Heroin, and other opiate drugs, are painful to withdraw from. It is this process that usually keeps people locked in their addiction; whenever they try to stop, the withdrawal symptoms feel too torturous to bear.
But there is hope; with support and treatment, you can get through the withdrawal period and move forward from there. Many people triumph over heroin withdrawal every day to start living healthy, addiction-free lives.
What is Heroin Withdrawal?
Heroin withdrawal occurs when a person stops taking the drug (especially after heavy use). Heroin and other opiates are some of the most addictive substances on the market and they can quickly lead to dependence. That means even though heroin harms our health, our bodies can become physically dependent on it.
You’re not likely to experience heroin withdrawal symptoms if you only experimented with heroin one time. However, if you’ve used heroin chronically and for a long-time and the drug has built up in your system, then you may experience extremely uncomfortable effects when you decide to stop using.
However, that doesn’t mean it isn’t worth quitting. Yes, heroin withdrawal is uncomfortable, but once you get through to the other side, a life that’s free of this drug can begin.
Why Do People Experience Heroin Withdrawal?
Heroin is a highly addictive drug, both physically and mentally.
Heroin and other opiates cause dependence. Chronic and long-term opioid use is linked to concrete changes to the brain; when this type of drugs enters our bodies, it slows down the activity of a part of the brain called the locus coeruleus. This slowing down results in feeling “high” and drowsy, with slowed respiration and heart rate.
The brain adapts to these changes by increasing the activity of the locus coeruleus to try to balance out the effect of the heroin. It starts producing more noradrenaline, the hormone that the locus coeruleus is responsible for releasing.
When a person uses heroin for a long time and then suddenly stops taking it, the body gets confused. It takes a while for the brain to catch up to the lack of opiates in the system, and for a while, it keeps up with the adjusted (increased) activity of the locus coeruleus. This is what causes people withdrawing from heroin to feel “dope sick” and experience symptoms like jitteriness, shaking, and anxiety.
Heroin Withdrawal: Timeline of Symptoms
Withdrawal symptoms usually come on within 6 to 24 hours of the last dose. The severity of your symptoms, and which ones you experience, depends on many different factors, including how long you’ve been using, how much you’ve been using, and the way you use it (i.e. whether you snort, smoke, or inject, for example).
This article is meant as a general guideline to help educate people about what to expect during heroin withdrawal. However, it’s important not to take this information and try to detox from heroin on your own. There are many facilities available that are specifically designed to help people withdraw from heroin as safely and comfortably as possible.
How Long Does Heroin Withdrawal Last? Timeline of Symptoms
Usually, people start experiencing these symptoms within a few hours — 6 to 12, to be specific — of their last heroin dose. The most common experience is that these symptoms worsen and peak within a couple days of stopping heroin but then dissipate after a week at most (usually between 5 to 7 days).
However, some people develop something called post-acute withdrawal syndrome, or PAWS, which can lead to heroin withdrawal symptoms for weeks, months, or even years after quitting. Symptoms of PAWS usually affect mental health, and include things like irritability, symptoms of OCD, depression, and difficulty concentrating. PAWS is usually a risk when withdrawing from alcohol, opiates, or benzodiazepines.
Mild to Moderate Heroin Withdrawal Symptoms
Most people won’t face danger or death because of heroin withdrawal (although it is possible), but that doesn’t mean that withdrawal symptoms aren’t intensely uncomfortable and even painful. The World Health Organization (WHO) likens it to a severe case of the flu which is extremely uncomfortable for the person experiencing it, but not usually life-threatening.
Common heroin withdrawal symptoms include:
- Nausea and vomiting
- Diarrhea and stomach cramps
- Fever
- Body aches and muscle pain
- Chills, cold flashes, or goosebumps
- Increase in bodily fluids, like a runny nose or sweating
- Tremors
- Insomnia, restlessness, and agitation
- Mood problems, like depression
- Cravings for heroin
The intense discomfort of these symptoms often leads people to run away and return to the “comforting” arms of heroin once again. However, heroin is an abusive lover; it may provide you with temporary relief, but it keeps you locked into this cycle of addiction and withdrawal. As painful as it is, it’s possible to get to the other side of heroin withdrawal; many people have and continue to do so every day.
Severe Heroin Withdrawal Symptoms: Can Withdrawal Be Fatal?
Most people view heroin withdrawal as non-life-threatening — and for the most part, it is. However, some experts say that we underestimate the risk of death or serious health complications from heroin withdrawal and it is something we need to pay attention to.
Unlike alcohol withdrawal, it isn’t the withdrawal process itself that’s dangerous with heroin. However, some people have died from the dehydration that comes with some of the above symptoms, particularly vomiting and diarrhea. This can cause people’s hearts to eventually give out.
On top of that, the depression that coincides with heroin withdrawal can sometimes lead to death by suicide. Suicide is always a risk with mood disorders and it needs to be watched out for.
These are completely treatable risks; with the right withdrawal management service, you can make sure you detox safely from heroin and avoid these rare, but deadly, risks. The important thing to remember is that the risks of heroin withdrawal are all treatable. Continuing to use heroin poses much more fatal risks than withdrawing from it.
Treatment for Heroin Withdrawal
Heroin withdrawal can be painful and uncomfortable, but you don’t need to go through it alone. Enormous amounts of research has been done on how to help people recover successfully from heroin addiction without giving into their cravings during withdrawal. This research has given birth to a multitude of effective treatments that help people successfully get through heroin withdrawal and start living a drug-free life.
Medical Detox
Inpatient detox facilities offer 24/7 medical supervision and monitoring while you’re going through the heroin withdrawal period. Medical staff will make sure that you’re safe, and that your body is handling the withdrawal well.
On top of giving you nutritious meals and a safe place to lay your head, some detox centers will provide you with medications to provide relief from your withdrawal symptoms. One such medication is lofexidine, which is FDA-approved to treat withdrawal symptoms like nausea, diarrhea, and body aches. Note that this medication isn’t the same as the opioid alternative medications that are used in heroin addiction treatment, which we’ll talk about next.
Pharmacological Treatments
Scientists have developed special medications that interact with the brain in the same way that heroin and other opioid drugs do, but that are less likely to cause the same health problems.
Taking a prescribed dose of these types of medications prevents you from feeling the painful symptoms of heroin withdrawal and makes it easier to stop yourself from going back to heroin use.
Some of the most commonly used medications to help people recover from heroin addiction include:
- Methadone
- Buprenorphine (Subutex)
- Naltrexone (Vivitrol)
- Buprenorphine + Naltrexone (Suboxone)
All these drugs are safe, as long as you take them exactly as prescribed. If you take more than that, then you risk becoming addicted and that will negate all the hard work you did recovering from heroin addiction. How long you stay on these medications depends on you and your situation. Some people only stay them on them for a few months, and others stay on them for the rest of their lives.
Only certified opioid treatment clinics are licensed to dispense these types of medications; these clinics are often referred to as “methadone clinics” or “MAT clinics”. People are usually required to go to the clinic every morning to pick up their daily dose, but some clinics have programs where you can earn take-home privileges (taking home more than one day’s worth of medication at a time) if you prove that you can be trusted not to take more than prescribed.
Medication-Assisted Treatment
The best and most effective way to use the above medications is as part of a comprehensive treatment program called medication-assisted treatment, or MAT. MAT combines pharmacological treatment with counseling and behavioral interventions. It understands that medication alone isn’t usually enough to help people fully recover from heroin addiction.
Most of the time, methadone, and other medications like it, are prescribed at MAT clinics so you’ll automatically be offered group and/or individual counseling. Federal law requires anyone receiving medication like methadone or any of the above medications to participate in counseling alongside the medication treatment.
Counseling in MAT involves a number of different behavioral interventions, including CBT and contingency management. Many opioid treatment clinics also provide patients with other services like vocational counseling and medical treatment.
MAT is approved by the FDA as the most effective treatment for opioid use disorders, including heroin addiction.
Ongoing Treatment and Rehabilitation
Even after you’ve gone through the most difficult part of heroin withdrawal, the journey towards recovery is far from over. Relapse, unfortunately, is a common part of recovery from heroin, and many people go back and forth before finally walking away from heroin for good.
Although relapse is nothing to be ashamed about, it’s not something to strive for, either. By getting the correct treatment right away, you can lessen your risk of relapse and stay on track toward living a heroin-free life.
Inpatient Rehab
Many people opt to enter a residential or inpatient treatment program when they’re in the early stages of heroin addiction recovery. An inpatient rehab requires you to live at a treatment facility, usually for 30 days or more. During your stay, you’ll participate in a highly structured program of treatment services, including group and individual therapy.
This option isn’t viable for everyone because of work and other responsibilities, but it can be an effective one for those who are able to attend. Many inpatient rehabs are covered by commercial insurance plans, and some are even covered by Medicaid.
If you’re suffering from a dual diagnosis condition (a mental health disorder like depression that you have on top of your heroin addiction), then make sure to choose a rehab that can treat both your heroin use disorder as well as the mental illness. Treating the addiction without treating the mental illness at the same time is likely to lead to relapse down the line.
Outpatient Rehab: Partial Hospitalization and Intensive Outpatient
Outpatient rehabs are an excellent option for people who, for whatever reason, aren’t able to enter into an inpatient program. They’ve often been shown to be just as effective as inpatient rehabs. The two most common types of outpatient rehabs are partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs).
Both PHPs and IOPs offer more hours of treatment and structure than traditional outpatient counseling; PHPs usually involve more hours (typically a full day) of treatment per day. Many outpatient rehabs offer evening schedules, which is a great option for people who need to work during the day.
Peer Support Groups
Although peer support groups aren’t necessarily considered “treatment” for heroin addiction, many people find them helpful. 12-step groups are the most popular type of peer support program.
The most well-known 12-step peer support program for heroin addiction is Narcotics Anonymous, or NA. NA, which is a branch of the original 12-Step Alcoholics Anonymous (AA) program, is peer-run and provides a supportive community for people recovering from heroin addiction. These groups can set you up with a peer sponsor and they often organize sober social events to partake in.
Sober Living
Sober living facilities are not a treatment in their own right, but they can be a good source of extra support while you’re recovering from heroin addiction. Sober living facilities consist of apartments or houses where people who are in recovery live together as a community. Some homes come with addiction coaches and a structured schedule, while others are simply a safe and sober place to detox.
Almost all sober living facilities will only accept you after you’ve gone through the withdrawal process from heroin, so it’s likely that you would transition to a sober living facility after you’ve gone through detox.
Special Mention: Harm Reduction and Safe Syringe Programs
Harm reduction isn’t a treatment for heroin withdrawal or addiction; however, it’s an important service that individuals who use heroin should be aware of. Many of the health risks that come with using heroin are due to injecting the drug, since the process can lead to medical complications like collapsed veins. Sharing needles is especially dangerous.
The harm reduction model works not only to help people recover from heroin addiction, but to encourage and empower people to use the drug in the safest possible way. While there’s no 100% “safe” way to use heroin, using clean syringes can protect you from some of the deadliest risks such as contracting diseases like HIV or Hepatitis.
Young people between the ages of 18 and 24 are the most likely to share syringes, but this isn’t a risk that you need to take. If you decide to continue injecting heroin, make sure you use clean syringes. Most metropolitan areas have a needle exchange program available where you can receive free sterilized syringes.
There Is Hope After Heroin Withdrawal
If you’re going through heroin withdrawal, then it’s crucial that you get the help you need right away to beat this disease. Trying to withdraw from heroin without help can be uncomfortable and dangerous. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
Withdrawing from heroin is the hardest part; once you’ve gone through the detox period, you can start focusing on your long-term recovery.
You can start your recovery process by looking for a nearby treatment facility on RehabAid. We have differentiated different specializations and treatment types for each rehab, so you can identify facilities that offer medication-assisted treatment or methadone specifically.
Recovery from heroin addiction is within reach; don’t let the fear of withdrawal stop you.
References
Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310652/
Connery, Hilary Smith (2015). Medication-Assisted Treatment of Opioid Use Disorder. Harvard Review of Psychiatry, 23(2),63-75
doi: https://doi.org/10.1097/hrp.0000000000000075.
Kleber H. D. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in clinical neuroscience, 9(4), 455–470. https://doi.org/10.31887/DCNS.2007.9.2/hkleber.
Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatment. Science & practice perspectives, 1(1), 13–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054.
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