According to the Foundation for a Drug-Free World, an estimated 9.2 million people worldwide use heroin. Heroin is growing in popularity in the United States, with an estimated 669,000 Americans admitting to heroin use in the prior year, per the 2012 National Survey on Drug Use and Health. With heroin use becoming more prevalent, the number of individuals who suffer from heroin addiction is also rising.
When the drug is smoked, snorted, or injected, the substance enters the brain, where it converts into morphine and binds to the opioid receptors there. As heroin use continues, the neurons in the brain adapt to the heroin exposure and begin to function normally only when the brain receives heroin. If the person doesn’t use the drug, both psychological and physical symptoms manifest.
Addiction doesn’t occur in every person who uses heroin. Certain factors, such as genetics, personality, and environment, determine whether someone becomes addicted and how quickly they become addicted.
Repeated exposure to heroin can lead to both physical and mental addiction to the substance. The initial physical withdrawal symptoms may only last for a week in some cases, but they are often severe and can feel like a severe case of the flu, which can lead to people resuming heroin use just to stop the withdrawal process.
Physical symptoms of heroin withdrawal include:
Psychological effects of heroin addiction include:
How heroin was taken (e.g., via snorting, injecting, etc.), how long it’s been taken, and how much the person is taking affect the withdrawal process. The symptoms of withdrawal can start within 12 hours of the person’s last exposure to heroin, as noted by MedlinePlus. The symptoms peak on the second and third days of withdrawal, and the physical symptoms may last up to 10 days. The psychological symptoms may last much longer, sometimes up to six months or longer.
The physical aspect of withdrawal is often too much for a person to handle alone; as a result, medical detox is recommended for heroin withdrawal. If going it alone, people who have a heroin addiction may resume heroin use simply to stop the withdrawal symptoms, even if they started out with a strong intention of quitting use.
As soon as people stop using heroin, their tolerance for the drug lowers, meaning less of the drug is needed to get high.
Therefore, when people with heroin addiction relapse, they often overdose because they don’t realize their tolerance is lower than before.
When people go through withdrawal, it can lead to dehydration from vomiting and diarrhea. Withdrawal also frequently leads to a wide range of emotions, ranging from depression to anxiety. The emotional instability is enough to make people resort to self-destructive acts, including self-harm and even suicide. As denoted by statistics provided by Psychology Today, up to 45 percent of individuals with an untreated substance use disorder commit suicide.
Unfortunately, the percentage of people who don’t receive formal treatment is high. In fact, only about 2.5 million people out of 23.1 million received the treatment they needed for alcohol or illicit drug abuse, as revealed by the 2012 National Survey on Drug Use and Health.
According to the National Institute on Drug Abuse, 40-60 percent of people addicted to an illicit drug will relapse at some point, and it’s not always due to physical withdrawal symptoms. Psychological symptoms of withdrawal cause a range of emotions, such as depression and anxiety, which can be incredibly difficult to handle, so people often resume drug use to make these emotions go away temporarily. This is especially the case if the person isn’t receiving any emotional support to help throughout the withdrawal and recovery process. At a treatment facility, professional staff members help people deal with these difficult emotions in order to prevent relapse.
When people with a heroin use disorder seek out formal treatment, medications may be used to reduce or eliminate the symptoms of withdrawal, making the detoxification process more comfortable. For instance, a person may be prescribed buprenorphine to treat the symptoms of withdrawal from opioids like heroin. In some instances, it can be used as a long-term maintenance drug.
Buprenorphine classifies as an opioid, but it generally doesn’t induce euphoria, and it causes less physical dependence than heroin. It’s a partial opioid agonist, so it does work on the same receptors as heroin, but it has less of a potential for misuse.
Buprenorphine may be given in combination with naloxone in the drug Suboxone. The naloxone works to deter abuse of the drug since it will knock buprenorphine off the opioid receptors in the brain if abused. Drugs that consist of naloxone and buprenorphine include Suboxone, Zubsolv, and Bunavail.
After medical detox, those suffering from heroin addiction may be put on a long-term drug maintenance program to further assist with treating the addiction. As the person grows stronger in their recovery, the dose of the maintenance drug may be reduced over time until the person is completely drug-free. It’s possible that people going through opioid withdrawal won’t require the use of maintenance medications. In some cases, comfort measures to alleviate the symptoms are given. For example, clonidine is used to reduce anxiety, muscle aches, runny nose, cramping, sweating, and agitation. Clonidine will not reduce cravings for heroin though. Other drugs can be given to treat diarrhea, insomnia, and vomiting.
Recovering from heroin addiction doesn’t stop with the detoxification process. As addiction is a chronic medical disorder, lifelong treatment is often needed to avoid relapse. This is particularly true since addiction doesn’t just cause physical symptoms; it changes a person mentally. Cravings for heroin that occur after detoxification can leave a person vulnerable to relapse. The first 90 days after people stop using is when individuals are most likely to relapse.
Therapy, along with peer support groups, can greatly reduce the risk of relapse though. Therapy teaches people how to cope without heroin use and helps people to identify triggers and how to avoid them. A comprehensive treatment program provides support and encouragement throughout the entire recovery process.Peer support groups, or 12-Step programs, bring individuals who are dealing with the same addiction issues together to discuss challenges they are facing, to offer support to each other, and to celebrate members’ successes in recovery. Oftentimes, new members are sponsored by more seasoned members, and new members can contact their sponsor when they feel as though they may relapse. This ongoing support can be vital to a person maintaining their recovery in the vulnerable early stages of recovery.
Since heroin addiction is such a serious addiction and can be difficult to overcome, inpatient treatment is generally recommended. By staying in an inpatient program, individuals are taken away from people who may have a negative impact on their recovery. People who opt for this route of treatment are also taken away from triggers since there is no opportunity to use heroin in an inpatient program.
In an outpatient setting, people still receive therapy to build a solid foundation in recovery, and medications may be used during outpatient detox and treatment. However, individuals in an outpatient program are still able to work and live at home with friends and family. If a person has only struggled with heroin addiction for a short time and has a strong support system at home, outpatient treatment may be appropriate, but most often, inpatient care is recommended.
While the heroin detox process itself doesn’t lead to death, complications can arise that could be life-threatening, such as severe dehydration. Or, in some instances, people may suffer from an underlying medical condition that is worsened by the withdrawal process. These potential complications, coupled with the high likelihood of relapse if attempting withdrawal alone, make medical detox necessary for heroin withdrawal.
Essentially, quitting heroin cold turkey without help leaves people at risk for various issues while seeking professional help reduces, or even eliminates, such issues. Those who enter into a medical detoxification program are monitored carefully, and measures are taken to keep them safe, ultimately increasing the likelihood that they complete withdrawal and go on to comprehensive addiction therapy.