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Fentanyl Withdrawal

With a potency 80 to 100 times that of morphine, fentanyl is fueling an unprecedented, deadlier chapter of the ongoing opioid crisis. The so-called third wave.

Drug dealers are mixing this synthetic opioid into heroin, cocaine, and counterfeit pills, endowing them with extraordinary potency and killing scores of people in the process.

Fentanyl has few peers when it comes to its ability to unleash carnage.

Want proof?

The U.S. Centers for Disease Control and Prevention (CDC) said that between 2011 and 2016, fentanyl-related deaths jumped by 1,000 percent, according to this CNN report.

Fentanyl has claimed its fair share of poster children, perhaps none more tragic than one accidental victim, a 1-year-old toddler from New York City.

States a 2019 article from The New York Times, little Darwin Santana-Gonzalez was “toddling around” a Bronx apartment two days after Christmas in 2018 where heroin, fentanyl, and a fentanyl variant were being prepared and packaged for sale.

Somehow, the fentanyl variant ended up inside Darwin. By the following morning, the toddler had stopped breathing and died. Authorities charged Darwin’s mother with his murder, and his father fled the country.

“The amount of fentanyl it would take to kill you or me would fit on the tip of your baby finger, and a small child would be much more susceptible,” said a New York city prosecutor in the aftermath of Darwin’s death.

Fentanyl is one of the deadliest substances of abuse in existence.

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What Is Fentanyl?

Given its potency and illicit use, one would think fentanyl is in the strictest class of controlled substances, Schedule I. These are drugs have no recognized medical value and a high potential for abuse, according to the Drug Enforcement Administration (DEA).

Nevertheless, fentanyl is designated as a Schedule II drug because it is prescribed to relieve pain in small doses, particularly in cancer patients. It’s worth noting that heroin is a Schedule I substance despite being about 50 times less potent than fentanyl.

Fentanyl is a synthetic, human-made opioid that is available as a patch, injection, lozenge, lollipop, or as an oral or nasal spray. What makes fentanyl more potent than heroin lies in its chemical structure.

Fentanyl binds to the same opioid receptors as heroin, but it does so more quickly than heroin, which by then, converts to morphine in the body.

What’s more, fentanyl latches onto the opioid receptor so tightly that just a trace amount is enough to “start the molecular chain of events that instigates opioids‘ effects on the body,” according to this STAT report.

This action leads to a flood of dopamine in the system, triggering pain relief, relaxation, and a profound euphoria. According to Medical News Today, its effects have a relatively short duration, lasting between 30 and 90 minutes.

Illicit Fentanyl Use

Fentanyl goes by a number of street names that vary from head-scratching to the ominous. On the street, it has been called Apache, He-Man, Tango and Cash, Dance Fever, China White, TNT, Drop Dead, and Flatline.

Fentanyl and its analogs are produced surreptitiously in illicit labs as powder and counterfeit pills.

Some have resorted to extracting the gel from discarded fentanyl patches, that they eat, smoke, inject, or place under the tongue.

Users have also been known to freeze fentanyl patches and cut them into pieces so that they can be placed under the tongue, according to the DEA.

It is sold alone or combined with heroin and cocaine.

Fentanyl Withdrawal Symptoms

Fentanyl withdrawal can produce symptoms so uncomfortable, that it can drive someone to go back to using the drug. Due to its potent nature, a relapse encounter with fentanyl can prove lethal on its own or in overdose.

That’s why it is dangerous to attempt detox on your own, without the oversight of medically-supervised detoxification.

According to WebMD, fentanyl withdrawal is marked by the following symptoms, which are characteristic of opioid/opiate withdrawal in general:

  • Anxiety
  • Nausea
  • Sweating
  • Tremors
  • Rapid heart rate
  • Muscle pain
  • Diarrhea
  • Vomiting
  • Abdominal pain and cramping
  • Insomnia

The psychological withdrawal symptoms of fentanyl can endure long after the drug cycles out of the system. This phase is known as Post-Acute Withdrawal Syndrome (PAWS), which can linger for months after the last use of fentanyl.

Those longer-term effects include:

  • Insomnia
  • Restlessness
  • Cravings
  • Drug fixation
  • Decreased mental performance
  • Anxiety
  • Depression
  • Irritability

Stages of Fentanyl Withdrawal

The length of fentanyl withdrawal and how it manifests can differ for each person. Certain factors may influence how people experience withdrawal.

Such factors include:

  • General physical health
  • Length of fentanyl use
  • How much fentanyl was used
  • Method of fentanyl ingestion
  • Whether fentanyl was abused with other substances
  • A history of substance abuse
  • Mental health profile

Nevertheless, the following can serve as a general timeline of fentanyl withdrawal:

The early stage of withdrawal can occur in as little as 12 hours after the last dose. Withdrawal symptoms can also manifest within 20 to 30 hours after the previous use. Early stage effects include body aches, insomnia, and flu-like symptoms such as a runny nose, sweating, fever, or chills.

Days three to five are considered the peak stage of withdrawal, where the symptoms will be at their most acute. Users can experience a multitude of effects in this phase like nausea, vomiting, enduring flu-like symptoms, continued insomnia, mood swings, and body aches down to the bone.

This is considered late stage withdrawal. Between the first and second week, the physical symptoms will begin to subside. However, psychological symptoms like mood swings and cravings can last for weeks or even months.

Why Should I Detox?

When it comes to potent synthetic opioids like fentanyl, there is a particular danger. When someone is detoxing from it, that person will likely develop a lower tolerance. Due to fentanyl’s sheer potency, a relapse where a person takes an amount they previously used can lead to a fatal overdose.

That’s why attempting a self-detox or even stopping use abruptly is not recommended. Opioids like fentanyl require a gradual taper. The safest, most effective setting for fentanyl withdrawal is through a medically-supervised detox.

How Professional Treatment Can Help You

Reputable, comprehensive treatment centers can provide you a medical detox where a team of doctors, nurses and medical staff can taper you off the fentanyl by providing approved maintenance medications to cycle the fentanyl from your system safely. Medical staff provides around-the-clock supervision and treats your withdrawal symptoms.

As you go through detox, a therapist will perform your assessment. With your input, that therapist will tailor a treatment schedule that meets your need.

For opioid abuse and addiction cases, clients are recommended for medication-assisted treatment (MAT).

The next treatment steps after detox are residential and outpatient treatment.

As the name suggests, residential treatment is an option where clients stay at the facility where they will receive treatment. Residential allows them to experience a structured environment where they can make their recovery top priority. Whereas detox only relieves the immediate, physiological effects of addiction and withdrawal, residential treatment uncovers the root cause of your substance abuse.

You will have access to therapy and care on a full-time basis, along with approved opioid treatment medications. Plus, residential treatment offers evidence-based and alternative therapies that address the entire person, not just the addiction itself.

The therapy models employed in residential treatment include:

    • Individual therapy
    • Cognitive behavioral therapy (CBT)
    • Motivational interviewing
    • Group therapy
    • Family therapy
    • Dialectical behavioral therapy
    • Mindfulness
    • Aftercare planning

Residential treatment for fentanyl abuse and addiction typically lasts 30 days. According to the National Institute on Drug Abuse (NIDA), a stay of 90 days or more can increase the effectiveness of treatment.

Clients with milder cases of addiction may be recommended for outpatient treatment, which provides the same kinds of services as a residential program but on a part-time basis. Clients can receive outpatient care from home or some other independent living arrangement. A client in residential treatment can also enter into an outpatient program to receive further care before re-entering regular life. Nevertheless, outpatient is a low-cost option for drug treatment that allows patients to attend to their life obligations.


Bond, A. (2018, March 08). Why fentanyl is deadlier than heroin, in a single photo. Retrieved from

Drug Enforcement Agency (DEA). (n.d.). Fentanyl. Retrieved from

Drug Enforcement Agency (DEA). (n.d.). List of Controlled Substances. Retrieved from

FNP, K. D. (2019, January 22). Fentanyl: Use, abuse, side effects, and warnings. Retrieved from

Heigl, A., & Rayne, N. (n.d.). Fentanyl: Drug That Killed Mac Miller, Prince and Tom Petty Has Long History of Abuse. Retrieved from

Kounang, N. (2019, March 21). Fentanyl deaths skyrocketed more than 1,000% over six years in the US. Here's who it's killing. Retrieved from

National Institute on Drug Abuse. (n.d.). Fentanyl. Retrieved from

National Institute on Drug Abuse. (n.d.). 7: Duration of treatment. Retrieved from

Otterman, S., & Correal, A. (2019, May 29). The Opioid Crisis in the Bronx Claims Tiny Victim: 1-Year-Old. Retrieved from

Tate, N. (2018, May 01). Fentanyl: What You Should Know. Retrieved from

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