Heroin Withdrawal: Symptoms, Timeline & Detox

Heroin Withdrawal Guide

Heroin use has become so widespread that it is now considered an epidemic. According to the Centers for Disease Control and Prevention, the number of people between 18 and 25 years old who use heroin is now twice what it was 10 years ago. An estimated 90% of those who use heroin also use another illegal substance, and almost half are also addicted to prescription painkillers that contain opiates.

In addition to an increase in heroin use, opioid overdoses and deaths are on the rise. Almost 500,000 people died from opioid overdoses over a 10-year period. Overdosing on heroin may cause shallow breathing, and the person can slip into a coma or die. Unlike some other drugs, heroin use affects people in every socioeconomic category.

Heroin Withdrawal

Heroin Addiction Treatment

Treatment for heroin addiction is available, but you need access to clinicians and counselors who can help you through the detox process. Once the drug is eliminated from your body, you start a treatment program with a counselor. Detox can be challenging, especially if you are doing it on your own, whether by choice or because you can’t acquire more heroin. The withdrawal symptoms are often enough to make people give up on getting clean.

Heroin Detox

When you use heroin over a long period of time, your body changes how it functions. It adapts to the presence of the drug, and your brain also changes how it works. When you suddenly stop providing heroin to your body, it goes through a very rapid change on a physiological level. This may cause a disruption that is significant enough to cause mild to severe symptoms. Eventually, your body will recover a natural balance, but this takes time. Many people who try to quit using heroin on their own find that the symptoms are unmanageable, and the only way to alleviate them is to use heroin again.

Medically Supervised Detox for Heroin

Medically supervised detox is a safer and more effective way to detox from heroin use. A clinician and a substance use counselor monitor your progress. They also provide support when the symptoms serve as a barrier to detoxing.

Can You Detox From Heroin on Your Own?

People have detoxed from heroin on their own, but the success rate is very low. Additionally, detoxing from heroin may cause serious medical issues such as coma, and it can be fatal. Medically managed detox from heroin use ensures that you safely stop using the drug to begin your journey of recovery.

Is Detoxing From Heroin Fatal?

There are some rare cases of death during unsupervised withdrawal from heroin. The most common causes are heart failure and dehydration. Remember that your body is now used to having heroin in your system to maintain your heart rate. Once you remove the heroin, your body may not be able to adapt quickly enough.

Extreme dehydration is another reason that some people die as they withdraw from heroin. As you experience the symptoms of detox, food and water may not appeal to you, but staying hydrated supports the normal function of your body. When you get very dehydrated, vital organs in your body start to shut down, including the brain, heart, kidneys, and liver. Dehydration also slows down the elimination of heroin from your body, so the withdrawal symptoms will last longer.

Heroin Withdrawal Symptoms

Symptoms you may experience while withdrawing from heroin range from mild to severe, depending on how long you’ve used the drug as well as other physiological factors.

Mild Withdrawal Symptoms of Detoxing From Heroin

People who chronically use heroin experience mild symptoms only hours after using the drug, as well as during detox when they try to quit. Symptoms may include:

• Cramping and abdominal pain
• Nasal discharge
• Aching in the bones and muscles
• Sweating
• Tearing eyes
• Chills
• Excessive yawning

Moderate Withdrawal Symptoms of Detoxing From Heroin

Moderate withdrawal symptoms from heroin may include:

• Nausea and vomiting
• Tremors
• Fatigue
• Gastrointestinal symptoms including diarrhea
• Difficulty concentrating
• Goose bumps
• Difficulty sitting still
• Irritability

Severe Withdrawal Symptoms of Detoxing From Heroin

People who have a long-term history of ongoing heroin use may experience more severe symptoms after they stop using heroin. These may include:

• High heart rate
• Cravings
• Difficulty breathing
• Inability to sleep
• Anxiety and depression
• High blood pressure
• Trouble sleeping
• Severe muscle cramps and spasms
• Inability to experience positive emotions and pleasure

Fatal Symptoms of Withdrawing From Heroin

Although few heroin withdrawal symptoms are actually life-threatening, some can cause behaviors that can lead to death. If a person experiences severe depression or painful symptoms, it may be enough to lead to thoughts of suicide. The experience may also make a person feel hopeless in their addiction, and this is another reason why some people consider suicide while detoxing from heroin. In other cases, people try to reduce the symptoms on their own by using more heroin, which may lead to an overdose.

Medications Used for Detoxing From Heroin

Treatment for heroin addiction has evolved as the epidemic has become more widespread. As a result, there are now some prescription medications available to help those who are detoxing from heroin.

Suboxone for Detoxing from Heroin

Heroin works by activating opioid receptors in the brain. Suboxone, which contains buprenorphine and naloxone,
works in the same way, but it only partially activates the receptors. This can reduce the severity and longevity of withdrawal symptoms from heroin. Blocking the receptors also prevents the transmission of signals in the brain that cause withdrawal symptoms. Suboxone works best when the dosing is gradually reduced as the person goes through detox, but this drug is not intended for long-term use.

Methadone and Heroin Recovery

Methadone is another medication that works specifically to help alleviate withdrawal symptoms from opiates. It is long-acting and works by easing symptoms and cravings. Methadone also lessens the effects of heroin. If a person taking methadone relapses, they will not experience the same effects as when they use heroin. This difference helps to modify addiction memories that often lead to relapse and cravings.

Methadone is only administered under clinical supervision to ensure that the client adheres to the required treatment regimen. If the client is able to follow the program under supervision, permission may be granted for using methadone at home. There is a risk of heart problems, and the active ingredients stay in the body longer compared to other medications for heroin treatment. For these reasons, methadone may not be an ideal option for everyone.

Lucemyra for Heroin Recovery

In 2018, the Food and Drug Administration approved Lucemyra to manage the symptoms of withdrawing from heroin. This is the first non-opioid medication for this purpose.

Lucemyra is intended for use over 14 days, and it is most effective when used in conjunction with other medications for opioid use disorder. The medication works by affecting the automatic nervous system that contributes to symptoms during withdrawal. It may reduce symptoms, but, unlike other medications, it does not prevent symptoms. Lucemyra may help with heart palpitations, aches, discomfort, running eyes, sleep disturbances, nausea, abdominal cramps, and excessive yawning.

How Long Does Withdrawal From Heroin Last?

The average heroin withdrawal timeline varies by person. It depends on how quickly your body metabolizes the drug, as well as other factors. In total, heroin detox may take up to two weeks. The important thing to remember when you are detoxing from heroin is that the symptoms won’t last forever. With the help and support of your medical team, you can successfully complete detox from heroin.

Initiation of Withdrawal Symptoms

Withdrawal symptoms from heroin typically begin within six to 12 hours of the last time you used the drug. This is when you may notice mild symptoms, and you may need only minimal support and encouragement from your medical team. Your counselor plays an important role in helping you manage any anxiety about the next stage of detox.

Peak of Withdrawal Symptoms

After 12 hours, your withdrawal symptoms may worsen. The peak is approximately two to three days after the last time you used heroin. This is when you may experience more symptoms or the same symptoms with more severity. Your clinician monitors your progress to determine if medications are needed to help you complete detox.

Withdrawal Symptoms Subside

After five days, your withdrawal symptoms start to subside, but you may not feel well for up to two weeks after you last used heroin. Because you are feeling a little better, though, this is a great time to engage in healthy activities. Go for a walk, journal, sketch, read, and help others in the facility. You may continue to take medications for withdrawal during this phase of detox.

Post-Acute Withdrawal Syndrome

Some people who complete detox from heroin experience long-term symptoms that last for several weeks or months after they last use the drug. Known as post-acute withdrawal syndrome (PAWS), it often involves mental health issues, such as depression, anxiety, and mood swings. PAWS affects approximately 90% of people who are recovering from heroin addiction. The syndrome is still being studied, but researchers believe it is linked to the physiological changes in the brain while using heroin.

Symptoms of PAWS

If you don’t quite feel like yourself after detoxing from heroin, stay positive. You may be experiencing the symptoms of PAWS. Symptoms may be continuous or triggered by stress and other factors. The most common issues are:

• Anxiety and panic attacks
• Depression and low mood
• Agitation and irritability
• Cognitive issues, such as trouble with memory, solving problems, and learning
• Decreased capacity to manage stress
• Obsessive compulsion
• Cravings
• Trouble sleeping
• Challenges with relationships
• Pessimism and lack of empathy

Risk Factors for PAWS

PAWS does not affect everyone who is recovering from heroin use. Although the condition is not well understood, there are some common risk factors that have been identified. Long-term heroin use may change the function of the brain to the point where it becomes highly active with even the lowest of stimulation, such as stress. Studies have also shown that children born to mothers with a history of heroin use may be at risk for PAWS. The condition has been identified in people who use other substances, such as benzodiazepine and alcohol.

Treatment for PAWS

The good news is that there are treatments for PAWS that help you stay on the path of recovery from heroin use. PAWS is considered a chronic condition, so you will need support over time. Acamprosate, which is often prescribed for recovering alcoholics, has also proven effective for people living with PAWS. Counseling can also help you manage the challenges and symptoms. If you are diagnosed with PAWS, expect to have symptoms that ebb and flow. This can be very stressful and frustrating. A counselor can teach you skills and provide tools to keep you on the path to recovery from heroin use.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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