Heroin is an opioid that is derived from morphine and was first introduced as an over-the-counter cough suppressant in the late 1800s. It was meant to be a less addictive alternative to morphine, but very shortly thereafter, heroin had one of the highest rates of addiction among those who used it.
In 1924, the United States banned the sale, import, and manufacture of heroin, and it is now classified by the U.S. Drug Enforcement Administration as a Schedule I substance, which means it is illegal to possess or manufacture, has a high potential for abuse, and no recognized medical use. Today, heroin is a significant contributor to the tragic statistics that make up the country’s current opioid crisis and is estimated to have been responsible for roughly 15,500 overdose deaths in 2016.
Heroin works by rapidly entering the brain and binding to its opioid receptors, which blocks the brain from receiving pain signals and also stimulates dopamine levels, which accounts for the effects of heightened euphoria and pleasure.
Currently, the American Society of Addiction Medicine estimates that at least 517,000 Americans are battling heroin addiction. Heroin is also more dangerous than ever, as it is increasingly often being mixed or entirely replaced with fentanyl, a synthetic opioid that is much cheaper and easier to manufacture than heroin, as well as far more potent and deadly.
Heroin is also the drug of choice many first-time opioid users use. Data in one government study show that in 2005, nine percent of nearly 6,000 first-time opioid users started with heroin, but by 2015, the number of first-time opioid users who started with heroin jumped to 33.3 percent. Also, according to the study, new opioid users preferred to use heroin over prescription drugs such as hydrocodone and oxycodone.
What are the Symptoms of Heroin Withdrawal?
The symptoms of heroin withdrawal are consistent with those generally associated with opioids. In the early stages of this kind of opiate withdrawal, those detoxing from heroin are most likely to experience at least some of the following mild symptoms:
- Flu-like symptoms (chills, sweats, runny nose, etc.)
- Excess tears
- Muscle aches
- Abdominal cramping
More moderate withdrawal symptoms that will usually appear at the peak of the withdrawal period include:
- Inability to concentrate
- Muscle aches
- Agitation and mood swings
- Restlessness and insomnia
Finally, the most intense symptoms that occur when detoxing from heroin might experience during heroin withdrawal, especially if the user has been abusing large amounts of heroin for a lengthy period, include:
- Muscle spasms
- Dangerously elevated heart rate
- Inability to experience feelings of pleasure
What are the Stages of the Heroin Withdrawal Timeline?
The severity and length of heroin withdrawal will often vary significantly from person to person based mostly on how dependent the brain and body have become on the drug, which is determined by:
- How long someone has been abusing heroin
- How much heroin they have been taking
- Whether they were using heroin in conjunction with other drugs or alcohol (more than 9 in 10 people who use heroin are also using one to three other addictive substances as well)
- Whether or not someone has a history of mental illness or previous addictions
- If they detox on a tapering schedule to slowly diminish their use
- If they detox with the aid of medication-assisted treatment
With those factors in mind, the established timeline for heroin withdrawal is as follows:
6-12 Hours After Last Use
Heroin is a fast-acting opioid, which means that it has a short half-life and that symptoms can begin appearing as early as six hours after the last dose and usually will have within 12 hours. This is when the mild, mostly physical symptoms described earlier will start.
This is when the moderate to major withdrawal symptoms, both physical and mental, will be at their peak intensity.
At this point, the majority of the physical symptoms of withdrawal should have either greatly lessened or disappeared completely. Some psychological symptoms will have most likely faded, but others such as depression and anxiety may still persist.
Even after the body is finished detoxing from heroin, some psychological symptoms and drug cravings can persist for weeks or even months after the last use.
Why Should I Detox?
Even though heroin withdrawal itself is typically not life-threatening, some of the symptoms have the potential to be, such as depression posing a suicide risk. Not getting detox help also puts users at risk of seeking out other drugs and falling deeper into addiction. In Chillicothe, Ohio, law enforcement officers and treatment centers have seen a trend in which more substance users are turning to methamphetamine to avoid the potent and potentially deadly effects of heroin.
Heroin also has an incredibly high relapse rate, with many people relapsing back into use before they have made it all the way through the withdrawal process, especially if they have chosen to stop using heroin all at once.
Quitting cold turkey means a sudden and immediate cessation of heroin’s euphoric, sedative effects on the brain. Where there was once a rush of pleasure, the brain’s dopamine levels instead bottom out. The intensity of this experience is more than enough to cut a detox short and drive someone back to using.
Because of this, it is vital that you detox from heroin in the care of expert health care professionals in a licensed medical detox facility. Not only is it significantly safer than attempting to detox on your own, detoxing under medical supervision minimizes any unnecessary discomfort from withdrawal symptoms and, with the help of a tapering schedule and medication-assisted treatment use, removes the risk of a mid-withdrawal relapse.
Many detoxification centers will choose to use drugs like Suboxone or buprenorphine to treat opioid dependency and slowly wean patients off of heroin. These drugs provide the same effects as heroin at a much weaker level, and without the addictive risk of methadone.
What is the Next Treatment Step?
Detoxing from heroin is only the beginning of a successful recovery. Forgoing any rehabilitation treatment or aftercare once you have completed the withdrawal process almost guarantees relapse. In fact, studies show that 91 percent of people who completed heroin detox but did not move on to any kind of aftercare returned to using, with 59 percent relapsing within just one week of discharge.
After clients have completed a medical detox, which can last anywhere from three to 10 days or longer, if needed, clients usually are evaluated before they enter a treatment program. An assessment helps ensure you or your loved one receives the proper diagnosis and treatment program that can best address the needs at hand. You may be asked standard questions about your heroin use and use of any other addictive substances. These questions may includes ones like:
- How long have you been using heroin?
- Are you taking other drugs? If so, what are they?
- Do you drink alcohol. If yes, how often do you drink?
- Have you ever been to drug or alcohol addiction treatment?
- Do you have a family history of addiction? If so, who in your family abused substances?
- Do you have other mental and/or physical health problems?
The assessment also helps determine if a mental health disorder is present along with a substance use disorder (SUD). When both disorders are present, the condition is known as co-occurring disorders, comorbidity, or dual diagnosis. Having both is common among people in need of addiction treatment. The more severe a person’s mental illness is, the more likely the person will abuse substances to self-medicate or manage symptoms. Illegal substances that are commonly abused include alcohol, marijuana, and cocaine. If it is determined that co-occurring disorders need to be addressed, an addiction treatment program that addresses both illnesses at the same time to give clients the best chance at recovery.
Rehabilitation treatment is crucial to remaining abstinent from heroin use. Once it has been determined which program is suitable for the client seeking treatment, the next step is to begin the program to address the psychological side of addiction. Addiction recovery treatment can be customized just for the person, so take into account any needs and preferences that can only enhance the experience.
There also rehab centers that serve a specific population, such as veterans, seniors, adolescents, and LGBTQ+. There are faith-based centers and ones that serve only men or only women. Treatment also can incorporate trauma therapy, holistic therapy, and family therapy. Your treatment program will be customized based on what works best for you.
Inpatient treatment or residential treatment, which can last from 28-90 days in a facility, depending on the program, involves various therapies that can help the person overcome their addiction. According to the National Institute on Drug Abuse, at least 90 days (three months) or more are needed to treat drug addiction.
Clients who stay in treatment for a longer time will give themselves time to acquire and develop the skills and strategies they need to live without using drugs.
Outpatient treatment for people who may be in the early stages of heroin addiction. Outpatient therapy does not require an on-site stay at a treatment center. This allows clients more flexibility as they work drug treatment into their schedules. However, outpatient clients are still required to attend structured sessions three to five times a week or more, depending on the situation. Treatment also can incorporate behavior therapy,12-step programs, holistic therapy, family therapy, and individual and group counseling.
There are many kinds of aftercare programs available, including individual and group counseling, therapy, support groups, and even sober living communities.
Many recovering heroin users realize once they have completed drug rehab, their life after rehab is the start of a new chapter, one that requires support to stay committed to their recovery goals and avoid relapse. Some people join 12-step groups and alumni organizations to connect with like-minded people who are also staying true to their decision to live in sobriety.
Some heroin users may find that still have post-acute withdrawal symptoms, which can last long after dependence on alcohol or drugs has ended. If that’s the case for you or your loved one, consider continuing therapy sessions and pursue a healthy lifestyle that involves getting adequate rest and following a wellness program.