Heroin Withdrawal

Ideally, a person undergoing heroin withdrawal will seek professional addiction treatment. With medical detox, they can be administered medication to control their symptoms and improve their chances of successfully overcoming their addiction.

Without medical detox, relapse is much more likely as the person may simply return to heroin use to make the discomfort of withdrawal disappear. 

Symptoms of Heroin Withdrawal

Opioid withdrawal, including heroin withdrawal, is often described as having “flu-like” symptoms. Heroin withdrawal is also associated with the following:[2],[10]

• Insomnia and other sleep problems
• Muscle pain
• Bone pain
• Diarrhea
• Nausea and vomiting
• Stomach cramps
• Goosebumps
• Cold flashes
• Sweating and fever
• Uncontrollable leg movements
• Depression
• Teary eyes and runny nose
• Excessive yawning

A person going through opioid withdrawal will also experience an intense craving for opioids, generally specifically the drug they’re trying to quit. [3] This, combined with the significant discomfort withdrawal can cause, can make resisting the urge to further use drugs difficult without expert assistance.

Heroin Withdrawal Timeline

Heroin is a short-acting opioid, which means that the onset of effects is rapid and the effects last a short while. A person can expect heroin withdrawal symptoms to begin about 6 to 24 hours after their last use, depending on many factors like severity of addiction and dependence, method of use, individual physiology, and more. [2],[10]

Heroin withdrawal will last about 4 to 10 days in total.[2],[10] After acute heroin withdrawal has resolved, a person may experience post-acute withdrawal symptoms for months.

The following is a table to help illustrate the timeline a person can expect when trying to stop use of heroin:[2],[10]

The longer a person goes without taking opioids, the lower their tolerance for the drug becomes. If they had previously used the drug heavily and built a strong tolerance, it can be very dangerous for them to go back to their previous level of drug use if they relapse. 

Once tolerance has dropped, a smaller amount of the same drug can have the same effect on the body that a larger dose did in the past. A previously “normal” dose may now cause a person to overdose.

It is best to work to resist drug abuse and seek expert addiction treatment for heroin abuse. But if you do relapse after going through withdrawal, monitor your drug use and use a smaller amount of opioids than you had been using before you began the recovery process. 

Can a Person Die From Heroin Withdrawal?

While potentially extremely uncomfortable, heroin withdrawal is not generally life-threatening, although it can be dangerous and is best treated under medical supervision. However, it can cause miscarriage or premature delivery in pregnant individuals.[2],[5] It is generally recommended to undergo methadone maintenance treatment rather than attempt to detox if pregnant. 

A person can become severely dehydrated while going through heroin withdrawal, leading to electrolyte imbalances, which could be dangerous or even deadly in rare cases. Other possible complications include aspirating vomit into the lungs, which can cause a lung infection.[11]

The most life-threatening complication of heroin withdrawal is relapse to alleviate painful symptoms. When a person gets through a period of abstinence such as during withdrawal, their tolerance reduces. If they take the same heroin dose they were previously taking, they may run the risk of an overdose. Plus, heroin isn’t regulated and is often cut with deadly opioids like fentanyl and carfentanil, so returning to heroin use is always risky.[11]

Ideally, a person will undergo heroin withdrawal at an addiction treatment facility, where experts are aware of the risks of heroin withdrawal and can help control a person’s symptoms and prevent medical emergencies. The goal is often to make patients as comfortable and safe as possible during withdrawal. 

If someone is undergoing heroin withdrawal at home or in an otherwise non-medical location, it is important they have someone caring for them who takes hydration seriously.

When to Seek Emergency Help

If you are going through heroin detox at home, it’s important to know when it’s time to seek emergency treatment. Some signs of severe dehydration and electrolyte imbalance include:[12]

• Extreme thirst
• Lack of urination
• Dark-colored urine when you do urinate
• Confusion
• Passing out
• Dizziness
• Shock
• Rapid heartbeat and rapid breathing

Returning to heroin use to alleviate withdrawal symptoms can have fatal consequences due to the risk of an overdose. If you take heroin to self-treat withdrawal, you need to know the signs of an overdose so you can call 911 immediately. Here are some overdose signs to be aware of:[13]

• Slowed or stopped breathing
• Slowed or stopped heartbeat
• Blue-ish lips or fingernails
• Vomiting
• Gurgling noises
• Clammy face
• Coma / unresponsive

Heroin Withdrawal Treatment

Treatment for heroin withdrawal will depend on the severity of a person’s symptoms and the extent of their heroin use.

Mild withdrawal treatment generally focuses on symptoms. Doctors will work to keep a person hydrated and to replace important vitamins. More severe withdrawal uses a similar approach, but it may also use medications to further treat symptoms. 

In some cases, drugs may be used to wean the patient off heroin. This can be completed by using drugs with a similar mechanism of action that can be administered in a controlled, medical setting. Many of these medications can largely eliminate withdrawal symptoms, helping to prevent relapse in early recovery.

At-Home Detox for Mild Withdrawal

If your heroin withdrawal is mild and you’d rather detox at home, here are some things you can do to stay safe and comfortable:[2]

• Drink 2-3 liters of water per day to replace fluids
• Take vitamin C and vitamin B supplements to balance nutrients
• Take loperamide for diarrhea
• Take over-the-counter pain medications like ibuprofen for aches
• Take Emetrol for nausea and vomiting

Try to make yourself as comfortable as you can. Take a relaxing bath, listen to calming music, and try meditation or mindfulness. It’s also helpful to have a support system who can help you during this difficult time.

Medications That Can Help With Heroin Withdrawal

A few different types of medications can help with heroin withdrawal.

Clonidine

This is a type of drug called an alpha-2 adrenergic agonist. It can relieve a wide variety of withdrawal symptoms, dramatically improving patient comfort. [6]

It is frequently combined with other withdrawal treatments (such as keeping a person hydrated) as they undergo withdrawal. 

Buprenorphine

This drug is considered the best medication for moderate to severe withdrawal management, sharply reducing withdrawal symptoms and cravings. It is a type of medication called a partial opiate agonist, so it significantly reduces cravings for heroin and other opioids. [2]

Methadone

Methadone is a synthetic, long-acting opioid. With carefully controlled administration, doctors can use it to help wean patients off less controlled, illicit opioid use. One helpful aspect of methadone treatment is that, in being an opioid, it can help reduce a person’s cravings and withdrawal symptoms. At the same time, methadone has a higher potential for abuse than buprenorphine. [2]

Heroin Detox is the First Step

While withdrawal is a key part of recovery, it isn’t enough on its own. The bulk of recovery work takes place in therapy. Whether you opt for medical detox or a different approach, you aren’t recovered just because heroin is processed out of the body.

You must work to address the underlying issues that led you to heroin. Once those problems get the focus they deserve, you can find a firm footing in recovery.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More