What is heroin withdrawal?

Going through heroin withdrawal will you make you feel agitated and anxious. Why does withdrawal from heroin occur. And when kicking a heroin habit, how do you get past the harder impulses to use when you are trying to detox? More here.

12
minute read
Reviewed by: Dr. Dili Gonzalez, M.D.

ARTICLE OVERVIEW: If you use heroin regularly, you can quickly develop dependence, which is a natural brain adaptation necessary for survival. Take away the heroin, and you get withdrawal. Heroin withdrawal symptoms can be difficult and commonly cause relapse. But while withdrawal is unpleasant, it is rarely (if ever) life-threatening. This article reviews how you can best treat withdrawal symptoms and what withdrawal is like.

TABLE OF CONTENTS:


What Withdrawal Is Like

Heroin withdrawal is painful and uncomfortable. Sometimes, symptoms have been compared to a really bad flu. One of the reasons that heroin withdrawal is so painful and dangerous is that heroin is one of the strongest opiates on the planet with a high dependency rate. So, if you’re taking heroin regularly, the withdrawal symptoms can be more intense and severe.

If you’re taking heroin at all, you are likely to develop a strong physical and psychological need for this opiate drug. And the more you use heroin, the worse your withdrawal symptoms become.

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Heroin withdrawal is like a case of extremely bad flu.


Symptoms

Withdrawal will you make you feel agitated and anxious, driving you to seek out more heroin. In fact, battling with cravings is one of the harder impulses to get past when you are trying to detox. Other, flu-like symptoms of heroin withdrawal are intense and will tire and exhaust you.

Withdrawal symptoms, can begin as early as a few hours after you last take heroin. These symptoms include:

  • Cold flashes with goose bumps.
  • Diarrhea and vomiting.
  • Restlessness.
  • Severe heroin cravings.
  • Severe muscle and bone pain.
  • Sleep problems.
  • Uncontrollable leg movements.

Other symptoms arise throughout withdrawal and can include:

  • Body aches.
  • Cold sweats and chills.
  • Constipation.
  • Cramps in the body.
  • Depression or malaise, a general “bad” feeling.
  • Extreme drug craving.
  • Fever.
  • Nausea.

Heroin withdrawal is rarely life-threatening. However, it is best to withdraw under medical supervision. Symptoms can be treated to make the process easier.


Why Withdrawal Occurs

Medically, drug withdrawal is:

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A substance-specific syndrome due to the cessation or reduction of drug dosing after heavy and prolonged drug use.

When you start to detox from heroin, your brain needs time to regain its chemical balance. So, to really understand withdrawal, we need to look at heroin in the brain.

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Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas in the brain, especially those involved in:

  • feelings of pain and pleasure .
  • controlling heart rate.
  • controlling sleeping.
  • controlling breathing.

While heroin can create a state of bliss and euphoria, it also causes depressant effects, slowing down certain functions in the body. To be able to survive, the brain “speeds up” or causes stimulant effects, especially when heroin is constantly in the system.

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Take away the heroin, and withdrawal is actually the manifestation of the counterbalanced stimulant effects in the body. After chronic heroin use, the brain and body react as they to stabilize and self-regulate without the drug. This is why muscle pain and cramps occur; the same reason is the cause for feelings of restlessness, anxiety, and mood swings. These symptoms even out over time but can be extremely painful while they peak and resolve.

Duration

You can expect to start to feel heroin withdrawal 12 hours after your last heroin usage. The severity of withdrawing from heroin peaks and lasts between 5-7 days. But how long does it take for heroin detox to completely end?

The degree and time you spend in heroin withdrawal will varies by person and is based on drug use history, how much heroin is in the system, your age, gender, weight, and metabolism factors.

JUST KNOW THIS: Complte detox from heroin can be a long process. Physical symptoms will dissipate within the first couple of weeks, but a psychological need for heroin can be present long after you’ve stopped using; so can mood and sleep disorders. As situations arise in your day-to-day life, stress can trigger potential cravings.

So, even months or years after you finish acute withdrawal, protracted symptoms can persist.

Protracted Symptoms

Although acute withdrawal symptoms are uncomfortable, they typically end after two weeks at most, especially when a medical professional oversees the detox process. However, some drugs can lead to prolonged or protracted withdrawal, lasting for months and sometimes up to a year. People who consume a large amount of an intoxicating substance for a long time are more likely to develop this condition, which is called post-acute withdrawal syndrome (PAWS).

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The term was created to describe the cluster of ongoing withdrawal symptoms, which are largely psychological and mood-related, that can continue after acute withdrawal symptoms have gone away. Although post-acute withdrawal rarely involves aches and pains, nausea, cramping, headaches, or other physical symptoms, it can be just as intense as acute withdrawal and still puts a person at risk of relapse, as they may return to drug use in an attempt to stop the discomfort.

PAWS refers to any symptoms that persist after acute withdrawal has resolved. It can feel like a “rollercoaster” of symptoms, which come and go unexpectedly. Each episode of PAWS can last for a few days, and these can continue cyclically for a year.

Symptoms of PAWS are individual to each drug, but the most commonly reported symptoms include:

  • Anhedonia, or the inability to feel pleasure.
  • Anxiety, panic, of fear.
  • Depression.
  • Exhaustion or fatigue.
  • Hostility or aggression.
  • Inability to sleep.
  • Irritability and mood swings.
  • Loss of interest in sex.
  • Sensitivity to stressful situations.
  • Trouble concentraiting or thinking.
  • Trouble with memory.

Long-Term Damage

Researchers are studying the long-term effects of heroin addiction on the brain. Studies have shown some loss of the brain’s white matter associated with heroin use, which may affect decision-making, behavior control, and responses to stressful situations.

Timeline

The half-life of heroin is about 2-3 hours, so physical symptoms of withdrawal generally start 6 to 24 hours after last use, peak in severity during days two to four, and generally subside within 5-10 days. However, psychological features of dysphoria, anxiety, sleep disturbances and increased cravings may continue for weeks or even months.

The following timeline has been outlined by the New York State Office of Alcoholism and Substance Abuse Services.

Day 1, Early Withdrawal.

The opiate withdrawal timeline starts with early withdrawal symptoms. Onset is within 6-12 hours for short-acting opiates like heroin. Most people report a sense of anxiety and doom. Although these subjective symptoms are not life-threatening, people feel as if something big is about to happen. Early phase symptoms can include:

  • Rhino rhea (runny nose)
  • Sweating
  • Tears in the eyes
  • Yawning

Days 2-3, Middle Withdrawal

During this stage of middle withdrawal, the next stage of symptoms of heroin withdrawal manifest. Many people report:

  • Dilated pupils
  • Lack of appetite
  • Gooseflesh
  • Irritability
  • Restless sleep
  • Tremor

Day 3-7, Late Withdrawal.

Late withdrawal symptoms peak within 72 hours and usually last week or so. They include an increase in all previous signs and symptoms, with additional symptoms of:

  • Bone pain
  • Depression
  • Diarrhea
  • Increased heart rate
  • Increased blood pressure
  • Muscle spasm
  • Nausea, vomiting, and abdominal cramps
  • Volatile mood
  • Weakness

The acute stage has mostly physical symptoms, and the post-acute stage has mostly emotional symptoms. The symptoms of post-acute withdrawal are less severe but last longer.

Main Treatments

Main treatments during withdrawal include:

  • Assessment.
  • Planning
  • Medications.
  • Supportive care.
  • Linkages to services for further treatment and support.

During withdrawal, detox clinic staff may:

  • Ask for your permission to speak with your other health care providers, pharmacist or family members.
  • Introduce pain therapies as needed.
  • Prescribe other types of medications to help you manage withdrawal signs and symptoms such as sleep, appetite and mood disturbances.
  • Regularly monitor your pulse, blood pressure and temperature.
  • Request urine or blood samples to check the type and amount of medication or other substances in your system.

In fact, a variety of effective treatments are available for a heroin problem. However, most are either medication-based or rooted in talk therapy. Both approaches help to restore a degree of normalcy to brain function and behavior. Research shows that for many people, integrating both types of treatments is the most effective approach.

Medications That Help

It is important that you are medically monitored from the beginning of any withdrawal. Abrupt withdrawal can be unpredictable and can lead to relapse if not carefully managed.

Doctors might prescribe medications to help with heroin detox. Below are four different FDA-approved medications that support and treat withdrawal symptoms from heroin. Other medications might include anti-depressants and anti-anxiety medications to help psychological effects of withdrawal.

1. Buprenorphine. Buprenorphine has said to shorten the duration of detox. In fact, buprenorphine is a recently used drug and said to be less addictive the methadone. It is showing promise in supporting heroin detox.
2. Clonidine. This is a medication which reduces anxiety, agitation, muscle cramps, and sweating.
3. Lofexidine. An oral tablet, this medicineis designed to manage the full spectrum of symptoms: aches and pains, muscle spasms/twitching, stomach cramps, muscular tension, heart pounding, insomnia/problems sleeping, feelings of coldness, runny eyes, yawning, and feeling sick, among others. The product is marketed under the brand name Lucemyra.
4. Methadone. Methadone helps you avoid withdrawal symptoms and live a normal life. This opioid medication is used to treat severe pain, but it’s also commonly used to treat opiate addictions over a period of six months or longer. It can be administered as a tablet, liquid or injection.
5. Naloxone. Sold under the brand name Narcan, naloxone is not a treatment for heroin addiction, but it can temporarily stop the effects of heroin use. Naloxone has recently been used by first responders and law enforcement officials to someone at the first sign of heroin and opiate abuse. If someone has been given naloxone for overdose, it’s very important to get them to an emergency room as soon as possible before the drug wears off.
6. Naltrexone. Naltrexone is an FDA-approved medication ideal for treating heroin addiction as it’s not habit forming. Naltrexone helps people avoid relapse by decreasing their cravings and preventing them from getting high if they were to take more heroin. After someone who used heroin has undergone detoxification, naltrexone is the next recommended step. This medication can only be used after a person has gone through detox, so one must either successfully stop using heroin for several weeks or opt for medically assisted detoxification if they want to use it in their recovery.

Home Remedies

Home remedies are beneficial and can supplement the withdrawal process. It is important that you plan for detox with a supervising physician. You should always go through heroin detox under medical supervision. Still, you can proactively seek out over the counter medications which can help the flu like symptoms, such as pain relievers and anti-nausea medication. The following home remedies have been recommended to help:

For aches and pains:

  • Heating pads.
  • Massages.
  • Warm showers or baths.

For drug cravings:

  • Go to AA/NA meeting.
  • Seek a safe, drug-free environment.
  • Talk about it with a sober friend.
  • Relaxation techiques.
  • Use the rubber band snap method.
  • Understand this is a natural occurrence.

For gastrointestinal (GI) distress:

  • Bland food diet.
  • Increase fluids.
  • Loperamide (Imodium).

For psychological symptoms:

  • Exercise.
  • Keep busy (find something to put your attention in).
  • Meditation.

Clinic Vs. Home Detox

Detoxing from heroin is best done at a drug rehabilitation facility. This is the safest option, for both one’s mental and physical health. Medically assisted detox also has higher rates of success than other methods; alternatives can be risky at best and even life-threatening at worst.

While it’s rare to die from withdrawal or detox, death is a possible side effect. Suicidal ideation, possible violence, and even hallucinations can occur. For this reason, it’s recommended that anyone who’s planning a heroin withdrawal detox at a medical facility.

It’s possible to withdraw at home when you do not have access to a detox clinic. In these cases, you might consider managing the withdrawal on an outpatient basis with a supervising physician. Additionally, you’ll need to meet a few other conditions. Withdrawal symptoms should be predicted to be mild to moderate in severity and you’ll need support from a family member or friend.

Still, you’ll need a medical clearance first! If you are unable to detox at an accredited facility, and home detox is the only option, it’s important you get the medical permission and make a plan to address risks. Your doctor can also help with other aspects of the withdrawal, including post-withdrawal support.

Home detox kits that contain vitamins, herbs and minerals are available at drugstores and online. However, these kits are rarely successful because they don’t address the deep-rooted psychological and behavioral issues that are tied to addiction. It’s highly suggested to seek professional help when undergoing something as serious as detox.
If you try to go through withdrawal on your own, you’ll need to be prepared. Try to slowly taper off before you go off heroin completely. This might limit the intensity of your withdrawal. However, given the compulsive nature of addiction, most people find self-regulated tapering to be impossible. It often leads to a full relapse into addiction.


It’s important to speak to a health professional before you go through withdrawal, as complications can occur and you may need medical assistance.


Benefits of a Detox Clinic

You may not want to pay the money to withdraw in a clinic. But there are many benefits of a detox clinic. Staff can guide you in terms of:

  • Strategies for coping with symptoms and cravings.
  • Strategies to remove high-risk situations.
  • The nature and duration of withdrawal symptoms.
  • The role of medication.

People often have limited concentration during withdrawal, and information may have to be repeated, perhaps even re-phrased, to be fully understood and absorbed. Counselling during withdrawal can be super supportive. Plus, most people tend to be irritable, agitated, tired and run-down; you may suffer from mood swings and poor sleep patterns, as well as having difficulty in concentrating. This is definitely not the optimal frame of mind in which to try to solve significant, long-standing life problems…however, supportive staff can get you through the difficult time.

Monitoring

An important part of withdrawal services is regular and frequent monitoring, to check:

  • Complications or difficulties.
  • Drug use.
  • General progress.
  • Ongoing motivation levels.
  • Response to the medication(s).
  • Severity of withdrawal symptoms (which can be facilitated by the use of withdrawal scales).

Doses of medication can then be adjusted according to the person’s progress. It is recommended that persons undergoing outpatient withdrawal be reviewed by a health professional.

Who Uses Heroin?

Wonder if you’re the only one facing a problem?
Just so you know…you’re not alone.

According to the National Survey on Drug Use and Health (NSDUH), in 2016 about 948,000 Americans reported using heroin in the past year,a number that has been on the rise since 2007. Additionally, heroin use no longer predominates solely in urban areas. Several suburban and rural communities near Chicago and St. Louis report increasing amounts of heroin seized by officials as well as increasing numbers of overdose deaths due to heroin use.

This trend appears to be driven largely by young adults aged 18–25 among whom there have been the greatest increases. The number of people using heroin for the first time is high, with 170,000 people starting heroin use in 2016, nearly double the number of people in 2006 (90,000). In contrast, heroin use has been declining among teens aged 12–17. Past-year heroin use among the nation’s 8th, 10th, and 12th graders is at its lowest levels since 1991, at less than 1 percent in each grade level.
The number of people meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for dependence or heroin use disorder increased dramatically from 214,000 in 2002 to 626,000 in 2016.

Dependence VS. Addiction

With repeated use of heroin, dependence will occur. When people use the term “dependence,” they are usually referring to a physical dependence on a substance. Dependence is characterized by the symptoms of tolerance and withdrawal. While it is possible to have a physical dependence without being addicted, addiction is usually right around the corner.

Addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued substance abuse. Substance use becomes the main priority of the addict, regardless of the harm they may cause to themselves or others. An addiction causes people to act irrationally when they don’t have the substance they are addicted to in their system.

If you think you’re addicted, you probably are.
Reach out for help. You don’t need to do it alone.

Your Questions

Do you still have questions about heroin withdrawal? Please share your questions and experiences with heroin in the comments section below. We’ll try to respond to you personally and promptly.

Reference sources: HEALTH.GOV.AU: Guidelines for the managment of heroin withdrawal
NCBI: A 50-Year-Old Woman Addicted to Heroin
NCBI: Drug Withdrawal Syndrome
NCBI: Molecular Mechanisms of Opioid Receptor-Dependent Signaling and Behavior
NHBI: Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review
NIDA: FDA approves first medication to reduce opioid withdrawal symptoms
NIDA: Heroin
NIDA: The neurobiology of drug addiction
RESEARCH REPORT SERIES: Prescription Drug Abuse
WEXNER MEDICAL CENTER: Post Acute Withdrawal Syndrome (PAWS)
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
Medical Reviewers
Dr. Dili Gonzalez, M.D. is a general surgeon practicing women's focused medici...

All of the information on this page has been reviewed and verified by a licensed medical professional.

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