This time will be different, you tell yourself. You'll throw out all the needles. You'll cut off all your dealers. You're determined to make sobriety stick, and you feel confident…
If you’re addicted to heroin, you may fear the withdrawal process. You’ve probably heard stories about intense nausea, vomiting, diarrhea, and sweats. These fears might be part of what drives you to turn back to heroin again and again.
The good news is that heroin withdrawal doesn’t have to be miserable. There are medications available that can lessen the severity of detox, and with medical supervision, you can resist the urge to relapse.
Detox from heroin will take different amounts of time, depending on whether you use medication-assisted treatment (MAT). Without medications, the detox process usually takes a week or two. With medications, the process may continue for months, but you won’t experience most withdrawal symptoms.
Heroin has quickly replaced prescription painkillers as a primary drug of abuse, accounting for more than half of all drug overdose deaths in the United States. According to the Centers for Disease Control (CDC):
- Between 1999 and 2017, 700,000+ Americans died of a drug overdose, and more than 400,000 of those deaths were caused by use of an opioid.
- In 2017, more than 70,000 people in the U.S. died due to a drug overdose, and 68 percent of those people died of an overdose involving an opioid drug.
- The number of deaths caused by opioid overdose was six times greater in 2017 compared to 1999.
- Every single day in the United States, an average of 130 Americans die as a direct consequence of using heroin, synthetic opioids like fentanyl, and/or prescription painkillers.
Prescription drugs like OxyContin and Percocet triggered the problem back in the 1990s as prescriptions for these drugs began to increase. The problem peaked in 2010 with illegal pill mills and doctors-turned-drug-dealers offering anyone a prescription for a price rather than medical need.
Around this time, laws were changed to limit access to these drugs, and as a result, many people turned to heroin rather than seeking treatment for addiction. The drug was easier to get and far cheaper.
Heroin overdoses spiked while prescription drug overdoses fell. Around 2011 and 2012, heroin overdose rates shot through the roof — not because more people were abusing the drug but because drug cartels were spiking heroin with fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine.
Found in everything from heroin to counterfeit pills sold on the street to stimulant drugs like cocaine and crystal meth, fentanyl is the primary cause of overdose death today. For this reason, connecting with a heroin detox program that supports supervised and safe recovery from heroin addiction is necessary for all who struggle with any level of use of the drug.
Physical Withdrawal Symptoms
The physical withdrawal symptoms associated with heroin detox are often the most fearsome for those considering heroin rehab. Once physically dependent on the drug, you will quickly feel sick if they do not have a steady level of it in your system.
Physical heroin withdrawal symptoms may include the following:
- Muscle and bone pain
- Stomach cramping
Because the symptoms can kick in during active addiction when you are without heroin for any length of time, you may be hesitant to choose treatment knowing what you will experience physically. Remember that there are options to escape most of this pain during detox.
Psychological Withdrawal Symptoms
The psychological withdrawal symptoms associated with heroin detox are arguably just as difficult to manage as the physical symptoms, amplifying the pain and discomfort of detox and adding a layer of urgency to the feeling that heroin is a necessary part of life.
- Emotional mood swings
- Difficulty sleeping
- Cravings for heroin and other substances
- Irritability and agitation
- General feeling of discomfort and unrest
- Inability to focus or feel calm
Heroin Detox Timeline
No two people living with a heroin addiction will experience detox in precisely the same way. The dose of the drug, use of other substances, and the presence of underlying mental health disorders or physical ailments can all impact how, when, and with what intensity heroin withdrawal symptoms will be experienced.
Each person is unique, and it is important to manage heroin detox according to individual need.
- 12 hours: Early withdrawal symptoms can begin within a few hours of the last heroin dose. Depending on the pattern of use and the dose, it can happen in just a few hours or it can take up to 12 hours to begin. These symptoms may be mild at first.
- 24 to 72 hours: Once heroin withdrawal symptoms begin, they will usually continue and build over the next three days. New symptoms may appear and original symptoms will often worsen. They will usually peak around day 3.
- Week 1: Once the peak of withdrawal symptoms is reached, a plateau often happens. That is, for the next week or more, intense symptoms can continue. This can be very difficult to navigate without the help of medical and therapeutic professionals and the support of peers who have been there or are also going through the same thing.
- Week 2 and beyond: After withdrawal symptoms peak and begin to slowly dissipate, post-acute withdrawal syndrome begins. This period can last for a couple weeks, a few months, or a year with some level of symptoms — especially cravings and agitation — continuing to be intrusive and requiring management.
Complications can develop at any time during heroin detox. If there are underlying mental health issues, they can cause problems early on. Psychosis may be a problem, deep anxiety can kick in, or another symptom of an ongoing mental health disorder can make it difficult to avoid relapse.
Similarly, medical issues that include chronic pain, pregnancy, or heart conditions can cause medical emergency and require immediate intervention.
External issues can be a problem as well. Living with people who keep drugs or alcohol in the house, who get high, or who are abusive can make it difficult to stay sober while dealing with intense withdrawal symptoms.
Even under the best of circumstances, it can be difficult to get through detox without returning to heroin. Relapse after a period of sobriety, no matter how brief, is more likely to be fatal than at almost any other time.
To avoid complications, it is always recommended that you connect with a detox program. They can help you address anything that comes up unexpectedly.
There are a number of medications approved for the treatment of opioid addiction that can diminish the severity of withdrawal symptoms. They can help you avoid the brunt of the physical symptoms so you can be more present for the therapeutic work.
Depending on your individual circumstances, one medication may be more appropriate than others. It is important to work with a medical professional trained in substance abuse treatment who is able to prescribe pharmaceutical support and follow up as needed.
Some medication options include:
- Methadone. This is the first medication used to treat heroin withdrawal, and it is appropriate for people who begin detox with a very high-dose addiction. Though it is an opioid drug itself and addictive, methadone can block the effects of heroin. Because it is administered daily at a clinic or by a treatment professional in liquid form, doses can be lowered incrementally, milligram by milligram, to help people move toward sobriety at their own pace while avoiding tough withdrawal symptoms along the way.
- Buprenorphine. This was the first drug to be FDA approved for nothing but the treatment of opioid addiction. It is available on an outpatient basis when prescribed by a certified physician. Buprenorphine is often used for low-dose heroin addictions or when someone gets low enough on their methadone dose that they can successfully transition.
- Vivitrol. Extended release naltrexone is usually administered as an injection once a month to assist people in staying sober who have a difficult time taking a medication daily or as prescribed. Naltrexone causes symptoms of illness if opioids are taken, but it is not usually administered until after detox. For example, it is often given to inmates who have gone through detox and need help staying sober after release.
- Lofexidine. This drug made headlines in 2018 for being the first non-opioid drug to be approved for the treatment of opioid addiction. It is a chemical cousin to clonidine, a drug that has been used to treat symptoms of opioid detox for decades. Unlike clonidine, lofexidine does not cause low blood pressure, making it more accessible to more people. However, there is some concern that it may not be as effective for the treatment of high-dose addictions or for those who struggle with relapse as there is no blocking component.
What Medication Is the Right Choice for You?
Though there are many options in medicated detox and medication maintenance, it may not be the best choice for you to take medications to manage heroin withdrawal symptoms. Some people prefer to move through the detox process as swiftly as possible or feel that their dose is low enough to make breaking free from addiction a relatively simple process on a physical level.
Make this decision under the guidance of trained professionals who can help to determine the safest and most effective path forward based on personal goals, challenges, and history. Talk to a professional before you attempt to stop taking heroin.