Heroin Withdrawal Symptoms & Detox

WHAT YOU NEED TO KNOW  

• Repeated heroin use causes physical dependence, leading to withdrawal when use stops or slows
• Heroin withdrawal is rarely life-threatening but is very uncomfortable and can drive relapse
• Withdrawal usually begins 8 to 12 hours after the last dose and eases within 3 to 5 days
• Medical detox is the safest first step, followed by heroin rehab and often MAT
• Relapse after detox is dangerous because lost tolerance raises the risk of fatal overdose

Heroin is an illegal, addictive street opioid that is derived from morphine. Repeated heroin use will quickly cause an individual to develop physiological dependence, at which point they may experience withdrawal symptoms when they attempt to quit or reduce their use.^1,2 This article will discuss opioid withdrawal and how it is treated.

Heroin Withdrawal and Heroin Rehab

Heroin is an opioid made from morphine. It is illegal and can quickly lead to physical dependence. If you have been using heroin for a while, you might notice withdrawal symptoms when you try to stop or use less.

Withdrawal can feel overwhelming, but it is possible to get through it with the right support. This guide walks you through what heroin withdrawal is like, how long it usually lasts, and how medical detox and rehab can help you move toward recovery.⁴

Heroin Withdrawal Symptoms

When your body gets used to heroin, stopping can bring on withdrawal symptoms. These symptoms are rarely dangerous, but they can be tough to handle. For some people, this discomfort is enough to make them want to use again.

Someone withdrawing from heroin may experience the following symptoms:^2,3

Medical detox provides a stable, drug-free environment where staff can give medications and supportive care to ease symptoms, prevent complications like dehydration, and potentially reduce relapse rates.³

How Long Does Heroin Withdrawal Last?

Heroin leaves the body quickly, so withdrawal often starts 8 to 12 hours after your last use. Most people find that the worst symptoms get better in about 3 to 5 days. Your experience may be different, depending on things like:

• Frequency of heroin use.
• Average dose of heroin.
• Duration of heroin use.
• Physical and mental health.
• Family history/genetics.

Post Acute Withdrawal Syndrome

Most withdrawal symptoms fade in a few days, but some can stick around for weeks or even months. This is sometimes called post-acute withdrawal syndrome, or PAWS. With opioids, PAWS can look like:

• Depressed mood.
• Irritability.
• Anxiety.
• Difficulty sleeping.
• The inability to concentrate and complete tasks.
• Heroin cravings.

Heroin Detox

With severe flu-like symptoms, anxiety, and insomnia, heroin withdrawal can be extremely unpleasant. Fortunately, there are safe ways to ease both symptoms and cravings. For many people, medical detox is a necessary first step in heroin rehab.

Medical detox is a way to clear substances from your body with support from staff who are there around the clock. The process usually happens in three main stages:

What Is Medical Detox?

Medical detox, or medically managed withdrawal, is a form of treatment that helps people rid their bodies of toxins like drugs and alcohol as safely and comfortably as possible. In a medical detox facility, medical staff are available 24/7 to respond to potential emergencies as well as monitor patients and administer treatment when needed.³

Detox is conducted in 3 parts, which may overlap: evaluation, stabilization, and facilitating entry into rehab.³

When patients are first admitted into medical detox, medical staff will evaluate them and determine the best course of action to ensure the safest and most comfortable withdrawal experience. 

The next stage of medical detox is stabilization. Medication is an important part of opioid detox and rehabilitation for many people. Some medications that may be used in the management of opioid withdrawal include:^3,7,8

• Methadone. A long-acting opioid agonist given in controlled doses to ease withdrawal symptoms, without eliciting a high, in individuals who are opioid-dependent or who are actively withdrawing from heroin. It also relieves heroin cravings and is often used after the initial detox phase, as a long-term maintenance treatment.
• Buprenorphine. An opioid partial agonist, meaning that, like other opioids, it may elicit some euphoric effects, but these effects are weaker than those of full opioid agonists such as heroin and methadone. Buprenorphine’s effects increase with each dose only up to a certain point after which dose increases won’t produce additional effects. This “ceiling effect” lowers the risk of misuse and dependence. There are various ways to administer buprenorphine, including a monthly injection, sublingual tablets, and a subdermal implant that is effective for 6 months.
• Clonidine. A non-opioid medication that is used to treat high blood pressure. It is sometimes used in an off-label medication to treat opioid withdrawal.
• Lofexidine. A non-opioid medication that is FDA-approved for the treatment of some opioid withdrawal symptoms. This medication, unlike methadone or buprenorphine, will not relieve heroin cravings. Lofexidine is in the same class as clonidine; however, it does not lower blood pressure, which can potentially be an unwanted side effect when treating opioid withdrawal.

The third stage of detox is fostering someone’s entry into a rehabilitation program. While supervised detox is the necessary initial step for many people battling opioid addiction, detox on its own is often not enough for someone to achieve long-term sobriety.³

Opioid use disorder (OUD) is a chronic, relapsing condition, and as a result, effective treatment needs to address the full spectrum of the patient’s needs—whether they’re psychological, social, vocational, etc.—and not just their physical dependence on heroin.^4,9

Behavioral therapy forms the foundation for most substance use disorder treatment programs. Behavioral therapy for heroin use disorder:^9,10

• Teaches patients the skills to recognize and overcome the underlying triggers that may lead them to relapse.
• Alters negative thought and behavioral patterns.
• Enables individuals to form supportive and meaningful interpersonal relationships.

Behavioral therapy may be used along with medication for a “whole-patient” approach to opioid use disorder treatment.¹¹

Can I Detox from Heroin at Home?

Heroin withdrawal is very difficult to endure without medical assistance. Although heroin withdrawal is rarely fatal, there are some medical complications that may occur during opioid withdrawal, such as dehydration, electrolyte imbalance, and hyperglycemia.³ Heroin withdrawal symptoms can be intense enough to cause someone to relapse.⁴

Medical detox can help people receive the care they need in order to stay on the path to recovery by making the acute withdrawal phase easier to bear. Additionally, medical detox can help create a smooth transition from detox into rehabilitation.

Medication-Assisted Treatment (MAT) for Heroin Addiction

Research has shown that individuals who practice complete abstinence after opioid detox, have a higher likelihood of  relapse.⁷

Relapsing after completing detox can be exceedingly dangerous and may result in a deadly heroin overdose since the individual no longer has a tolerance to heroin, and as a result even relatively small amounts of heroin during a relapse can be lethal.^7,12

Medication-assisted treatment (MAT), which involves the use of maintenance medications (e.g., methadone or Suboxone) with therapy, can help relieve cravings and support sustained recovery from heroin.

Using maintenance medications such as naltrexone, Suboxone, and methadone as part of treatment does not negate your sobriety or mean that you are  “substituting one opioid addiction with another.”¹³

MAT has “proved to be clinically effective,” per the Substance Abuse Mental Health Administration, providing a more well-rounded approach to treating the patient. Evidence shows that MAT is successful in treating substance use disorders and can help many people stay in recovery long-term and build self-directed lives.¹¹

MAT may be offered in both inpatient and outpatient treatment programs, and many people will continue MAT for years or even a lifetime—as long as it supports their recovery.²

Heroin Addiction Treatment in Rhode Island

At AdCare, we offer differen types of addiction treatment—from medical detox and inpatient programs to outpatient care and even telehealth treatment.

If you or a loved one is struggling with opioid addiction, please reach out to one of our admissions navigators at to discuss treatment options, the rehab admissions process, and the care available at our inpatient alcohol and drug rehab facility in Rhode Island or one of our sister facilities located on the East Coast.

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