to the anxiety and physical discomfort caused by fentanyl withdrawal. The difficulty in falling or staying asleep can last for weeks or months. Insomnia is included in the list of signs and symptoms of opioid withdrawal, according to “The Diagnostic and Statistical Manual of Mental Disorders (DSM–5)”.
• Fever: Fever occurs when the body struggles to regulate itself due to the absence of fentanyl. This causes mild to moderate fever, a spike in body temperature, and cold and flu symptoms.
• Diarrhea: Diarrhea occurs when the gut experiences hyperactivity while having a hard time adjusting to fentanyl withdrawal. Diarrhea causes frequent loose stools and severe dehydration if not treated on time.
• Dysphoria: Dysphoria is a sense of uneasiness or dissatisfaction caused by opioid withdrawal due to the brain struggling or failing to regain balance. This mental state causes physical discomfort and accompanies other mental health issues.

What are the Causes of Fentanyl Withdrawal?

The causes of fentanyl withdrawal are mainly linked to physical dependence caused by long-term use and opioid use disorder. As fentanyl binds to our brain receptors and provides intense pain relief and feelings of euphoria, the human body adapts to it. The brain becomes dependent on fentanyl and reduces its natural production of dopamine.

When an individual suddenly stops the use of fentanyl, the body struggles to regain balance on its own, thus causing severe withdrawal symptoms. The prolonged use of fentanyl leads to changes in the central nervous system which makes it hyperactive and causes symptoms like muscle pain, sweating, nausea, anxiety, and cravings.

What is the Fentanyl Withdrawal Timeline?

The fentanyl withdrawal timeline consists of early symptoms, peak symptoms, and post-acute withdrawal syndrome (PAWS).

The withdrawal timeline of fentanyl is listed below.

• Early Symptoms (12-30 hours): Early symptoms start occurring after 12-30 hours of leaving fentanyl. These symptoms are known as the initial signs of withdrawal as the opioid starts leaving the bloodstream. These early symptoms include restlessness, sweating, mild anxiety, muscle aches, and yawning.
• Peak Symptoms (2-4 days): Peak symptoms occur during the second and fourth days of stopping fentanyl consumption. It is known as the most intense and uncomfortable phase with both physical and psychological symptoms like vomiting, diarrhea, chills, fever, severe cravings, increased anxiety, and insomnia.
• Post-Acute Withdrawal Syndrome (PAWS): Post-Acute Withdrawal Syndrome causes long-lasting symptoms that can go on for weeks, months, or even longer. The symptoms during this stage are less intense than peak symptoms but are more persistent due to the brain struggling to adjust to the chemical changes caused by fentanyl use. These symptoms include insomnia, anhedonia, depression, anxiety, fatigue, and dysphoria.

What are the Treatment Options for Fentanyl Withdrawal?

The treatment options for fentanyl withdrawal are detoxification, therapy and counseling, and inpatient and outpatient treatment programs.

These treatment options are described below.

• Detoxification: Detoxification refers to clearing out all remains of fentanyl from the patient’s body during the withdrawal phase. The process involves strong professional supervision at all times while giving medications like buprenorphine and methadone to reduce cravings and discomfort. Detoxification lasts 5-10 days and it significantly speeds up recovery but does not manage long-term psychological dependence
• Therapy and Counseling: Therapy and counseling treatments like Cognitive-Behavioral Therapy (CBT) and motivational interviewing are essential for identifying triggers and developing coping strategies. Counseling helps address ongoing trauma or other mental health disorders. Therapy lasts a few weeks or months and is a highly effective long-term recovery method but it needs to be combined with other treatments for maximum results.
• Inpatient Treatment Programs: Inpatient treatment programs involve staying at a rehabilitation facility while providing the patient with 24/7 care and supervision during withdrawal. Inpatient treatment lasts 30-90 days and is highly beneficial for individuals with severe addiction.
• Outpatient Treatment Programs: Outpatient treatment programs allow individuals to stay at home while attending regular treatment sessions. This option is more flexible but requires strong dedication from the patient. Outpatient programs usually last 12–24 weeks and are highly effective for patients with moderate addiction cases.

What are the Best Medications for Fentanyl Withdrawal?

The best medications for fentanyl withdrawal are methadone, buprenorphine, clonidine, naltrexone, and lofexidine.

These medications are described below.

• Methadone: Methadone is an effective opioid agonist medicine that reduces fentanyl cravings and helps control withdrawal symptoms. Methadone does not produce intense euphoria like fentanyl and it stabilizes the brain’s opioid receptors, which is why it is highly used in long-term medication therapy.
• Buprenorphine: Buprenorphine is a mild opioid agonist medicine that manages withdrawal symptoms while reducing euphoria to prevent the risk of misuse. It is commonly combined with another medicine called Naloxone to get the best results. Buprenorphine typically takes 24-48 hours to provide maximum relief from withdrawal symptoms and is preferred by many patients.
• Clonidine: Clonidine is a non-opioid medicine that helps control various fentanyl withdrawal symptoms like sweating, chills, anxiety, and high blood pressure. Clonidine does not help reduce fentanyl cravings but is highly effective in reducing the discomfort caused during opioid withdrawal. Clonidine is useful as it provides an alternative to risky opioid-based treatments.
• Naltrexone: Naltrexone is an opioid antagonist medicine that helps block the effects of opioids in the brain. Naltrexone is used to prevent relapse after detoxification treatment as it eliminates the euphoric effects of fentanyl, and reduces the risk of opioid misuse.
• Lofexidine: Lofexidine is a non-opioid medicine similar to clonidine but it is specifically approved for opioid withdrawal treatment. Lofexidine is known for reducing symptoms like anxiety, diarrhea, and abdominal cramps. Lofexidine is a safe medicine that prevents the risk of misuse and is particularly used to reduce withdrawal symptoms during the early stages.

What are the Coping Strategies for Fentanyl Withdrawal?

The coping strategies for fentanyl withdrawal are self-care practices, meditation, acupuncture, friends and family support, and support groups.

These coping strategies are described below.

• Self-Care Practices: Self-care practices refer to maintaining a healthy lifestyle. Eating balanced nutrition, proper hydration, and regular exercise boosts your energy levels, improve your mood, and boost your immunity to help the withdrawal recovery process. Eating a balanced diet and proper hydration helps tackle symptoms like fatigue and weakness. It’s an effective coping strategy as it balances both physical and emotional well-being.
• Meditation: Meditation refers to mindfulness techniques that help improve your well-being. Guided meditation sessions help individuals to focus on themselves and control psychological symptoms like stress and opioid cravings. Regular meditation helps improve emotional stability during the fentanyl withdrawal phase. The mindfulness and relaxation that meditation provides helps develop better coping mechanisms.
• Acupuncture: Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points of the body. Acupuncture reduces withdrawal symptoms like nausea, muscle aches, and anxiety by stimulating the body’s natural pain-relief mechanisms. It supports overall body strength and immunity, making it a highly effective coping strategy.
• Friends and Family Support: Friends and family support provides a strong emotional support network and proper motivation during opioid withdrawal. Individuals should share their struggles or successes during the withdrawal phase with their family members and friends to build trust and a sense of accountability. Sharing a sense of support is a helpful coping strategy as it provides great emotional stability.
• Support Groups: Support groups connect individuals to other people who share the same experiences so they can understand each other’s struggles and not feel isolated during their withdrawal journey. Support groups offer a safe space for individuals to share their coping strategies and techniques to manage withdrawal symptoms and encourage each other

What is Fentanyl?

Fentanyl is a highly potent synthetic opioid drug commonly used as an analgesic. Fentanyl was intended for pain management in medical settings, but its misuse became common, especially in North America and Europe. Fentanyl is often mixed with other drugs like heroin or cocaine to increase the potency, which leads to further health risks and misuse.

How Long Does Fentanyl Take to Kick in?

Fentanyl takes around (300 to 900 seconds) to kick in, especially when consumed using intravenous (IV) injection. The effect arrives slower in other forms like patches, usually occurring within (half a day to a day) hours as the opioid gradually absorbs through the skin.

What Does Fentanyl Look Like?

Fentanyl comes in various forms, with pharmaceutical types including transdermal patches, lozenges, tablets, injectables (clear liquid in vials), and nasal sprays.

Can Fentanyl Use Lead to Dependency and Addiction?

Yes, fentanyl use leads to dependency and addiction as it is highly potent and rapidly activates the opioid receptors in the brain. Prolonged use further increases fentanyl addiction as it alters brain chemistry to build up a tolerance for the opioid.

Is Methadone Ideal to Deal with Fentanyl Addiction?

Yes, methadone is ideal for dealing with fentanyl addiction in many cases as it reduces cravings and withdrawal symptoms by stabilizing opioid receptors. Methadone is highly effective in medication-assisted treatment (MAT) programs.

How Severe is Fentanyl Withdrawal Compared to Other Opioids?

Fentanyl withdrawal is far more severe than withdrawal from other opioids due to its extreme potency and great risk of misuse. Symptoms like intense cravings, anxiety, and physical discomfort begin within a few hours after withdrawal.

Does Fentanyl Withdrawal Require Different Treatment Methods than Heroin Withdrawal?

Yes, fentanyl withdrawal does require different treatment methods than heroin withdrawal as it is 50 times more potent and has a 20 times shorter half-life. Even though both involve similar medications, fentanyl withdrawal often needs closer monitoring and adjustment than heroin withdrawal.

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