Last Updated Dec 2, 2021
Detoxing from heroin and going through acute withdrawal can take between 4 and 10 days. A person feels generally unwell and still experiences strong drug cravings for a significantly longer period, however.
Medication-assisted treatment, such as the use of buprenorphine or methadone, can make this process much easier.
What Is Detoxing?
To detox, meaning “to detoxify,” is to allow the body the time it needs to fully process the drugs currently in its system without taking any more drugs to compensate. In the context of addiction, this means a person gets sober. Unless medications are prescribed to help prevent withdrawal symptoms, they will likely begin to experience acute withdrawal symptoms and significant drug cravings.
Detoxing is often thought of as the first major step of addiction recovery. Depending on the substance of abuse and the severity of the addiction, this can be a fairly challenging process if a person is trying to detox from heroin or other opioids.
Key Facts About Heroin Detoxing
When detoxing from heroin, comfort is generally the priority. It is more or less a waiting game, with a person needing to refrain from drug use as their body processes the drugs they’ve already taken.
As they detox, a person struggling with addiction is likely to experience withdrawal, meaning they will slowly become increasingly uncomfortable, developing flu-like symptoms. They should stay hydrated and can sleep or rest if they are able.
Light physical activity is okay, but exercise and intense physical activity should generally be avoided. It should definitely not be forced as part of the treatment process.
Importantly, a true “detox” isn’t always the best or safest option for a person. For example, pregnant people should not undergo opioid withdrawal, as it can lead to miscarriages and premature births. Instead, they should generally be put on a methadone treatment. Methadone doesn’t require a person to detox first. Medication-assisted treatment (MAT) is an evidence-based addiction treatment plan that can help a person start their recovery and manage their drug cravings.
How to Detox From Heroin
If you want to detox from heroin, you should usually begin by talking to an addiction treatment professional about the best option for your needs.
Heroin is a short-acting opioid, with withdrawal symptoms usually beginning around 8 to 24 hours since a person last used. If acute withdrawal is allowed to begin, it will generally last between 4 to 10 days.
During this time, a person will usually want to be under medical supervision. While there is a safety element to this supervision, it is generally intended to keep the person comfortable and help them avoid using drugs again while they’re vulnerable. It’s important to manage potentially intense drug cravings during this time.
What Does Heroin Withdrawal Look Like?
Heroin withdrawal is usually described as causing “flu-like” symptoms, including these:
- Mood changes
- Hot and cold flashes
- Aches and pains
- Runny or watery eyes
- Runny or watery nose
Later symptoms of withdrawal include the following:
- Dilated pupils
- Stomach cramps
- Nausea and vomiting
Withdrawal symptoms are usually at peak severity about 2 to 3 days after the last use of short-acting opioids such as heroin. An individual may also experience sleep issues, muscle tension, heart pounding, spasms, and just a general feeling of being unwell. This general feeling of being unwell is actually likely to continue for months after acute withdrawal has passed unless medications are used to prevent this, as the body adjusts to a lack of opioids.
These symptoms can range from not present to severe, depending on the individual and their history of opioid use. This will impact the best way to treat the person, with more severe symptoms warranting certain medications that wouldn’t be used for mild withdrawal.
Is Detoxing at Home Dangerous?
Detox is a spectrum, with some people having a much harder time detoxing from opioids like heroin than others. This isn’t an indication of a person’s health or strength. Depending on a person’s body and their history of drug use, there can be significant variance in how intense a person’s withdrawal symptoms might be.
Detoxing from heroin isn’t usually dangerous, with some important caveats discussed in the next section. As such, detoxing at home usually won’t be life-threatening. However, it can be difficult to detox without the support of medical professionals who understand addiction treatment and have the potential to prescribe medications to help control your symptoms if necessary.
Most often, the biggest risk from detoxing at home relates to relapse and potential overdose. In order to make the discomfort of withdrawal disappear, people often return to heroin use.
Can You Die From Withdrawal Symptoms?
It is possible to die from opioid withdrawal, although unlikely. Persistent vomiting and diarrhea can cause a person to become severely dehydrated, which can be life-threatening.
Neglecting a dehydrated person who is detoxing is generally only associated with improper care while a person undergoing withdrawal is in jail. Seemingly all reports of this type of withdrawal-related death comes from incarceration facilities (jails and prisons) that provided inadequate care to inmates. However, it does highlight the importance of a person undergoing withdrawal to be kept hydrated, as vomiting, diarrhea, and sweating can cause them to lose a significant amount of fluid.
Vomiting can also present a choking risk in some scenarios, although how often this presents a serious danger to people who are going through withdrawal is unclear.
Death is most likely to occur from heroin overdose if relapse occurs during detox. This is why medical supervision during this vulnerable period is so important.
There are broadly three evidence-supported treatment options that are considered good options for overcoming addiction. Detox is often included as the first step in these programs.
Outpatient treatment, which ranges in intensity, is often thought of as the “default” addiction treatment option. With outpatient treatment, an individual receives their treatment from a provider periodically but then can otherwise act autonomously, going to work and school and spending time doing whatever else they want or need to do.
Notably, many people who benefit from outpatient treatment may still stay at a treatment facility for the detox portion of their recovery. Spending a few days in a specialized facility can help people to get through the first few days, which is often when they are most vulnerable to relapse.
Partial hospitalization is a middle ground between outpatient and inpatient treatment. An individual spends a significant portion of their time at a treatment facility but can periodically leave, often so they can perform essential duties like going to work or school.
Inpatient or Residential Treatment
This type of treatment is the most intense and expensive, but it can help people who need to get treated for a particularly severe addiction or who are in crisis and don’t trust themselves to avoid drugs long enough to meaningfully begin their recovery journey.
This type of treatment involves staying at a specialized facility for multiple weeks or months. People will have a scheduled treatment routine designed to help them physically and mentally recover while also equipping them to better resist drug use once they leave the facility.
What Medications Are Used for Heroin Detox?
Several medications can be used as part of medication-assisted treatment for heroin and other types of opioid addiction.
Buprenorphine is a type of medication called a partial opioid agonist that can treat withdrawal and shorten the length of a person’s detox. It can also be used on a long-term basis to control opioid cravings.
Buprenorphine is often combined with the drug naloxone, such as in the drug Suboxone, which helps to prevent it from being abused. Since buprenorphine can be prescribed for at-home use, and Suboxone and other forms have abuse-deterrent ingredients, it is often considered the gold standard in treatment for heroin addiction.
Clonidine is a medication that can treat withdrawal symptoms, reducing anxiety, agitation, muscle aches, sweating, running nose, and cramping. It may be combined with other medications to further control withdrawal symptoms, such as medications that can help reduce vomiting and diarrhea, and those that can help with sleep.
Naltrexone is a medication that can help prevent people from relapsing. It can counteract opioids, deterring a person from using them because they simply won’t have the desired effect.
Importantly, naltrexone shouldn’t be taken when a person has opioids in their system for this very reason. It can cause sudden and severe withdrawal if a person hasn’t detoxed.
Methadone is an interesting treatment option in that it doesn’t require a person to undergo the detox process. Methadone is a full opioid agonist, the same type of drug as the opioids people abuse (and methadone itself has abuse potential if misused).
While this makes some people hesitant to use methadone, it is still an evidence-based MAT. It can curb a person’s heroin cravings, help them to avoid withdrawal symptoms, and allow them to continue with their recovery. Methadone is not allowed to be given out for at-home use, so people must visit a methadone clinic or similar facility daily to get their dose.
To avoid an opioid addiction, only use opioids as prescribed. Talk to your doctor if you start to experience strong cravings to use more opioids or are experiencing withdrawal symptoms when your prescribed opioids aren’t in your system.
Never use illicit opioids, such as heroin. It is impossible to verify these drugs are what the seller claims, and street drugs often contain fentanyl, which can lead to deadly overdose.
Getting Help for Heroin Use
If you know you have an opioid use disorder and want to stop using heroin, you need help. Many people want to stop using but are concerned about the detox process. With MAT, it doesn’t have to be a painful or even uncomfortable process. The key is to get the right help.
Experts can work with you to form a treatment plan that makes sense for your needs. The right evidence-based treatments can maximize your chances of a successful recovery. And often, much of the cost of treatment is covered by insurance. Reach out for help today.
Withdrawal Management. (2009). World Health Organization.
Yes, People Can Die From Opiate Withdrawal. (August 2016). Addiction.
Opiate and Opioid Withdrawal. (May 2020). U.S. National Library of Medicine.
Pharmacological Strategies for Detoxification. (February 2014). British Journal of Clinical Pharmacology.
Incarceration and Opioid Withdrawal: The Experiences of Methadone Patients and Out-of-Treatment Heroin Users. (March 2010). Journal of Psychoactive Drugs.
Pharmacological Management of Heroin Withdrawal Syndrome. (March/April 2022). American Journal of Therapeutics.
Review Article: Effective Management of Opioid Withdrawal Symptoms: A Gateway to Opioid Dependence Treatment. (March 2019). The American Journal on Addictions.
New Directions in the Treatment of Opioid Withdrawal. (June 2020). The Lancet.
Buprenorphine for Managing Opioid Withdrawal. (February 2017). Cochrane Library.
Buprenorphine vs Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds. (January–April 2012). Journal of Neurosciences in Rural Practice.