Quitting Heroin Cold Turkey: How to Get Off Heroin Safely
How Does Heroin Addiction Develop?
Individuals smoke, snort, sniff, or inject heroin, which enters the brain, converts to morphine, and binds to the opioid receptors.2,3 As heroin use continues, the neurons in the brain adapt to the heroin exposure, diminishing the drug’s sensitivity and making it harder for the individual to to function normally without heroin.4 If the person doesn’t use the drug, both psychological and physical symptoms manifest.2
Not every person who uses heroin, however, becomes addicted. Certain factors, such as genetics and environment, impact whether someone becomes addicted.4
Repeated exposure to heroin can lead to both physical and psychological withdrawal if the individual abruptly stops using heroin or drastically decreases their use.2 While the initial withdrawal symptoms usually subside within a week to 10 days, they can be severe, which may lead some people to resume heroin use to stop the withdrawal symptoms.2,5
Symptoms of heroin withdrawal may include:2,5
- Hot flashes.
- Cold sweats.
- Painful bone and muscle aches.
- Runny eyes and nose.
- Muscle spasms.
- Severe heroin cravings.
The method in which heroin is ingested, the duration of use, and the frequency and quantity of use affect the withdrawal process. The symptoms of withdrawal can start within 8-24 hours after last use.5 Major withdrawal symptoms typically peak between 24-48 hours after the last dose and may last up to 10 days.3,5 However, some individuals may experience persistent withdrawal symptoms longer, for many months.3
What Are the Dangers of Quitting Heroin Cold Turkey?
The term cold turkey refers to the abrupt and complete cessation of heroin (or other substance) use. Quitting addictive drugs, like heroin can be harder cold turkey. As mentioned before, withdrawal symptoms can be severe, which can be too much for a person to handle alone.3 Thus, 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 feel the desired effects.5
Therefore, when people with heroin addiction relapse, there is an increased risk of overdose because they don’t realize their tolerance has lowered.5 In 2020, approximately 13,165 people died from an overdose involving heroin.3
Additionally, individuals experiencing heroin withdrawal symptoms may be prone to dehydration from persistent vomiting and diarrhea. If untreated, this can raise sodium levels in the blood (hypernatremia) and, in some cases, lead to heart failure, which can be life threatening.6
Why Is Medical Detox Recommended for Heroin Addiction?
Estimates for individuals with substance use disorders show that 40-60% of people relapse.4 Research indicates that heroin users, especially those who use other substances as well, have higher cravings for heroin, have difficulty coping with cravings, and relapse more often than individuals experiencing withdrawal symptoms from other opioids or alcohol.7
Medical detox allows an individual to rid their body of heroin in a safe, medically monitored environment. Healthcare providers may prescribe medications to ease cravings and reduce or eliminate other symptoms of withdrawal, making the detoxification process more comfortable.3
For instance, a healthcare provider may prescribe buprenorphine, an opioid partial agonist that works on the same receptors as heroin but has less potential for misuse. Given to individuals experiencing heroin withdrawal symptoms, buprenorphine can relieve cravings without producing the euphoric feelings.3
Buprenorphine may be given in combination with naloxone in the drug Suboxone. The naloxone works to rapidly bind to opioid receptors, preventing heroin from activating them.3 Additionally, naloxone, being an opioid receptor antagonist medication, can eliminate all signs of opioid intoxication; therefore, reversing an opioid overdose.3
Methadone can relieve or prevent withdrawal symptoms as well. It’s a slow-acting opioid agonist, so even though it does affect the same receptors in the brain as heroin, it doesn’t cause the same euphoric effect as heroin since it acts slowly.3
Additionally, the U.S. Food and Drug Administration recently approved lofexidine, a non-opioid medicine designed to reduce the severity of opioid withdrawal symptoms.3
Besides medications intended to manage heroin cravings and opioid withdrawal symptoms, other medicines may be given to treat additional symptoms during withdrawal. For example, clonidine may reduce an elevated blood pressure, ibuprofen can relieve muscle aches and pain, and other medicines may help with diarrhea, nausea, and vomiting.8
Heroin Addiction Treatment
After medical detox, individuals typically enter inpatient treatment, which removes them from triggers and the ability to use heroin, or an outpatient program at a substance use treatment facility. That’s because detox alone is rarely sufficient for someone’s long-term recovery from heroin addiction. A formal treatment program includes counseling and behavioral therapies that help individuals understand the underlying thoughts, emotions, and behaviors that led them to substance misuse; aids them in identifying triggers and ways to avoid them; and teaches them strategies to help them cope.9
Aftercare programs then commence upon completion of treatment to support an individual’s long-term recovery.9 As addiction is a chronic medical disorder, lifelong treatment is often needed to avoid relapse.
Part of the aftercare program may include ongoing participation in mutual-help groups, or 12-Step programs, which brings individuals who are dealing with the same addiction issues together to discuss challenges, offer support, and celebrate 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 abstinence in the vulnerable early stages of recovery.9
Additionally, aftercare might include a long-term medication maintenance program. Research indicates that a long-term medication maintenance program—with either methadone or buprenorphine—provides the best opportunity for individuals to achieve lasting recovery from opioid addiction with better treatment retention rates, reduction in opioid use, decreased cravings, and improved social functioning.10
Take Our Substance Use Self-Assessment
Take our free, 5-minute substance use self-assessment below if you think you or someone you love might be struggling with substance use. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.
Should I Quit Heroin Cold Turkey?
Though generally not life threatening, withdrawal from heroin can be severely uncomfortable, which can lead to relapse and an increased risk of overdose, as previously mentioned. Therefore, it’s important to seek guidance and supervision from your healthcare provider before quitting heroin. A doctor trained in addiction can determine the best course of treatment and/or refer you to a detoxification program.8