Fentanyl Withdrawal Symptoms: What to Expect

Fear of withdrawal is probably one of the biggest reasons why many have difficulty entering into addiction treatment.

The prospect of feeling sick, being uncomfortable, having extreme emotions, and possibly relapsing after all that effort can seem unbearable. Knowing that withdrawal from fentanyl will be unpleasant but temporary is helpful. Furthermore, knowing what to expect during withdrawal is beneficial as well. Withdrawal symptoms may look different from person to person, but they  happen in a predictable pattern, and there are steps you can take to ensure a safe and successful transition.

Common Fentanyl Withdrawal Symptoms

Fentanyl is a very potent synthetic opioid that the body quickly becomes accustomed to, and when fentanyl use is stopped, it then takes the brain and body time to adjust to its absence[1]. Withdrawal symptoms result from this necessary adjustment, and the intensity and types of symptoms experienced will vary from individual to individual.[2]

We’ll describe them in more detail by stage of withdrawal.

Early Withdrawal Symptoms

Typically within hours of discontinuing fentanyl, users report:

• Anxiety
• Restlessness
• Yawning
• Runny nose
• Itchy or watery eyes
• Sweating
• Insomnia
• Mild muscle aches
• Craving

Peak Withdrawal Symptoms

After early symptoms occur, the majority of users experience worsening withdrawal symptoms. At this stage, the majority of users will encounter:

• Extreme muscle pain
• Bone pain
• Nausea
• Vomiting
• Diarrhea
• Abdominal cramping
• Chills
• Goose bumps
• Enlarged pupils
• Irregular heartbeat
• Shaking or tremors

Withdrawal symptoms affect both the body and mind. Alongside physical discomfort, many individuals experience:

• Sadness or depression
• Anger and irritability
• Panic attacks and mood swings
• Difficulty concentrating
• Sleep disturbances
• Strong cravings

Withdrawal cravings are usually stronger due to the fact that fentanyl affects the brain’s reward pathway. Without fentanyl’s presence in the system, the brain has difficulty naturally stimulating production of sufficient levels of dopamine to replace the feelings associated with fentanyl use. This causes the brain to create intense cravings to return to fentanyl once it realizes it cannot obtain sufficient amounts of dopamine on its own.[3]

Timeline for Fentanyl Withdrawal Symptoms

Opioid withdrawal timelines are highly dependent on multiple factors; specifically, the type of opioid used, frequency and dosage level, and length of time used.[4] A generalized example of what can be expected with regard to the fentanyl withdrawal timeline is below:

The First 24 Hours

Users typically exhibit anxiety, excessive sweating, restlessness, increased craving for fentanyl, and insomnia in the first day after they stop taking the drug. Due to fentanyl’s rapid elimination from the body, withdrawal symptoms appear earlier than would be seen with longer-acting opioids.[5]

Days 2–5 (Peak Withdrawal Time Frame)

This time frame represents the greatest degree of physiological distress. Users may experience intense vomiting, diarrhea, severe abdominal cramping, muscle pain, chills, and may struggle to fall and/or stay asleep. Cravings for fentanyl also tend to peak during this timeframe.

Relapse rates are higher these days, as the intense discomfort of symptoms often leads users to seek relief by returning to fentanyl use. Support at this phase is crucial. Tolerance to opioids drops quickly after even a short period of abstinence and returning to a previously safe dose at this time dramatically increases the risk of overdose.[6]

Days 5–7

By this time frame, physical symptoms have begun to subside. Appetite returns gradually, hydration becomes easier, and other physical symptoms such as nausea and vomiting subside. Sleep disturbances may persist for additional days.

Two Weeks + (Post-Acute Withdrawal)

Although physical symptoms diminish significantly by week two or later, many users report persistent fatigue, lack of motivation, insomnia, anxiety, depression, and cravings for weeks, months, or even years after acute physical symptoms have diminished.

This prolonged emotional healing process is sometimes termed post-acute withdrawal syndrome (PAWS).[8] While PAWS is not being emphasized here as a primary concern, understanding that emotional recovery typically takes longer than physical recovery is valuable knowledge.

Factors Affecting Duration of Fentanyl Withdrawal Symptoms

While everyone experiences withdrawal in a unique way, various factors affect how long symptoms last and how severe they become:

• Duration of fentanyl use
• Dosage level used
• Frequency of use
• Method of administration
• General health status/liver function
• Presence of other substances used concomitantly
• History of co-occurring mental illnesses
• Prior exposure to another opioid

Preparing for Each Phase of Fentanyl Withdrawal

Understanding what to expect during each phase of withdrawal can alleviate some uncertainty and provide reassurance that you can navigate this challenging process safely.

Pre-Withdrawal Preparation

• Discuss expectations with a medical professional, as well as discuss available resources for support.
• Establish relationships with family, friends, support personnel, and treatment teams who will be able to support you during withdrawal.
• Eliminate access to fentanyl.
• Stock up on hydrating beverages and easy-to-eat food options before starting withdrawal.
• Schedule leave from employment, work, and/or school commitments if possible.

During Peak Symptoms

• Drink plenty of water, electrolytes, and fluids.
• Eat small portions of easily tolerated foods.
• Engage in gentle exercises when able.
• Soak in warm baths or showers to ease muscle aches.
• Get as much rest as you need

Emergency Signs

Displaying any of the below signs during withdrawal warrants immediate medical intervention:

• Inability to retain liquids and severe dehydration (typically due to diarrhea and vomiting)
• Chest pain
• Difficulty breathing
• Severe confusion
• Seizures
• Thoughts of suicide

If you or anyone you know is thinking about ending their life, call or text 988 Suicide & Crisis Lifeline immediately for assistance.

The Importance of Professional Treatment

Using professional healthcare treatment services generally promotes safer outcomes than self-directed detoxification. Professional treatment services, whether inpatient or outpatient, provide individually tailored support addressing a patient’s history and current needs.

A medical detox can also provide FDA-approved medications such as buprenorphine, methadone, clonidine, and lofexidine, which can help with withdrawal symptoms and lower the risk of relapse.[9]

Professionals are readily accessible to provide medical management for emerging symptoms as well as provide counseling focused on the emotional aspects related to recovery. Individuals managing drug use and co-occurring mental health disorders receive integrated treatment focusing on both concerns simultaneously rather than separately. Ongoing development of relapse prevention plans and recovery support networks assists patients in maintaining stability throughout their extended recovery process.

You Don’t Have To Do This Alone

Fentanyl withdrawal is both physically and emotionally taxing, but follows a predictable sequence, and your symptoms will improve with time.

Both medical treatment and professional care can help with creating a safer environment than doing this by yourself. If you or someone you know is contemplating stopping use of fentanyl, or if they are currently going through withdrawal, please understand that help is available, and that you don’t have to walk this road by yourself. Asking for help is usually the first step towards long-term recovery.

Epiphany Wellness understands that recovery from fentanyl addiction involves great challenge and trauma, and we approach care with compassion and an appreciation for our clients’ individual journeys. Reach out today to see what treatment could look like for you.