Fentanyl Withdrawal Symptoms and Timeline

Fentanyl is a potent opioid that the DEA has classified as a Schedule II drug, meaning that while it does have medical uses, it also has a very high potential for abuse, addiction, and overdose.¹ It is available in various forms, including tablets, transdermal patches (Duragesic), lollipops, a spray used under the tongue, and as an injection. The drug is used for chronic and persistent severe pain that cannot be managed by other means.^{1, 2}

Fentanyl withdrawal symptoms resemble those of other opioids, and they can often be distressing and painful. Since fentanyl is a fast-acting medication, withdrawal signs may appear roughly 6–12 hours after last use, and the timeline lasts up to a week in most cases.⁴

What is Fentanyl Tolerance and Dependence?

Tolerance means a person’s repeated use of a drug causes changes in the person’s system that reduce the effects of the drug.¹ When this happens, the person may take larger doses to achieve the same effects they felt before.

When someone regularly uses fentanyl and/or takes increasingly higher doses, the brain and body become accustomed to the presence of the drug. This process is known as dependence, and it occurs when the individual needs fentanyl to continue functioning normally. If the person stops using fentanyl or drastically reduces their intake, they will likely experience withdrawal effects.¹

Can You Die From Fentanyl Withdrawal?

Fentanyl withdrawal symptoms can be very uncomfortable. But they are rarely associated with death. Complications can occur, however, and some of the major risks associated with detoxing from fentanyl include:

• Dehydration. Fentanyl withdrawal effects often include nausea, vomiting, and diarrhea, which can lead to dehydration if not properly monitored and treated. Dehydration can also cause electrolyte imbalances, which can be especially harmful.³
• Aspiration. When fentanyl withdrawal signs cause prolonged vomiting, individuals can accidentally inhale vomit into their airways, posing a risk of choking or developing a lung infection.³
• Depression. Withdrawal can lead to depression. Those who are suffering from severe depression or have an underlying mental health issue are at higher risk of suicidal thoughts or behaviors.
• Anxiety. Opioid withdrawal is often associated with anxiety.^{3, 5} People who use fentanyl as a coping mechanism are more likely to experience an increase in anxiety, which can contribute to urges to relapse.⁵
• Insomnia. Another sign of fentanyl withdrawal is difficulty falling or staying asleep.^{3, 4} The inability to sleep can be another trigger for relapse.
• Increased risk of overdose upon relapse. One of the most dangerous aspects of fentanyl withdrawal is relapse. If a person returns to using the same amount they are accustomed to, overdose is more likely if a fair amount of time has passed since their last dose and their tolerance has been lowered.³

Fentanyl Withdrawal Symptoms

The fentanyl withdrawal timeline and symptoms vary from person to person and can be influenced by various factors. These can include how severe the addiction is, the length of time one has been using fentanyl, the amount used on a consistent basis, use of other drugs or alcohol, and any underlying medical or mental health issues.

How a person uses fentanyl can also affect withdrawal. Fentanyl is available in various immediate-release formulations, as extended-release patches, or as an injection. Previous abuse of extended-release forms of fentanyl can prolong the withdrawal process, while injection abuse of fentanyl may be associated with a faster onset of withdrawal, as well as more severe withdrawal effects. Fentanyl withdrawal can include many signs and symptoms, They are listed below:

Fentanyl Withdrawal Timeline

The withdrawal timeline can vary significantly based on the type of fentanyl used. Withdrawal signs for short-acting forms of fentanyl, such as Actiq, can appear within 6–12 hours of the last dose.⁴ These symptoms tend to peak between 1–3 days and subside gradually between 5–7 days.⁴

Long-acting forms of fentanyl, such as the transdermal patch, usually have a more extended withdrawal timeline, with initial symptoms appearing 12-48 hours after stopping use and slowly resolving over a period of about 10 days to 3 weeks.⁶ In some cases, post-acute withdrawal symptoms can persist for several weeks or months.⁴ These can include anxiety, depression, low mood, and sleep troubles.⁴

Those with co-occurring chronic pain conditions, mood disorders, or anxiety may have a more difficult time dealing with detox, as it can significantly exacerbate these conditions.⁵

Treatment for Fentanyl Withdrawal

People that want to detox from opioids such as fentanyl should consider formal treatment. Detox and rehab facilities are staffed with medical and psychiatric professionals that are trained to identify issues and provide the medication and support to ease the withdrawal process.

Many medications are approved to treat fentanyl withdrawal and the associated symptoms, helping patients to get through withdrawal as comfortably as possible while reducing the risk of complications.