Because prescription painkillers are becoming harder to obtain and the cost is increasing, many people who abuse opiates are turning to heroin as a cheaper and stronger alternative. Nearly half of heroin users began first by abusing prescription opiates. The CDC reports that in the past 10 years heroin abuse has doubled for Americans aged 18-25. 8,200 people died from a heroin overdose in 2013, which is almost four times the amount of overdose deaths in 2002.
Heroin withdrawal may only last about a week, but the symptoms endured can be severe. Medical detox facilities provide medications to help manage symptoms, increasing the chances of a safe and successful withdrawal. Some common symptoms include:
- Nausea
- Sweating
- Shaking
- Abdominal pain
- Anxiousness
- Agitation
- Depression
- Muscle spasms
Heroin Withdrawal Timeline
Heroin is a short-acting opioid, which means that it enters the bloodstream rapidly but also leaves the bloodstream quickly. Symptoms of heroin withdrawal usually begin 6-12 hours after the last dose, peaking between 1 and 3 days after the last dose and subsiding within a week or so. Post-Acute Withdrawal Syndrome can make these symptoms persist much longer.
Because withdrawal symptoms can peak after a few days of the last dose, detoxing in a rehab facility that offers medicine and various types of support is often the safest and most comfortable way to get off of heroin and avoid relapse. In a medical detox you will usually begin treatment before the heroin completely leaves your system. Anti-nausea medications, antidepressants, and anticonvulsants are some of the medications that will be made available to you in a medical detox facility. Medical detox usually lasts between 5 and 7 days, but may last longer for those who are more dependent on heroin. During your stay your vital signs like your blood pressure, heart rate, breathing rate, and temperature will be monitored to be sure you are safe during the entire process.
Withdrawal Symptoms
Each person’s experience detoxing from heroin will be different. The length of time of abuse, dosages, and overall health will all be factors in how well the brain and body adapt to abstinence from opiates. Because of this, the length of time needed to safely detox from heroin or other opiates and the severity of the symptoms will differ from patient to patient.
Because heroin is an opiate it suppresses functions of the central nervous system like heart rate and blood pressure and the regulation of temperature and breathing. Opiates bind to opioid receptors which flood the brain with dopamine, a neurotransmitter responsible for feelings of pleasure. When heroin use is stopped abruptly, the opposite of these effects take place and the individual often experiences overwhelming negative symptoms. The severity of these symptoms will depend on how dependent the brain is on heroin.
Mild symptoms can include:
- Nausea
- Stomach cramps
- Runny nose and/or eyes
- Chills and sweats
- Excessive yawning
- Body aches
Moderate symptoms can include:
- Vomiting
- Diarrhea
- Shaking
- Tiredness and fatigue
- Goosebumps
- Difficulty concentrating
- Restlessness
- Agitation
Severe symptoms can include:
- Anxiety
- Depression
- High blood pressure
- High heart rate
- Insomnia
- Muscle spasms
- Difficulty breathing
Although withdrawal from heroin on its own isn’t typically life-threatening, some of the more severe symptoms can have complications that can lead to death or severe injury. Heroin detox should never be attempted without the supervision of medical and/or mental health professionals who have access to medications to ease symptoms and a range of other methods of keeping the individual safe.
Withdrawal and Suboxone
Generally addicts will first go through a medical detox and then continue on to intensive therapy treatment. Opioids, like heroin, are special in that there are medications available that are designed to help ease withdrawals from them as well as medicine to help patients stay abstinent. A heroin user in recovery, for example, may be treated with buprenorphine (Suboxone), naltrexone, or methadone. The USDA approves drugs like Suboxone for use in opioid withdrawals and as an abstinence maintenance therapy. Patients benefit from buprenorphine, the generic name for Suboxone and Subutex, because of the its ability to suppress both cravings and symptoms of withdrawal. Sobriety rates after one year are reported to be 40%-60%.
Although buprenorphine has a lower potential for abuse compared to methadone because effects plateau at a certain point, it is still abused by some users as a way to decrease symptoms in the hours between heroin uses, effectively maintaining their addiction instead using it as a way of overcoming it. It is not uncommon for patients with buprenorphine prescriptions to supply it on the street.
Buprenorphine is also used in a dangerous practice known as “chipping,” slang for recreational heroin use typically with the goal of avoiding clinical addiction.
Heroin Addiction Treatment
A frequently used drug in heroin addiction treatment is methadone. Methadone is an opioid similar to heroin in that it is a potent opiate, but different in that it is long-acting and the onset is slower. This means that the user doesn’t get the same rush of euphoria that heroin produces. It is usually administered orally in the form of a pill, and stays active in the bloodstream much longer than heroin, usually needing to take it just once a day. The dose is generally decreased over time until the brain adjusts and no longer needs supplementation. Care needs to be taken to not become dependent on methadone, as it, like heroin, has the potential for creating dependency. You will need to discuss this option with your medical provider to decide if there is a better option for you.
Another option is adding Naloxone to a buprenorphine treatment program. Naloxone works by blocking opioid receptors, which has an important place in treating opioid overdoses in addition to making heroin unappealing because of the fear of withdrawal symptoms triggered by the Naloxone. Naloxone can be used for long-term heroin abstinence maintenance.
