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Heroin Detox: Everything You Need to Know

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.

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Heroin detox involves undergoing heroin withdrawal in a professional treatment setting, such as a hospital, freestanding detox center, or inpatient drug rehab. The safest form of detox for heroin dependence is medical detox, which involves round-the-clock medical supervision, care, and monitoring to prevent and address any complications that may arise.

During medical detox, the medical team will likely use opioid withdrawal medications, such as methadone or buprenorphine, to ease withdrawal symptoms and cravings to make detox. This can make the process much more comfortable and also make it more likely that a patient transitions into comprehensive heroin addiction treatment afterward.

Is it Safe to Quit Heroin Cold Turkey?

Quick Answer

While technically people have been able to quit heroin and go through withdrawal at home, it is not recommended. SAMHSA recommends a 24-hour detox treatment setting for individuals with a heroin addiction. This is due to the painful and distressing nature of heroin withdrawal.[6]

What is Heroin Detox?

Generally speaking, detox involves clearing the body of all toxins, including drugs like heroin. If a person doesn’t receive medication or treatment, then the detox process will involve acute heroin withdrawal symptoms and severe drug cravings. However, the best place to go through detox is in a hospital where a medical team can monitor you.

The goals of heroin detox include:[1]

  • Achieve medical stabilization
  • Achieve a drug-free state
  • Involve family and other significant support people in the person’s life
  • Foster entry into heroin rehab program

Heroin detox is the first step on the continuum of addiction care. It helps clear your body of substances and prepares you for addiction treatment, which includes therapy, counseling, and medications, to help create lasting behavioral change.

What Happens When You Detox from Heroin?

When you abruptly stop taking heroin or reduce your use, you will experience unpleasant and painful withdrawal symptoms. These symptoms happen because long-term heroin use leads to physiological dependence, which means your body and brain have adjusted to the presence of this opioid. Suddenly quitting disrupts your body’s functioning and results in heroin withdrawal symptoms.

Heroin withdrawal is usually described as causing “flu-like” symptoms, including these:[1]

  • Mood changes
  • Hot and cold flashes
  • Aches and pains
  • Runny or watery eyes
  • Runny or watery nose
  • Sweating

Later symptoms of withdrawal include the following:[1]

  • Dilated pupils
  • Goosebumps
  • Stomach cramps
  • Diarrhea
  • Nausea and vomiting

These symptoms can range from mild 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.

Heroin Detox Timeline

Heroin is a short-acting opioid, which means that its effects come on fast but don’t last very long. This is one of the many reasons it is so addictive—people may use it repeatedly once the high wears off.

If you are detoxing cold turkey at home, the heroin detox timeline will look something like this:[11]

Time Since Last UseSymptom Manifestation
8-24 hoursMild to moderate symptoms emerge
3-4 daysSymptoms peak in intensity and can be very severe and distressing
7-10 daysSymptoms begin to improve and dissipate

How Long Does Heroin Detox Last in a Treatment Program?

If you undergo heroin detox in a professional treatment setting, the heroin detox timeline may be extended to a couple of weeks.

This may be due to opioid substitution, in which the medical team administers methadone or buprenorphine to ease your withdrawal symptoms and cravings. If you don’t want to continue taking those medications after detox, they will have to gradually wean you off of them, which can make detox last longer but ultimately, it is far more comfortable and safer.

Can You Die From Withdrawal Symptoms@2x

Can You Die During Heroin Detox?

It is possible to die from opioid withdrawal, although unlikely. Persistent vomiting and diarrhea can cause a person to become severely dehydrated, leading to electrolyte imbalance, especially elevated sodium levels. This can cause heart failure and be life-threatening without proper care or hospitalization.[3]

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. Another risk related to vomiting is that of inhaling the stomach contents into the lungs, which can cause a lung infection.[3]

The biggest risk of heroin detox is that of relapse and overdose. The detox period reduces a person’s tolerance, which means they don’t need as much heroin to get high. Because heroin withdrawal is so distressing (at home without support), this can cause people to relapse to alleviate the symptoms. If they relapse and return to using the same dose as before, they run the risk of a heroin overdose. Plus, heroin is an unregulated street drug, which means it is often cut with deadly opioids like fentanyl and carfentanil, both of which can cause a fatal overdose.

Heroin Detox Settings

Professional heroin detox can occur in many different treatment settings, which vary in intensiveness, structure, medical care, and more. Here are some safe and appropriate detox settings for heroin withdrawal:[6]

  • Medically managed intensive inpatient detox: This is the most intensive and safest detox setting, occurring in a psychiatric hospital or hospital, and offering 24-hour medical care.
  • Medically monitored inpatient detox: This is a step down from heroin detox in a hospital and occurs in a freestanding detox center, offering round-the-clock supervision.
  • Ambulatory detox with extensive onsite monitoring: This outpatient option for heroin detox involves medical and clinical oversight at a day treatment center or partial hospitalization program.

No matter which heroin detox program you choose, make sure that they offer medical care and opioid withdrawal medications to ensure your comfort and safety.

What Medications Are Used for Heroin Detox?

Several medications may be used during heroin detox in order to manage withdrawal symptoms, ease cravings, and ensure a person’s comfort and safety. [5]

Buprenorphine

Buprenorphine is a partial opioid agonist that relieves heroin withdrawal symptoms and cravings. It can be used during acute withdrawal and also as long-term medication-assisted treatment (MAT) to prevent relapse. [10]

Buprenorphine is often combined with the drug naloxone, such as in the brand-name 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.

Methadone

Methadone is a full opioid agonist medication that reduces opioid cravings and alleviates heroin withdrawal symptoms. Much like buprenorphine, methadone is used during acute heroin withdrawal and as a maintenance medication for long-term relapse prevention.[2]

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.

Clonidine

Clonidine is an alpha-2 adrenergic agonist medication that is not intended to be the sole medication for heroin withdrawal. Rather, it is a symptomatic medication that can be used with other medications to relieve physical symptoms like chills, anxiety, sweating, tremors, and insomnia.[2]

Protracted Withdrawal After Acute Heroin Detox

Once acute heroin withdrawal resolves, you may experience post-acute or protracted withdrawal symptoms. These can last for up to six months and are milder than acute symptoms but can still be unpleasant or frustrating. Protracted withdrawal symptoms may include:[2],[13]

  • Heroin cravings
  • Depression
  • Anxiety
  • Sleep disturbances
  • Fatigue
  • Emotional blunting
  • Irritability
  • Reduced executive functioning
  • Impaired focus and attention

These unpleasant physical and psychological symptoms can increase the risk of relapse to heroin use. Because of these symptoms and because of the lasting changes heroin makes in the brain, it’s important to receive ongoing support and care.[2]

Once you detox from heroin, it’s important to attend an inpatient or outpatient addiction treatment program where you can learn coping skills and relapse prevention strategies.

Once you complete treatment, you should follow an aftercare plan that involves ongoing therapy, support groups, sober living, MAT, and more.[2]

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. 

Profile image for Dr. Alison Tarlow
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

Updated December 27, 2023
Resources
  1. Detoxification and Substance Abuse Treatment [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 1 Overview, Essential Concepts, and Definitions in Detoxification.
  2. Withdrawal Management. (2009). World Health Organization.
  3. Yes, People Can Die From Opiate Withdrawal. (August 2016). Addiction.
  4. Opiate and Opioid Withdrawal. (May 2020). U.S. National Library of Medicine.
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  6. Detoxification and Substance Abuse Treatment. Substance Abuse and Mental Health Services Administration. A Treatment Improvement Protocol TIP 45.
  7. Pharmacological Management of Heroin Withdrawal Syndrome. (March/April 2022). American Journal of Therapeutics.
  8. Review Article: Effective Management of Opioid Withdrawal Symptoms: A Gateway to Opioid Dependence Treatment. (March 2019). The American Journal on Addictions.
  9. New Directions in the Treatment of Opioid Withdrawal. (June 2020). The Lancet.
  10. Buprenorphine for Managing Opioid Withdrawal. (February 2017). Cochrane Library.
  11. Buprenorphine vs Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds. (January–April 2012). Journal of Neurosciences in Rural Practice.
  12. Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. January 2020.
  13. Protracted Withdrawal. Substance Abuse and Mental Health Services Administration.
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