Heroin Withdrawal and Detox: How to Quit Heroin Addiction Safely?

Last Updated: December 17, 2020

Authored by Olivier George, Ph.D.

Reviewed by Michael Espelin APRN

The most important step in quitting heroin is equipping oneself with relevant information. There is a lot of information on the Internet, offering advice on how to quit heroin. However, there is not much information touching on the two most important dynamics of the whole process, heroin withdrawal symptoms and detoxification.

Judging from the current heroin withdrawal stories, the journey to sobriety is marred with difficulty. This article will explain withdrawal, detoxification, and relapse prevention processes for a safer and more fruitful journey to sobriety.

What Heroin Withdrawal Feels Like

Heroin withdrawal is the state of physical and mental discomfort that manifests itself as soon as the user stops using the drug. Derived from what might be termed as the heroin plant, it latches itself to the brain, making the brain depend on the drug. Once the brain gets used to the drug, any discontinuation causes symptoms that are not pleasant to the user.

Causes of Heroin Withdrawal

Like any other opioid, it is highly addictive. It affects the brain, enabling it to release dopamine, otherwise known as the feel-good hormone. Once dopamine is released, the user feels good for a couple of hours before using it again. This disrupts homeostasis, and the user becomes more reliant on the drug.

Discontinuation from the drug leaves the brain with the heavy task of adjusting to the new conditions. This brings about severe and uncomfortable symptoms known as heroin withdrawals.

Heroin Withdrawal Symptoms

The heroin half-life is rather short, and the fact that it is stronger and clears from the body faster than other drugs or alcohol makes the symptoms more severe.

Some of the Symptoms One Could Experience During This Period Include:

  • Nausea and vomiting
  • Insomnia
  • Agitation
  • Diarrhea
  • Dilated pupils
  • Sweating
  • Anxiety
  • Abdominal cramping
  • Muscle aches
  • Low blood pressure
  • a runny nose
  • loss of appetite
  • elevated heart rate
  • Dilated pupils
  • Sweating
  • Muscle spasms

Can You Die From Heroin Withdrawal?

While withdrawal from the drug rarely causes death, some symptoms like vomiting and diarrhea can turn fatal if ill-managed. Vomiting and diarrhea may result in dehydration and later into hypernatraemia that is dangerous as elevated blood sodium level may lead to heart failure.

Duration and the Timeline of Withdrawal

In 2018 in the US, about 808,000 people reported the use of heroin within the previous year.

It is important to understand that this is a hard drug, and one might not have such a pleasant time after they stop the intake. It provides a high that is more powerful than most drugs. Symptoms of heroin withdrawal usually start 6 hours after the last intake. Users who embark on quitting heroin start to feel the effects of what is called acute withdrawal.Depressed man.

These symptoms intensify with time, and by the 6th day, the user is usually experiencing abdominal cramping, sweating, and vomiting. These symptoms are some of the reasons why an addict might have such a hard time getting off heroin.

After stopping for a week, acute withdrawal symptoms dissipate, and the addict starts to get some semblance of normalcy. Heroin withdrawal symptoms usually wane off to what is now called Post-Acute Withdrawal Syndrome. This period could go on for years, and they involve bouts of depression, irritability, and insomnia.

Below is a table describing the heroin withdrawal timeline and the symptoms:

Timeline Symptoms
Day 1-2 (6-12 hours) Anxiety

Muscle aches

Insomnia

Diarrhea

Muscle aches

Day 3- 5 Abdominal cramping

Sweating

Shivering

Nausea and vomiting

Day 6-7 End of acute withdrawal symptoms
Post-Acute Withdrawal Symptoms These could take years and might include depression, insomnia, and anxiety.

Heroin Detox

As with most drugs, heroin has side effects on the body. The symptoms are not pleasant to the users and the society around them. It is why addicts and their loved ones try to help them get rid of this bad habit. There is a method to get rid of the body’s drug in preparation for a rehabilitation process. The removal of such toxins from the body is called detoxification.

Medication Used During Heroin Detox

Detoxing from opiates is not easy. The proper way to carry out detoxification is to seek professional help. Professional doctors apply an elaborate detoxification plan that involves heroin detox drugs.

Among the Most Commonly Used Medications for Detox are:

Methadone

Methadone has the same effects as heroin, but without the euphoria. Addicts are usually introduced to this drug to get off heroin. While it is helpful, methadone can be addictive to the user; therefore, clinics regulate its intake.

Buprenorphine

It works the same way as methadone and helps addicts who are working on coming off the drug.

Naltrexone

Naltrexone only covers one aspect of the process. It helps to subdue the urge to take more of the harmful drug by stopping its effects in the brain. It does not help treat signs of heroin withdrawal.

Clonidine

It helps muscles relax. This drug is effective in treating symptoms such as stomach cramps, muscle spasms, and shivering.

Antidepressants (Zoloft, Prozac)

During opiate use, the human brain is usually used to help the drug produce the feel-good hormone – dopamine. During the heroin withdrawal treatment, the brain lacks the assist, which leads to the user feeling depressed. Additionally, it is a depressant, and prolonged use of the drug could lead to its effects even after quitting. A doctor, in this case, can prescribe Ativan for opiate withdrawal.

Benzodiazepines

This heroin withdrawal drug helps reduce anxiety and irritability in addicts. Benzodiazepines have a sedative effect, thus calming the addict.

An open bottle of pills.

Gabapentin

Recent medical developments have recommended Gabapentin for heroin withdrawal. The drug is used during the detox process to relieve the pain caused by withdrawal symptoms.

Kratom

Some methods people might use to treat heroin withdrawal at home is to use herbal drugs such as Kratom. It is important to note that the FDA is yet to approve kratom for heroin withdrawal.

Dangers of Home Detox

It is a dangerous endeavor to try detoxification from home. Heroin affects the brain in a great way. It takes people who understand how the brain works actually to help an addict detox from it. A medical professional is the most trusted person in this process because they are fully trained on detoxing from heroin.

Also, It is important to note that due to the different methods of introducing the drug to the body, such as sniffing heroin, doctors might require different approaches to increase their chances of success. This is what makes detoxification from home a bad idea.

Here is Why One Should NOT Attempt it:

  • There is a high probability that addicts and their companions are less equipped to treat withdrawal symptoms. These symptoms are highly severe and need a lot of monitoring from professionals who are always found in rehabilitation centers for drug addicts.
  • Without them, one might succumb to complications such as excessive vomiting and diarrhea, which bring about dehydration. Professionals also usually have helpful heroin withdrawal tips.
  • The drug affects each brain differently. While home detoxification might seem like a great idea, it is important to note that people are different. This means that addicts are affected differently by the drug.
  • Using conventional knowledge to treat withdrawals could lead to a heroin withdrawal death. A doctor is more likely to give an accurate assessment of how long to detox from heroin to get the best results.
  • Addicts almost always need counseling and follow-ups. Getting rid of the habit can hardly be treated using medication alone. One needs a complete overhaul of their life to prevent a relapse, which might ultimately lead to a heroin overdose.
  • Addicts are usually met with a lot of triggers, situations, or things that tempt them to use again. Due to the severe withdrawal symptoms, relapse triggers could have an overwhelming power on the user. It is, therefore, always wise to explore the substance abuse treatment models nearby for professional help.

Among the most challenging factors with detoxing from heroin addiction at home is succumbing to a heroin relapse. The body tends to build a lot of tolerance to the drug. This allows addicts to take large doses without succumbing to an overdose. When discontinued, the tolerance goes away. A relapse involves an addict going back to using it after discontinuing it for some time. This could be caused by heroin cravings, which ultimately lead to using if left unchecked.

Relapse Warning Signs to Look Out For

It is possible to identify relapse signs. Just like spotting the signs of heroin addiction, spotting signs of relapse is important in preventing it from happening.

Here are Some of Heroin Relapse Signs:

  • Erratic changes in behavior (e.g., change in eating behaviors)
  • Mood changes
  • Denial
  • Secretive behavior
  • Withdrawal from support systems
  • Social irresponsibility such as committing or taking part in crimes
  • Personal irresponsibility (e.g., neglecting their hygiene)

It is best to help an addict as soon as they start manifesting heroin relapse symptoms. Therefore, familiarizing oneself with the signs of heroin relapse can help one catch them early enough. This way, they can get the help they need.

Heroin Relapse Rates. Why are They so High?

According to statistics by the Center for Disease Control (CDC), heroin-related overdoses have more than quadrupled since 2010. These mirrors other heroin statistics that show the same discouraging numbers. Such heroin relapse rates point to a severe enough statistic for the CDC to classify death from opioid-related drugs as an epidemic. However, it is unclear how many of them are relapse related.

Relapse rates are very high for any opiate addiction, including heroin. It does not matter what method of treatment is applied. With increased national attention on the problem, more resources are pouring into medication-assisted treatment. This has done well to improve the overall quitting heroin success rate. However, recovery is a complicated process.

The addiction often starts from abusing prescription opiates. Users report it makes them feel good, and they enjoy it. As the body develops tolerance, it needs more of the drug to feel good. This led many to go deeper into addiction. Consequently, the bad feelings associated with withdrawal are more pronounced. It becomes the only thing stopping an addict from feeling heroin withdrawal symptoms.

Heroin Relapse Risk: Biological and Behavioral Reasons

There are biological and behavioral factors to consider when assessing the risk of relapse. Biologically, the brain becomes used to large doses. This leads to painful withdrawal symptoms and intense cravings.

man hiding something in hands.

Medication-assisted treatment with methadone, buprenorphine, or naloxone can help calm these effects and prevent overdose.

As mentioned before, addicts center their lives around getting and using the drug. Consequently, this means lifestyle changes are necessary when they quit. Before addiction set in, the drug served a purpose for the individual taking it. Without an alternative, a person is likely to return to using in order to fulfill that purpose.

Also, the ritual of getting and using the drug can cause conditional responses to develop. They refer to conditional responses in addiction treatment as triggers.

Furthermore, it Can be Anything Such as:

  • People
  • Places
  • Smells
  • Drug paraphernalia
  • Music
  • Environments

When a trigger confronts someone with a history of abuse, cravings intensify. As a result, the ability to “just say no” decreases significantly. Triggers are strong behavioral cues, and they need to be substituted with healthier activities.

Social aspects of using are another significant factor to look out for. Someone’s entire life may revolve around its use. Then, all their friends and associates are likely triggers. Asking someone to get rid of social connections can be devastating. Therefore, it is important to provide an alternative to replace those social connections.

Preventing Heroin Relapse

It is possible to recover from addiction. One will, however, need to use comprehensive clinical treatment. Such treatment focuses on biological and behavioral risk factors. Medication-assisted treatment can prevent overdose and relieve withdrawal symptoms. Behavioral and mental health counseling can deal with underlying issues. Furthermore, long-term peer support can help build a heroin-free lifestyle.

This Includes:

  • Addressing physical cravings and withdrawal symptoms with medication-assisted clinical treatment.
  • Behavioral therapy to deal with issues related to finding a new purpose in life. It should include identifying and resolving triggers and building recovery-focused social connections.
  • Mental health counseling to address underlying issues related to drug use and the purpose that the drug fulfilled.
  • Medical services for health complications related to its use.
  • Family and community-based recovery support, including legal, educational, and vocational services. This could also involve learning about and understanding ex-heroin addict personality in order to create a conducive environment for their recovery.
  • Peer support to build comprehensive lifestyle changes and give long-term recovery support (one could explore helpful avenues such as heroin anonymous).

Not all communities have treatment systems that meet the needs of those seeking help. There are other barriers to treatment, as well.

patient speaking to a doctor at a consultation.

It includes:

  • An inability to pay for services
  • Failure to get to services because they are far away
  • Lack of supportive others

Heroin Relapse Risk Groups

Anyone can experience a relapse while in recovery, but research shows several things increase the chances:

  • Anxiety-related mental health issues
  • No personal connections to lead them through treatment
  • Bad experiences while in treatment or with a treatment provider
  • Idleness
  • No support with finances, jobs, or other life issues once they get out of treatment

For example, one might wait a week to get into an inpatient program following detoxification. On the other hand, they might be waiting to get into an outpatient program following an inpatient program. Most users relapse within days of exiting a treatment program.

What to Do in Case of Relapse?

The best option to consider in case of relapse is to consider medication-assisted treatment as an option. These medications significantly decrease the risk of death by overdose. They will cut physical cravings and withdrawal symptoms and block the euphoria.

Evaluate the treatment. According to best practices, if the ex-addict in recovery is not involved in a comprehensive treatment program, consider available options. Then, fill in the areas not covered and help them with those areas outside of treatment services. For example, if treatment only focuses on behavioral triggers, one could consider supplementing that with the pursuit of education or vocational training.

Seeking Treatment After Relapse

Heroin relapse can and does occur sometimes. This should not be the end of the road. The best way to recover from a relapse is to face it head-on by seeking the right treatment.

Here are some of the steps that will help get ahead of a relapse:

  • Recognize the relapse and accept the weakness
  • Understand the triggers and avoid them
  • Come up with a plan to the fight addiction
  • Get professional help from a medical rehab facility or professional
  • Seek help from people who understand what it means to be an addict. These might include former addicts.

Even in situations where coming back from a relapse is hindered by financial constraints,  one could look for helpful alternatives such as rehab without insurance.

Successful detoxification and preventing a relapse from happening might not be easy; neither is bouncing back from a relapse. But it is doable. Like with all cases where treatment for drug addiction occurs, one should understand that the battle to staying clean is hardly won alone.


Page Sources

  1. Diaper A. M., Law F. D., Melichar J. K. Pharmacological strategies for detoxification. British Journal of Clinical Pharmacology. 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014033/
  2. National clinical guidelines and procedures for the use of buprenorphine in the Maintenance Treatment of Opioid Dependence. Guidelines for the management of heroin withdrawal. https://www.health.gov.au/internet/drugstrategy/publishing.nsf/Content/9011C92D2F6E1FC5CA2575B4001353B6/$File/bupren4.pdf
  3. National Institute on Drug Abuse. What are the treatments for heroin use disorder? 2018. https://www.drugabuse.gov/publications/research-reports/heroin/what-are-treatments-heroin-use-disorder
  4. UNSW MEDICINE, National Drug and Alcohol Research Centre, Yes, people can die from opiate withdrawal, https://ndarc.med.unsw.edu.au/blog/yes-people-can-die-opiate-withdrawal
  5. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Opioid Overdose, Heroin Overdose Data, https://www.cdc.gov/drugoverdose/data/heroin.html
  6. World Health Organization, Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, 2009, https://www.ncbi.nlm.nih.gov/books/NBK310652/
  7. U.S. National Library of Medicine, Opiate and opioid withdrawal, https://medlineplus.gov/ency/article/000949.htm
  8. Drug and Alcohol Services South Australia, Heroin withdrawal, https://www.sahealth.sa.gov.au/wps/wcm/connect/975ead1b-dec4-43e9-b44a-86bd848787a2/Heroin+withdrawal+-+FINAL+2019.WR+V3.pdf

Published on: August 2nd, 2016

Updated on: December 17th, 2020

About Author

Olivier George, Ph.D.

Olivier George is a medical writer and head manager of the rehab center in California. He spends a lot of time in collecting and analyzing the traditional approaches for substance abuse treatment and assessing their efficiency.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.