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Fentanyl Withdrawal: Symptoms, Timelines & What to Expect

Fentanyl withdrawal symptoms include fatigue, sweating, anxiety, and depression as well as increased pain sensitivity.

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The timeline for fentanyl withdrawal depends on individual drug use characteristics and other factors, but it generally lasts several days up to several weeks. Most people who have been misusing fentanyl benefit from medication-assisted treatment (MAT), so they can largely avoid the withdrawal process.

Understanding Fentanyl Withdrawal 

Fentanyl withdrawal symptoms occur due to the drug’s effects on function of the body and brain over time with repeat use. 

Fentanyl binds to opioid receptors. When someone continually uses the drug and those receptors are always activated by fentanyl, the brain adapts and becomes dependent on it, adjusting the function of other parts of the body in response.[1] If the person suddenly stops taking the drug, freeing up the opioid receptors and leaving the body to function without it, the physical and psychological response usually involves a slew of extreme withdrawal symptoms. 

The severity of these withdrawal symptoms can vary depending on factors such as these: 

  • The pattern of use
  • If other drugs of abuse are used
  • The dose taken daily (on average)
  • How long the person has been actively using fentanyl
  • Underlying medical issues
  • Co-occurring mental health issues

Fentanyl withdrawal is a challenging process. Attempting to quit using the drug without professional help can be dangerous because relapse is highly likely due to the discomfort of withdrawal, and fentanyl relapse can easily result in overdose, which can be fatal. 

Medically supervised detoxification and addiction treatment programs can provide support and medications to manage withdrawal symptoms safely and increase the chances of successful recovery.

Symptoms of Fentanyl Withdrawal

Fentanyl detox triggers a range of uncomfortable withdrawal symptoms that affect the person behaviorally, mentally, and physically.[1]

Behavioral Symptoms

  • Drug-seeking behavior
  • Social withdrawal
  • Restlessness
  • Irritability
  • Loss of interest in activities
  • Financial strain

Mental Symptoms

  • Anxiety
  • Depression
  • Difficulty concentrating
  • Mood swings
  • Suicidal thoughts

Physical Symptoms

  • Flu-like symptoms [2]
  • Gastrointestinal issues
  • Excessive sweating
  • Pupil dilation
  • Increased heart rate and blood pressure
  • Muscle and joint pain
  • Insomnia and sleep disturbances
  • Goosebumps 

Fentanyl Withdrawal Timelines & What to Expect

Fentanyl withdrawal timelines will differ for everyone based on the details of their experience, but in general, the timeline often unfolds as follows:[1]

Time Since Last DoseWithdrawal Symptoms
6–12 hoursEarly withdrawal symptoms begin and include the following:Anxiety and restlessnessMuscle aches and joint painSweating and chillsRunny nose and teary eyesInsomnia and difficulty sleeping
12–24 hoursSymptoms intensify, including these:Nausea and vomitingDiarrhea and stomach crampsIncreased heart rate and blood pressureDilated pupilsGoosebumps (“cold turkey” skin)
2–3 daysPeak withdrawal symptoms occur:Severe cravings for fentanylIntense anxiety and irritabilityMuscle and bone painDepression and mood swingsDifficulty concentrating
4–7 daysSymptoms gradually start to subside, but these may persist:Cravings for fentanyl Some mood swings and irritabilityLingering fatigue and difficulty sleeping
After 1 weekPhysical symptoms continue to improve, but these may continue:Psychological symptoms Emotional instability 
1 week and beyondPhysical symptoms should be mostly resolved, but these may still be present:Psychological symptoms Cravings Low energy levels 

Factors That Can Impact Fentanyl Withdrawal Timelines

Everyone is unique in their medical history, mental health, life experiences, and use of fentanyl and other substances, and these variables all work together to impact how long it takes for someone to fully detox off fentanyl and what their experience will be like in the process. Some of those variable factors include the following:[3]

  • Metabolic rate: The speed at which the body metabolizes anything, including fentanyl, will vary from person to person. Those who have faster metabolic rates typically process and eliminate the drug more rapidly, leading to shorter withdrawal periods than people with a slower metabolic rate may experience.
  • Age: Age plays an integral part in drug metabolism as well. Younger people tend to have more efficient metabolic systems, leading to faster drug clearance and shorter withdrawal periods. On the other end of the spectrum, older individuals might have slower drug elimination processes, leading to longer withdrawal durations.
  • Weight: Body weight can influence drug processing. People with higher body weight may take longer to eliminate fentanyl from their system, leading to extended withdrawal periods compared to those with lower body weight. 
  • Frequency and duration of use: The length of time a person has been using fentanyl and how often they use it can impact withdrawal timelines. Chronic and heavy users may experience more prolonged and severe withdrawal symptoms compared to occasional or short-term users.
  • Dosage and tolerance: The amount of fentanyl used and an individual’s tolerance level are important factors in withdrawal. Using higher doses of the drug and having a higher tolerance for it can lead to more significant physical dependence. This means longer and more intense detox experiences.
  • Overall health and medical conditions: Pre-existing medical conditions and overall health can affect how the body handles fentanyl detox. Conditions that impact liver or kidney function, for example, may influence drug metabolism and elimination. Additionally, if one is already prone to headaches or gastrointestinal difficulties, it is more likely that fentanyl detox will come with those issues and that those symptoms will be significant.
  • Genetics: Genetic factors can also play a role in how an individual’s body responds to fentanyl. Variations in certain genes can affect drug metabolism and clearance, influencing the duration and intensity of withdrawal.
  • Polydrug use: If a person uses other substances along with fentanyl, it can complicate the withdrawal process. This can potentially prolong the overall timeline if the person stops use of both substances at the same time because they will experience withdrawal symptoms caused by both drugs.

The one thing that stands true for every person detoxing from fentanyl across the board is that some level of withdrawal symptoms will occur with cessation of use, and medical supervision and support are always recommended. Even if the person is taking a low dose of fentanyl, there are risks of medical issues. It’s imperative to work with a medical professional and have a medical plan in advance of starting detox.

Treatment for Fentanyl Withdrawal

Fentanyl withdrawal can be an intense and challenging process. Attempting to detox without medical supervision can be dangerous and even life-threatening (if relapse occurs). Professional medical treatments can effectively and safely manage withdrawal symptoms, helping people to remain compliant and safe during detox. 

Here are a few treatment methods used for fentanyl detox:

  • Medical detox: This prioritizes safety, as it features medical supervision and round-the-clock medical care. Medical detox is recommended for those with moderate to severe addictions who are expected to experience strong withdrawal symptoms. It’s also recommended for those who are at risk of medical complications during withdrawal. 

Detox is overseen by a team of medical professionals who can provide medications as needed for specific withdrawal symptoms. They will be on standby in the event that a medical emergency occurs, or the person feels the urge to relapse. Those participating in this type of program can expect the following:

  • 24/7 medical supervision and support
  • Evaluation of physical and mental health 
  • Administration of medication to manage withdrawal symptoms
  • Emotional support and counseling
  • A customized treatment plan

In some cases, gradual tapering off fentanyl or other opioids may be used to minimize withdrawal symptoms.  

  • Medication-assisted treatment: MAT is considered the gold standard in treatment for opioid use disorder. It always includes the use of medications that are FDA approved for the treatment of opioid dependency. MAT also utilizes counseling and behavioral therapies to help people avoid relapse.

    Common drugs utilized as part of MAT for fentanyl addiction include the following:[1]
  • Buprenorphine: This partial opioid agonist helps to reduce withdrawal symptoms and cravings without producing the intense euphoria associated with full opioids. It is often combined with naloxone (an abuse-deterrent medication) in the combination medication Suboxone.
  • Methadone: A full opioid agonist that suppresses withdrawal symptoms and cravings, this medication is usually administered under strict medical supervision in specialized clinics, dose by dose. At-home doses of this medication are generally not approved for those in early recovery, so people must visit a methadone clinic daily if they aren’t in an inpatient treatment program. 
  • Naltrexone: Naltrexone is an opioid antagonist medication that blocks the effects of fentanyl. It may serve as a deterrent for relapse even after the detox process is complete.
  • Counseling and behavioral therapies: Therapy plays an integral part in combating fentanyl addiction or any type of opioid use disorder. Behavioral therapies, such as cognitive behavioral therapy (CBT) and contingency management, can help people to address the underlying causes of addiction, develop coping strategies, and learn essential life skills to support lasting recovery.[2]

The Danger of Cold-Turkey Detox

Quitting fentanyl “cold turkey” or attempting to self-detox without medical assistance can be extremely risky due to the intensity of fentanyl dependence. The sudden onset of severe fentanyl withdrawal symptoms can be incredibly strong. 

It is not uncommon for people who attempt at-home detox to experience nausea and vomiting as well as diarrhea. This can cause them to become dehydrated and develop an electrolyte imbalance. Though rare, opioid withdrawal can be life-threatening in these instances.[5]

The effects of a cold turkey fentanyl detox are often described as the worst flu imaginable, but the truth is that it is far more serious than that. In fact, many feel that it is so intolerable that they relapse to end the illness and either return to active addiction or overdose as a result. 

Fentanyl withdrawal can be an emotionally and physically draining experience, which makes professional treatment essential in order for people to reach the other side safely. Medical detox, MAT, and counseling offer the comprehensive support necessary to stop using fentanyl for good and to build a new life in recovery that involves no use of illicit substances. 

If someone you love is struggling with fentanyl addiction, don’t wait to reach out to a treatment program that can provide them with the medical and psychological care they need to safely stop use of the drug. With your help, they can immediately begin the transition into recovery. 

Updated August 27, 2023
Resources
  1. What is fentanyl? National Institute on Drug Abuse. Published June 1, 2021. Accessed July 20, 2023.
  2. Opioid addiction and withdrawal: What you should know. University of Connecticut. Published June 30, 2022. Accessed July 20, 2023.
  3. Luba, Rachel et al. Fentanyl Withdrawal: Understanding Symptom Severity and Exploring the Role of Body Mass Index on Withdrawal Symptoms and Clearance. Addiction (Abingdon, England). 2023;118(4):719-726.
  4. Medications for opioid overdose, withdrawal & addiction. National Institute on Drug Abuse. Published January 14, 2022. Accessed July 20, 2023.
  5. Shah M, Huecker MR. Opioid withdrawal. [Updated 2023 Apr 29]. [Updated 2023 Apr 29]. StatPearls Publishing; Accessed July 20, 2023.
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