Heroin Detox and Withdrawal: Symptoms & Treatment Programs
Heroin is a very addictive illicit drug that comes from morphine, which is created from the seed pods of certain poppy varieties.7 If a person becomes physically dependent on heroin, and then tries to stop using the drug, they may experience several physical withdrawal symptoms, which can be very unpleasant and uncomfortable.2
If you or a loved one is struggling with heroin addiction, there are medications to help manage opioid cravings, and a heroin detox center or recovery program can be a safe and more comfortable way to manage withdrawal and start on the road to recovery.
What is Heroin Withdrawal?
Heroin withdrawal occurs when a person suddenly reduces or stops using heroin, resulting in withdrawal symptoms. With continued use, a person can develop tolerance, which means that they will require more heroin to feel its effects. Over time, a person will develop a physiological dependence, which means they will experience withdrawal symptoms if they stop using the substance.9
While heroin withdrawal isn’t usually life-threatening, it can be highly uncomfortable.8 Due to this discomfort, it may be helpful to enter a heroin detox center or treatment facility to receive supervised care. Care may include the use of certain medications to help reduce cravings and ease withdrawal symptoms such as buprenorphine or methadone.8
Heroin Withdrawal Symptoms
When people who have developed a physiological dependence stop using heroin, their bodies experience symptoms of withdrawal. Heroin withdrawal signs and symptoms typically include:1, 8
- Fast pulse.
- Cold chills.
- Abdominal cramping.
- Body aches.
- Bone and muscle pain.
These withdrawal symptoms vary from person to person and their severity depend on such factors as the length of time a person has been abusing heroin, genetics, and other mental and physical factors.1
Risks of Withdrawal
The symptoms of heroin withdrawal and other opioids are not typically life-threatening; however, medical complications can arise and should be treated. Medical supervision can also help to prevent discomfort and medications can be used to help reduce symptoms and opioid cravings.
People who have used heroin by injection are at a higher risk for certain medical conditions like HIV/AIDS, viral hepatitis, or sexually transmitted diseases.1 This makes it important to receive a thorough medical assessment to receive proper care during heroin detox.1 Heart complications, anxiety disorders, or chronic pain can also complicate withdrawal.1
Heroin Detox Timeline
Heroin withdrawal symptoms typically begin 8 to 12 hours after last use and can last from 3 to 5 days.1 However, some people experience withdrawal symptoms for a longer period.2
Cravings or psychological symptoms (depressed mood or anxiousness) may last for up to 6 months.8 Medications like methadone and buprenorphine that are started during detox can be continued throughout and after drug treatment and can help reduce drug cravings and hopefully minimize a person’s risk of relapse. Nonpharmacological recovery strategies, such as individual counseling or group participation, may also help to prevent relapse.8
Detox Process and Protocol
Detox from heroin is the first stage of recovery from heroin addiction. Detox alone is not typically sufficient to achieve long-term abstinence10 Continuing heroin treatment after the detox phase may help change patterns of long-term substance use and build the foundation for lasting recovery.9
People who only go through detox without follow-up treatment may have a higher chance of relapsing and begin using heroin again.3
The thought of going through detox can be frightening for someone who has never experienced the process. The processes involved with supervised detox programs are designed to be supportive and involves:1
- Evaluation: Medical and psychological screening that tests for substances in the bloodstream and checks for co-occurring disorders to provide proper level of treatment.
- Stabilization: Supportive care provided to a person while they go through acute withdrawal phase and helps keep a person medically stable and comfortable.
- Preparation for further treatment: Support to help encourage a person to continue treatment, particularly if they have previously completed detox and then relapsed.
Medications for Detox
Medications used to treat moderate to severe opioid use disorder, including people with heroin addiction, can be started during the detox/withdrawal phase and can alleviate symptoms and reduce cravings.12 Other medications may also be used during detox to alleviate specific symptoms.11
Methadone is an opioid agonist, which means it attaches to the same opioid receptors in a person’s brain as heroin and thus blocks people from feeling withdrawal symptoms or cravings for heroin.11 It can be a highly effective treatment to ease withdrawal from heroin. However, methadone used improperly can lead to an overdose, and it also has the potential to be abused. Therefore, it must be administered under strict supervision.
Buprenorphine is an opioid receptor partial agonist, meaning that it affects the opioid receptors in the brain in a similar way as heroin to help ease withdrawal symptoms and cravings.11 It is available under brand names Subutex, an oral form, and suboxone.
Suboxone is a form of buprenorphine that also contains naloxone (as a deterrence to misuse).11
Other medications sometimes used during heroin detox to manage withdrawal symptoms include:1,13
- Clonidine: can reduce anxiety, sweating, and irritability.
- Lofexidine: can help ease insomnia, stomach pain, and fast heartrate (tachycardia).
- Prescription and over-the-counter medications to treat nausea, diarrhea, insomnia, as well as aspirin and over-the-counter pain medication for muscle aches, bone pain and headache.
Detox Centers and Addiction Treatment Programs
Many treatment facilities offer heroin detox and may include:
- Detox centers. Some programs operate solely as a detox center, meaning that they offer only a short stay of usually 1 to 3 days to allow a person to detox safely under the supervision of medical personnel. Detox alone, or without additional follow-up drug rehab treatment is rarely sufficient to achieve long-term abstinence from heroin.
- Inpatient treatment. Some detox programs are part of an inpatient or residential rehab treatment program, which provides group and individual counseling in a structured environment. People in rehab programs usually stay anywhere from a few days to a few weeks (usually 28 or 30 days). Long-term programs lasting many months are also an option for those who have not been able to remain free from heroin despite repeated stays in detox and/or other shorter-term programs.
- Outpatient treatment. Outpatient drug rehab is available at varying levels of intensity, including partial hospitalization programs, intensive outpatient, and standard outpatient. Some providers offer both inpatient and outpatient services, which provide patients with flexibility to get the type of treatment they need and to step up or down as needed. Outpatient treatment typically includes group and individual counseling, but you do not have to live at the facility.
Careful research of the programs you are considering will help you gain more understanding about the detox center or rehab program that is best for you.
Risks of Detoxing at Home
Experiencing heroin withdrawal at home can be highly uncomfortable and, in some rare cases, unsafe. The pain and discomfort associated with heroin withdrawal may lead an individual to relapse to alleviate withdrawal symptoms. This can be dangerous, as a person’s tolerance becomes lower when they stop using heroin. If they return to heroin use at the same level as when they started detox, they risk experiencing an overdose.
People with co-occurring mental health disorders or certain physical conditions or medical diseases may also need additional medical support to help them safely detox.
Ongoing Treatment and Aftercare for Heroin Addiction
Ongoing treatment and aftercare can help sustain a person’s recovery from addiction. Continuing treatment and recovery may be helped with group and individual therapy, which can:
- Teach you skills to help you resist using drugs.
- Work on problem-solving skills.
- Remain motivated to continue staying drug-free.
- Replace drug-using activities with other activities that promote sober living.
Family therapy can also assist in improving family relationships that have suffered as a result of heroin addiction.4
There are many different forms of ongoing treatment after detox:
- 12-step or mutual-help programs are free and exist in almost every community. Narcotics Anonymous (NA) is one such group that helps give a recovering person a supportive environment in which to work on maintaining a drug-free lifestyle and preventing a relapse. Twelve-step programs are an important part of many aftercare efforts following other forms of treatment.4
- Group counseling gives you an environment with positive feedback to aid in the recovery process. Isolation can be a challenging for many recovering from heroin addiction, and group counseling can helps keep a person from feeling isolated. Group members who have been in recovery for a sustained period of time can be role models for those who are just starting the recovery process.4
- Individual counseling may also be beneficial. Various therapy models can be used such as cognitive behavioral therapy, which helps you work on changing the behavioral patterns that trigger heroin use. In addition, individual counseling programs often use contingency management, which provides you with rewards for remaining free from drug use.5
Frequently Asked Questions
Can heroin detox kill you?
Detoxing from heroin seldom results in death or other serious medical issues. Medical complications, such as cardiac issues or severe dehydration from vomiting, can arise occasionally. In general, heroin detox can make you feel very sick and uncomfortable, but it is not life-threatening.
How does heroin detox affect pregnancy?
Detoxing from heroin while pregnant is possible and usually involves medication. This must be done under medical supervision to ensure the safety of the mother and the baby. Medication treatment using methadone or buprenorphine during pregnancy may help improve infant outcomes.14
How do I pay for heroin detox with no insurance?
Some programs offer low-cost or free heroin detox. Many offer sliding scale fees, long-term payment plans and other options if you do not have insurance. Contact the Substance Abuse and Mental Health Services Administration’s toll-free helpline at 1-800-662-HELP (4357) for more information about these programs.
Are there free heroin detox centers?
Some community-based services may offer low-cost or sliding scale payment options. These programs are often administered by county, state, or local government agencies. Many programs will not turn anyone away due to an inability to pay the full amount. Various programs may offer free services to those in need who meet certain criteria. You can also locate similar programs via the Substance Abuse and Mental Health Services Administration.
Find a Heroin Detox Center
Whether you have concerns about your own heroin addiction or are seeking help for a family member or friend, call 24/7 to speak to an American Addiction Centers’ admissions navigator. They can help you find a heroin detox center or addiction treatment facility in your area. They can also help you check your insurance coverage at an AAC facility.
Detox for Specific Drugs
Learn more about the detox process for commonly abused drugs, including:
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2021). What are the long-term effects of heroin use?
- National Institute on Drug Abuse. (2016). Understanding Drug Abuse and Addiction: What Science Says.
- Center for Substance Abuse Treatment. (2005). TIP 41: Substance Abuse Treatment: Group Therapy.
- Substance Abuse and Mental Health Services Administration. (2015). Treatments for substance use disorders.
- U.S. Food and Drug Administration. (2014). U.S. marshals seize botanical substance kratom from southern California facility.
- National Institute on Drug Abuse. (2021). What is heroin and how is it used?
- World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
- National Institute on Drug Abuse. (2017). Tolerance, Dependence, and Addiction: What’s the Difference?
- National Institute on Drug Abuse. (2020). Principles of Effective Treatment.
- National Institute on Drug Abuse. (2021). Medications for Opioid Overdoes, Withdrawal, & Addiction.
- Substance Abuse and Mental Health Services Administration. (2021). TIP 63: Medications for Opioid Use Disorder.
- Bryce, C. (2019). Lofexidine (Lucemyra) for Treatment of Opioid Withdrawal Symptoms. American Family Physician
- National Institute on Drug Abuse. (2017). Treating Opioid Use Disorder During Pregnancy.