Fentanyl Withdrawal Symptoms & Timeline: The Fatal Risks Associated With Using This Drug

The current threat of illicit drugs to the very fabric of American life cannot be understated. Countless lives have been affected by this scourge already, and countless more lives hang in the balance. Not only the lives of the people using the drug, but also the friends and family members who care about and love them. Most people are familiar with the names of the more well-known drugs like marijuana, cocaine, heroin, and meth, but there is a relatively new chemical assassin that is hitting the streets in more and more areas, both rural and metropolitan.

This drug is called fentanyl, and it is a synthetic opioid that is about 50 times stronger than heroin and 50 to 100 times stronger than morphine.[1] It was initially developed in the ‘60s as an anesthetic that was administered intravenously, but in recent years it has found a new home as a street drug due to its low cost and incredible potency. It is also used in limited cases on a prescription basis for individuals with chronic extreme pain that cannot be reduced or otherwise mitigated by less potent analgesics like morphine or oxycodone.

Fentanyl is so powerful in even small amounts that it is often only used in prescription cases where the individual suffering from pain has already been prescribed opioids previously and has become accustomed to them or developed a tolerance to their effects. It is not only available in pill form but is also commonly administered in a transdermal patch that allows absorption through the skin over time, as well as lozenges that dissolve in the mouth. In rare cases, it may be prescriptively administered by injection.

How Does Fentanyl Work?

All opioids, fentanyl included, act on the central nervous system via receptors in the brain and chemically block out many pain sensations. These receptors are also responsible for releasing dopamine, a powerful neurotransmitter that signals the pleasure centers of the brain, creating feelings of euphoria and bliss. Those who are prescribed fentanyl and are not misusing the substance will generally only feel the relief of the pain the drug was prescribed to manage, while those who use fentanyl illicitly, misuse their prescription, or use the drug recreationally will feel the powerful euphoric feelings the opioid drug family is usually known for.

This misuse or abuse of fentanyl or fentanyl derivatives is incredibly dangerous. It can not only cause a long list of potential health issues and medical conditions, but the drug can also be the cause of a possibly fatal overdose situation. While most fentanyl addicts will buy the drug knowing exactly what it is, this is something that cannot be guaranteed in some cases.

Overdose Potential

Fentanyl is becoming a common cutting agent in heroin, adding cheap bulk to the product so dealers can make more money.[2] The problem with this is that people buying heroin often know their dose, but when part of that dose is composed of fentanyl, and they don’t realize it or are unfamiliar with the effects, it can be deadly. Since the person will take much more fentanyl than their body can take, it can lead to incapacitation, respiratory depression, coma, and even death.

Signs that an overdose may be imminent or actively occurring include:[3]

• Labored or shallow breathing
• Lowered heart rate
• Low blood pressure
• Faint pulse
• Pupillary constriction
• Loss of consciousness or fainting
• Loss of mobility and speech
• Confusion and disorientation
• Muscle spasms
• Hallucinations
• Seizure

According to the Centers for Disease Control and Prevention, over 70,000 synthetic opioid deaths occurred in 2022 alone,[4] with fentanyl as the primary cause. One of the most dangerous aspects of fentanyl overdose is that many people don’t know they’ve taken it. Even people with a high opioid tolerance are at risk for an overdose.

If the person can avoid all of the dangerous acute effects of the drug, they will often develop a dependency very rapidly. Once the chemical dependency is established in their system, they will experience withdrawal symptoms in as little as a few hours following their most recent dose if they do not take more. This can also lead to psychological dependence, where they consume the drug for fear of eventual or potential withdrawal symptoms.

What Do Fentanyl Withdrawal Symptoms Look Like?

Fentanyl withdrawal symptoms will generally reflect the most common opioid withdrawal symptoms. While they can vary in severity from person to person, the symptoms themselves rarely differ significantly. Once the dependency and addiction have been created, stopping the use of fentanyl or even reducing the dosage in some cases can immediately cause the withdrawal symptoms to begin. These symptoms will usually include:[5]

• Powerful and lasting cravings or urges to use fentanyl
• Flu-like symptoms
• Watering eyes
• Runny nose
• Increased agitation and irritability
• Uncontrollable, excessive sweating
• Intense and painful abdominal cramps
• Body-wide pain in muscles and bones
• Reduction in appetite
• Nausea
• Diarrhea
• Vomiting
• Dysphoria

In many cases, one of the most dangerous threats during the withdrawal stage is dehydration that occurs. In some people, the dehydration can be so severe that it carries the risk of seizure, and in some individuals, these seizures can prove fatal.

Additional signs of fentanyl withdrawal may emerge during the detox period, including insomnia, goosebumps, yawning, high blood pressure, and extreme restlessness. Many people report significant psychological symptoms like overwhelming anxiety or panic attacks, especially during the first 72 hours.

Timeline of Fentanyl Withdrawal Symptoms & How They Differ Person-To-Person

The timeline of fentanyl withdrawal symptoms will vary from person to person and will depend heavily on the abuse profile of the individual and the methods they use to complete a withdrawal. Many people who attempt the withdrawal stage solo end up experiencing a long period of more intense symptoms, but the overall process can be done quickly.

When the process is attempted with medical supervision in a controlled environment, the addiction professionals will often taper down the use over time. While this can make the withdrawal process much more comfortable and successful than a solo “cold turkey” quit, it can take longer since the individual needs to be weaned off the fentanyl.

In most fentanyl cases, the withdrawal stage will average about 5 to 7 days. This generally does not include the first few days following the absence of the drug, and under some circumstances, the withdrawal can go much longer. It is rare for people to experience intense withdrawal symptoms for more than 14 days in any scenario. If applicable, some people may obtain a recommendation from their healthcare provider for medically-assisted detox, which can drastically reduce withdrawal time.

Medically assisted detox is where qualified medical professionals administer a specific type of drug, called an opioid agonist, that chemically prevents opioids from binding with receptors and helps remove opioids from receptors they have already bound to. This forces the body to go without opioids on a very compressed time scale and can usually only be done when the person is in relatively good health aside from their addiction, since it places so much stress on the body.

Commonly used drugs include buprenorphine, a partial opioid agonist, and naloxone, a complete opioid receptor antagonist.[6] While buprenorphine binds to receptors and relieves some withdrawal symptoms, it doesn’t produce a high or pleasurable experience for the person. Naloxone completely blocks the receptors from all opioids in the system and only activates in the presence of opioids, otherwise remaining inactive in the system.

Clonidine may be used to reduce sweating, cramps, and high blood pressure. Loperamide can help with diarrhea.[7] These medications not only make withdrawal more comfortable but can help prevent complications like electrolyte imbalances caused by dehydration.

Are Fentanyl Detox Symptoms Dangerous?

Fentanyl withdrawal isn’t usually dangerous on its own, but the severe symptoms can cause serious complications like dehydration, electrolyte imbalances, and seizures, especially if you don’t have medical supervision.[8] That’s why medical detox is highly recommended for fentanyl detox.

How The Withdrawal Symptoms from Fentanyl Can Point to An Underlying Addiction

Fentanyl is a powerful opioid that can cause physical dependence in a short period of time, even if it’s taken as prescribed. Some people are prescribed fentanyl for severe pain and may not realize they’ve developed dependence until they miss a dose and experience symptoms. People using fentanyl recreationally may underestimate how quickly tolerance and withdrawal can develop. The key sign of dependence is the onset of withdrawal symptoms when fentanyl use is reduced or stopped. Fentanyl acts on the central nervous system quickly, so withdrawal symptoms often begin 6 to 12 hours after the last dose.

Dependence isn’t the same as addiction, though. Dependence refers to the body getting used to the drug, leading to withdrawal symptoms when it’s not present. Addiction has a behavioral aspect that leads to compulsive use despite harmful consequences, loss of control, and preoccupation with obtaining or using the drug.

If you notice that you’re relying on fentanyl to feel normal, increasing your dose over time, or continuing to use fentanyl despite adverse effects on your health or relationship, these may be signs of a fentanyl use disorder (fentanyl addiction). Experiencing withdrawal symptoms is a clear sign that your body has become dependent and may indicate a possible addiction.

How To Mitigate The Withdrawal Symptoms Experienced From Fentanyl: Seeking Professional Help

If you, a family member, a friend, or anyone else you care about may have developed an addiction to fentanyl, getting help from qualified local addiction experts can be the first step to a successful and long-lasting recovery. Reach out today to talk to a professional in complete confidentiality about your detox needs. By working with addiction professionals, not only can you receive fentanyl addiction treatment in a clean and comfortable environment, but you can complete the withdrawal stage much more safely by doing it with medical supervision and help.

Get Help for Fentanyl Addiction

Fentanyl withdrawal can be intense and possibly life-threatening if complications occur. The symptoms of fentanyl detox may indicate that professional help is needed to reduce the risk of overdose, alleviate uncomfortable symptoms, and start the recovery process.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more