The first step of recovering from fentanyl addiction is ridding the body of fentanyl and its toxic metabolites. This process is known as detoxification or detox. As the body clears the fentanyl and adjusts to its absence, the unpleasant experience of withdrawal occurs.
Many people who use substances want to escape their addiction, but fear of withdrawal keeps them from trying. However, millions of people have found long-term recovery, and that period of detox and was a small but necessary price to pay for huge rewards.
Fortunately, withdrawal and detox symptoms can be managed in a medical setting. By participating in an inpatient detox and withdrawal program, people can get through the experience safely and more comfortably.
Doctors in the ER use fentanyl for sedating patients briefly during painful procedures, such as fixing a dislocated shoulder or straightening a broken bone, or for end-of-life pain management for terminal patients. Fentanyl is extremely potent, so ER doctors can use a tiny dose. It has a very quick onset of action and is quickly eliminated from the body.
These same properties — high potency, quick onset of action and short half-life — make fentanyl ideal for drug dealers. Tiny amounts of the powder can be put into drugs to increase potency, make “fake” drugs, or make it easier to smuggle. People get high very quickly, and then the drug is rapidly metabolized by the body. This makes withdrawal symptoms appear quickly, and people who use fentanyl are compelled to go out and pick up another dose very soon.
Many people are addicted to fentanyl without even realizing it. Some illicit drug dealers make fake heroin with it, and many people treated for “heroin” overdose have no actual heroin in their system. The drug they thought was heroin was simply fentanyl and cutting agents. Even cocaine — a non-opioid — is being faked with fentanyl.
Synthetic opioids, such as fentanyl and its related compounds, are currently the main drivers of drug overdose deaths in the U.S. This makes recovery from drug use more urgent than ever before.
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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 that case, withdrawal symptoms usually start within 24 to 36 hours of removing the patch.
Stages of Fentanyl Withdrawal Symptoms
The duration of fentanyl withdrawal can be broken down into three stages:
Some of the first fentanyl withdrawal symptoms to appear include:
- Intense cravings
- Diaphoresis (intense sweating)
- Muscle aches
- Runny nose
- Shaking, hot and cold chills, goosebumps
The peak withdrawal effects are usually seen two to four days after the last use of the drug. These usually last until about a week after the last use.
After the acute detox period — usually about a week or so in most individuals — the longer-term symptoms become prominent. These are primarily psychological, but physical cravings can occur. Typical psychological symptoms include:
- Relapse dreams
- Anhedonia (inability to experience pleasure)
- The “pink cloud” syndrome (excessively happy feelings, ignoring the reality of life)
- Negative feelings typical of addiction: guilt, remorse, self-loathing, low self-esteem and anger
These symptoms are an especially potent cause of relapse. Because of them, proper rehab treatment is necessary to help people return to good mental and physical health and maintain lasting recovery from substance use.