Heroin withdrawal is arguably the most prominent obstacle to breaking the heroin addiction. Notoriously painful and uncomfortable, heroin withdrawal symptoms alone tend to shut down most attempts at getting sober.

The complications which lead to heroin withdrawal are two-fold: the longer you have been using heroin, the more tolerance you build up to the effects of the drug. As a result, heroin withdrawal gets more difficult the longer you have been using.

Second, one of the principal features of heroin withdrawal is an intense, overwhelming craving for the drug itself. Thus, quitting and going through heroin withdrawal can feel impossible.

What is Heroin Withdrawal?

Heroin withdrawal is medically defined as a substance-specific syndrome brought on by the cessation of drug use. The key term is syndrome: a combination of symptoms and signs which together form the basis of a disease or medical condition.

Heroin withdrawal is not a single phenomenon and it can be manifested in different levels of intensity depending on a number of factors. There are some general symptoms characteristic of heroin withdrawal which include:

• Nausea
• Abdominal pain
• Sweating
• Shaking
• Nervousness
• Agitation
• Depression
• Muscle spasms
• Intense craving for the drug

All of these can occur simultaneously, but the levels of intensity may differ from one person to another.

Heroin withdrawal is not life-threatening. It is, however, extremely painful and uncomfortable.

Heroin is an opioid, and like all opioids, when used these chemicals bind with the opioid receptors in the brain. This chemical reaction is the source of the pain reducing effects of all opioids. The secondary effect is to release to cause the brains and nervous system to release dopamine. Dopamine causes pleasurable feelings, the “high,” associated with heroin and opioid abuse.

Another effect of heroin and other opioids is the suppression of the release of the neurochemical noradrenaline, or norepinephrine. This chemical normally allows for alertness. Thus, when people use heroin they become extraordinarily sleepy. This is the phenomenon of “nodding off” so common to heroin users.

As you use heroin over extended periods of time the brain adapts to the increased levels of dopamine and lower levels of noradrenaline. As a result, the brain learns to function normally only with the presence of the drug and reacts to the absence of the drug as abnormal. This produces the medical condition of physical dependence.

Still further, as the brain adapts to the presence of the drug, you will need to use more heroin in order to achieve the same effects. This is the process of building tolerance.

With your brain completely dependent on large amounts of heroin, you will experience an extreme reaction once you stop using it. Your brain reacts to the absence of the drug as if something is wrong, and physical symptoms begin to manifest themselves. The symptoms described above are the result of this condition.

Stages of Heroin Withdrawal

The stages of heroin withdrawal are dependent upon a number of factors. While there is a general timeline for heroin withdrawal, several variables will determine how long withdrawal will last and the intensity of each stage. The stages of withdrawal depend on the following:

• How long you have been using
• How much heroin you have been taking and how long
• How you use heroin (snorting, injecting, etc.)
• History of previous addictions
• The presence of mental illness or other co-occurring disorders.
• The general state of your physical health
• The use of maintenance drugs during withdrawal

All of these factors will play a role in the length and intensity of your withdrawal. If you have been using alcohol or other drugs while using heroin, this too will impact the stages of heroin withdrawal.

The stages of withdrawal follow the routes of the neurochemical process in the brain and nervous system. As the dopamine levels drop and norepinephrine levels increase, everything from your mental state to your physical well-being will be compromised. Leading to illnesses in a variety of forms.

Heroin Side Effects

Heroin use profoundly impacts your life both physically, emotionally, and socially. Beyond the desired effect, heroin can have a range of negative side effects. Addiction in general, and heroin addiction, in particular, can impact your home, career, and personal appearance. Some of the most common side effects include:

• Social problems
• Sleep issues
• Financial difficulties
• Serous physical health problems (HIV/AIDS and Hepatitis C are extremely common in heroin users)
• Deterioration of your appearance (Weight loss, complexion problems, dental issues)
• Work and school problems (Getting fired or expelled)
• Serious criminal problems
• Suicide
• Death from overdose

Heroin is a dangerous drug. It negatively impacts virtually every aspect of life. Using heroin can be fatal. In 2017 there were over 70 thousand deaths from heroin overdoses in the United States.

Heroin Withdrawal Timeline

Heroin withdrawal will typically begin after about 6-8 hours after your last use. The acute phase of heroin withdrawal will set in within 24 hours. The entirety of acute withdrawal typically lasts roughly 7 days:

• 1-2 Days: Symptoms will begin with muscle aches. This will intensify over the next 48 hours. Other symptoms are likely to include anxiety, panic attacks, insomnia, and diarrhea.
• 3-5 Days: Withdrawal will completely set in. At this point, you will experience cramping, sweating, shivers, nausea, and vomiting.
• 6-7 Days: This generally marks the end of what is known as acute withdrawal. Muscle aches and nausea will begin to abate. The other symptoms will pass. However, most people will still feel extremely worn down and tired.
• Post-Acute Withdrawal Syndrome (PAWS): Because of the neurological changes brought on by heroin use, many people will experience PAWS for as much as 24 months. The most common symptoms include anxiety, periodic bouts of depression, fatigue, insomnia, and irritability.

It is crucial to know that all of these symptoms—the entire withdrawal syndrome—can be treated so as to minimize pain and discomfort. These symptoms only occur with full intensity without medical intervention.

Heroin Withdrawal Symptoms

Heroin withdrawal symptoms, like most other medical conditions, can range from mild to severe depending on the factors listed above. Generally, heroin withdrawal symptoms fit into three basic categories:

Mild Symptoms:

• Muscle aches
• Fever and Chills
• Excessive sweating
• Runny nose
• Uncontrollable crying
• Restlessness
• Difficulty concentrating
• Abdominal pain

Moderate Symptoms:

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

Severe Symptoms:

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

The level of intensity depends on the risk factors and other complications we have already listed. Most people do not experience all of these symptoms. However, most heroin users will experience mild to moderate heroin withdrawal symptoms.

Again, heroin withdrawal is not considered fatal. Heroin withdrawal differs from alcohol or benzodiazepines which can lead to seizures and death Though difficult and painful, heroin withdrawal is not a fatal condition. However, the symptoms of heroin withdrawal can produce suicidal thoughts. Heroin withdrawal and detox are safest under the care of professional addiction services.

How long do Heroin withdrawal symptoms last?

Acute heroin withdrawal symptoms generally only last about one seven days. The long-ranging effects of fatigue, anxiety, and depression can persist for several weeks. This is due to the severity of acute withdrawal symptoms.

Post-Acute Withdrawal Symptoms (PAWS) may persist for as much as 24 months. Depression and anxiety can come and go over the course of these months due to the profound changes in the brain and nervous system.

PAWS can be treated in the course of a long-term recovery program. Counseling and support groups tend to minimize the impact of PAWS. As with all substance abuse disorders, long-range recovery programs are the most effective ways to ensure a full recovery.

How is Heroin Withdrawal diagnosed?

The medical diagnostics of heroin withdrawal follow an 11-item scale which is designed to determine the severity of the symptoms. This allows doctors and addiction care professionals to assess the level of addiction and intensity of withdrawal in order to provide the best possible care which will help alleviate the symptoms.

The system of evaluations, called the Clinical Opiate Withdrawal Scale (COWS), is an 11-item scale. Each item provides the clinician with a rating which will determine the kind of care and medical assistance necessary to guide you through heroin withdrawal. This scale will also help determine the types of pharmaceuticals which may be used to assist with detox and recovery.

The purpose of the COWS rating and diagnostic tool is to ensure that you are as comfortable as possible during withdrawal and detox.

Heroin Withdrawal Medication

Heroin detox and recovery now include several medications which will ease the discomfort and pain of heroin withdrawal. These medications are not cures for heroin addiction. Rather, they help alleviate the symptoms of heroin withdrawal and detox and make it much easier to transition into a long-term program of recovery.

Methadone has been prescribed for heroin withdrawal for many years and dates back as far as World War II.

Methadone blocks the high you obtain from using heroin while simultaneously effecting brain chemistry so that you do not experience the pain of withdrawal symptoms. Methadone is often referred to as replacement therapy because it replaces heroin in your nervous system and allows you to remove the more dangerous drug from your body.

Methadone must be administered by a physician. It comes with its own set of side effects and you can develop a tolerance to methadone in the same way as heroin. It is not a replacement. It is a medical treatment toward more long-range treatment programs.

Buprenorphine and naloxone are known by their commercial name of suboxone. While suboxone can produce euphoric effects similar to heroin, these effects are greatly reduced. Suboxone works by binding to the same opioid receptors as heroin and makes it possible to cease heroin use without the horrible withdrawal symptoms.

Buprenorphine and suboxone, like methadone, must be administered by a healthcare professional. These drugs do have a risk of dependence. Buprenorphine and suboxone are designed to work toward a comprehensive recovery program. They are not cures or long-term replacements for heroin use and addiction.

However, under the proper medical care and supervision, methadone and buprenorphine are medically proven to ease heroin withdrawal and facilitate long term recovery. Taken under the supervision and used correctly, both of these medications will break the cycle of heroin addiction.

What treatments are available for Heroin Withdrawal?

Heroin withdrawal is not something you should do on your own. As stated above, heroin withdrawal is not life-threatening, but the pain of heroin withdrawal can be so severe that it becomes nearly impossible to go through it alone.

It is recommended that withdrawal is monitored as part of a medically supervised detox process in a medical facility equipped and trained to treat heroin detox and withdrawal.

Medication-assisted treatment for heroin addiction will ensure medically proven support during acute withdrawal and into the post-acute phase.

Evidence-based practices for heroin withdrawal and detox generally include methadone and/or buprenorphine which will help you through the worst phases of withdrawal.

A medical detox facility will be prepared for any and all symptoms. They will be able to monitor vital signs, provide a comfortable and stable environment, and administer medications as needed and prescribed. These facilities are also prepared for secondary issues such as severe depression and anxiety.

Finally, a medical detox facility will be able to help you on to the next phase of recovery by providing long-term comprehensive recovery programs which are medical proven effective.

Wrapping this up

Riverwalk Ranch provides both inpatient and outpatient recovery programs for people dealing with heroin addiction. The addiction care professionals and medical staff will evaluate your needs and recommend the best program for your long-term recovery.

Riverwalk Ranch offers three options depending on your needs:

• Residential Program
• Partial Hospitalization Program
• Intensive Outpatient Program

All of these programs will allow you to partake of a host of treatment modalities including Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), among others.

These treatment modalities also offer a relapse prevention program designed to keep you free of your addiction.