Heroin Withdrawal Symptoms & Detox

Withdrawal from heroin is painful for most individuals that experience it. A medical detox is often necessary to avoid complications and alleviate withdrawal symptoms. Co-occurring issues should also be addressed by a healthcare professional.

What to Expect When an Individual Withdraws From Heroin

Heroin is one of the more tenacious addictions, with relapse rates that reach 60 percent in some cases. This is mainly due to the intensity and discomfort of heroin withdrawal. Detox is used to ease the symptoms until normal brain function is restored; medical treatment and therapy address the underlying causes of addiction and related health problems.

One of the main reasons that this addiction is so difficult to beat is the pain of heroin withdrawal. Long after the pleasurable effects disappear, dependence makes cessation unbearable. This is because the drug disrupts the natural regulation of brain chemistry, replacing it with an artificially induced release of high levels dopamine and other endorphins.

Those are the chemicals that control response to outside stimulus and cause feelings of pain and pleasure. When heroin is withdrawn, the body tells the brain that it’s experiencing pain. Since the brain can no longer produce and release endorphins on its own, the only solution it can consider is more drugs.

How Long Does Heroin Withdrawal Last?

The onset and duration of heroin withdrawal symptoms last about a week, but depression and cravings can continue for several weeks after quitting. During the first few days, the body and brain need to detox from the drug. Sweating, vomiting, and diarrhea are due to the release of built-up toxins from the system after months or years of habitual use.

Once brain function is restored somewhat, the body needs time to recuperate from the effects of dependence and abuse. Recovering addicts can work with their drug counselors and doctors to deal with lingering mental health and medical problems once the immediate side effects of withdrawal abate.

Withdrawal Timeline

Although heroin withdrawal and recovery are individual journeys, the basic withdrawal timeline follows the same path for most heroin users.

Signs of Heroin Withdrawal

When someone is experiencing withdrawal, some of the first signs are anxiety and agitation. Whether the user is trying to quit cold turkey or doesn’t have immediate access to heroin or another opioid, it’s normal to feel a sense of panic. There are also physical symptoms that can become debilitating.

The symptoms and signs of heroin withdrawal are both physical and emotional. In the early stages, the symptoms can be mistaken for the flu. An addict may even be able to explain away mild symptoms as being in a bad mood or coming down with something. Chills, fever, sweating, and nausea begin between six and 24 hours after heroin use is discontinued. The onset depends on the length and severity of abuse.

Looked at separately, many signs of withdrawal can be explained away. They also differ with the individual. Taken together, especially if there is a known history of drug abuse, they should never be overlooked or minimized.

Other withdrawal symptoms include:

  • Overwhelming sadness and depression
  • Aching muscles, especially in the back and legs
  • Restlessness and anxiety
  • Runny nose
  • Insomnia or sleep disturbances, often accompanied by nightmares or hallucinations
  • Diarrhea
  • Drug cravings

These symptoms peak in intensity after a few days, and they taper off by the end of the first week. Severe addictions and relapses may need to be managed with medical support for months, sometimes years, after leaving a treatment program.

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Heroin Detox and Addiction Treatment

It’s possible to withdraw from heroin by just quitting without assistance, but going “cold turkey” isn’t recommended. Statistically, it’s temporary drug cessation without addressing the causes of addiction and devising a realistic relapse prevention plan. Addiction recovery programs aren’t something new, and deeper insight into the nature of drug dependence has led to more effective treatment options.
Research indicates that a comprehensive, individualized approach to recovery improves the chances of long-term success. This includes an inpatient residential program or intensive outpatient treatment for at least 90 days, with an initial course of medically supervised detox to get through the withdrawal period.
Drugs Used for Heroin Detox

The most critical part of the heroin detox timeline is the first 24 – 72 hours after the last dose is taken. This is an intense experience, and many recovering addicts return to using during this time just to stop the pain. There’s also a higher risk of death due to medical complications and a high rate of suicide. These are some of the best reasons why recovery treatment should include medical detox and supervision in a calm, secure residential setting.

The standard medications used during detox include a combination of milder opioids, non-narcotic pain relievers, and medications to manage depression and anxiety. Detox medications are divided into three groups, agonists, antagonists, and partial agonists, which can be used during and after active treatment.

Heroin is a full agonist, as are most opioids that are abused, including the most prevalent maintenance drug, methadone. These drugs bond directly to opioid receptors in the brain and produce the full effect. The reason methadone is used for medical maintenance is that it is considered a milder, more manageable opioid than those that are commonly abused.

Antagonists are able to bond to the receptors without activating them. This means there is no effect from the drugs, and they block other opioids from bonding. These drugs are used mostly to reverse an overdose. Common antagonists are naltrexone and naloxone, which is the generic name for Norcan.

Partial agonists are showing promise for both detox and post-rehab maintenance. Medications like buprenorphine don’t fully bond with opioid receptors, so they offer enough of an effect to stop the cravings without the abuse potential of a full agonist like methadone. Hybrid drugs like suboxone are manufactured with the partial agonist, buprenorphine, and the antagonist, naloxone, to control cravings while causing a severe, unpleasant reaction if the user attempts to take a full agonist opioid. It is similar to how drugs like Antabuse work to deter alcohol intake after recovery.

After Care and Long-Term Recovery

Recovery is an ongoing process that can last a lifetime. An effective treatment program will include access to ongoing support like group or individual therapy, participation in support groups, social and employment support, and transitional housing in a sober living community for those who need stability. Medical maintenance programs provide low-dose opioids like methadone or suboxone to control cravings and prevent relapse. This is usually done by a daily dispensation of extended-release formulations under controlled circumstances.

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