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Is Heroin Withdrawal Lethal?

Heroin withdrawal will not kill you. The painful and uncomfortable withdrawal symptoms that heroin produces will make most people feel like they have the flu.

Still, there have been rare occasions when those withdrawal symptoms were enough to kill someone. Several factors can determine whether someone can die from heroin withdrawal. Those include their history of addiction, the severity of their withdrawal symptoms, and the level of their physical fitness.

One notable case is that of Judith McGlinchey, who was incarcerated in a United Kingdom prison in 1998. McGlinchey, who had a long history of heroin addiction, experienced acute symptoms of withdrawal. She vomited excessively and had sudden weight loss, and finally, became dehydrated. She would suffer brain damage as a result of cardiac arrest and die. 

Again, while heroin withdrawal is not lethal, death can occur if a user experiences excessive bouts of vomiting and diarrhea, two common symptoms associated with opioids.

“Persistent vomiting and diarrhea may result, if untreated, in dehydration, hypernatremia (elevated blood sodium level) and resultant heart failure,” according to one study.    

The symptoms of heroin withdrawal are not as life-threatening as those from alcohol or benzodiazepines. However, it remains a dangerous, highly addictive drug that rewires the brain. Plus, heroin overdose can be fatal, particularly when the drug is adulterated with potent substances like fentanyl

What Heroin Does to the Body

Heroin can profoundly alter a user’s brain chemistry. The substance impacts opioid receptors and the limbic system, the areas that govern the pleasure and reward centers of the brain, respectively. This activity is what compels addiction.

Heroin works by mimicking the opioids that the body naturally produces. These opioids are neurotransmitters created by the brain and body to block pain signals. These chemicals are also responsible for modifying stress levels as well.

Like other opiates, heroin rapidly binds to opioid receptors, which leads to an overproduction of opioids. The brain ultimately becomes flooded with these feel-good chemicals, leading to an intense rush of euphoria, sedation, and pain relief.

Opioids affect the following areas:

  • Brainstem: Heroin and other opioids create blocks around the brainstem. This action keeps pain signals from reaching the brain, but it also slows down breathing. This is why opioids, in general, have cough-suppressant effects.
  • Spinal cord: Heroin also produces blocks around the spinal cord to keep pain signals in check and blunt the moderate-to-severe pain that injuries cause. 
  • Limbic system: The limbic system is stimulated by dopamine, the neurotransmitter that governs emotion, cognition, and pleasure. It also regulates how humans process feelings of motivation and reward. Heroin boosts dopamine levels that cause the spike of euphoria that comes with use. 

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Heroin Withdrawal Symptoms 

A user can quickly become dependent on heroin because of how it affects dopamine production in the brain. Repeated heroin use will cause the brain to produce less of the dopamine chemical on its own. This will cause users to experience intense cravings for the drug. Why? Because they need to put heroin in their bodies to feel “normal.”

When the body relies on heroin for dopamine, it will build up a tolerance, requiring someone to use more of it to experience the same effects from previous dosages.

Once that use stops, especially after dependency has set in, the system crashes as a response to the loss of dopamine and opioids. This crash causes a wave of withdrawal symptoms that range from mild to severe.

Those symptoms include:

Mild:

  • Muscle aches and pains
  • Fever and chills
  • Excessive sweating
  • A runny nose
  • Uncontrollable crying
  • Restlessness
  • Difficulty concentrating
  • Abdominal pain

Moderate:

  • Nausea and vomiting
  • Diarrhea
  • Insomnia
  • Extreme fatigue
  • Depression
  • Anxiety
  • Agitation and mood swings
  • Intense heroin cravings

Severe:

  • Hallucinations
  • Tremors
  • Irregular heartbeat
  • Elevated blood pressure
  • Impaired breathing
  • Panic attacks
  • Suicidal thoughts

The Stages of Heroin Withdrawal

Heroin withdrawal symptoms in and of themselves are distressing and uncomfortable. Yet, another unfavorable consequence of withdrawal is duration, which can vary widely from person to person. What’s more, the intensity of these withdrawal symptoms will also depend on the user. 

The length of someone’s withdrawal timeline will depend on the following:

  • How long heroin has been abused
  • How much heroin has been taken and how often
  • How the heroin has been ingested (by smoking, snorting, injection, etc.)
  • Substance abuse, addiction history
  • Mental health history or history of other co-occurring disorders
  • One’s overall physical health in general
  • If medical maintenance opioid therapy is being used as part of detox

Another factor that impacts the duration of heroin withdrawal is whether it has been abused with alcohol or other drugs. More than nine in 10 people who use heroin also has used at least one other drug, according to the U.S. Centers for Disease Control and Prevention (CDC).

Stages of the Heroin Withdrawal Timeline 

6-12 hours – Early withdrawal symptoms from heroin occur within six to 12 hours and are physical and flu-like.

1-3 days – Between days two and three, withdrawal symptoms usually peak. At this stage, some symptoms will intensify. The common symptoms that manifest include anxiety, cravings, nausea, vomiting, shaking, fatigue, irritability, insomnia, body aches, and more flu-like symptoms. The severity of these effects will depend on the factors mentioned above.

4-7 days – The intensity of the symptoms will diminish each day after day three, with the exception of heroin cravings. Users typically report that they still experience cravings even at the end of the first week of withdrawal and beyond.

After 1 Week – Between a week to 10 days, the body will have flushed out the toxins associated with heroin. However, the cravings may still linger. Also, fatigue, depression or mood swings can endure for some weeks or perhaps even months.

How Heroin Can Be Lethal 

Heroin overdose can be lethal. Most people die from a heroin overdose when the drug causes them to go to sleep, and they don’t wake up.

“Heroin makes someone calm and a little bit sleepy, but if you take too much then you can fall asleep, and when you are asleep your respiratory drive shuts down,” Dr. Karen Drexler, an addiction expert and professor, told CNN.

In other words, a heroin overdose will cause you to fall asleep, but it will also make your body forget to wake up. Heroin overdose can also cause low blood pressure, which can lead to heart failure, another fatal consequence. 

The lethality of heroin is greater when it is adulterated with other toxic substances such as fentanyl. As a synthetic opioid, fentanyl is already at least 30 to 50 times more potent than heroin. Yet dealers will adulterate heroin with it, making it even more deadly.

Plus, just a quarter of a milligram of fentanyl is enough to kill a human being.

Why Professional Treatment Helps

When users try to go “cold turkey” by quitting heroin abruptly on their own, the withdrawal symptoms they experience may compel them to relapse, which increases the likelihood of a fatal overdose. 

This is why professional treatment is essential. It can effectively put a halt to your addiction and those cravings.

In a reputable heroin addiction recovery program, you can undergo detox via medical maintenance therapy, which alleviates the uncomfortable symptoms of withdrawal while ridding your body of the harmful drug.

Medications that are used during heroin detox include:

  • Methadone, a synthetic opioid that is longer-acting than heroin. It works by lessening cravings and blocking heroin’s euphoric effects by taking up space in the brain’s opioid receptors. Methadone itself can be addictive, and maintenance treatment of this kind requires careful monitoring.
  • Buprenorphine acts on the same neurotransmitters as heroin but, as a partial opioid, it is much weaker. Buprenorphine is like methadone, but it has much lower addiction potential.
  • Suboxone, the brand name for a combination of buprenorphine and naloxone, is used in emergency overdose situations. It works by binding to opioid receptors and blocking them.
  • Naltrexone completely blocks the effects of opioids and is nonaddictive. It can be taken once a day in pill form or once a month in the form of an extended-release injection under the brand name Vivitrol.

When heroin is removed from your body, and you are medically stabilized, the next treatment step is inpatient or residential care or outpatient care, depending on the severity of your addiction.

Because the relapse rates from heroin are relatively high compared to other substances, residential treatment is the most effective inpatient plan. In inpatient, you will live at the treatment facility while receiving comprehensive therapy and around-the-clock supervision. 

Treatment length will depend on the specific needs of a client. Still, the National Institute on Drug Abuse (NIDA) states that the minimum length for effective treatment is at least 90 days. In some cases, people will need anywhere from six months to a year in long-term residential treatment.

Professional treatment will allow you access to treatment modalities and services to bolster your chances of achieving sustained sobriety. Those methods and therapies include: 

  • Individual therapy
  • Group therapy
  • Family therapy
  • Dual diagnosis treatment
  • Addiction education classes
  • Holistic therapy
  • Cognitive behavioral therapy
  • Motivational interviewing
  • Medication management
  • Stress management
  • Relapse prevention planning
  • 12-step programs

After your treatment process, you can be connected to aftercare services like alumni programs, support groups, and sober living communities to provide you with the necessary support. 

Sources

Christensen, J. (2014, August 29). How heroin kills you. Retrieved from https://www.cnn.com/2014/02/04/health/how-heroin-kills/index.html

Darke, S., Larney, S., & Farrell, M. (2016, August 11). Yes, people can die from opiate withdrawal. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/add.13512

Heroin overdose: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved from https://medlineplus.gov/ency/article/002861.htm

Kounang, N. (2018, November 05). What you need to know about fentanyl. Retrieved from https://www.cnn.com/2016/05/10/health/fentanyl-opioid-explainer/index.html

Ragno, J. (2018, August 21). Guide to Heroin Detox – Withdrawal Symptoms, Timeline and Tips. Retrieved from https://delphihealthgroup.com/heroin/detox-withdrawal/

Today's Heroin Epidemic | VitalSigns | CDC. (n.d.). Retrieved from https://www.cdc.gov/vitalsigns/heroin/index.html

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