Heroin Withdrawal & Detox

Medically Reviewed by

Annamarie Coy, BA, ICPR, MATS

Written by

Kelly Jamrozy

Evidence Based

3 sources cited

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Overview: Heroin Use & Withdrawal

Heroin is an opioid and morphine derivative. It relieves pain and anxiety and triggers euphoria. It’s an illicit drug that is sold as a powder and smoked, snorted, or dissolved into a liquid and used intravenously. Many people turn to heroin after developing an addiction to prescription painkillers and being unable to gain legal access to those drugs.

Heroin is highly addictive and turns a user’s life upside down. Despite the problems it causes, someone with heroin addiction will continue to use the drug. Signs of heroin use and/or addiction include:

Presence of drug paraphernalia
Changes in behavior or mood
Use of street slang related to heroin
Missing valuables or money
Track marks
Legal troubles
Lying and secretiveness
Loss of touch with old friends and/or new friendships with people who also have a drug use problem

Withdrawal Symptoms of Heroin

Addiction and physical dependence are possible. This means unpleasant withdrawal symptoms will occur when someone stops using the drug. This is because the body has grown accustomed to heroin and requires it to function.

Breaking a heroin addiction, even with motivation, is difficult because of the intense withdrawal symptoms.

Heroin is a non-prescription opioid. It’s illicit, and there is no medical purpose for it. Effects of heroin include:

It suppresses the central nervous system, reducing heart rate, respiration, and blood pressure.
It triggers feelings of euphoria by binding to the brain’s opioid receptors.
Use results in an immediate rush of pleasure and an extended phase of extreme relaxation.
As the effects wear off, the opposite occurs. A person coming down from a heroin high experiences low mood, anxiety, and increased heart rate.

The withdrawal process after addiction has developed differs for everyone. Heroin withdrawal symptoms vary based on the amount, potency, and frequency of use of the drug before going clean. Additionally, if a person has a history of mental illness or has undergone withdrawal for other opioids tend to experience strong withdrawal symptoms.

Mild heroin withdrawal symptoms include:

Abdominal cramps
Chills
Goosebumps
Muscle and bone pain
Nausea
Runny Nose
Sweating
Tearing
Runny nose
Yawning a lot

Moderate heroin withdrawal symptoms include:

Agitation
Diarrhea
Fatigue
Restlessness
Tremors
Trouble concentrating
Vomiting

Severe heroin withdrawal symptoms include:

Anxiety
Insomnia
Depression
Difficulty feeling pleasure
Drug cravings
Hypertension
Impaired respiration
Muscle spasms
Rapid heart rate

Heroin withdrawal has no direct withdrawal symptoms that are potentially fatal. However, some symptoms can be life-threatening indirectly.

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Timeline of Heroin Withdrawal Symptoms

Heroin withdrawal symptoms develop very quickly, usually within six to 12 hours of a person’s last use of the drug. Symptoms peak in severity between two and four days after the last use and begin to taper off for most people after about a week to 10 days.

However, something known as post-acute withdrawal syndrome (PAWS) might occur. This can extend the withdrawal phase for months or years after a person stops using the drug. Though symptoms of PAWS are not as severe as the ones experienced in the days after stopping the use of heroin, they can be enough to trigger someone to use the drug again.

Symptoms of PAWS include:

Depression
Anxiety
Irritability
Cognitive difficulties
Relationship problems
Obsessive-compulsive behaviors
Cravings
Insomnia
Pessimism
Stress

These symptoms might arise when someone faces drug use triggers, but they can also appear without any trigger.

Heroin Detoxification Process

Detoxification is the first step in recovery from heroin addiction. It is possible to detox without medical intervention. Most of the symptoms associated with detox are not life-threatening. However, it is a very unpleasant experience, and medically supervised detox increases the chances of success.

Medical detoxification begins while there is still heroin in a person’s system, and the process usually lasts about five to seven days. It can take up to 10 days for those who were heavy, long-term users.

Medical detox uses prescription medication to ease withdrawal symptoms and therapy to help someone manage their addiction. Other issues monitored during detox include:

Blood pressure
Heart rate
Breathing
Temperature levels
Hydration

Vomiting and aspiration are two of the most common symptoms and serious symptoms of detox. However, the greatest risk associated with detox is relapse. Because the experience is so unpleasant, some people aren’t able to resist the urge to ease their withdrawal symptoms by using heroin. And because tolerance levels decrease quickly, there is a significant risk for overdosing if a person immediately returns to his or her previously used dosage.

Types of Heroin Detox

Someone who intends to recover from a heroin addiction can choose from several different detox programs. For example:

Outpatient care – this treatment program is the least restrictive and takes place in a physician’s office or home health care agency
Outpatient care with extended monitoring – this addiction treatment is more restrictive than regular outpatient care. It takes place in a daytime hospital program and includes monitoring by medical staff
Medically monitored inpatient detox – this rehab occurs in a standalone detox center and includes 24-hour supervision and monitoring
Medically managed intensive inpatient detox – these treatment centers provide the highest level of care that takes place in an inpatient setting and includes 24-hour acute monitoring and support

Heroin Detox Medications

There are multiple prescription medications available to ease withdrawal symptoms. They include:

Methadone
Subutex/Suboxone
Clonidine

After Detoxification

Addiction isn’t cured after a person detoxes from heroin. There is still a great deal of work to be done. After detoxification, medical experts encourage people with heroin addiction to:

Participate in behavioral counseling to manage their addiction
Participate in group, and individual therapy to explore the roots of their addiction and learn to manage addiction triggers. This could also include medication assisted treatment/therapy (MAT)
Attend a 12-step or other long-term support group

Relapse is a common issue for those with a heroin addiction, so it’s important to also understand how to manage a relapse.

Find Help For Your Addiction

You don’t have to overcome your addiction alone. Professional guidance and support is available. Begin a life of recovery by reaching out to a specialist today.