The Fentanyl Withdrawal from Hell

One person's story of an excruciating month-long withdrawal from a heavy fentanyl habit. "Thirty days until I started to feel whatever the fuck normal is."

“Junk turns the user into a plant. Plants do not feel pain since pain has no function in a stationary organism. Junk is a pain killer. A plant has no libido in the human or animal sense. Junk replaces the sex drive. Seeding is the sex of the plant and the function of opium is to delay seeding. Perhaps the intense discomfort of withdrawal is the transition from plant back to animal, from a painless, sexless, timeless state back to sex and pain and time, from death back to life.”

― William S. Burroughs, Junky

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It’s rather easy to describe the physicality of opioid withdrawal. Everyone’s had a bad flu at least once, right? You run hot, then cold, then come the chills. Your nose runs, runs, runs. Head and body ache. Legs cramp. Sometimes vomiting, diarrhea. Liquid pours out of every bodily orifice at varying levels of intensity. Even eyes get watery. Everyone has felt some variety of these symptoms before. Listing them off just doesn’t capture the deep dark depths of feeling.

The atmosphere of it all is missing.

Have you ever seen the alien movie Under the Skin? Withdrawal reminds me of when the alien in human form—in Scarlett Johansson form, to be precise—tries to eat a bite of a perfect layer cake but she can’t hold it down. She spits it out. Her alien body rejects human food. Opioid withdrawal feels alien. Everything looks, tastes, smells, and feels ugly. Like you crash landed on Earth and every single cell in your body is dying to get out.

Old William Burroughs used anatomic and metabolic language to capture the way heroin changes the core function of not just the human body, but human experience. He called withdrawal the transition from plant to animal. Floating boundaryless in a bath of body temperature salt water to being violently awakened naked on a freezing glacier.

“You haven’t lived until you’ve kicked dope” is not an ethusiastic endorsement of the experience so much as it is true. Every droplet of sweat, every goosebump, every sensation is felt at once. That’s after living for days, weeks, months, years, however long, in that timeless, sexless, painless place between death and life.

I’ve personally felt this pain and sickness very intensly and acutely. I wouldn’t wish it upon my worst enemies. But at a certain point, my experience hits a limit. Today’s street opioid game, dominated by fentanyl and its many analogues, is fundamentally something different. The days of oxycodone and heroin are beyond waning. For the majority of people out there using today, those days are long gone.

It’s all fentanyl now. And that has changed things.

“It was the scariest time of my life”

I’m now going to introduce you to Matt from Naples, Florida. To preserve his privacy, I am not going to use his last name.

But before that, I just want to say this: There’s tons of journalism about fentanyl and America’s overdose crisis, and I’ve noticed it’s still rare to hear from people like Matt in the media, people who actually survived their fentanyl addiction. They get talked about a lot. But I believe it’s important to listen closely to what they have to say.

Matt is 39 years old and from about 2013 to 2019 he was in recovery from an addiction that began during the golden age of Florida pill mills. At one point, Matt even worked at a pill mill in Ft. Myers, Florida, a “pain clinic” that only took cash and prescribed 30 milligram oxycodone (“blues”) en masse. Around 2010 the pills became scarce, and like so many other people, Matt switched to heroin. After a few years of that life, he kicked heroin, and had a solid run at recovery.

“Fentanyl is not like any other opiate I’ve done in my life,” Matt told me during a wide-ranging two hourlong phone call. From March 2020 until November 2022, fentanyl had taken over his entire life. Matt started to use again right as the pandemic was upending society. His habit escalated fast, and at his peak, he was spending $700 every couple days buying fentanyl in powder form. His dealer always had it, and never ran out.

“I was throwing a gram in the spoon and shootin’ it,” he told me. “It was the scariest time of my life. Every single day, every single hour, I had to shoot up. Just out of habit. I had to do it. I didn’t have a choice.”

11 o’clock: use

12 o’clock: use

1 o’clock: use

At a certain point, the fentanyl started to feel weak. After shooting up a large dose he’d barely feel anything. “Literally, it did nothing,” he said. “I just did it for the taste. When you shoot drugs, you taste it. You can taste the drug, the fucking water. I could tell you the difference between Zephyrhills® and fucking Nestle.” To try and feel something, anything, Matt would use more and more and more. To no avail.

Street fentanyl, especially in powder form, is typically weak and impure, average potency is about 10 percent. But there’s some insidious aspects to fentanyl’s pharmacology, properties that make it a brutal drug, especially when it’s used repeatedly at high doses over a long stretch of time.

Matt said he was “riddled” with anxiety and fear the whole time he was using. His partner, whom he shared a home with, was also using fentanyl. “I’m in love with my wife and I’m constantly worried about her,” he said. “There’d be nights where I’d stay up all night just watching her, making sure she wouldn’t stop breathing while she was sleeping.”

“From the time I started using fentanyl, it was just anxiety, panic attacks, and scared all the time,” Matt said.

Matt tried to stop more times than he could count during those two years he used fentanyl. He would buy Suboxone on the street, hunker down over a weekend, wait until he startd to feel dope sick and start taking Suboxone. It never worked. “It takes way more time than that,” Matt said.

(Matt was lucky he didn’t suffer from something called “percipitated withdrawal,” which happens to some people when they take Suboxone too soon while fentanyl is still in their system. It’s probably the worst, most violent thing that can happen to a human being on this planet).

When Matt said that fentanyl is unlike any other opioid he’d tried before, he was right. “Fent changed everything,” he said.

“The longest 30 days of my life”

By the end of his run in 2022, Matt would be driving his dump truck around Naples and, at any given time, he’d have roughly 7 grams of fentanyl, $300 worth of crack, and dozens of Xanax bars in his backpack.

Then, a series of disasters struck. From big distasters like Huricane Ian ripping through Southwest Florida to personal disasters that left his job in jeopardy. That’s when a friend of Matt’s, another truck driver who was selling him crack, told him it was time to get help. Matt knew he couldn’t keep on going.

“I'm not supposed to be doing this,” he told himself. “I'm not supposed to be this person.”

Matt called up a treatment center in Naples and they took him in. The treatment center’s detox protocol for opioid users lasts about a week, and then patients would transfer to the 28-day program. But these protocols were setup long before the fentanyl era, and they weren’t going to work for Matt.

Matt did not start feeling any withdrawal symptoms for five whole days after he stopped using. Read that line again. He stopped using and didn’t get dope sick for five whole days. He was in the detox wing and felt totally fine. No symptoms whatsoever. “I'm sure some of the staff didn't even believe me,” Matt said.

He wanted to start on Suboxone at the facility, but he wasn’t feeling any symptoms. After six days of waiting and waiting, the staff transfered Matt out of the medical detox wing over to the 28-day residential wing. And then, about halfway into day six, the day before Thanksgiving, the sickness started.

“This was different,” he said. “The withdrawal from fentanyl is so different. It’s so fuckin’ mental, in the head.”

First, he had no energy. It felt hard to walk. Hard to move. He couldn’t eat. He wasn’t drinking enough water. Right before they moved him to the 28-day program, Matt asked the nurse for Suboxone. But the nurse told him no. “Your protocol is over.” He thought, whatever, he’ll try and get Suboxone in the residential wing. But it was Thanksgiving, and the doctor wouldn’t be available. In other words, he was fucked.

His thoughts started racing: Man, just kick the fuckin’ door open. Let me out. What am I doing here?

But he stayed.

Two years worth of wreckage and damage, two years worth of guilt and shame, all of it came flooding in. “I fucked everything up. Every relationship. Lied to everybody. And all I could do was sit in that.”

“I didn’t sleep for days.”

“Shitting and pissing out of my ass for days.”

“The flu times a million.”

“Pure fucking hell.”

Let me the fuck outta here

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OK. You’re probably thinking what the heck is going on here. Why didn’t Matt start to feel any withdrawal symptoms for nearly a week after he stopped using? And why was Matt trapped in a cold turkey withdrawal from a heavy fentanyl habit? Why no medicine to help him get through it?

When I talked to Matt on the phone, he said he weighed 314 pounds. “I’ve been big my whole life,” he told me. When he was deep into his fentanyl addiction, he got down to about 240 pounds, which he said was the smallest he’d been since high school.

Matt’s weight matters here. Fentanyl is highly lipophilic, which means it dissolves into and gets stored in lipids (fats). Most short-acting opioids just take a couple days to start clearing through out of the body. Not fentanyl. Fentanyl can take a very long time to clear because a reservoir of it gets stored in fat, and that means fentanyl continues to slowly release in the body long after someone has stopped taking it. As fentanyl gets stored in the body’s fat, it starts to act like an internal fentanyl patch slowly releasing the drug.

When fentanyl is used at high doses over a long period of time, it starts to do strange things at the metabolic level. There’s basically zero research on the metabolism of these new fentanyl analogues on the street. In a way, people like Matt are guinea pigs in a fucked up human subjects experiment.

A 2020 study in the journal Drug and Alcohol Dependence found fentanyl had a mean clearence of 2 weeks, with a range of 4 to 26 days. “Treatment providers should be aware that clearance of fentanyl is fundamentally different than other opioids and can have serious negative implications during early OUD treatment,” the researchers wrote.

Fundamentally different, indeed. For a bigger guy like Matt, there was so much fentanyl stored in his system that it took nearly a week for that reserve to start clearing. This also sheds light on why Matt said he barely felt anything after injecting large doses of fentanyl so frequently. When fentanyl is new to the body, it is very fast-acting and wears off rapidly. But that’s only at first. Because fentanyl is extremely lipophilic, once it starts getting stored in the body’s fat tissue, the drug changes from a short-acting mode to a long-acting, extended-release mode.

Matt had a massive of amount of fentanyl stored up in his system. Weeks after he stopped using his drug tests came back positive for fentanyl.

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Back to Matt’s detox story. Two weeks into the 28-day program, two weeks of feeling god awful, Matt decided he was done. “I called an Uber, I got out of there, I came home.” His wife had stopped using the same time he did, and she was staying home, and he wanted to be with her and his dog. Plus, he hated the food at the facility and thought eating better might help him.

He left treatment, but the withrawal wasn’t over. “Still, just no energy, none whatsoever. I couldn’t even move, man. I couldn’t even take my dog outside.” It wasn’t until another week after leaving the facility that he had a full night of good sleep. It also took about three weeks for his bowels movements to go back to normal. Three weeks in, Matt was wondering when the the pain would end.

“I was waiting for that 30 day mark. Man, if this doesn’t fuckin’ end by 30 days? Fuck it, dude. I’m gonna go get some fentanyl. C’mon man! 30 fuckin’ days? How much longer can it last.”

All that time, he suffered through it. And he figured he made it this long without using a medication like Suboxone that he would try and keep going without it. In the past, he told me he always used methadone and Suboxone to get high, never as a maintenence treatment.

Finally, 30 days hit. The longest 30 days of Matt’s of life. “I'm not gonna say I woke up on the 31st day and felt fine,” he said. “But yeah, 30 days until I started to feel whatever the fuck normal is.”

He could sleep again. He could eat again. He could move again. After day 30, it was almost Christmas, and Matt decided he was well enough to do some shopping. And then, he thought, he should go try and “fix some things.” Fix the damage.

Matt always had some kind of depression, which still felt “horrible” 30 days later. During this whole disaster, Matt was fired from his job driving a truck for his uncle. He apologized to his uncle, and asked for his job back. But that’s complicated, he said. So, “I’ve just been sitting on my ass, spending money like crazy,” Matt said.

“I’ve been supplementing my addiction with buying a PS 5 (Playstation). Going to Texas Road House and buying a ribeye. Retail therapy. Shit I shouldn’t be doing. Put down the drugs, pick up the fork, man.”

For how bad things are, Matt realizes he’s still lucky. Lucky to be alive, for one. But lucky that his material circumstances weren’t destitute. The only reason he could stay at home and recover with no job is because he and his family have some money. While he was using he sold his house and he made $180,000 on top of what he’d originally paid. “My plans was to make the money, pay off debt, stop the drugs.” That didn’t happen, and he wound up spending most of that money on fentanyl but still had some leftover.

“Not everybody has the ability to do it how I did it,” Matt said. “I understand that. When I got out of treatment I was able to literally just sit on my ass for another two weeks and not do anything.”

Usually they say kicking dope is just the beginning. Then comes the hard part: living life without it. Matt still has to work. He’s got bills to pay. He has responsibilities. He’s 39 years old, and he has a lot of life ahead of him.

“I don't know what I want to do,” he said. “Maybe try and help people.”

While Matt was in treatment, he met a peer specialist who worked at the facility. “Their job is to basically act cool, show people the ropes, and try to get people to stay in recovery.” Matt says he still talks to that peer specialist. And maybe it’s something he might want to do to help others like him. He’ll need a minimum of two years in recovery (probably abstinence-based) before he could get that job.

Matt says he does attend some self-help meetings. “I should probably be going to more meetings, that’s what helped kept me clean me before. But honestly I got my own views on all that,” he said. “Lately, it’s been hard for me to go.”

Matt hasn’t used since November 17, 2022. That’s almost 90 days. After our long talk, I briefly followed up with him.

Matt’s been here before. Newly in recovery and figuring out what’s next. “It takes a while to find something that gets you motivated,” he said. “It's like, I just I just need to find that thing.”

He got a new job and he’s staying busy. He’s felt much better physically and mentally after going through his hellish withdrawal. If there is anything to takeaway from Matt’s story, I think it’s that there is a way out. There is no easy way out. But there is a way. People can and do survive fentanyl.

“I’m definitley happier,” Matt told me. “I’m not using. I’m not fuckin’ up my life. I’m not on the verge of dying everyday. I’m not worried about my wife dying everyday.”

“I’m OK. I’m just, OK.”

Fentanyl has massively accelerated and complicated this crisis in important ways. In ways that I don’t think have been fully appreciated. Namely, some of fentanyl’s pharmacological properties change the nature of addiction, withdrawal, and treatment in uniquely weird and brutal ways. Matt’s story brings these changes to light and, I think, show that America’s treatmen sector is woefully unprepared for the task of helping people struggling with fentanyl addiction.