Heroin Withdrawal & Detox

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.

What Are the Symptoms of Heroin Withdrawal?

As an individual’s body adjusts to functioning without opioids, one can expect to experience withdrawal symptoms.³ Heroin withdrawal is not typically physically dangerous, or life-threatening, such as alcohol withdrawal, but heroin withdrawal can be very uncomfortable, which may lead to relapse in some cases.⁴

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

• Anxiety.
• Difficulty sleeping.
• Fast heart rate.
• Elevated blood pressure.
• Teary eyes.
• Runny nose.
• Fever.
• Excessive sweating.
• Twitching muscles.
• Muscle and bone pain.
• Abdominal pain.
• Muscle and bone pain.
• Nausea and vomiting.

Medical detox provides a stable, drug-free environment where medical staff can administer medications and offer supportive care to ease withdrawal symptoms, prevent medical complications (e.g., dehydration), and potentially reduce relapse rates.³

How Long Does Heroin Withdrawal Last?

Heroin is a short-acting opioid, which means withdrawal generally begins between 8-12 hours after the last dose. Acute withdrawal usually subsides in 3-5 days.³ However, the exact timeline—and the severity—of a person’s withdrawal symptoms may vary based on factors that include:

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

Post-Acute Withdrawal

While many unpleasant withdrawal symptoms subside relatively quickly, some withdrawal symptoms may persist for longer. When withdrawal symptoms persist for weeks, months or years, this is known as protracted withdrawal, or post-acute withdrawal syndrome (PAWS). Symptoms of PAWS for opioids include:^5,6

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

Medical Detox for Heroin

With severe flu-like symptoms, anxiety and insomnia, heroin withdrawal can be extremely unpleasant. However, there are ways to safely mitigate both symptoms and cravings.^{2, 3}

For many people seeking to get sober, medical detox is a necessary first step in the treatment course for heroin addiction.³

What Is Medical Detox?

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. These include:³

1. Evaluation.
2. Stabilization.
3. Facilitating entry into rehab.

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. During the evaluation, staff will ascertain:

• The presence and concentration of substances in the patient’s bloodstream.
• The patient’s general physical and mental health and social situation.
• The patient’s history of substance use and prior withdrawal experiences.

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

• Methaodone. 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.⁹ Behavioral therapy for heroin use disorder:

• 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.^9,10

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 deadly 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

At AdCare, we offer the full continuum of care to support your recovery from opioid addiction—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 an AdCare admissions navigator at to discuss treatment options and care at one of the several facilities located on the East Coast.

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