Heroin Withdrawal Timeline

Heroin withdrawal can be largely avoided with the use of medication-assisted treatment (MAT). Use of methadone or buprenorphine, combined with therapy, is generally considered the standard treatment for heroin withdrawal, lessening and even eliminating uncomfortable withdrawal symptoms and cravings.[2]

Understanding Heroin Withdrawal

Heroin withdrawal is a series of unpleasant symptoms that can result from suddenly stopping the use of heroin after a prolonged period of using the drug or other opioids. 

It occurs due to chemical changes that the use of opioids like heroin can cause in the brain, with repeated use of these drugs causing the brain to start compensating for their presence. Then, in the absence of opioids, the brain starts to overcompensate. A person experiences various withdrawal symptoms as a result, as the brain is not able to suddenly adjust back to drug abstinence. Instead, a person must go through a period of withdrawal, as the brain slowly readjusts to a lack of opioids.[1] 

Going through heroin withdrawal isn’t necessarily the same thing as having a heroin addiction, although these issues are related. Withdrawal is caused by repeated drug use. Addiction is a compulsion to repeatedly abuse drugs. A person could theoretically abuse heroin without being addicted but still become physically dependent on the drug, meaning they will go through withdrawal if they stop using it. 

In any case, heroin has no accepted medical uses. Its abuse can be very dangerous, easily resulting in heroin overdose, which can be fatal.[3] An individual should work to stop using the drug, whether they are addicted to it or not.

Signs & Symptoms of Heroin Withdrawal

Opioid withdrawal, including withdrawal from heroin, is often described as flu-like. A person may experience a variety of symptoms during heroin withdrawal, including these:[1]

• Diarrhea
• Nausea
• Vomiting
• Tearing
• Runny nose
• Heavy sweating
• Excessive yawning
• Goosebumps
• Dilated pupils
• Light sensitivity

Heroin withdrawal can be life-threatening in some cases. A researcher writing for the National Drug and Alcohol Research Centre said this: “Persistent vomiting and diarrhea may result, if untreated, in dehydration, hypernatremia (elevated blood sodium level) and resultant heart failure. People can, and do, die from opiate withdrawal—and all such deaths are preventable, given appropriate medical management.”[4]

While very rare, there have been fatalities as a result of heroin withdrawal, although these have usually been the result of negligence in prisons where inmates going through withdrawal did not receive proper attention.[5]

The severity of heroin withdrawal isn’t easy to predict, as it can depend on a variety of factors. However, one of the most important is the frequency of a person’s heroin use and the amount of heroin they would use in a given session prior to quitting.

Using multiple substances at once can also increase the risk of serious withdrawal symptoms. For example, in a study of deaths in American jails, 76% involved alcohol withdrawal.[10] If you often mix alcohol with heroin, your withdrawal process could be more complicated than usual.

Taking heroin or other opioids for a long time or in high amounts will usually mean a person has more severe withdrawal symptoms. If heroin is used in conjunction with other substances, such as alcohol or benzodiazepines, withdrawal is also likely to be more intense.

Typical Withdrawal Timeline

Heroin is considered a short-acting opioid.[1] This means that withdrawal will typically begin eight to 24 hours after a person’s last use of the opioid.[1] When quitting heroin, it’s important to refrain from using any opioid, not just heroin.

Once this initial time has passed, a person will begin acute withdrawal, where withdrawal symptoms are generally at their worst. This period will last four to 10 days. During this time, many people will benefit from staying at a medical detox center. At a treatment facility, staff members will ensure you stay hydrated, nourished, and supported during the early phase of withdrawal.

After the acute withdrawal phase, protracted withdrawal begins. This is a period that can last up to six months, during which you might still feel strong heroin cravings, but the most severe withdrawal symptoms will have faded. If you are taking a form of MAT, cravings will usually be controlled by the medication.

After the protracted withdrawal phase, a person isn’t cured of addiction—there is no cure for addiction—but their body will no longer be physically dependent on opioids. Addiction treatment is needed to help you build a life without heroin use.

A typical heroin withdrawal timeline might look like the following.[1,8,9] Know that this is an estimate, and your experience could be very different.

What to Do if You Experience Withdrawal

If you start to experience withdrawal from heroin, seek help. Acute withdrawal is a difficult process, and it’s important to focus on recovery and getting as comfortable as possible while avoiding any type of drug abuse. Without professional help and support, relapse is highly likely during heroin withdrawal.

It can be extremely helpful to check in to a treatment center with a program designed to help you get through withdrawal safely and comfortably. In a heroin rehab, you’ll be surrounded by addiction treatment professionals who will guide you through the withdrawal process. You may be prescribed medications during this time, either MAT or medications designed to address certain symptoms of withdrawal.

Once you get through acute withdrawal, continue to seek care from addiction treatment professionals, as they can help you develop strategies to cope with the urge to abuse drugs and help you prevent a relapse. They can also make sure you can more quickly regain control over your actions in the event you do relapse, reducing the impact of that relapse.

Similarly, your treatment will evolve after you’ve completely gone through withdrawal, but it shouldn’t stop completely.[6] Continued therapy and supportive activities can help you maintain your progress and monitor your mental health. You can then address any issues you’re having before they have a serious risk of devolving into drug abuse. Ongoing participation in treatment will reduce the risk of relapse.

MAT for Heroin Addiction

Medication-assisted treatment involves taking prescriptions that can reduce your risk of relapse to drug use. Counseling is paired with these therapies, allowing you to identify your triggers and build your sober skills.

The U.S. Food and Drug Administration has approved three medications for opioid use disorder. Researchers with the National Academies Press say this about MAT options: “All three medications reduce opioid cravings and help to sever the ties between opioid use and established situational or emotional triggers. These medications work by targeting the mu-opioid receptor within the endogenous opioid system, although each has a distinct mechanism of action.”[11]

The three medication options for heroin addiction include the following:[12]

• Methadone: This full opioid agonist has been used in treatment programs since 1947. The National Institute on Drug Abuse (NIDA) says this medication significantly improves treatment outcomes for people with opioid addiction.
• Buprenorphine: This partial opioid agonist was first approved in 2002. Some people use medications that contain just buprenorphine, while others take medications that include naloxone as an abuse deterrent. The NIDA says both of these forms are effective for the treatment of opioid addiction.
• Naltrexone: This medication blocks the efficacy of opioids, and it’s typically administered by an extended-release shot. The NIDA says this medication is effective for people with opioid addiction.

While MAT can be an effective choice for some people, it does come with drawbacks. Medications like methadone and buprenorphine work on the same receptors used by heroin, and they can be abused. They can also cause withdrawal symptoms when you stop them abruptly.

Medications like naltrexone don’t cause tolerance or addiction, but they also don’t help to ease withdrawal symptoms and cravings. They might not be enough to help you deal with a very strong craving for heroin.

Some people use MAT for a short time to help them through the early stages of withdrawal, and they quit these therapies as soon as they can. Others don’t use these medications at all. Your doctor can help you find the option that’s right for you.

The Psychology of Heroin Recovery

While MAT can help to ease chemical imbalances caused by heroin abuse, the psychological problems caused by your abuse can remain. Therapy can help you make sense of your challenges and find a new life in sobriety.

Common challenges you might need to address include the following:

• Triggers: People, places, and things could remind you of heroin. When you encounter them, you could feel an overwhelming urge to use heroin.
• Coping: You might be accustomed to using heroin to deal with complex emotions, such as depression or anger. When you’re not using heroin, you’ll need to find new ways to handle these issues.
• Emotions: As your brain adjusts to a life without drugs, you might experience problems like anxiety and agitation. You might not know how to deal with these problems without drugs.
• Social connections: Your friends might be tied to your drug use. Connecting with sober peers could take time.

Your treatment team can help you learn how to identify your sober challenges and learn how to handle them without relapsing to drugs. Building a healthy support system helps too. 

Connect with a local Narcotics Anonymous group and go to meetings as often as you can. Identify your friends and family members who can support you when you’re feeling low. Above all, work with your treatment team and ensure your recovery is progressing as it should.