What is the Timeline for Heroin Withdrawal?
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Heroin Withdrawal Symptoms
The symptoms of heroin withdrawal range from mild to severe depending on someone’s heroin use habits. While the same symptoms may be present during any level of withdrawal intensity, they can vary in severity.
Moderate symptoms of heroin withdrawal can include:
- Gastrointestinal Distress (pain in the abdomen & writhing stomach)
- Diaphoresis (excessive sweating)
- Feeling Cold (no matter the ambient temperature)
- Creeping Feeling in the Skin
- Frequent Yawning
Additionally, vomiting and diarrhea are very common during heroin withdrawal. These issues can lead to dehydration. Coupled with sleep deprivation due to insomnia, a person can easily become delirious if their symptoms are severe enough and they are not under medical supervision.
Some of the more severe symptoms of heroin withdrawal may include:
- 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)
While heroin withdrawal is rarely fatal, it can lead to dangerous conditions that can be life-threatening. This is especially true when other preexisting medical conditions (such as diabetes or heart disease) are present.
Aside from the direct symptoms, it’s common to get sick either during or shortly after withdrawal. Opioid withdrawal has a severe impact on immune system function through mechanisms that are not fully understood. Conflicting studies have shown both increased and decreased immune function immediately after withdrawal.
Heroin Withdrawal Timeline
Heroin withdrawal is unpleasant no matter the severity. The duration and intensity of symptoms are dependent on the amount used and the length of time someone used. On average, heroin withdrawal can last around 5 days. The symptoms will increase, peak, and resolve during this time. Lingering symptoms may persist for several weeks or months.
Heroin withdrawal begins between 8 to 12 hours after the last time it was used. The first symptoms are usually increased anxiety and cravings followed by sweating and a runny nose. Muscle and joint pains will begin during the first 24 hours but may be minor at first. Nausea and lower stomach pain appear, and appetite will decrease throughout the first day and be nonexistent towards the first night. Insomnia will also be an issue along with an inability to sit still, resulting in constant tossing and turning.
The second day usually exhibits excessive sweating, runny nose, and increased joint and muscle pain. A simultaneous feeling of hot and cold can be felt and is often described as cold skin, hot insides. Constant goosebumps and repeated yawning are also common features during this time. Nausea will intensify and diarrhea will be frequent along with intense stomach pain. Anxiety and cravings will also intensify and be joined with depression. Appetite remains nonexistent and insomnia will be severe. Shaking or tremors may begin during the second day.
This is when the symptoms reach their worst. All of the symptoms from the second day are still present, they have intensified to their max. This is when danger from dehydration peaks. Several days of vomiting and diarrhea can lead to electrolyte imbalance and subsequent heart failure. Protracted insomnia and anxiety may make the perception of these symptoms worse.
The fourth day tends to be a little less severe. Muscle and joint pain may begin to lessen. Diarrhea and vomiting may decrease in frequency but stomach pain is often still present. Appetite may return somewhat and the feeling of hot and cold may reduce in intensity. Anxiety may lessen some, but cravings and depression will still be present. Shaking and tremors may begin to subside as well.
The fifth day is usually when most symptoms begin to resolve. Sweating, runny nose, and muscle or joint pain are still present but reduced. The feeling of hot and cold will subside and goosebumps may be less frequent. Stomach pain and nausea should resolve, but minor diarrhea may still be present. Appetite should be returning. Insomnia should be less prevalent and anxiety may lessen some. Cravings and depression will persist for some time. Excessive yawning will linger as well.
On average, the sixth day is when people begin to feel physically well again. Lingering symptoms such as minor diarrhea and mild stomach troubles will last for several more days, decreasing in severity. Depression, cravings, and repeated yawning will take several weeks or months to resolve. Anxiety may still be present, but the more time spent away from heroin use, the less intense it will be.
After acute withdrawal has been overcome, there may still be post-acute symptoms that may linger. Depending on how long someone used heroin, it will take time for their body and brain to return to normal function. Medication may be able to provide some relief and help while the body heals.
Post-acute withdrawal syndrome (PAWS) is a common condition among people who have struggled with heroin addiction. It can happen with many drugs, and it seems to be especially long-lasting with heroin and opioids. While the brain is trying to re-balance itself, chemistry changes can produce many negative psychological effects. Some of these may include:
- Insomnia or Irregular Sleep
- Anxiety (especially social anxiety)
- Fatigue or Lethargy
- Heroin Cravings
- Anhedonia (reduced ability to feel pleasure)
- Inability to Concentrate or Focus
- Frequent Mood Swings
When detoxing from heroin, it is recommended to seek medical assistance and supervision. There are detox facilities all over the country. Many large cities will also have government-funded facilities. There are many benefits to being in a detox program as opposed to doing this alone.
Find out more about detox centers in Atlanta, Georgia.
Medication-assisted treatment (MAT) is another benefit of going to a heroin detox center. MAT uses medications that reduce the worst of the withdrawal symptoms. These medications can help someone make it through withdrawal safely and with a minimum amount of discomfort.
Medications for Heroin Withdrawal
There are many medications available for heroin withdrawal. All medications are effective when used in combination with detox and heroin addiction treatment programs. These are a few of the medications that can reduce the risks and discomfort of withdrawal. Some of these medications may include:
- Lofexidine (Lucemyra). This is the first non-opioid medication that has been FDA-approved to treat opioid withdrawal. Similar to clonidine, it is also an α-agonist that was used to treat high blood pressure and anxiety. It can lessen the symptoms of opioid withdrawal and shorten the duration of withdrawal.
- Buprenorphine (Subutex). Itself an opioid, it acts as a partial μ-opioid receptor stimulator. Buprenorphine has a long binding duration and can keep the worst withdrawal symptoms at bay for 24 to 36 hours from a single dose. It possesses a higher binding affinity for μ-opioid receptors than other opioids (including heroin). It interacts with the opioid receptors without producing the same euphoric effects. Buprenorphine is also subject to the “ceiling effect,” meaning that at a certain dosage, the effects plateau and do not increase anymore. This can help prevent abuse of this medication.
- 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 pull out any other opioids currently in the receptor and take their place. This feature enables it to reverse a heroin overdose. This also means that if someone takes naloxone while they are high, they will go into precipitated withdrawal.
- Buprenorphine/Naloxone (Suboxone). Similar to Subutex but with the addition of naloxone. If naloxone is already in someone’s body prior to heroin use, then heroin will not be able to get them high. The reason for this formulation is that naloxone is not well absorbed through ingestion. If someone were to inject suboxone to try and get high from buprenorphine, the naloxone would bind to the opioid receptors and prevent any euphoria.
- Naltrexone (Vivitrol). An opioid antagonist, it will block the effects of opioid drugs. It is chemically similar to naloxone. It acts as a competitive opioid receptor antagonist with a very high binding affinity for the μ-opioid receptor. It is used to treat opioid addiction and is also helpful in the treatment of alcohol addiction.
- Propranolol (Inderal). Originally used as a blood pressure medication, it can lessen nervous system hyperactivity such as high blood pressure and elevated heart rate. It is most often used for its secondary anti-anxiety effects.
- Clonidine (Catapres). Also a blood pressure medication, it is an α-agonist that lessens nervous system hyperactivity such as high blood pressure. It is also used for its anti-anxiety effects.
- Methadone (Methadose). A fully-synthetic opioid, methadone is used to moderate withdrawal symptoms. It is a full μ-opioid receptor agonist as well as having other neurotransmitter interactions. It has a long half-life, duration of action, and usually poses less risk of neurotoxicity compared to other opioid drugs.
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