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The Ins And Outs Of Heroin Withdrawal

by Landmark Recovery

July 9, 2019

In order to see why heroin withdrawal can be so severe and problematic, it’s worth taking a look at how the drug works.

By better understanding the effects of this powerful narcotic, it’s easier to see how you can successfully stop using the drug.


What Is Heroin?

Heroin is a highly addictive substance derived from morphine from the seeds of the opium poppy. This substance is chemically dissolved into partially purified morphine near the growing fields. From these refineries, the drug is then trafficked around the world.

By the time the drug makes its way onto the streets, the powder varies in color according to purity levels. White powder generally indicates a purer form of heroin while brown and black heroin is often substantially diluted.

Regardless of the country of origin or purity, heroin is strongly addictive. Heroin can be smoked, snorted or injected directly into the veins. Whatever the delivery method, heroin reaches the brain in short order with intravenous injection providing the quickest route.

But, once heroin has entered the system, how does it alter consciousness and what makes it so addictive? These factors both play a role in why heroin withdrawal is such a tricky business.


How Does Heroin Work?

As an opiate, heroin interacts with the opioid receptors in the brain to deliver both pain-relieving properties and pleasurable sensations.

Neurotransmitters in the brain linked to mood, movement and core physiological processes are designed to send out endorphins or feel-good chemicals as required. Taking a drug like heroin causes the brain to be flooded with these endorphins. This brings anxiety levels down while creating a sense of enormous euphoria.

Along with these extreme effects, the high-fat solubility of heroin allows the drug to be absorbed into the body and brain quicker than any other opiate.

Tolerance to heroin builds as dramatic changes in brain chemistry are exerted by the drug which can lead to issues such as withdrawal that can bring about unpleasant side effects. While seldom fatal, acute withdrawal syndrome can be a hard enough experience that recovery seems like an uphill struggle and relapse can very easily occur.

Supervised medical detox and medication-assisted treatment (MAT) can mitigate some of these difficulties. SAMHSA (Substance Abuse and Mental Health Services Administration) endorses MAT as an effective approach when dealing with heroin withdrawal.

Before we examine how to effectively cope with detoxing and recovering from heroin addiction, we should look at the signs and symptoms that you can expect when starting the journey to recovery from dependency on the drug.


Heroin Withdrawal Symptoms

If your body has become dependent on heroin or any other opioid, you’re almost certain to undergo a number of extremely disagreeable withdrawal symptoms when you stop using the drug.

Withdrawal sets in during the detoxification stage when your body purges itself of heroin and all toxic metabolites. For many heroin users, the fear of withdrawal is enough to stop them from attempting any form of recovery treatment. There’s no need for this, though. By simply becoming aware of these symptoms and informed about what to expect, you can see that heroin withdrawal symptoms might be hostile but are manageable.

Withdrawal symptoms will not be the same for all users. Many variables impact the range and severity of side effects. How the drug was abused, how much was taken and the time scale involved are all factors influencing the nature of withdrawal symptoms. A history of mental illness or prior opioid withdrawal can also ramp up the intensity of side effects.

You can think of heroin withdrawal symptoms as roughly the opposite of the intoxicating effects brought about by using the drug. Taking heroin suppresses some functions of the central nervous system and increases feelings of pleasure. With heroin no longer entering the system, boosted heart rate, lowered mood and general anxiety can replace the euphoria and relaxed state induced by the drug.

Heroin withdrawal symptoms can be generally grouped on a sliding scale of severity:

  • Mild symptoms
  • Moderate symptoms
  • Severe symptoms


Mild Symptoms

When heroin has not been abused in large quantities or for lengthy periods, withdrawal symptoms can be surprisingly mild. That said, a moderate, short-term user who stops taking heroin can expect to experience rather more acute side effects.

  • Abdominal cramps
  • Aches (bone and muscle)
  • Chills
  • Nausea
  • Runny nose
  • Sweating profusely
  • Tearing eyes
  • Yawning excessively


Moderate Symptoms

If the drug has been abused in larger amounts or for extended periods of times, withdrawal symptoms can become a bit more debilitating.

  • Agitation
  • Diarrhea
  • Fatigue
  • Goosebumps
  • Problems with focus
  • Restlessness
  • Tremors
  • Vomiting


Severe Symptoms

With more severe and ongoing heroin dependency, stopping the drug can trigger a correspondingly severe backlash from both mind and body.

At this upper end of the scale, symptoms include:

  • Anxiety
  • Cravings for heroin
  • Depression
  • Hypertension
  • Inability to feel pleasure
  • Insomnia
  • Muscle spasms
  • Rapid heart rate
  • Respiration problems
  • Uncontrollable leg movements

Despite these problems, there’s some good news: heroin withdrawal is a reasonably rapid process.


How Long Does Heroin Withdrawal Last?

Typically, heroin withdrawal symptoms manifest 6 to 12 hours after the last dose of the drug. This is known as the comedown period when the euphoric effects of the drug are starting to wear off.

Peak effects occur between 1 and 3 days of stopping the drug. These side effects start to subside after as little as 5 to 7 days. Since heroin is a short-acting opioid, it takes effect quickly but leaves the bloodstream equally quickly.

With post-acute withdrawal syndrome (PAWS), withdrawal symptoms can last for weeks or even months.

Everyone’s experience differs when it comes to heroin withdrawal but one element is constant: a craving or strong desire to take more heroin. Cravings are at least partially due to a yearning to re-experience the pleasurable high. Also, the user understands that taking heroin would almost immediately eliminate those unpleasant withdrawal symptoms.

Even if you have the best intentions, these seemingly insatiable cravings mean it’s essential to have an appropriate treatment plan in place if you’re dependent on heroin and determined to stop using the drug.


Treatment Plan for Heroin Withdrawal

Withdrawal from heroin can take place in many different settings and it’s normal for this to be medically supervised.

However, it should be noted that it’s unwise to attempt heroin withdrawal completely alone since willpower by itself with no supporting framework in place is a shaky foundation to work from.

Detoxing should be viewed as part of a broader recovery plan. Stopping drug use is simply the start of the journey but it’s something you need to get right or you’ll be stalled before you get started.

With serious heroin addiction, inpatient treatment is usually the optimum solution. A recent study showed inpatient detox amplifies the chances of successful and sustained recovery following discharge. An inbuilt advantage of inpatient treatment is the fact it provides a seamless transition to counseling, a crucial element of ongoing recovery for most heroin addicts.

Outpatient treatment can be a workable option if the patient has used heroin in smaller amounts for a relatively short period of time. In order for this to work, a stable and supportive environment is key. This approach to heroin withdrawal still calls for regular visits to a treatment center for medication, observation, tests and counseling.

Residential treatment will give you the best overall chance of successfully withdrawing from heroin. You’ll get a guaranteed drug-free environment with a full suite of medical support in place. You can be continuously monitored and, if necessary, MAT can help to dilute some of the more noxious withdrawal symptoms.

To reiterate, detoxing from heroin is only the first step in a lengthy journey. Ensuring this detoxification period is medically supervised will make things a whole lot more comfortable. Beyond this, you’ll feel secure that any complications, whether physical or psychological, can be promptly addressed.

You should speak to your doctor to establish whether you could feasibly stop using heroin in an outpatient setting or whether residential treatment would make more sense given your specific circumstances.

If you pursue medical detoxification in a residential setting, it pays to be realistic about expectations and clear about the core objective of heroin withdrawal.


Objectives of Medically Supervised Heroin Withdrawal

Withdrawal services should be viewed as a transitional step to ongoing recovery rather than a standalone treatment likely to guarantee abstinence. Too many users harbor impractical expectations and end up predictably disappointed if initial treatment fails.

What can residential treatment for heroin withdrawal hope to achieve, then?

Here are some core goals pertinent to any treatment program:

  • Alleviate distress during withdrawal: Arguably the primary motivator for anyone seeking supervised heroin withdrawal is the alleviation of discomfort.
  • Minimize the chance of complications: Heroin withdrawal itself is rarely life-threatening. Complications can occur if the patient has an underlying mental health issue, though. These issues can be monitored and addressed under medical supervision. If relapse occurs outside a residential treatment center, there’s an increased risk of overdose due to reduced opioid tolerance. This can be worsened if any medication like benzodiazepines is being administered. Treatment centers will be drug-free, so there’s no real chance of the patient using heroin and overdosing.
  • Kickstart the process of counseling and ongoing treatment from a solid, drug-free base: Heroin addiction is a chronic and relapsing condition while withdrawal services are acute services focused on a short term outcome, namely detoxification. Treatment centers can form the perfect linkage to ongoing treatment and help the patient to engage in this immediately.


Heroin Withdrawal and Medication

We’ve mentioned medical-assisted treatment (MAT) several times, and there are a number of medications that can be effectively used to lessen the effects felt during and after withdrawal.

  • Buprenorphine: Buprenorphine is a synthetic opioid that affects the same opioid receptors as heroin. Since it only has partial opioid agonist properties, the effect is more limited and less potent than that exerted by heroin. Taken orally under the tongue, buprenorphine provides a stabilizing relief from withdrawal symptoms without encouraging relapse, something that can occur as a result of using a full opioid agonist.
  • Naltrexone: Naltrexone is a compound that blocks the opioid receptors and is most commonly used to discourage opiate abuse following successful detox.
  • Suboxone: Suboxone consists of a combination of buprenorphine and naloxone and is designed to discourage heroin abuse. Since it contains both an opioid activator (buprenorphine) and an opioid antagonist (naloxone), the patient can be slowly eased away from addiction with the effects of withdrawal minimized.

These medications all need to be administered by qualified medical professionals so they’re not suitable for use during a home detox.

If you feel your heroin addiction is severe enough to warrant residential treatment, choosing a treatment center is not something to undertake lightly. Don’t rush into this decision and you’ll improve your chances of securing the best possible solution to beat addiction and begin the challenging but rewarding journey to recovery.

Luckily, choosing a treatment center is not as tough as you might first think.


Choosing a Treatment Center for Heroin Withdrawal

You should start by asking yourself a few simple questions:

  • Does the program offer fully supervised detox?
  • Are medications used when necessary?
  • Does the medical center have the right staff/patient ratio?
  • What are the costs of treatment? Can you afford it?
  • Does the treatment center accept insurance? If so, will there be any out-of-pocket expenses?
  • What time frame is involved and does this fit with your schedule?

You should always speak with your doctor before embarking on any attempt to stop using heroin.

Take your time to investigate a number of treatment centers so you can establish which program best fits with your needs. If time is of the essence and you need to take action safely and decisively, though, we can help out and here’s what you can do.


What To Do Next

If you or anyone you know is ready to stop using heroin and you’ve decided that a residential program is the best solution, call our admissions line in complete confidence at 888-448-0302.

We can arrange for treatment to start in a matter of days so don’t continue using the drug in the mistaken belief that heroin withdrawal is not manageable.

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About the Author

Landmark Recovery

Landmark Recovery

Landmark Recovery was founded with a determination to make addiction treatment accessible for all. Through our integrated treatment programs, we've helped thousands of people choose recovery over addiction and get back to life on their own terms. We're on a mission to save one million lives over the next century. We encourage all those struggling with substance use to seek professional help.