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Heroin Withdrawal Timeline | What to Expect & What to Do

The specific timeline of heroin withdrawal will depend on the individual, but it will begin about eight to 24 hours after cessation of use. Acute withdrawal, which is what most people mean when they discuss withdrawal, will take about four to 10 days.[1] This will be followed by a period of feeling generally unwell and having sometimes quite strong drug cravings that can last for several months.

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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.[4] In virtually all cases, without use of MAT, opioid withdrawal is uncomfortable. It’s important to stay hydrated, as several of the symptoms can cause significant amounts of fluid loss that can be dangerous if a person isn’t replenishing their fluids. 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. 

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.

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.

Updated December 20, 2023
Resources
  1. Opioid withdrawal. Mansi Shah, Huecker MR. StatPearls. Published June 4, 2019. Accessed November 17, 2023.
  2. Medication-assisted treatment for opioid addiction: Methadone and buprenorphine. Saxon AJ, Hser YI, Woody G, Ling W. Journal of Food and Drug Analysis. 2013;21(4):S69-S72.
  3. Heroin Overdose: Research and evidence-based intervention. Darke S. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2003;80(2):189-200.
  4. Yes, people can die from opiate withdrawal | NDARC - National Drug and Alcohol Research Centre. Published 2020. Accessed November 17, 2023.
  5. Drug- and alcohol-associated deaths in U.S. jails. Fiscella K, Noonan M, Leonard SH, et al. Journal of Correctional Health Care. 2020;26(2):183-193.
  6. Impact of continuing care on recovery from substance use disorder. McKay JR. Alcohol Research: Current Reviews. 2021;41(1).
  7. A comparative study of factors associated with relapse in alcohol dependence and opioid dependence. De Sousa A, Kadam M, Sinha A, Nimkar S, Matcheswalla Y. Indian Journal of Psychological Medicine. 2017;39(5):627.
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