Heroin Withdrawal: Symptoms, Detox & Timeline

Heroin withdrawal happens when someone who has been using heroin regularly suddenly cuts back or stops altogether. This can lead to what’s known as opioid withdrawal syndrome—a condition where the body reacts to the absence of the drug it has grown dependent on1. Regular heroin use changes the brain’s chemistry, creating both physical and psychological dependence. When heroin is no longer in the system, the body struggles to adjust, leading to uncomfortable and intense withdrawal symptoms.

These symptoms can make it incredibly tough for people trying to quit heroin and stay sober. The discomfort of withdrawal often pushes patients back to using heroin again just to feel better.

When someone quits using heroin, their body and mind can react intensely to the sudden lack of the drug, triggering a range of withdrawal symptoms. These symptoms aren’t just uncomfortable—they can be mentally and physically overwhelming, making quitting heroin incredibly challenging.

The intensity and duration of heroin withdrawal symptoms can vary depending on how long the person has been using, the amount they’ve been taking, and their overall health. Some of the most common symptoms people experience during heroin withdrawal include1,2,3,7:

• Intense cravings for heroin
• Nausea, vomiting, or diarrhea
• Restlessness and irritability
• Anxiety 
• Runny nose
• Fever and chills
• Sweating
• Muscle aches and pains
• Insomnia and sleep disturbances
• Dilated pupils and tearing eyes
• Abdominal cramps

These symptoms can begin as soon as a few hours after the last dose and may persist for days or even weeks, making withdrawal a challenging obstacle in the path to recovery.

How Long Does Heroin Withdrawal Last?

The timeline for heroin withdrawal can differ from person to person, depending on a variety of factors like how long someone’s been using, how often they use, and how much they usually take. Other things, like their overall physical and mental health, can also make a difference.

Usually, withdrawal symptoms start showing up within 8 to 12 hours after the last use4,5. Over the next 4 to 10 days, these symptoms gradually start to ease up, but for some people, withdrawal can last longer4,5.

Sometimes, people experience what’s called post-acute withdrawal syndrome, or PAWS. This is when symptoms stick around for months after the initial withdrawal phase. Unlike the early, mostly physical symptoms, PAWS typically includes psychological symptoms, and it can make the recovery journey feel like a constant struggle.

Knowing what to expect during withdrawal can help those dealing with heroin addiction prepare for what’s to come and get the support they need to get through it.

PAWS Symptoms

Post-acute withdrawal syndrome, or PAWS, can lead to a mix of lingering withdrawal symptoms, mostly psychological, that stick around long after the early withdrawal period is over. These symptoms are usually more subtle, but they can be just as tough to deal with, because they can last for months5.

The symptoms of PAWS can differ from person to person, but they often include5,6,7:

• Anxiety and panic attacks
• Depression and mood swings
• Fatigue and low energy
• Difficulty concentrating or decreased attention span
• Dysphoria, or a general feeling of unease or dissatisfaction
• Irritability and restlessness
• Insomnia or disrupted sleep patterns

Because these symptoms can persist for such a long time, they can make it difficult for patients to stay focused on their recovery. However, understanding PAWS and getting help can help patients maintain long-term sobriety.

Heroin withdrawal, while rarely life-threatening, can still be dangerous in certain situations5. The withdrawal symptoms themselves are rarely fatal, but there’s always some risk, especially if someone has existing health issues or faces serious complications like dehydration, severe vomiting, or heart problems8. For most people, the real danger of heroin withdrawal comes from how intense it is and the high likelihood of relapse that can follow.

One of the biggest risks during opioid withdrawal is that the symptoms can become so overwhelming—both physically and emotionally—that they might push someone to relapse. After even a short break from heroin, the body’s tolerance drops significantly. This means if a person starts using again and takes the same amount of heroin as before, they’re at a much higher risk of overdose, which can be fatal5. That’s why it’s crucial for patients to go through a medical detox program, where they can get the supervision and support they need during withdrawal.

A well-structured detox program helps manage withdrawal symptoms, lowering the chances of relapse and the dangers that come with it. By safely getting through withdrawal with medical care, patients can break the cycle of relapse, paving the way for long-lasting recovery.

Heroin Detox & Treatment Medications

Medical detox programs help your body get rid of heroin or other opioids while keeping withdrawal symptoms under control. It’s the first step in treating heroin addiction, and it’s not just about quitting—it involves medical care to make sure you’re safe and comfortable during the process. A detox program provides a supportive, controlled environment where you can get the help you need while managing the uncomfortable withdrawal symptoms.

These detox programs are designed to help you through the tough and sometimes risky withdrawal symptoms that you’d likely face if you tried to quit on your own. In these settings, healthcare professionals use different medications to ease those symptoms and cut down on cravings, making detox safer and easier to handle. Some of the commonly used medications include5,9:

• Buprenorphine: A partial opioid agonist that helps to alleviate withdrawal symptoms without producing the same high as heroin. It’s often used in combination with naloxone to further reduce the potential for misuse.
• Methadone: A long-acting opioid agonist that helps to manage withdrawal symptoms and reduce cravings by acting on the same receptors in the brain as heroin but in a more controlled and less euphoric way.
• Naltrexone: An opioid antagonist that blocks the effects of heroin and other opioids, helping to prevent relapse. Naltrexone is non-addictive and does not produce withdrawal symptoms when stopped.

These FDA-approved medications for opioid use disorder (OUD) can be incredibly helpful in managing withdrawal and getting started on the path to recovery9. But it’s crucial to remember that detox on its own isn’t a cure for heroin addiction. It’s just the beginning of a broader treatment plan that should also include counseling, behavioral therapy, and ongoing support to maintain long-term recovery.

Getting started with treatment for heroin addiction at Empowered Recovery Center, is a straightforward process designed to help you or your loved one begin the journey to recovery. Our compassionate team is here to guide you through every step, from the initial rehab admission process to exploring payment options and verifying insurance coverage. We understand that seeking help can be overwhelming, so we work to make this transition as smooth as possible.

At our Atlanta rehab facility, we offer a range of addiction treatment programs tailored to meet the unique needs of each individual. Whether you’re looking for outpatient programs, intensive outpatient care, or specialized therapy options, we provide comprehensive treatment plans that address both the physical and psychological aspects of addiction. 

If you or someone you care about is struggling with heroin addiction, don’t wait to get the help you need. Reach out to us today to discuss how we can assist you in starting treatment.

References

1. Strain, E. C., & Kahana, S. Y. (Eds.). (2018). The opioid withdrawal syndrome. In The ASAM principles of addiction medicine (6th ed.). https://www.ncbi.nlm.nih.gov/books/NBK526012/
2. American Society of Addiction Medicine. (n.d.). Clinical Opiate Withdrawal Scale (COWS) Induction Flow Sheet. https://www.asam.org/docs/default-source/education-docs/cows_induction_flow_sheet.pdf?sfvrsn=b577fc2_2
3. Cleveland Clinic. (n.d.). Opioid Use Disorder (OUD). https://my.clevelandclinic.org/health/diseases/24257-opioid-use-disorder-oud
4. Substance Abuse and Mental Health Services Administration. (2015). Substance use disorders: A guide to the use of language. HHS Publication No. (SMA) 15-4131. https://store.samhsa.gov/sites/default/files/sma15-4131.pdf
5. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd ed.). https://www.ncbi.nlm.nih.gov/books/NBK310652/
6. SAMHSA. (2010). Substance Abuse Treatment Advisory: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. https://store.samhsa.gov/sites/default/files/sma10-4554.pdf
7. PCSS. (n.d.). Opioid Withdrawal. https://pcssnow.org/courses/opioid-withdrawal/
8. West, R., & Brown, J. (2017). Theory of addiction (2nd ed.). Addiction, 112(7), 1390-1391. https://doi.org/10.1111/add.13512
9. Food and Drug Administration. (2023, July 28). Information about Medications for Opioid Use Disorder (MOUD). https://www.fda.gov/drugs/information-drug-class/information-about-medications-opioid-use-disorder-moud
10. National Institute on Drug Abuse. (2023, June 20). Opioids. https://nida.nih.gov/research-topics/opioids
11. Tenny, S. (2023, July 13). Opioid withdrawal timeline: Symptoms and stages. Medical News Today. https://www.medicalnewstoday.com/articles/opioid-withdrawal-timeline#early-stage