Fentanyl withdrawal produces a range of mentally and physically distressing symptoms like cravings, nausea, and pain. Those interested in ending use may encounter a distressing withdrawal process, and those at risk should always consult with a professional to ensure safety. Fentanyl is a powerful opioid substance that carries the risk of addiction, dependence, and overdose for anyone using the drug.
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What Is Fentanyl Withdrawal?
Fentanyl withdrawal is a very uncomfortable and sometimes life-threatening condition that occurs when someone dependent on fentanyl abruptly stops or reduces their intake of the substance. Fentanyl withdrawal is caused by the body becoming imbalanced by the lack of fentanyl in the system and struggling to adjust to normal functioning without an opioid.1, 2
Fentanyl is a synthetic opioid substance sometimes prescribed to manage pain. It is about 100 times more potent than morphine. Fentanyl is one of the drugs fueling the opioid overdose crisis in the U.S. The number of overdose deaths involving synthetic opioids rose by 1800% between 2013 to 2020.3
When a person uses fentanyl, the drug produces chemical changes in the brain by influencing the release of certain neurochemicals. With frequent use, increasing amounts, or erratic use, the body and the brain begin adjusting to the higher levels of these neurotransmitters, which triggers higher tolerance and creates a physical dependence on the substance. Here, fentanyl is needed to feel well and function normally.
With fentanyl, physical dependence and addiction overlap greatly, but they are not the same. Addiction, sometimes called a substance use disorder, is a psychological effect of drug use that impacts a person’s actions and thoughts. Someone can be dependent without being addicted and addicted without being dependent or experience dependence and addiction simultaneously.1, 2
Fentanyl addictions and dependence will have similar features as the symptoms of other opioid addictions, so someone using heroin, oxycodone, or morphine will share similar experiences. However, the potency of fentanyl may make the dependence and withdrawal more intense and more dangerous.3
Fentanyl Withdrawal Symptoms
Fentanyl withdrawal symptoms will have similar symptoms to other opioid withdrawals when someone stops or dramatically lowers their dose, with differences related to the timing and intensity of their symptoms. The discomfort of fentanyl withdrawal symptoms can start just a few hours after the last dose, so people should plan ahead. But if stopping fentanyl unexpectedly or without advance planning, they should get medical attention right away, even before any withdrawal symptoms begin.2
The likelihood of fentanyl withdrawal symptoms and their severity will vary due to individual factors like:1, 4
- Duration of opioid use. Ending opioid use after more than six months is highly associated with withdrawal, but people could note symptoms after only two weeks of use.
- The dose used. Higher doses of fentanyl are linked to increased risk from withdrawal.
- Previous experiences with opioid withdrawal
Fentanyl withdrawal symptoms may include:
- Agitation
- Anxiety
- Depression
- Watery eyes
- Runny nose
- Insomnia
- Sweating and fever
- Yawning
- Nausea, vomiting, and diarrhea
- Muscle aches and pain
- Cramping
- Goosebumps
- Uncontrollable leg movements
People who are experiencing fentanyl withdrawal may experience all or some of these symptoms. They could come at once or in waves. In any case, a person should always prioritize their safety and well-being.
Fentanyl Withdrawal Timeline
Like other substances, the fentanyl withdrawal timeline varies from person to person, but there are some standard milestones to consider. Depending on the dose and duration of use, fentanyl withdrawal symptoms can begin as soon as a few hours after the last use.2 From there, symptoms may build and peak within three days.5 Acute symptoms may remain intense for several days and begin to fade after a week.5 Some longer-lasting opioid withdrawal symptoms, like low mood, can last for weeks or months after use stops.
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Risk Factors & Causes of Fentanyl Withdrawal
It’s important to note that fentanyl dependence can occur even when the drug is used as prescribed. People who never misused their medication could still feel fentanyl withdrawal when stopping the drug.
Fentanyl Withdrawal Treatment
Fentanyl withdrawal should always occur under the care and guidance of addiction professionals. Like other opioid treatments, the best course of action is dependent on the level of use, physical health status, and previous attempts at withdrawal. Fentanyl withdrawal treatment can take place at various levels of inpatient or outpatient care. The professionals will recommend a course of treatment that involves ending use, tapering fentanyl dose or frequency, or switching to another opioid and then beginning a tapering schedule.
Addiction treatment resources that may be helpful for Fentanyl withdrawal include: 1, 6
At Home Care
At-home care for fentanyl withdrawal is not common and should only be attempted with the direction of an addiction or medical expert. Any substance withdrawal experience has a level of uncertainty and unpredictability, so withdrawing from home can reduce safety.
Some things you can do to prepare for an at-home detox include:
- Receive approval from a professional: Unless you have a medical expert explicitly advising an at-home detox, do not attempt it.
- Establish a weaning schedule: Your doctor may recommend a specific system for gradually taking less medication to reduce symptoms, and you should stick to the plan.
- Gather your support system: Don’t try to detox alone. Ask your loved ones to check on you and spend time at your home.
- Care for your physical health: Detox places a lot of stress on your body, so prepare good foods and drinks to stay hydrated and fed.
Rehab & Detoxification Centers
Many people will need the safety, structure, and medical support of rehabilitation centers during their fentanyl withdrawal. Detox centers are available in acute care hospitals and stand-alone treatment centers and allow you to live at the treatment center for the duration of your detox. They provide 24-hour care from a team of medical and mental health professionals to help you experience the withdrawal process as safely and comfortably as possible.
Intensive Outpatient Programs
Outpatient programs offer a compromise between the security of detox centers and the freedom of at-home withdrawal. Intensive outpatient programs (IOPs) can offer multiple hours of treatment each day or several days per week to monitor and treat your fentanyl withdrawal process. Professionals can offer medications, encouragement, and support to help your detoxification.
Therapy & Support Groups
Most fentanyl withdrawal treatment focuses on managing the physical health symptoms of an individual, but caring for the person’s mental health is important as well. After the acute symptoms have faded, the person can attend group therapy or support group sessions to meet with people in similar situations to gather information and build a sense of community.
Therapeutic methods that can help address addiction and chronic withdrawal symptoms include:7
- Cognitive behavioral therapy (CBT): By connecting thoughts, feelings, and behaviors, CBT can help you understand triggers of use and warning signs of cravings to maintain recovery.
- Contingency management (CM): CM offers rewards and positive reinforcement for staying away from alcohol and other drugs to encourage recovery and healthy lifestyle choices.
- Motivational interviewing (MI): MI develops internal motivation for change by emphasizing your goals and what you’re doing to accomplish them.
- Family therapy: Based on the understanding that addiction can be a family issue, family therapy helps improve relationships and build more effective communication styles.
Any other therapy styles that address the underlying roots of addiction are beneficial. Treatment options like dialectical behavior therapy (DBT), eye movement desensitization and reprocessing (EMDR), and acceptance and commitment therapy (ACT) may be helpful choices after the acute withdrawal phase is completed.
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8 Ways to Cope With Fentanyl Withdrawal Symptoms
Fentanyl withdrawal can be an extremely uncomfortable and distressing process. With time, patience, and the use of healthy coping skills, symptoms will improve, and you can return to the type of life you’ve been missing.
Here are eight tips to help alleviate fentanyl withdrawal symptoms:1, 2, 6
- Follow doctors’ orders. Your healthcare team should provide specific instructions about managing your fentanyl withdrawal symptoms before they begin.
- Consider medications to assist. Medications like methadone, buprenorphine, and clonidine provide helpful assistance with fentanyl dependence. Discuss options with your treatment team.
- Wean off slowly. Rather than switching to another opioid, you may be encouraged to reduce your prescription fentanyl dosage slowly over time. This process helps reduce withdrawal symptoms, but you must adhere to the plan to get the best results.
- Stay hydrated. Withdrawal is a physically demanding process, so you must tend to your physical health. Start by staying hydrated to avoid complications from diarrhea and excessive sweating.
- Eat regularly and move your body. During the first days of detox, energy and appetite may be low, but as symptoms reduce, healthy foods and some level of exercise for your mental health will be an important part of your recovery.
- Practice self-care. Being kind to yourself in the hours and days of withdrawal through self-care practices will be essential. Practice good hygiene, take a long shower, or treat yourself to your favorite show or new movie to ease the discomfort of withdrawal.
- Seek care from non-dependent people. Having supportive, recovery-focused people around you is a key element to recovery. Stay focused on recovery and health while sharing your experience with encouraging support.
- Avoid shortcuts. Since withdrawal may seem long and uncomfortable, some people seek out shortcuts to speed up or add comfort to the process. Many of these shortcuts add a level of risk and increase relapse. Stick to your doctor’s recommendations.
Final Thoughts
With any type of withdrawal, side effects vary based on individual differences. Due to the potential physical and mental health effects, it’s important to discuss stopping fentanyl use with your care team and family before taking the first step. A thoughtful plan has a better chance of creating long-term recovery and improved health.
Additional Resources
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