What Is Fentanyl Withdrawal?

Fentanyl is a powerful synthetic opioid, which is a group of drugs used to manage severe pain. Chronic use of fentanyl and other opioids can lead to dependency on the drug, which means that your brain and body become used to the drug and dependent on its effects.

Due to this dependency, when you suddenly stop taking or reduce the amount of fentanyl used, your body will react in the form of fentanyl withdrawal symptoms, which can be dangerous as well as uncomfortable to experience.

Common Fentanyl Withdrawal Symptoms

Fentanyl withdrawal symptoms can be categorized based on the stage of withdrawal you are in. The stages and severity of withdrawal symptoms may be assessed and categorized by using something called the Clinical Opiate Withdrawal Scale, otherwise known as the COWS assessment tool.

Some early to moderate-stage fentanyl withdrawal symptoms may include:

  • Agitation
  • Anxiety
  • Aching muscles
  • Insomnia
  • Increased production of tears
  • Runny nose
  • Sweating
  • Yawning

Later stages or severe withdrawal symptoms that may appear include:

  • Abdominal cramping
  • Diarrhea, nausea, and vomiting
  • Dilated pupils
  • Chills and goosebumps

Some physiological symptoms, or symptoms impacting your body’s physical functioning, that may occur during fentanyl withdrawal include:

  • Tachycardia (fast heart rate)
  • Hypertension (high blood pressure)
  • Increased body temperature
  • Insomnia
  • Hyperreflexia (heightened reflexes)
  • Sweating
  • Increased respiratory rate
  • Muscle spasms

These withdrawal symptoms can be very uncomfortable and may cause dangerous complications.

The COWS Assessment Tool

When being managed in a treatment facility, providers will utilize the COWS scale, which is an assessment tool used to determine the severity of opioid withdrawal and its symptoms.

The scale consists of the most common signs and symptoms of opioid withdrawal and rates them on a scale of 0 to 47:

  • Mild withdrawal is considered to be a score of 5-12
  • Moderate withdrawal is considered to be a score of 13-24
  • Moderately severe withdrawal is considered to be a score of 25-36
  • Severe withdrawal is considered to be a score of 37 or greater

This tool is used by clinicians to determine the treatment plan and to know when to adjust the doses and types of medications being used during a supervised detox and withdrawal of fentanyl. It is also helpful to avoid under or overmedicating those going through fentanyl withdrawal.

How Long Is Fentanyl Detox?

The timeline for fentanyl detox and withdrawal can vary based on several factors, including:

  • How long a person has used fentanyl
  • The amount usually taken
  • Frequency of use
  • If the drug was used with other drugs or medications

Overall, fentanyl detox typically starts within 12 hours after the last dose and can last up to a few days to a week.

Fentanyl Withdrawal Timeline

Withdrawal symptoms occur after a period of refraining from fentanyl use.

8-24 Hours After Last Use

Usually, you’ll start to feel the first signs of withdrawal symptoms 8-24 hours after your last use of fentanyl. Symptoms usually experienced at this point are mild and may include mood changes such as agitation and anxiety, as well as mild physical symptoms such as sweating, yawning, runny nose, and aching muscles.

24-72 Hours After Last Use

After about 24-36 hours after your last use of fentanyl, you may experience what is known as the “peak intensity” of symptoms, which means that withdrawal symptoms are known to be at their highest intensity. These peak withdrawal symptoms can usually last between 36-72 hours after your last fentanyl use.

You may experience previously mild symptoms at a higher intensity, and more moderate symptoms, including gastrointestinal symptoms and physiological symptoms such as high blood pressure, high pulse rate, heightened reflexes, and more.

7-10 Days After Last Use

After 72 hours of fentanyl withdrawal symptoms, you may continue to experience the same withdrawal symptoms at a decreased or more mild intensity. This can last for 7-10 days after the onset of fentanyl withdrawal.

12 Days to a Few Weeks After Last Use

Although what is known as “acute” withdrawal typically finishes 7-10 days from your last use of fentanyl, you may experience mild symptoms for longer, up to even a few weeks. People who have used the drug for longer periods may experience something called post-acute withdrawal syndrome, or PAWS.

PAWS can present as persistent mild withdrawal symptoms impacting your mental health and daily functioning, including low mood, anxiety, depression, irritability, fatigue, and decreased focus.

How Do You Manage Fentanyl Withdrawal?

Although fentanyl withdrawal can be manageable at home, it is preferable to be managed in a facility, such as a detox treatment center. Staff at a treatment center will monitor your condition throughout the withdrawal process and can provide medical treatment for any uncomfortable withdrawal symptoms.

Medications to Manage Fentanyl Withdrawal

When treated in a treatment center, where fentanyl withdrawal symptoms can be closely monitored, you can expect to receive medications to help manage withdrawal symptoms. Providers may utilize medications such as methadone, naltrexone, or buprenorphine.

Methadone

Methadone is a medication commonly used in opioid withdrawal, including fentanyl withdrawal. This medication is a slow-acting, low-strength opiate used to help prevent and ease uncomfortable fentanyl withdrawal symptoms. After a short period of maintenance of this drug, the dosage may be slowly decreased over a longer period, helping to reduce the intensity of withdrawal symptoms and cravings for fentanyl use.

Buprenorphine

Buprenorphine, also known by its brand name, Suboxone®, is a commonly prescribed drug for fentanyl detox and withdrawal. It has been approved by the FDA as a detox and maintenance medication as an alternative to methadone in the setting of withdrawal, especially because it may shorten the length of detox time. This medication helps reduce cravings and physical withdrawal symptoms, like vomiting and muscle aches.

Naltrexone

Naltrexone is a drug typically used to prevent relapse from an addiction. If used while you still have opioids such as fentanyl in your system, you may experience sudden and severe withdrawal symptoms. Therefore, naltrexone is usually utilized after detoxing from fentanyl or during late withdrawal stages.

Additional Treatment Medications

Furthermore, common withdrawal symptoms may also be treated with other medications, such as anti-nausea medications for nausea and vomiting, ibuprofen for muscle pains, antidiarrheals for diarrhea, and more. Other medications may be utilized to help with physiological symptoms such as high heart rate, blood pressure, and temperature if necessary.

What Are The Dangers Of Fentanyl Withdrawal?

Like all opioid withdrawals, fentanyl detox and withdrawal carry many risks and potentially dangerous complications. These dangers lie within potential complications with the common withdrawal symptoms of nausea, vomiting, diarrhea, tachycardia (high heart rate), and hypertension (high blood pressure).

The complications these withdrawal symptoms can cause include:

  • Dehydration
  • Severe electrolyte imbalances that can impact your heart’s functioning
  • Cardiac arrest (heart attack)
  • Aspiration, which is when one vomits and breathes stomach contents into the lungs, can cause further complications of infection and pneumonia

Can You Die From Fentanyl Withdrawal?

Although uncommon, people can, and have, died from fentanyl withdrawal. Dangerous complications of withdrawal, such as dehydration, electrolyte imbalances, and heart attack, can ultimately lead to death.

Furthermore, the most common and perhaps lesser-known danger of fentanyl withdrawal is overdosing after relapse. Most people who have just finished detoxing or withdrawing from fentanyl and relapse into using fentanyl again, do not realize that they are at risk for overdosing on a smaller dose of fentanyl than they used to take, leading to an overdose death.

Find A Center To Safely Detox From Fentanyl

Treatment centers are equipped to help you safely detox from fentanyl and can help prevent dangerous and deadly complications of fentanyl withdrawal. Getting treatment for your fentanyl addiction can give you or your loved one a real chance at a safe recovery.

Explore Addiction Center’s rehab directory to find a treatment near you that can help you safely detox from fentanyl, address underlying issues, and create an aftercare plan for long-lasting recovery.

If you or your loved one is thinking about making a change in their life by quitting fentanyl, reach out to a treatment provider to learn more about your treatment options. Have a free, confidential conversation with a treatment provider to discuss the treatment process, verify insurance coverage, and get enrolled in a licensed drug treatment facility.