Heroin Withdrawal Symptoms, Timeline & Detox for Heroin

What is Heroin Withdrawal?

Heroin and other opioids are highly addictive substances that can lead to physiologic changes in the brain and alterations in behavior.⁵ Heroin binds to the body’s opioid receptors in the brain and central nervous system, activating certain cells (neurons) because their chemical structure mimics the body’s natural opioids (e.g., endorphins).⁶ However, heroin activates opioid receptors in a different way than an endogenous, or naturally occurring, opioids, leading to abnormal signals being sent to the brain and the brain stem, which controls basic function such as heart rate, breathing, and sleeping.

The brain begins to adapt with regular heroin use, leading to tolerance (where a person needs to take higher doses of heroin to feel the same effects) and physiological dependence. Dependence is characterized by withdrawal symptoms which occur when someone attempts to cut back on their heroin use or stop using it entirely. Withdrawal symptoms are not typically life-threatening but very unpleasant and even painful, making it difficult for many people to quit using heroin.⁵ Withdrawal is a phenomenon characterized by a set of symptoms that happen when someone stops using a substance that their body has become dependent on, such as heroin.⁷

The withdrawal symptoms across all opioids are comparable, though there can be wide variations in the time of onset, the severity of symptoms, and how long withdrawal symptoms take to subside. These factors generally depend on the specific opioid(s) someone used, as well as how much they used (the dosage), how long they used it, other substances they use, and the time between doses.⁵

Although heroin withdrawal symptoms alone are not usually dangerous, the gastrointestinal symptoms produced by heroin withdrawal (such as diarrhea and vomiting) can lead to an electrolyte imbalance, dehydration, and potentially life-threatening symptoms based on the possibility of these effects.⁵

Acute (Short-Term) Heroin Withdrawal Symptoms

Heroin withdrawal can occur within hours of someone’s last dose of heroin. Typically, heroin withdrawal starts around 8 to 24 hours after someone’s last use; however, exactly when acute, short-term heroin withdrawal symptoms appear can vary between individuals.^5,8 Acute heroin withdrawal can last anywhere from 3 to 10 days.^5,8 The duration of acute heroin withdrawal may vary and depends on factors such as frequency of heroin use, dose of heroin used, and duration of heroin use.⁸ A person’s individual and genetic factors play a role as well, including current physical and mental health condition, and medications or other substances they use.

Short-term symptoms of heroin withdrawal are very uncomfortable and distressing, leading many to return to heroin use. Short-term signs and symptoms of heroin withdrawal may include:⁵

• Fast pulse.
• Increased breathing rate.
• Increased blood pressure.
• Elevated body temperature.
• Sleep disturbances such as insomnia.
• Dilated pupils.
• Unusually heightened reflexes.
• Sweating.
• Goosebumps (“piloerection”).
• Watery discharge from eyes and nose.
• Muscle spasms, cramps, and/or pain.
• Bone pain.
• Nausea and/or vomiting.
• Diarrhea.

Protracted (Long-Term) Heroin Withdrawal Symptoms

Long-term heroin withdrawal symptoms, sometimes called “protracted withdrawal.⁹ occurs when persistent impairments  are felt even after a period acute withdrawal.¹⁰

Withdrawal symptoms that may persist after acute withdrawal from heroin and other opioids may include:¹⁰

• Anxiety.
• Depression.
• Sleep disturbances.
• Continued fatigue.
• A general sense of feeling down or emotionally dull (dysphoria).
• Loss of interest or pleasure in activities previously enjoyed (anhedonia).
• Irritability.
• Short-term memory problems.
• Decreased attention, impaired concertation, and difficulty making decisions.
• Drug craving.

People may want to alleviate these distressing post-acute withdrawal symptoms by returning to heroin use. ¹⁰ It is critical, however, for people who have withdrawn from heroin or other opioids to know that they have a reduced tolerance to opioids following acute withdrawal, and they are at a greater risk of a heroin overdose if they return to use after a period of abstinence.⁹

Detox for Heroin & Withdrawal Treatment

Opioid detoxification (commonly referred to as simply “detox” or medically supervised withdrawal) can be an initial first step in more comprehensive treatment for heroin addiction or an opioid use disorder.¹¹

Medically supervised withdrawal is a treatment approach where doctors or other clinical staff provide monitoring, medication, and other treatment interventions to help manage and ease the discomfort of withdrawal signs and symptoms.¹² Commonly prescribed medications for treating heroin withdrawal are also used to manage opioid use disorder and include methadone or buprenorphine.¹³ These medications are opioid agonists, which means they bind to the same brain receptors as heroin and work similarly but do so in a way that eliminates or reduces withdrawal symptoms without the high or euphoria of illicit opioid use. Methadone and buprenorphine (e.g., Suboxone) help eliminate or reduce withdrawal symptoms, reduce cravings for heroin and other opioids, and aid in preventing relapse or a return to opioid use.¹⁴

How to Quit Heroin

After someone has successfully detoxed from heroin and is medically stable, they may benefit from further treatment of an opioid use disorder. Ongoing treatment can help manage the behavioral and psychological aspects of heroin misuse or heroin addiction and may also include a continuation of medications used during detox or prescribed after detox to help manage opioid use disorder. There are different treatment options in various treatment settings (including inpatient/residential rehab, outpatient rehab, and other more nuanced levels of care). Some common treatments for heroin and opioid use disorder include:

• Medications for Opioid Use Disorder (MOUDs). Medications have been developed to effectively treat opioid use disorder. They include methadone, buprenorphine, and naltrexone. Methadone and buprenorphine can eliminate or blunt the euphoric effects of illicit opioids and reduce cravings for heroin and other opioids.¹⁵ the effects of opioids entirely.¹⁵
• Behavioral therapies. There are a wide range of behavioral therapies often employed to treat substance use disorders. Cognitive-behavioral therapy is often used in substance use disorder treatment and helps people learn healthy coping skills and change the way people think about and behave toward substance use.¹⁵

Call an American Addiction Centers (AAC) admissions navigator to verify your insurance, learn more about treatment options, or begin treatment today.