Fentanyl Withdrawal Timeline

Fentanyl is a synthetic opioid that’s 50–100 times potent than heroin or morphine.1 The United States Drug Enforcement Administration lists fentanyl as a Schedule II controlled substance, indicating that although the drug has medicinal uses, it also has a very strong potential for abuse and the development of physical and psychological dependence.2

Fentanyl can only legally be obtained with a prescription from a physician. It’s usually used to treat moderate to severe chronic pain.1 It can be given as a shot in medical settings but is also commonly used as a transdermal patch applied to the skin but also can be taken as a nasal spray or as a dissolvable lozenge.1

Fentanyl is also sold illegally sold as a powder and can be administered by those wishing to abuse it in a number of ways. It is often mixed with other illicit drugs, many times unbeknownst to the end user. Fentanyl is increasingly being added to heroin as well as being pressed into counterfeit prescription opioid pills.3,4 The risk of an opioid overdose when using fentanyl-laced heroin and illicitly manufactured pills is greatly increased as a result of fentanyl’s high potency.1

The amount of fentanyl being distributed illicitly has increased dramatically in recent years. In September 2017, the DEA analyzed approximately 584 kilograms of fentanyl and fentanyl-related substances in powder form for that year, an increase of 796% from the 65 kilograms of powder analyzed during 2014.5 Overdose deaths are rising alongside fentanyl’s increasing prevalence, with overdose deaths involving fentanyl increasing nearly 47% from 2016 to 2017.3

Opioid Dependence

All opioid drugs have the potential to cause tolerance and physical dependence in anyone who uses them for lengthy periods of time. A dependence to opioids consists of exhibiting both the symptoms of tolerance (the need to use greater amounts of a drug to achieve effects that were once achieved at lower amounts) and withdrawal (a series of negative and often very unpleasant physical, emotional, and psychological effects that occur when one discontinues using the drug or drastically cuts down on the amount being used).6

MORE ON SUBSTANCE WITHDRAWAL:

Fentanyl Withdrawal

The withdrawal process from fentanyl can be severe and begin as early as a few hours after the last dose. Withdrawal symptoms include:1

  • Insomnia.
  • Vomiting and diarrhea.
  • Muscle and bone pain.
  • Goose bumps and cold flashes.
  • Uncontrollable leg movements.
  • Restlessness.
  • Anxiety, irritability and/or depression.
  • Intense cravings.

It’s difficult to predict which withdrawal symptoms an individual will experience, their severity or length of duration. There can be quite a bit of individual variation associated with withdrawal from opioid drugs. Several factors affect the length of the withdrawal process and the severity of the symptoms that one will experience. These factors include:7,8

  • The length of drug use. Lengthier and more severe withdrawal symptoms are associated with using fentanyl and other opioids for longer periods of time.
  • The amount of the drug that was typically used. Individuals who typically took higher amounts of the drug will experience more severe and lengthier withdrawal syndromes.
  • How the person stops taking the drug. Individuals who abruptly cease using the drug will experience more intense withdrawal symptoms, whereas individuals who are able to taper down the dosage over time will experience less severe withdrawal syndromes, though the overall withdrawal process will take longer.
  • Using multiple drugs (e.g., alcohol, Xanax, etc.) at the same time as fentanyl and other opioids. Individuals who have polydrug physical dependence will have more complicated withdrawal syndromes.
  • Individual differences. Differences in metabolism and emotional or psychological stability will affect the withdrawal process.

Long-term fentanyl and opioid use may also result in an individual experiencing lingering physiological symptoms that impacts temperature, sleep, breathing, and blood pressure.8 This protracted withdrawal may last anywhere from 1 week to about 6 months following the initial opioid withdrawal phase.8

Medication combined with behavioral therapies have proven to be effective in treating fentanyl and opioid addiction.8 Individuals undergoing medically supervised withdrawal management (i.e., medical detoxification) will likely be given medications to reduce cravings and lessen withdrawal symptoms.1 Individual and group counseling typically follows detox and helps people modify their perspective, attitudes and behaviors related to opioid use.1,8

References

  1. National Institute on Drug Abuse. (2019). DrugFacts: Fentanyl.
  2. Diversion Control Division. Drug Enforcement Administration. (2018). Fentanyl.
  3. Centers for Disease Control and Prevention. (2019). Opioid Basics: Fentanyl.
  4. Centers for Disease Control and Prevention. (2019). Synthetic Opioid Overdose Data.
  5. DEA Intelligence Brief. (2018). Fentanyl Remains the Most Significant Synthetic Opioid Threat and Poses the Greatest Threat to the Opioid User Market in the United States.
  6. National Institute on Drug Abuse. (2018). What are the long-term effects of heroin use?
  7. Taylor, D. R. (2015). Managing Patients with Chronic Pain and Opioid Addiction. Cham: Springer International Publishing.
  8. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More