Heroin Withdrawal: Symptoms, Medications and Detox

While heroin withdrawal is rarely fatal in and of itself, it can lead to potentially dangerous conditions which can be life threatening, especially in conjunction with other preexisting medical conditions (such as diabetes or heart disease for example)¹.

Additionally, because of the vomiting and diarrhea caused by heroin withdrawal, it is very easy to become dehydrated. Coupled with sleep deprivation due to insomnia, a person can easily become delirious if their withdrawal symptoms are severe enough and they are not under medical supervision. Depending on dose quantity and length of use, acute withdrawal can last between 3 and 7 days.

Heroin Withdrawal Symptoms

Moderate heroin withdrawal symptoms include:

  • Gastrointestinal Distress (pain in the abdomen & writhing stomach)
  • Diaphoresis (excessive sweating)
  • Insomnia
  • Anxiety
  • Depression
  • Feeling Cold (no matter the ambient temperature)
  • Creeping Feeling in the Skin
  • Frequent Yawning

Some of the more severe symptoms of heroin withdrawal include:

  • Insomnia
  • Severe Anxiety
  • Severe Depression (with or without suicidal ideation)
  • Feeling Both Hot and Cold Simultaneously (typically expressed as cold skin, hot insides)
  • Crawling Sensation Under the Skin (typically expressed as bugs crawling or pin pricks)
  • Incessant Yawning and Stretching
  • Excessive Diarrhea
  • Severe Gastrointestinal Distress (pain in abdomen)
  • Frequent Vomiting
  • Diaphoresis (excessive sweating)
  • Psychomotor Agitation (constant foot tapping, pacing, or tossing & turning in bed)
  • Pain in the Muscles, Joints, or Bones
  • Allodynia (perceiving pain from typically non-painful stimulus)

Aside from the direct symptoms of heroin withdrawal, it's common to get sick either during or shortly after withdrawal. Opioid withdrawal has a severe impact on immune system function through mechanisms which are not fully understood. Conflicting studies have shown both increased and decreased immune function immediately after withdrawal¹.

Post Acute Withdrawal

After acute withdrawal has been overcome, there are still minor ongoing heroin withdrawal symptoms which you may need to deal with. Just because the drug is out of your system, it does not mean that you are “as good as new”. Depending on how long you used, it will take time for your body and brain to return to regular function. Heroins interaction with opioid receptors and the subsequent change in endogenous opioid peptide production and regulation will take a while to get back to normal, and in the mean time you will more than likely be uncomfortable.

Post Acute Withdrawal Syndrome (PAWS) is a common condition with people who have struggled with addiction. It can happen with many drug types, and seems to be especially long lasting with heroin and opioids. While your brain is trying to re-balance itself, the chemistry changes can produce many negative psychological effects. Some of these include:

  • Insomnia or Irregular Sleep
  • Depression
  • Anxiety (especially Social Anxiety)
  • Fatigue or Lethargy
  • Irritability
  • Heroin Cravings
  • Anhedonia (inability to feel pleasure)
  • Inability to Concentrate or Focus
  • Frequent Mood Swings
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Heroin Detox

When detoxing from heroin it is highly recommended to seek medical assistance and supervision. There are detox centers all over the country and many large cities will have government funded facilities. Detoxes in other states can be found . There are many benefits to being in a detox program as opposed to doing this by yourself.

View our comprehensive list of detox centers in Atlanta, Georgia.

You will most likely want medical supervision to deal with the secondary effects of Heroin withdrawal such as dehydration and nutrition. You will most likely not even want to think about eating during this time, and malnutrition can make the subjective effects of withdrawal much worse. Also, depending on any preexisting medical conditions, you may be at higher risk for dangerous outcomes if undergoing withdrawal unsupervised. Medically Assisted Detox (MAD) is another benefit in which you will be prescribed medication(s) to lessen the withdrawal symptoms.

Medications for Heroin Withdrawal

There are many medications available for heroin withdrawal. All of these are best introduced in combination with detox and heroin addiction treatment. All medications listed below are all equally effective for withdrawal from other opioids. They can reduce the agony of withdrawal to a bearable level and help you to get through the worst of it. Some of these medications include:

  • Buprenorphine (Subutex): Itself an opioid, it acts as a partial μ-opioid receptor agonist and a weak κ-opioid receptor antagonist. Buprenorphine has a long binding duration and can keep the worst withdrawal symptoms at bay for 24 to 36 hours. It possesses a higher binding affinity for μ-opioid receptors than other opioids (including heroin). It does this without producing the same level of activity in the pleasure seeking areas of the brain. Also, it is subject to the “ceiling effect” meaning that at a certain dosage, the effects plateau and do not increase any more. This helps prevent abuse by limiting the euphoric effects of buprenorphine.
  • Naloxone (Narcan): Naloxone is an opioid antagonist with a very high affinity for μ-opioid receptors. At these receptors it acts as an inverse agonist which means that it will essentially rip out any other opioids currently in the receptor and take their place. Through this fashion it can reverse the effects of opioids such as heroin. If you take naloxone while you are high on heroin, you will go into precipitated withdrawal due to naloxone having a higher opioid receptor binding affinity.
  • Buprenorphine/Naloxone (Suboxone): Similar to subutex but with the added help of naloxone. If naloxone is already in your system prior to heroin use, then heroin will not be able to displace it from the receptors and you will not get high. The reason for this formulation is that naloxone is not well absorbed through ingestion but if someone were to inject suboxone to try and get high from buprenorphine, the naloxone would preferentially bind to the receptor preventing any subjective euphoria.
  • Naltrexone (Vivitrol): An opioid antagonist, it will block the effects of opioid drugs. It acts as a competitive μ, δ, and κ opioid receptor antagonist, with a very high binding affinity for the μ-opioid receptor. It is commonly used in opioid addiction and is also helpful in the treatment of alcohol addiction.
  • Propanolol (Inderal): A Beta-Blocker which modulates adrenergic responses and can lessen autonomic nervous system hyperactivity such as high blood pressure and elevated heart rate.
  • Clonidine (Catapres): An Alpha-Agonist, it also modulates adrenergic responses and can lessen certain autonomic nervous system hyperactivity such as high blood pressure.
  • Lofexidine (Lucemyra): Similar to clonidine and also an Alpha-Agonist, this is a newer drug used for opioid withdrawal (FDA approved as such in 2018). Originally used to treat high blood pressure and anxiety, it can lessen the symptoms of opioid withdrawal and shorten the duration of withdrawal (compared to Methadone)¹.
  • Methadone (Methadose): Itself a fully-synthetic opioid, methadone is used to moderate withdrawal symptoms. It is a full μ-opioid receptor agonist and an NMDA Glutamate receptor antagonist which mimics the endogenous opioids. It has a long half-life and duration of action as well as less risk of neurotoxicity compared to other opioid drugs.
Michael Smeth

Michael Smeth

Michael Smeth is the Director of Online Marketing at The Summit Wellness Group. He has been involved in the addiction recovery community for over 18 years. In addition to actively attending at least five 12-Step meetings a week and sponsoring others, he's a huge advocate of the healing power of therapy. He has over a decade of experience in content strategy and online marketing, which he uses to spread the message of hope that recovery has brought him and countless others.
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