For anyone who has completed fentanyl withdrawal, the hardest part may seem over. But many people are surprised when symptoms reappear weeks or even months later—unpredictably and without warning. This experience, called Post-Acute Withdrawal Syndrome (PAWS), is a common and challenging phase in recovery from opioids like fentanyl. While PAWS can feel discouraging, knowing what to expect and having the tools to manage it can make all the difference.
In this article, we’ll explore what PAWS is, why fentanyl users experience it, and practical ways to manage the ongoing effects.
What Is Post-Acute Withdrawal Syndrome (PAWS)?
PAWS is the experience of ongoing withdrawal symptoms after the acute or immediate withdrawal phase has ended. In the case of fentanyl, people often go through a rough first week or two of intense symptoms—nausea, chills, muscle aches, and cravings. But for some, even after that stage ends, subtle symptoms stick around, fluctuating in intensity and making day-to-day life feel like a constant push.
The brain’s adjustment process causes these lingering symptoms. Fentanyl is a synthetic opioid, and because it’s so powerful, it causes deep changes in the brain’s chemistry. PAWS can impact physical, mental, and emotional well-being, which makes it challenging to feel “back to normal” for a while.
Why Does Fentanyl Use Lead to PAWS?
When it comes to PAWS, not all substances are created equal. Fentanyl, due to its high potency and how it interacts with the brain’s reward pathways, often leads to a more intense PAWS experience.
Here’s why:
- Intense Brain Changes: Fentanyl strongly affects the brain’s opioid receptors, creating a profound dependency. Over time, the brain adapts to fentanyl by reducing its natural production of endorphins, making it harder to feel pleasure or calm without the drug.
- Rapid Tolerance: People using fentanyl can develop tolerance quickly, meaning the brain has to adjust even more dramatically over time. When fentanyl use stops, the brain is left trying to function without the “help” it’s been relying on, leading to longer-lasting symptoms.
- Longer Rebalancing Process: Because fentanyl affects multiple parts of the brain—reward, motivation, mood, and pain processing—returning to balance takes time. PAWS is, in many ways, the brain’s process of gradually rebalancing these functions.
Common Symptoms of PAWS
While PAWS looks a bit different for everyone, there are a few symptoms people often experience. These symptoms can come and go and may appear unexpectedly, even after weeks of feeling fine.
Here are some common signs of PAWS:
- Mood Swings: Feeling irritable or down without a clear reason is common. PAWS can bring unpredictable mood shifts, which can be frustrating and exhausting.
- Anxiety and Panic: Many people experience a heightened sense of anxiety or worry, sometimes bordering on panic attacks. Small stressors can feel overwhelming.
- Low Energy and Fatigue: PAWS often leaves people feeling drained, even after a good night’s sleep. This fatigue can make daily tasks feel harder than usual.
- Sleep Issues: Insomnia, restless sleep, and strange dreams can all make it difficult to feel truly rested. Sleep disturbances are among the longest-lasting symptoms of PAWS.
- Concentration Problems: Many find it hard to focus on tasks, even simple ones. This “brain fog” can make it difficult to concentrate, remember details, or stay motivated.
- Cravings and Urges: Occasional cravings can still come up, especially in stressful moments or when encountering familiar triggers.
These symptoms can fluctuate, often coming in “waves” that feel intense, followed by stretches of feeling better. Understanding this ebb and flow can help you ride out the more challenging times.
How Long Does PAWS Last?
The duration of PAWS varies widely and depends on factors like how long fentanyl was used, the dosage, and individual health. For some, PAWS may last for a few months; for others, it can stretch into a year or more, with symptoms gradually fading over time.
Generally speaking:
- 3–6 Months Post-Withdrawal: PAWS symptoms are typically most noticeable, often with frequent waves of symptoms.
- 6–12 Months: Symptoms usually begin to decrease in frequency and intensity but may still pop up occasionally.
- Beyond 1 Year: For most people, PAWS symptoms become rare and much more manageable, though they may still appear under stress.
It’s completely normal for symptoms to feel unpredictable—some weeks, you may feel completely fine, and others might bring symptoms back. This inconsistency can be frustrating, but keeping track of symptoms and knowing that they will fade over time can make it easier to cope.
6 Strategies for Managing PAWS
Dealing with PAWS can be discouraging, but small daily steps can help ease the journey. Here are some strategies to support your recovery and boost resilience:
1. Set Realistic Expectations and Track Your Progress
Because PAWS symptoms can fluctuate, having realistic expectations can prevent frustration. It’s helpful to keep a journal or tracker of symptoms—this way, you can see patterns over time and notice gradual improvement.
Even on difficult days, looking back at your progress can remind you that things are, in fact, improving.
2. Stay Physically Active
Exercise is a powerful tool during PAWS recovery. Physical activity, even something as simple as a daily walk, releases endorphins (the body’s natural mood boosters) and helps ease symptoms like fatigue, muscle tension, and anxiety.
- Low-Intensity Options: Try yoga, stretching, or walking.
- Build Slowly: Start with small goals and gradually increase your activity. The goal is consistency, not intensity.
3. Focus on Nutrition
Good nutrition can support brain healing and help manage PAWS symptoms. For example, foods rich in protein, omega-3s, and antioxidants provide building blocks for neurotransmitter repair.
- Protein-Rich Foods: Eggs, fish, lean meats, and beans support dopamine production.
- Healthy Fats: Salmon, walnuts, chia seeds, and avocados aid brain function.
- Vitamins and Minerals: B vitamins, vitamin D, and magnesium may help with energy, mood, and sleep.
Staying hydrated also helps reduce fatigue and aids cognitive function, so drink plenty of water throughout the day.
4. Prioritize Sleep Hygiene
Sleep issues are common with PAWS, but improving your sleep hygiene can help. Try creating a consistent sleep routine:
- Limit Screen Time: Turn off electronics an hour before bed.
- Create a Calming Routine: Read, meditate, or stretch before sleep.
- Stay Consistent: Going to bed and waking up at the same time helps regulate your body’s internal clock.
If sleep remains difficult, consider speaking to a healthcare provider. Certain non-addictive sleep aids or supplements like melatonin may help ease your mind as you drift off.
5. Explore Therapy and Support Groups
The emotional side of PAWS can be tough, and sometimes, professional support can make all the difference. Therapy can provide guidance and tools for managing anxiety, depression, and mood swings. Support groups, both online and in person, can offer a safe space to share experiences with others who understand.
- Cognitive Behavioral Therapy (CBT): This helps manage negative thought patterns.
- Group Support: Connecting with others on a similar path can provide encouragement.
- Mindfulness Practices: Meditation, deep breathing, or grounding exercises help with stress management.
Many people benefit from a combination of therapy, support, and self-guided tools, especially during difficult phases of PAWS.
6. Consider Medication Assistance Through QuickMD
For people managing PAWS after fentanyl use, certain medications can make the process more manageable. At QuickMD, licensed professionals can provide guidance and, when appropriate, medication options that support PAWS recovery.
- Medication-Assisted Treatment (MAT): Options like Suboxone (buprenorphine) may ease cravings and stabilize mood swings, providing balance as the brain heals.
- Anti-Anxiety Medications: If anxiety is a persistent issue, a provider can recommend options that don’t interfere with recovery.
QuickMD’s online consultations offer personalized advice to help navigate lingering symptoms from the comfort of home. With daily availability, compassionate providers, and a secure online platform, you can find support right when you need it. Learn more about QuickMD’s addiction treatment services here.
How QuickMD’s Telehealth Counseling Can Support Your Recovery
At QuickMD, we believe that getting the mental health support you need should be simple and accessible. Our telehealth counseling services make it easy to connect with licensed professionals from the comfort of your home. Whether you’re dealing with PAWS, stress, anxiety, or any other life challenges, our counselors are here to help guide you through.
For just $45 per 30-minute session, QuickMD connects you with compassionate, qualified counselors who listen without judgment and help you develop personalized strategies to cope and heal.
We know that recovery can be tough, and our mission is to provide a supportive, flexible option for counseling that works around your schedule.
Getting Started with QuickMD Counseling
Accessing counseling services through QuickMD is straightforward:
- Licensed, Professional Support: Our counselors are licensed and experienced in a range of therapeutic approaches, so you’re in safe, knowledgeable hands.
- Accessible, Wherever You Are: Simply log in and start your session—no travel, no waiting rooms, and complete privacy.
- Flexible and Affordable: With affordable sessions and easy scheduling, you’re in control of when and how you get the support you need.
Taking care of your mental well-being should be stress-free, and we’re here to make sure that happens. Learn more, book a session through QuickMD’s telehealth counseling services, and get started on your path to a balanced, healthier state of mind.
Moving Forward with PAWS: A Recovery That Lasts
Living with PAWS is a unique challenge, but it’s one that many people successfully manage with patience, support, and time. Remember, PAWS won’t last forever, and each day brings you closer to healing. Be gentle with yourself, reach out for support, and keep moving forward.
Every small step counts, and with the right strategies and support, you can find balance and reclaim your well-being on this journey to a healthier life.
