Key takeaways:

  • The longer someone has had a heroin use disorder, how it was abused (e.g intravenously), and the amount that was taken each time all affect how dependent a person is, and how severe their withdrawals will be
  • Physical addiction is the main cause of heroin withdrawals. These withdrawals are so unpleasant that some users will continue using just to avoid them, even after they’ve built such a high tolerance that they can no longer get high from the drug
  • While the physical withdrawals are usually gone within a week, some people develop Post-Acute Withdrawal Syndrome (PAWS), which can last up to a year or in some cases, longer

Heroin withdrawal causes a lot of discomfort. It is not medically necessary to detox in an inpatient center, but many people benefit from starting treatment in a structured setting. Medications like Suboxone can ease the withdrawal symptoms and cravings.

What causes heroin withdrawal?

Heroin, like other opioids, affects the brain's reward system by flooding it with dopamine, a brain chemical largely responsible for the ‘high’ users experience. Heroin users build up a tolerance quickly, which means they need to take more of the drug to get the same effects. Unfortunately, increasing the dose also increases their risk of becoming addicted.

Once a person is addicted, they experience painful withdrawal symptoms when they don’t have the drug in their system. Unlike other substances, regular use of heroin leads to physical addiction, meaning the body becomes dependent on the drug. 

Physical addiction is the main cause of heroin withdrawals. These withdrawals are so unpleasant that some users will continue using just to avoid them, even after they’ve built such a high tolerance that they can no longer get high from the drug.

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Heroin withdrawal symptoms

Most people experiencing heroin withdrawal will begin to feel symptoms within the first 8-24 hours after their last dose, and sometimes even sooner. [1] Heroin is an opioid drug made from the seeds of poppies. Other opioid drugs include prescription painkillers like morphine or Oxycontin, which also are physically addictive and lead to painful withdrawals.

The symptoms of heroin withdrawal are similar to that of a terrible case of the flu and include aches, chills, and G.I. upset. The most intense period occurs during the first few days, and most of the physical withdrawals are complete within one week. [1, 4] The exception is that people who take long-acting synthetic opioids like Suboxone can experience prolonged withdrawals that last for two weeks or sometimes longer. [1]

The longer someone has had a heroin use disorder, how it was abused (e.g intravenously), and the amount that was taken each time all affect how dependent a person is, and how severe their withdrawals will be. Therefore, someone with a relatively short history of heroin abuse may only encounter mild symptoms, those who have been taking the drug in large doses for months or years will likely experience the most severe form of withdrawal. External risk factors, such as mental health issues or previous opioid addiction can also affect heroin withdrawal symptoms.

Not everyone will experience the same symptoms during withdrawal from heroin or another opioid, but here are some of the most commonly reported withdrawal symptoms: [1]

  • Nausea, cramping, diarrhea or other G.I. problems

  • Sweats, fever, or hot and cold chills

  • Watery discharge from eyes and nose

  • Muscle, bone, headaches or body aches

  • Sore or tense muscles or muscle spasms

  • Increased heart rate, blood pressure, and respiration

  • Yawning, feeling tired but not being able to sleep

  • Restless legs, feeling unable to sit still

  • Anxiety, irritability, or mood problems

These symptoms can be mild, moderate, or severe, depending on how many symptoms are reported. While these symptoms may not be directly life-threatening, they do cause a lot of discomfort and distress to a person, and make it hard to function. 

While the physical withdrawals are usually gone within a week, some people develop Post-Acute Withdrawal Syndrome (PAWS), which can last up to a year or in some cases, longer. The symptoms of PAWS are often more psychological and include mood problems, drug cravings, fatigue, trouble concentrating, and cognitive impairments. [2] 

Most people report PAWS symptoms are milder, and ‘come and go’ throughout this time period. While these effects on mood and behavior can last for months after the initial period of heroin withdrawal, the longer the person remains drug-free the more these symptoms will start to dissipate.

Heroin withdrawal timeline

As outlined above, the length of time and severity of heroin withdrawal depends on several factors, including:

  • The period of heroin abuse

  • The quantity of heroin taken per dose

  • Frequency of abuse

  • Method of abuse (intravenous, inhaled, snorted) 

  • The type of opioid used (i.e. heroin or synthetic opioids)

Days 1-7 - Symptoms usually present within 8-24 hours of the last heroin dose. The first few days of heroin withdrawal can be difficult, with most people reporting flu-like symptoms that can include nausea, vomiting, cramps, aches, hot and cold chills, sweating, and insomnia. [1, 4]

Days 7-10 - At this point, most people report that the most intense symptoms of withdrawal have tapered off. Mild symptoms like occasional chills, aches, cramping, or insomnia sometimes persist. [1, 4]

Post-Acute Withdrawal Syndrome (PAWS) - For those with a long history of heroin abuse or who used large doses, PAWS may persist for months after acute withdrawal signs have faded. These can include depression, insomnia, hypersensitivity, fatigue, mood swings, anxiety, and irritability. [2]

Heroin detox

While it’s usually safe for people to detox from heroin on their own, many prefer to do so in an inpatient setting. This can make the experience more comfortable for the user and it can also increase the chances of a full recovery by providing a structured and drug-free setting. Without treatment, many people relapse during heroin withdrawal because of the discomfort and pain they experience during this process.

Medications used in heroin detox

There are many forms of medication available for people in recovery from heroin addiction that can help manage cravings and ease or prevent withdrawals. These medications are often recommended to people who want to stop using opioids because they have been shown to be safe and effective: [1]

  • Methadone: A low-strength opiate that takes longer than heroin to take effect, methadone is a common medication used in heroin detox and long-term recovery. 

  • Buprenorphine: Another extremely common prescribed drug to help with heroin withdrawal symptoms that prevent withdrawals as well as helping manage cravings. 

  • Naltrexone: A medication that blocks the receptors in the brain that react to heroin and other opioids. Over time it can reduce cravings and works best with heroin users who have already completed detox.

  • Suboxone: A combination of buprenorphine and naltrexone, suboxone relieves withdrawal pains such as muscle aches and abdominal cramps and inhibits the effects of heroin on the brain. 

  • Clonidine: A medication that can help to ease many of the physical symptoms associated with heroin and other opioid withdrawals.

Treatment for Heroin Addiction

Medication is not recommended as a stand-alone treatment for people in recovery from addiction to heroin or other opioids. According to best practice guidelines, these medications should only be prescribed in addition to other forms of treatment, including inpatient or outpatient rehab, or group or individual counseling. [3] 

Inpatient rehab centers provide round-the-clock care and professional medical supervision to help with the detox and withdrawal process. This level of care is recommended for people with more severe addictions. Outpatient treatment programs offer addiction treatment in facilities or office-based settings and may meet the needs of people with less serious addictions. 

These treatments help people in recovery address the root causes of their addiction while also learning ways to manage cravings and prevent relapse. If you or someone you love is struggling with an addiction to heroin, the best thing to do is to reach out to an addiction treatment center. Setting up an appointment with a licensed addiction specialist can help you determine which treatment is best for you.