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.
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What is Fentanyl Withdrawl?
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.
Fentanyl Withdrawal Timeline & Symptoms
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.
The Stages of Fentanyl Withdrawal
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.
How Long Does Fentanyl Withdrawal Lasts
Fentanyls’s withdrawal timeline and duration is variable. It depends on several factors, including:
- The individual’s state of physical and mental health
- The genetic and biological characteristics of the individual
- The duration and intensity of the drug use
- Whether or not withdrawal was medically assisted
For most people, withdrawal symptoms taper off and end after 7-10 days.
Fentanyl Withdrawal Medications
There are currently three medications approved by the FDA for use in treating opioid withdrawal:
- Methadone: opioid replacement
- Buprenorphine: opioid replacement
- Extended-release naltrexone: blocks opioid effects
With opioid replacement therapy, a long-acting opioid medication such as methadone or buprenorphine is used to keep drug cravings and withdrawal symptoms to a minimum. Then, the dose of these drugs is tapered in a slow and controlled manner until the recipient is opioid-free.
Of the two FDA-approved opioids for the treatment of fentanyl withdrawal, buprenorphine generally has a more favorable side-effect profile than methadone. The buprenorphine product Suboxone is commonly used during opioid detox. Besides buprenorphine, Suboxone also contains naloxone, which blocks opioid receptor sites to prevent any attempts of abuse.
Extended-release naltrexone is a non-opioid medication, but it reduces cravings by blocking opioid receptors in the brain. If the recipient relapses and uses opioids, the naltrexone will block the physical effects of the drug. Unfortunately, the recipient must already be detoxed from fentanyl for at least a week before starting this medication. Otherwise, it will worsen the withdrawal symptoms.
Other medications may also be used during fentanyl detox in order to help with specific symptoms. These include sedatives, such as benzodiazepines, and the medication clonidine, which helps reduce some withdrawal symptoms.
Fentanyl Withdrawal Deaths
Despite the toxic lethality of fentanyl, withdrawing from fentanyl use is safer than withdrawing from alcohol. Opiate withdrawal, however, is occasionally fatal. When people die from fentanyl withdrawal, it’s usually due to vomiting and diarrhea, which are typical withdrawal symptoms. If left untreated, these symptoms can rapidly dehydrate the body and cause dangerously high levels of sodium to accumulate in the blood (hypernatremia). This can cause the heart to fail.
These cases occur when people withdraw from fentanyl on their own, usually in the jail setting. Such deaths can be prevented by medical supervision in a detox facility.
Fentanyl Withdrawal Cold Turkey
Stopping fentanyl “cold turkey” results in a rapid onset of withdrawal symptoms that are usually severe. The risk of relapse during withdrawal is high, as the craving to use fentanyl to stop the symptoms can be overwhelming. When people try to self-taper their fentanyl, they are rarely successful because the ability to control substance use is not in the nature of addiction.
Quitting cold turkey is not recommended, as it is the most difficult way to stop fentanyl use. Rather, medically supervised detox and medications, fentanyl abuse counseling support and symptom management make the experience much easier, safer, and more likely to result in a successful recovery.
Fentanyl Withdrawal Tips
The biggest tip for heroin withdrawal is to not do it alone. Withdrawal is usually a cruel ordeal, and the willpower to overcome addiction is rarely enough to make it through. There is excellent professional help available to make withdrawal safe, comfortable and provide a foundation for long-term recovery. A specialized treatment facility with medically assisted detox is the safest method for quitting fentanyl use and avoiding relapse.
Fentanyl detox is the medically supervised withdrawal from fentanyl for optimal safety and comfort. Detox should be done as part of an overall plan for recovery. It is important to keep in mind that recovery from substance addiction takes much more than simply ending drug use. The underlying causes of the addiction and the mental devastation from the addiction itself must be addressed for the best chances of a successful recovery.
Medical Detox from Fentanyl
Medical detox involves the use of medications and medical supervision to safely withdraw from fentanyl or other substance use. An inpatient detox program forms the first part of a substance addiction treatment program and is a natural transition to counseling, which forms a crucial part of the overall treatment plan.
Can You Detox From Fentanyl at Home?
When deaths have occurred from fentanyl withdrawal, they have almost always been in people who were alone at the time. Because of fentanyl’s ultra-high potency and its short half-life, withdrawal from this opioid can be especially harsh, and people who try to detox on their own might not succeed. They are putting themselves through unnecessarily difficult symptoms.
People considering detoxing from fentanyl at home should do so under the care of their doctor. They should also be honest with their doctor about their drug use so they can receive the appropriate advice and care.
The internet is brimming with various chemicals and remedies that are promised as a way to detox from fentanyl, but caution is advised. Most are unproven, untested and unregulated. It is advisable to speak with a healthcare professional before taking any such medicines.
There are some over-the-counter medications that can help with some of the withdrawal symptoms, such as antidiarrheals and antinauseants to help with stomach symptoms and acetaminophen for muscle aches.
People who plan to detox at home should have some characteristics in place:
- They have not been addicted to fentanyl for long
- They should have a stable and supportive home environment
- They should not live alone, and the people at home should be aware of the detox situation
- They should be highly motivated to recover
Remember that detox does not in any way constitute treatment for fentanyl addiction. People should find treatment to address the reasons behind the substance use and recover from the mental and physical damage caused by drug use.