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Fentanyl Withdrawal

9 Minutes

Edited & medically reviewed by THE BALANCE Team

Fact checked

CONTENTS

The strong potency of fentanyl, being up to 100 times more potent than morphine, makes withdrawal a difficult and frequently intense experience. Fentanyl is one of the most addictive synthetic opioids, and creates physical and psychological dependence very quickly, meaning people can experience severe withdrawal symptoms just hours after the last dose.

It is important to recognize and manage these symptoms as withdrawal can lead to extremely intense cravings with a high risk of relapse, and possibly overdose if not handled under medical supervision.

Fentanyl is a synthetic opioid about 50 to 100 times more potent than morphine, developed initially for medical use to relieve extreme pain in those with cancer or after surgery. But in recent years, it’s been misused on a wider scale, causing addiction and deadly overdoses in thousands of people. According to CDC data, over 118,000 drug users died this year in the US, a staggering majority (over 68%) having involved fentanyl or other synthetic drugs [1]. The fentanyl epidemic is causing concern and it is high time we understand the exact dangers of fentanyl dependence, and what fentanyl withdrawal looks like.

The biochemical effects of Fentanyl make the body quickly dependent on it, even when it’s used in prescribed doses. It leads to a relentless loop of dependence on the drug to function in daily routine, and to avoid agonizing withdrawal symptoms known as ‘fentanyl comedown’. It’s often inevitable; the users trying to break free from fentanyl find themselves in withdrawal, and it disrupts their body functions and their minds. Raising awareness and having access to information on fentanyl withdrawal can help mitigate its effect.

Fentanyl withdrawal is the experience someone goes through when they stop taking the drug after using it for a while. Like other opioids, the body and brain become used to the presence of fentanyl and the person will develop tolerance and dependence. If someone goes ‘cold turkey’ off it the body reacts punitively and the symptoms suffered—intense cravings, muscle aches, nausea, fever, insomnia, and severe mood swings—are the price paid. The high potency of fentanyl indicates these symptoms can be nasty.

Fentanyl withdrawal is believed to be particularly difficult compared to other opioids in part because it is a very potent drug with a short half-life. That means withdrawal symptoms can start earlier and be more severe compared to heroin or oxycodone. The gravity of discomfort caused by the above symptoms can push people back to using fentanyl to suppress the distress and create a cycle of relapse that tends to be hard to break without support.

Generally, the timeline for fentanyl withdrawal follows a predictable pattern but tapers off surprisingly quickly. Individuals, and their families, can prepare themselves (and hopefully know what to expect) at each stage, and seek the right support.

The Early Phase Of Withdrawal

Early symptoms start within 12 to 24 hours after the last dose and include sweating muscle pain, and anxiety. The initial symptoms can mimic someone experiencing a severe flu. Many will experience intense cravings for fentanyl as the body notifies the mind that it needs the drug to perform its regular functions. This part may be referred to as the ‘acute phase’ of withdrawal, and more typically lasts from 24 to 48 hours.

Peak Withdrawal Period

People typically have the worst symptoms between days two and four. Withdrawal symptoms during this phase may include vomiting, chills, severe muscle cramps, rapid heart rate, and, in the worst cases, depression and irritability. This phase is called the most difficult of the withdrawal journey since both physical and psychological symptoms are severe.

What Symptoms May Persist For A Long Time After Recovery

After the peak period, physical symptoms go away gradually, but some will continue to suffer psychological symptoms including anxiety and depression for weeks and even months. Mood swings, low energy, and sleep disturbance are a part of this stage often called Post Acute Withdrawal Syndrome (PAWS) [2]. Symptoms during this chronic phase can be less intense but are equally difficult to manage as the brain slowly stabilizes and can remain for months.

What Factors Determine Withdrawal Duration

How long fentanyl withdrawal lasts varies depending on several factors, such as the amount of time you’ve used fentanyl, how often and what dosage, and your general health. If fentanyl is used frequently, as in chronic long-term use, the withdrawal timeline could take longer and the body has had more time to become used to high levels of fentanyl. How long withdrawal symptoms last also varies with age, genetics, and the presence of any other co-occurring mental health conditions.

Comparison With Other Opioids

Fentanyl withdrawal often occurs faster and is generally more intense than other opioids, such as heroin or morphine. Because fentanyl has a short half-life, which means it is quite easy to clear off the system and so results in early onset of symptoms. Moreover, these symptoms can be more severe and intense especially if you’re taking a lot of fentanyl or you’re using some other drugs like benzodiazepines.

The Physical Symptoms Of Fentanyl Withdrawal

The most immediate, recognizable signs of fentanyl withdrawal are typically physical. Symptoms include chills, sweating, fever, nausea, vomiting, diarrhea, and severe muscle and bone pain. Additionally, many people feel extremely compulsive urges to retake the drug, sometimes accompanied by the sensations of a rapid heartbeat and elevated blood pressure, and more stress on body systems if they have existing health issues. The Substance Abuse and Mental Health Services Administration (SAMHSA) notifies that these physical symptoms can be mild or severe depending on the dose and how long the drug has been used.

Negative Psychological Effects Of Withdrawal

Fentanyl withdrawal can also be equally debilitating, psychologically. Many of them feel depression, anxiety, insomnia, and restlessness. As the brain has become used to the euphoric and numbing effects of fentanyl, these symptoms follow as the brain adjusts to life without it. According to The National Institute on Drug Abuse (NIDA), severe anxiety and irritability during withdrawal are highly dangerous as they warrant a significant risk of relapse [3]. Managing this part of withdrawal often requires psychological support, and sometimes medications to minimize anxiety or depression.

It is especially difficult to kick the habit of fentanyl, which is so powerful and immediate in its effects. Fentanyl’s ability to bind to opioid receptors in the brain is so strong (its affinity is high) that it is incredibly potent and also, therefore, extremely addictive. Sustained withdrawal from fentanyl without strong support networks or medical intervention is exceedingly difficult because even when someone decides to quit, the combined physical and psychological symptoms don’t allow it to be sustained.

Fentanyl withdrawal frequently spreads into relapse and cravings tend to peak during the early and peak phases of fentanyl withdrawal. If someone relapses, there are medications, such as methadone, buprenorphine, or naltrexone that can manage cravings by blocking the effect of fentanyl, and help make it easier to get off the drug. Behavioral therapists, support group facilities, and structured recovery programs also play an important part in resolving the psychological factors that make fentanyl craving start, managing triggers, and building up resilience.

Medical Vs. Natural Detox Approaches

Medical detox is usually the safest way to go with fentanyl withdrawal, as it involves a controlled environment such as a hospital or detox center where healthcare professionals can keep an eye on symptoms and treat them as they happen. There are medications available that can ease the unpleasant symptoms of withdrawal making the whole process more comfortable. On the flip side, without professional supervision, at home or natural detox lacks the benefits of having a skilled person supervise you during the process and can expose you to complications and relapse risks because symptoms are harder to control without helping hands.

How Long Will Fentanyl Detox Last

Most fentanyl detox lasts 1 to 2 weeks, and the greatest symptoms can begin within the initial several days. How long is it going to last, though, varies from person to person depending on your particular factors and the specific detox method you chose. Oftentimes medically supervised detox is more effective and will shorten the amount of time required to safely detox. On the other side, however, natural detox takes longer and makes the onset of symptoms more difficult to tolerate, increasing rates of relapse.

What Is Fentanyl Rapid Detox?

Fentanyl rapid detox is akin to the fast track: patients are sedated, with the effects of withdrawal symptoms quickly addressed under very close medical supervision. During this procedure, medications are given to get the detoxification process to speed up withdrawal as well as to reduce the withdrawal symptoms and make the withdrawal period short. Rapid detox is conducted in a hospital or a clinic and usually takes between a couple of hours and a day, during which patients are watched for any side effects. Research studies are divided on its efficacy, side effects, and long-term recovery outcomes.

Risks And Benefits Of Rapid Detox

The main benefit of rapid detox lies in the fact that people are put under sedation and don’t feel all the manifestations of withdrawal symptoms. For those who worry about fentanyl withdrawal being too intense, this method is attractive. But rapid detox is by no means risk-free; complications including respiratory distress, heart rhythm problems, and even death, may happen. Research from the American Society of Addiction Medicine (ASAM) showed that despite the instant relief that may be provided by rapid detox, it doesn’t treat the psychological side of addiction that’s so critical for continued recovery [4]. Rapid detox must be assessed carefully and in consultation with a healthcare provider before it is pursued by patients.

Home Detoxification Risks

It is highly risky for individuals to try to detox at home because symptoms can be intense and unpredictable. Physical symptoms can come on quickly, and rapidly become serious, with symptoms including dehydration, nausea, vomiting, and severe muscle pain. Psychological symptoms like intense anxiety and depression can make it even more complicated, breaking down the odds of relapse or self-harm. If you are taking opioids such as fentanyl, the National Institute on Drug Abuse (NIDA) warns against an at-home detox, since withdrawal may require medical support.

When Professional Help Is Necessary

If you’ve been using fentanyl for a long time, or are taking high doses, professional help is necessary. In a clinical setting, medical staff can administer drugs to help control withdrawal symptoms and keep an eye on vital signs to avoid problems. In addition to physical support, therapy, and counseling, they give you access to psychological support that allows you to overcome those emotional issues that come with withdrawal. Because of these risks, the safest detox procedure is typically perceived as an inpatient (if you go to a medical detox center) or medically assisted outpatient, but never detoxing at home.

Luxury Detox Centers Have Some Of The Most Prized Features

A luxury detox center presents a very comfortable environment, with a high-end environment equipped with private rooms, gourmet meals, fitness services, and recreation options. Many of these centers will engage the holistic treatments such as acupuncture, yoga, and mindfulness exercises to help the patient detox. Because it focuses a lot on relaxation, it can help to wither away the asphyxiating physical and psychological process of withdrawals.

How Holistic And Personalized Care Are Contributing To Detox

Unlike most fentanyl detox centers, luxury detox centers will offer individualized detox treatment programs focusing on both aspects of fentanyl withdrawal – the physical and psychological. Along with medical detox, these facilities sometimes offer one-on-one counseling, group therapy, and post-recovery preparation to cultivate long-haul sobriety. In luxury centers, holistic care is an approach that tries to explore deep underlying mental health issues and creates a supportive system/lifestyle. For those at high risk of relapse, the personalized attention from being in such an environment during the vulnerable part of the withdrawal phase can be invaluable.

1. U.S Centers For Disease Control And Prevention. Preventing Opioid Use Disorder. https://www.cdc.gov/overdose-prevention/prevention/preventing-opioid-use-disorder.html

2. WebMD. Post-Acute Withdrawal Syndrome and Opioids. https://www.webmd.com/mental-health/addiction/opioids-post-acute-withdrawal-syndrome

3. National Institute On Drug Abuse. Fentanyl. https://nida.nih.gov/research-topics/fentanyl

4. The American Society of Addiction Medicine (ASAM). Opioid Withdrawal. https://sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/docs/default-source/guidelines/npg-jam-supplement.pdf?sfvrsn=a00a52c2_2

FAQs

Can You Die From A Fentanyl Withdrawal?

Fentanyl withdrawal isn’t fatal by itself, but it can cause severe symptoms that pose a significant danger to your health when left untreated. Withdrawal can lead to dehydration, high blood pressure, increased heart rate, severe anxiety that puts stress on the cardiovascular system, etc. Moreover, the strong cravings and psychological stress of withdrawal raise the possibility of relapse, and a flight back to fentanyl would likely break the tolerance and lead to overdose. That’s why you should always detox and withdraw under medical supervision as the complications can be handled timely and duly and support will be provided to make the withdrawal process as safe as possible.

Can You Quit Fentanyl Cold Turkey?

Fentanyl withdrawal symptoms and cravings are so intense that it’s almost impossible to quit fentanyl ‘cold turkey.’ However, for many people cutting out cold turkey unfortunately results in severe physical and mental distress including feelings of intense nausea, sweating, pain, and anxiety. Withdrawal symptoms are safely handled and relapse is lowered by the use of a slow taper of medications or medication-assisted treatment (MAT), which clinicians usually recommend. Generally quitting cold turkey without professional support is not advised as it may increase your risk of complications, or see you just as quickly return to use, due to the overwhelming symptoms.

How Do You Know If Someone Is Ready To Start Fentanyl Withdrawal Treatment?

Individuals are ready to begin fentanyl withdrawal treatment when they express a strong desire to quit or when they show motivation to recover. Other signs are an increased self-awareness of the negative effects of fentanyl use on health, relationships, or daily responsibilities. If there’s proof a person has high-risk behaviors that could result in an overdose and/or severe side effects from long-term use, withdrawal treatment can begin whenever medical professionals determine it is necessary.

What Dietary Or Lifestyle Changes Ease Fentanyl Withdrawal Symptoms?

Some dietary and lifestyle changes can help support the body during fentanyl withdrawal. However, owing to the active use and metabolic effects of fentanyl, even a nutritious and healthy diet would suffice and restore the energy levels. Hydrating can help with both withdrawal and better assimilation of dietary nutrients, as can regular mild exercise as tolerated, and some relaxation techniques such as deep breathing. While these changes aren’t substitutes for medical care, they can be beneficial during withdrawal physically and emotionally.

What Is The Difference In Fentanyl Withdrawal From Other Synthetic Opioids Like Tramadol?

Since fentanyl is powerful and can attach to opioid receptors quickly and strongly, fentanyl withdrawal is likely to be more severe than withdrawal from other synthetic opioids, such as tramadol. For instance, the milder opioid effect can also raise serotonin and norepinephrine levels and cause withdrawal symptoms that are slightly different. On one hand, both drugs can cause great discomfort in the withdrawal process, but because fentanyl has higher addiction potential and induces more dramatic withdrawal symptoms, management of its withdrawal is more comprehensive.

HOW THE BALANCE CAN HELP WITH Opioids

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