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Heroin Withdrawal Symptoms & Heroin Withdrawal Timelines

Heroin is a highly addictive, illicitly-manufactured opioid drug associated with several adverse health effects.1 Heroin is most often encountered as a white or brown powder or a black sticky substance that people can inject, smoke, or snort.2 People who use heroin risk developing significant physiological opioid dependence, at which point they may experience heroin withdrawal symptoms if they cut down or stop their use.2, 3

People who use heroin are also at risk of developing an opioid use disorder (OUD), the diagnostic term for opioid addiction.3 According to the 2020 National Survey on Drug Use and Health (NSDUH), approximately 902,000 people used heroin in the past year, and 691,000 people had a past-year heroin use disorder, the term used by the NSDUH for heroin addiction.4

If you or someone you know use heroin and want to quit, you may wish to learn more about withdrawal symptoms for heroin, the heroin withdrawal timeline, and how detox can help you start the path to recovery.

What Is Heroin Withdrawal?

The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies heroin addiction as an opioid use disorder (OUD).5 One of the 11 criteria that healthcare professionals assess prior to diagnosing an OUD is the presence of opioid withdrawal symptoms when opioid use slows or stops, or conversely, the need to continue using opioids to avoid the onset of such symptoms.5 Withdrawal alone doesn’t necessarily equate with addiction or OUD (for example, people on prescription opioid regimens with no otherwise problematic patterns of use may experience some magnitude of withdrawal when they stop taking their medications), however, it is something that many with OUD also experience.

Heroin withdrawal symptoms can be uncomfortable, which is one of the reasons why people continue to use the drug or experience relapse after first trying to quit.7 People who are struggling with heroin addiction commonly develop significant opioid dependence and, should they suddenly stop using the drug, may develop severe withdrawal symptoms.2

What Are Common Heroin Withdrawal Symptoms?

Chronic heroin use can lead to withdrawal symptoms that, while not typically medically dangerous, can cause significant discomfort.8 Genetic, physiological, and psychological factors can impact withdrawal severity.8

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends against clinicians attempting to manage opioid withdrawal without medication, as doing so could result in needless suffering.8 There can be a risk of certain medical complications that, while not usually life-threatening, should be addressed and treated quickly if they occur.8

Again, based on principles of humanitarian and safety concerns, SAMHSA indicates that If you can’t enter a hospital, receiving withdrawal services in a setting that provides a high level of nursing and medical backup can help ensure you withdraw comfortably and safely.8

Heroin withdrawal symptoms can include:2, 5, 7

  • Anxiety.
  • Depressed mood.
  • Bone and muscle pain.
  • Muscle cramps.
  • Difficulty sleeping.
  • Restlessness.
  • Chills and goosebumps.
  • Fever and sweating.
  • Teary eyes.
  • Runny nose.
  • Nausea and vomiting.
  • Diarrhea.
  • Yawning.
  • Uncontrollable leg movements.
  • Severe heroin cravings.

How Long Does Heroin Withdrawal Last?

The onset, duration, and severity of heroin withdrawal can depend on different factors, such as the half-life of the opioid, the duration of use, the daily dose, and the interval between doses.8 Heroin is a short-acting opioid, and acute withdrawal often lasts around 5 to 7 days.5

Heroin withdrawal signs and symptoms typically increase in severity when left untreated, but then subside on their own.8 The following information can help you understand the average timelines for initial, peak, and post-peak heroin withdrawal.

Initial Heroin Withdrawal

As heroin is a short-acting opioid, withdrawal symptoms typically begin 6 to 12 hours after a person’s last dose, but some people can develop symptoms up to 24 hours later.5, 7, 9 Symptoms can be uncomfortable in the beginning phases of withdrawal, and can continue to escalate.9 It’s recommended that people are monitored 3 to 4 times a day beginning with this phase of withdrawal to check for symptoms and complications.7 Medications may be used to manage acute withdrawal.3

Peak Heroin Withdrawal

Heroin withdrawal symptoms usually peak in severity anywhere from 1 to 3 days after a person’s last use and gradually resolve over a period of 5-7 days.5 You might feel the above-mentioned withdrawal symptoms at a very intense level, and you might feel like you have a very bad flu.7

Post-Peak Heroin Withdrawal

Post-peak heroin withdrawal refers to symptoms that occur beyond the typical acute withdrawal timeframe, or symptoms that last longer than 7 days.5, 10 The DSM-5 explains that these less acute withdrawal symptoms can last anywhere from weeks to months.5 These symptoms usually include anxiety, anhedonia (an inability to feel pleasure), dysphoria, and insomnia.5

Getting Help for Heroin Withdrawal

As mentioned earlier, heroin withdrawal may include several unpleasant symptoms but is typically not life-threatening.8 Most clinicians believe that heroin withdrawal should be treated aggressively with a medically-monitored detox.8 Medical detox can help people comfortably and safely withdraw from heroin by providing medication, monitoring, and support.8 It can also address medical complications that can arise because of withdrawal.8

Some of the medications that people may receive during detox can include:2, 7, 8, 12

  • Methadone. Methadone activates the same opioid receptors that heroin and other opioids activate to minimize withdrawal symptoms and reduce cravings. A person may remain on methadone after detox for a long time as a part of a methadone maintenance program. This can help prevent relapse.
  • Buprenorphine. Buprenorphine is a partial agonist medication with a ceiling to its opioid effects, resulting in an improved safety profile and inherently lower potential for misuse. Like methadone, buprenorphine helps to reduce cravings and ease withdrawal symptoms. Also like methadone, a person may remain on buprenorphine for maintenance long after the initial detox and rehabilitation period.
  • Clonidine. This medication does not have the potential for misuse and is not an opioid. It is not FDA-approved for opioid withdrawal but is sometimes used off-label during detox to reduce withdrawal symptoms.
  • Lofexidine. With a mechanism of action similar to clonidine, this is an FDA-approved, non-opioid medication that can reduce certain opioid withdrawal symptoms.

While detox is an important part of the recovery process for many people, it is not a substitute for more comprehensive heroin addiction treatment efforts. Rather, detox can be the first step in preparing a person for additional rehabilitation or treatment for substance use disorders.11

Research has shown that people who receive some form of continuing care following detox have better drug abstinence and rates of readmission outcomes than people who do not continue with post-detox treatment.8 This might mean entering an inpatient or outpatient rehab, depending on your specific needs and the recommendations of your treatment team.

Find Out if Your Insurance Covers Rehab for Heroin Addiction

If you or someone you care about are struggling with heroin use, American Addiction Centers (AAC) can help. You can call our confidential, free helpline 24 hours a day, 7 days a week to speak with a compassionate AAC admissions navigator. They can listen to your story, answer questions you have about substance use, provide information about treatment options, and verify your insurance.

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