Heroin Withdrawal: Understanding the Symptoms, Timeline, and Treatment Options

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Heroin withdrawal is a dangerous medical condition that can occur when one stops using heroin after a prolonged period of use and addiction. Heroin withdrawal can cause mild to severe withdrawal symptoms and should always be attempted with the guidance of a doctor or addiction specialist. Symptoms generally peak after three to five days of withdrawal from heroin and can range from mild to severe. In some cases, symptoms of heroin withdrawal can even be post-acute. Avenues Recovery provides an in depth overview below on heroin withdrawal and its effects.

What is Heroin Withdrawal?

Heroin is a powerful opioid drug that is normally sniffed, smoked, snorted, or injected. All these pathways enable heroin to enter the brain rapidly where it binds to opioid receptors. The brain receptors affected the most by heroin are those involved in feeling reward, pleasure, and the perception of pain. Heroin also slows down a person’s brain function and affects their breathing (which can slow down or even stop). Their body temperature and blood pressure drop, and their heartbeat can become irregular.

Heroin addiction can completely overpower one’s body. The more a person uses heroin, the more they develop a tolerance to the substance. Drug tolerance occurs when a person needs a higher or more frequent dose to feel “high”. Complete dependence on heroin is the most severe problem caused by continued use. People who are addicted to heroin and try stopping abruptly may experience severe heroin withdrawal symptoms. Heroin’s powerful withdrawal symptoms necessitate the use of medical drug detox to successfully overcome addiction. Many who are fighting heroin addiction find themselves relapsing to avoid these painful symptoms.

Heroin Withdrawal Symptoms

Since heroin is an opiate drug that impedes the functions of the central nervous system, heroin withdrawal symptoms will be the opposite of the drug’s intoxicating effects. For instance, heroin reduces a person’s heartrate and induces euphoria. As such, during heroin withdrawal, they will instead experience a rapid heart rate and a low mood, among other symptoms.

Heroin withdrawal symptoms range from mild to severe depending on a person’s dependence level and how long they have been abusing the drug. Below are some of the mild, moderate, and severe symptoms of heroin withdrawal that may be experienced.

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Mild Withdrawal Symptoms:

  • Chills
  • Sweat
  • Runny nose
  • Yawning a lot
  • Nausea
  • Tearing
  • Abdominal cramps
  • Muscle and bone aches

Moderate Withdrawal Symptoms:

  • Diarrhea
  • Vomiting
  • Tremors
  • Agitation
  • Restlessness
  • Fatigue
  • Concentration difficulties
  • Goosebumps

Severe Withdrawal Symptoms:

  • Drug cravings
  • Depression
  • Hypertension
  • Impaired respiration
  • Muscle spasms
  • Insomnia
  • Rapid heart rate

Post-Acute Withdrawal Symptoms

People recovering from heroin addiction are also likely to suffer long-term withdrawal symptoms depending on the duration of use. These symptoms can last for 18-24 months and can include the following:

  • Poor concentration
  • Poor sleep
  • Panic attacks
  • Memory loss
  • Mood swings 

Behavioral effects of heroin withdrawal typically last longer than the other symptoms. However, as time passes and the person avoids heroin, the symptoms begin to diminish.

How Long Does Heroin Withdrawal Last?

Symptoms of heroin withdrawal kick in as early as a few hours after the last dose. The duration of the withdrawal symptoms will differ for every user.

Five Factors that Affect Heroin Withdrawal 

As explained above, how long heroin withdrawal lasts is not the same for everyone. Withdrawal from heroin depends on a number of factors:

  1. Duration - the length of time a person has used heroin will determine the duration of the withdrawal symptoms. For someone who has only been abusing heroin for a short period, the symptoms of heroin withdrawal may be milder and only last for a short while. People who have abused the drug for months or years will generally have more severe withdrawal symptoms, lasting longer.
  2. Dosage - the amount of heroin a person took each time also determines the duration and severity of their withdrawal from heroin. People who take massive doses frequently will have more intense withdrawal symptoms and must be enrolled in a medical detox program, so they can be given drugs to manage the severe symptoms.
  3. Frequency - how often a person uses heroin is a key determinant of the duration of heroin withdrawal symptoms. If they use the drug often, their body is more dependent on it, and they are bound to suffer greater withdrawal than those who use it less often.
  4. Form of heroin - the method they used to ingest the drug also impacts how long heroin withdrawal will last. Different methods used to take heroin influence the severity of dependence on it. Injecting it into the bloodstream has been found to cause the most harmful effects. Those who take the drug by injection will experience more severe symptoms compared to other methods, like smoking.
  5. Co-occurring medical/mental health disorders - the presence of co-occurring disorders can also heavily impact one’s withdrawal symptoms. For instance, people with anxiety disorders or depression will experience more severe psychological symptoms compared to others. Depression may even lead someone to consider suicide as a means of escaping the painful symptoms.

Heroin Withdrawal Timeline

Heroin withdrawal symptoms generally last for about one to two weeks for most people. However, some may experience these symptoms for several weeks or even months after withdrawing from heroin. This is especially the case for people who have been using the drug in massive doses for a long time. The withdrawal symptoms can be broken down into the following heroin withdrawal timeline:

  • One to two days: Symptoms start kicking in around six hours after the last fix. On the first day, pain starts to develop, manifesting as muscle aches. The pain intensifies over the first 48 hours. During this period, one is also likely to experience insomnia, panic attacks, anxiety, diarrhea, and shaking.
  • Three to five days: This is when the symptoms of heroin withdrawal are at their peak. One is likely to experience severe abdominal cramps, heavy sweating, shivers, and vomiting. Most people find themselves facing a myriad of digestive and physiological problems. This is also when drug cravings are at the highest, and most people find themselves relapsing. Quitting the drug feels impossible at this point, even if the person is motivated.
  • Six to seven days: A week typically marks the end of acute withdrawal for most users. During this period, most of the symptoms, such as nausea and muscle aches, begin to wane. The person generally starts to return to feeling normal, though they might feel weak and exhausted.
  • Post-Acute Withdrawal Symptoms (PAWS) [1]: After the acute withdrawal symptoms are over, other symptoms may persist for months. These symptoms are mostly behavioral as they are caused by neurological changes. Heroin heavily impacts brain functions, and withdrawals from heroin can cause anxiety, depression, insomnia, fatigue, and irritability.

Treatment for Heroin Withdrawal

Detoxing from heroin is not life-threatening in itself, but there are some health complications that can arise from the symptoms. This is why it is important to seek medical supervision when quitting heroin


Drug Detox

Drug and alcohol detox involves detailed and structured care that is planned after a thorough assessment of the user, looking at their medical and psychiatric history in full. Heroin withdrawal symptoms can be quite painful and difficult to manage alone at home. With medical supervision, the person can be given drugs that help with the symptoms. This makes it easier to make it through the peak period and avoid relapsing.

Most users also take heroin alongside other drugs. At times, attempting to withdraw from these substances can be fatal [2]. It is hard to know how a person’s body will react to the detox process, so it is safer to have trained medical personnel in charge to handle any problems that may arise.

Medications Commonly Used to Treat Heroin Withdrawal

A medically supervised withdrawal approach will generally use medication assisted treatment for OUD. Methadone and buprenorphine are commonly used medications which alleviate the painful withdrawal symptoms and cravings. Methadone and buprenorphine bind to the same brain receptors that heroin does thereby causing the body not to need heroin as much. These medications are also generally used to treat opioid use disorder. 

A Supportive Environment Can Make All The Difference

There are several emotional withdrawal symptoms related to heroin. Depression, panic attacks, and anxiety are especially prevalent among people with an underlying disorder or a history of mental illness. When one stops using heroin, their dopamine levels dip, causing a crash of emotions. This makes it hard for the person to experience pleasure even when doing things they loved before. This significantly increases the risk of attempting suicide. Receiving support in recovery from a supportive surrounding environment with people who are familiar with the mental effects of withdrawal, will make it much easier for the person to get through the process.

Heroin Withdrawal Treatment at Avenues Recovery

Heroin is a powerful drug that is highly addictive. Recovering from heroin addiction is a challenge for most people because of the many heroin withdrawal symptoms, which can be quite severe due to the drug’s impact on the central nervous system. Although recovery is a long journey, detoxing is made easier when one is under medical supervision. Avenues Recovery professionals are skilled at helping clients with heroin withdrawal and teaching them how to move on to live fulfilling lives in sobriety. We provide a variety of treatment programs to help you get back to your best self. Reach out today if you are struggling with a heroin addiction, help is available!

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[1] semel.ucla.edu

[2] ndarc.med.unsw.edu.au

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