Substance Use

Heroin Withdrawal

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Heroin withdrawal marks a challenging phase in the journey toward recovery from opioid dependence. This process begins when an individual ceases or significantly reduces heroin use after prolonged addiction, triggering a series of physical and psychological symptoms as the body attempts to recalibrate to its absence and moves toward well-being. (1)

Characterized by intense discomfort and craving, withdrawal is often described as one of the most nerve-wracking barriers to overcoming heroin addiction. The detox experience underscores not only the potent grip of opioids on the human brain but also highlights the critical need for supportive care and medical intervention.

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What is Heroin Withdrawal?

Heroin withdrawal is what happens when someone who has been using heroin regularly stops taking it or drastically cuts back on their use. Heroin, a powerful opioid drug, creates strong feelings of pleasure and can be very addictive. (2)

Over time, the body gets so used to having heroin that if the person suddenly stops using it, their body throws a bit of a fit because it’s missing something it thinks it needs to feel normal.

Withdrawal symptoms can kick in within just a few hours after the last dose of heroin, and they’re far from pleasant: people might get muscle pains that make them feel like they’ve run three marathons back-to-back; they could start feeling really anxious or agitated without reason; many find themselves unable to sleep even though they’re exhausted.

Some experience severe stomach issues including:

  • Nausea
  • Abdominal cramps
  • Diarrhea (2)

The whole process can be tough and scary, which is why support, whether through medical professionals, addiction specialists, friends, family, or anyone going through it. Understandably, fear of experiencing these unpleasant effects often keeps folks tied to cycle dependency despite wanting to quit.

However, knowing about various treatment options available—from medication-assisted therapy to emotional counseling—can provide hope and light at the end of the tunnel for you or a loved one.

What Causes Heroin Withdrawal?

To better understand the cause of heroin withdrawal, you must know its mechanism of action. There are three types of opioid receptors, including mu, delta, and kappa.

Like other opioids of abuse, heroin mainly influences the mu receptor, which has a significant effect on the reinforcing action of heroin. Following prolonged use, brain changes result. (3)

Opioid tolerance, dependence, and addiction all develop because of changes in the brain due to chronic opioid abuse. Brain changes that lead to dependence appear to resolve following the heroin withdrawal process.

In most cases, dependence resolves within days to weeks. However, the underlying causes of heroin addiction are far more complex. The brain changes associated with addiction are wide-ranging and long-lasting.

Recent studies show that repeated heroin use changes both the physical structure and physiology of your brain. These changes lead to neurological and hormonal imbalances and are often difficult to reverse. (4)

One of the brain circuits that is activated during heroin use is the mesolimbic reward system. This system signals a part of your brain called the ventral tegmental area (VTA), which results in the release of dopamine.

This spike in dopamine creates feelings of pleasure. Other brain regions associate that feeling with the circumstances or environment, creating a memory. These enduring records can create cravings in response to specific triggers. (5)

These abnormalities may produce cravings months or even years after you are not dependent on heroin. As discussed above, this is often associated with post-acute withdrawal syndrome. The psychological effects of heroin abuse can last much longer than physical dependence, so ongoing support is essential. 

When considering the cause of addiction, comorbidity between substance use disorders and mental illness is also a key area of focus. However, the high prevalence between these two conditions does not necessarily mean one caused the other.

One can certainly influence the other, creating a vicious cycle of abuse. There are many considerations concerning comorbidity, including genetic and environmental variables. (6)

Heroin Withdrawal Symptoms, Timeline & Detox Treatment Options

Heroin is a commonly abused opioid made from morphine, extracted from poppy plants grown in various regions, including Columbia, Mexico, and Asia. This substance can be a brown or white powder or sold as a sticky substance known as black tar.

Sadly, heroin use contributes to high overdose death rates, especially since fentanyl hit the streets. Heroin withdrawal can be extremely difficult, making it hard to quit heroin.

If you have been using heroin for an extended period or have been using high doses, you will have developed a physical (and likely a psychological) dependence. If you discontinue use, heroin withdrawal symptoms will surface, making it challenging not to relapse.

Heroin withdrawal symptoms are known for being highly uncomfortable, and for some, these symptoms can be life-threatening. 

What Are the Symptoms of Heroin Withdrawal?

Unlike many other substances that are abused, withdrawing from opioids can be fatal. Heroin withdrawal syndrome is a potentially life-threatening condition that results from opioid dependence.

Although the physical symptoms may only last a week or two, this period of heroin withdrawal can be severely uncomfortable, painful, and, under certain circumstances, fatal. 

Research shows that complications of opioid withdrawal, including heroin withdrawal, are often underestimated and not adequately monitored. The greatest concerns are based on two key symptoms — vomiting and diarrhea.

If you become dehydrated and experience elevated sodium blood levels, you could face heart failure. This finding is most prominent in jail and prison settings where clinical management programs are not accessible. (7)

Heroin withdrawal can also become life-threatening because of certain other medical or psychological symptoms, which is why each user should receive an assessment before the withdrawal period and be monitored throughout. Having access to a multidisciplinary expert team ensures optimal comfort and safety. 

The symptoms of heroin withdrawal are similar across all opioids of abuse and include:

  • Depression
  • Anxiety 
  • Shaking 
  • Sweating 
  • Nausea
  • Stomach pain 
  • Nervousness 
  • Muscle spasms 
  • Cravings 

Many experience initial heroin withdrawal symptoms as flu-like, but much more severe. Symptoms also range from mild to severe, and not all users experience the full list of potential symptoms.

The severity of heroin withdrawal symptoms will depend on several factors, including duration of use. If you have been taking heroin for 6+ months, you can expect more severe withdrawal. (8)

It’s important to note that heroin withdrawal will not be the same for everyone. The following will all influence the severity and duration of the heroin withdrawal process.

  • The duration in which you have been using heroin
  • How much you take
  • How you administer heroin (snorting, smoking, injecting)

Mental health disorders can also complicate the process, as can combining various substances of abuse. 

Opioid use is often associated with what’s known as post-acute withdrawal syndrome (PAWS). These symptoms manifest following heroin withdrawal and are often similar to the symptoms of mood and anxiety disorders. (9)

Approximately 90% of recovering opioid users experience these symptoms, including:

  • Anxiety
  • Depression
  • Insomnia
  • Panic attacks
  • Cravings
  • Increased sensitivity to stress

How Long Does Heroin Withdrawal Take?

All opioids produce similar withdrawal symptoms but varying duration and severity depending on the opioid of choice. Heroin is what’s known as a short-acting opioid, which means it takes effect quickly but also leaves the bloodstream quickly. An average heroin withdrawal timeline will go something like the following.

With heroin, withdrawal symptoms often begin within six hours after your last dose, lasting an average of five days. Some users will experience symptoms in as little as a few hours, or the initial symptoms may take up to 12 hours to surface.

Symptoms generally peak within 2-3 days. From a clinical standpoint, heroin withdrawal symptoms that surface during this timeframe are the most powerful factors driving heroin use. (10)

After a week (6-7 days), physical heroin withdrawal symptoms typically subside. Nausea and muscle aches will taper off. However, you may feel worn down and fatigued. 

As previously mentioned, after undergoing heroin withdrawal and medical detoxification, you might experience Post-Acute Withdrawal Syndrome (PAWS). These symptoms can persist for months or even years, likely due to the neurological changes that occur. 

Additionally, underlying mental health disorders could significantly impact the recovery process and your ability to maintain a drug-free lifestyle.

How to Safely Manage A Heroin Detox

When you first experience heroin withdrawal symptoms, a professional care team at a substance abuse treatment center must perform an assessment. You must be monitored throughout the heroin withdrawal process at a detox center if you have any underlying medical conditions.

Another key area of assessment is whether poly-drug withdrawal is a concern. For example, have you been combining several drugs and are now dependent on more than one substance? 

During heroin withdrawal, typical side effects include dehydration because of select symptoms, like vomiting and diarrhea. Although this may seem like a minor consideration, these symptoms can lead to serious complications for those living with pre-existing health conditions. Severe dehydration can also worsen how you feel. 

Several withdrawal scales are used to assess the severity of signs and symptoms, such as the Clinical Opiate Withdrawal Scale (COWS). This 11-item scale is administered by a clinician helping patients in outpatient or inpatient settings.

The score of this assessment is used to better determine the severity of withdrawal and the level of dependence. Some of the items include the degree of bone or joint aches, the level of restlessness, and the severity of tremors. (11)

To address heroin withdrawal symptoms, medications are often administered. This is known as medication-assisted treatment. However, this approach is highly individualized. Buprenorphine (Suboxone®) is commonly administered for heroin withdrawal, as is methadone.

The laws surrounding the prescription of this drug depend on whether you are within an outpatient treatment or inpatient treatment setting.

For inpatient treatment, you can be prescribed buprenorphine for up to two weeks without authority from the Drugs of Dependence Unit. You should only take this drug under direct supervision, and the first dose should not start until there is clear evidence of withdrawal. 

Many different reports show that buprenorphine can be highly effective. Research from the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration indicates that when assigned buprenorphine, 77% of inpatients completed their 13-day opioid tapering plan.

Other medications that may also be offered include:

  • Diazepam
  • Clonidine
  • NSAIDs
  • Loperamide (used to decrease the frequency of diarrhea) (12)

Naltrexone is a drug that blocks opioid receptors so that heroin no longer has the same effect. This drug is not sedating or addictive, which is why it may be used to help reduce cravings. 

Naltrexone works best in patients who have already completed the heroin withdrawal process. For example, when taking short-acting opioids, like heroin, it’s recommended that you wait at least seven days before you begin taking naltrexone. The FDA also approves this drug to treat alcohol use disorder. (13)

You must seek professional assistance when aiming to overcome heroin addiction. Once you complete the heroin withdrawal process, you’ll need to focus on your ongoing addiction treatment programs. Depending on your treatment plan, you may need to address symptoms of a mental health condition.

One of the most significant complications of heroin withdrawal is returning to drug use, which is most common when you do not have the proper support system and heroin treatment plan

Most opioid overdose deaths occur in users who have just detoxed after their last use because tolerance can lower. Following the heroin withdrawal process, your standard dose may now be too potent. (14)

When to Contact a Medical Professional

Heroin withdrawal symptoms often act as a barrier to treatment. Although these symptoms can be uncomfortable, avoiding the treatment process could be fatal.

If you have attempted to detox in the past, know that there is a better way. When you seek the assistance of a professional substance abuse and mental facility, you’ll gain access to the tools and support you need to ensure a more comfortable, safe heroin withdrawal process. Once your body has physically eliminated heroin, you can then focus on the next steps. 

While working with an expert multidisciplinary team, you will benefit from an individualized, holistic plan. Opioid use disorder is a complex disease and is often associated with other medical or mental health conditions. To ensure optimal wellness, continuous care and support in outpatient programs or rehab programs are needed. 

Ready to take the first step toward a healthier, more fulfilling future with addiction treatment? Get in touch with a healthcare professional at a treatment facility today at (855) 430-9439.


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