Heroin is one of the most addictive opioid drugs, which led the Drug Enforcement Administration (DEA) to list the substance as Schedule I under the Controlled Substances Act (CSA). This drug was synthesized in the 19th century as a less addictive alternative to morphine after an epidemic of painkiller addiction among Civil War veterans caused concern.
However, heroin becomes active in the brain after a few seconds. If it is injected, the drug takes only seven to eight seconds to bind to the brain’s opioid receptors, and the high lasts for 15 minutes or less. Drugs that rapidly cycle through the body like heroin often lead to compulsive behaviors and substance abuse because coming down from such an intense high can be uncomfortable.
This potent synthetic opiate also quickly leads to physical tolerance, so someone who abuses this drug will soon find that they need a larger dose to achieve the original high. Heroin quickly causes physical dependence, so the person feels like they need a consistent high to feel normal or to be able to function. The compulsive drug-taking behavior, tolerance, and dependence all mean that it is very difficult to quit taking this drug once you start.
Many people attempt to quit heroin cold turkey, or suddenly, without help. Quitting like this is more likely to lead to relapse and overdose than a slower withdrawal process. Although opioid withdrawal symptoms are not life-threatening, they can be uncomfortable, and the physical and emotional discomfort can trigger relapse if the individual does not have medical supervision.
Heroin is a synthetic opioid drug, derived from morphine, which is, in turn, derived from the opium poppy. Regular use can lead to tolerance, dependence, and addiction. Many users feel like they need to constantly take this drug to feel normal. Intense cravings begin as the body metabolizes the drug out, so people who abuse heroin often take several doses a day.
Once the initial rush from heroin wears off, users may be “on the nod” or “nodding” for several hours, where they alternate between wakefulness and falling asleep since it is such a powerful central nervous system (CNS) depressant. Too much heroin and breathing may become shallow, irregular, or very slow. In some cases, breathing could stop altogether. These are signs of an overdose that could lead to death.
Often, people who become addicted to heroin try to stop using on their own. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) cites multiple attempts to stop or being unable to control drug consumption as one of the 11 signs of addiction. When trying to quit, a person struggling with any addiction, including opioid abuse, will be unable to control their behavior, and this will lead to relapse.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there were 586,000 people in the United States struggling with heroin addiction in 2014.
For most people, heroin withdrawal symptoms themselves are not life-threatening. However, the risk of relapse can be deadly because of the potential for overdose. As a result, the discomfort associated with heroin withdrawal must be monitored and treated.
Withdrawal symptoms come in two stages, early and late. Early stage symptoms include:
Later withdrawal symptoms include:
Cravings for the drug will persist through both phases, and they may continue after the physical symptoms of withdrawal go away. The most intense and uncomfortable heroin withdrawal symptoms, even for heavy users, typically go away within two to three days; however, psychological symptoms like anxiety, sleeplessness, and cravings may continue, especially if the person does not have social support.
The safest approach to ending a heroin addiction is to work with addiction specialists using medication-assisted treatment (MAT) to taper off the physical dependence on opioids. Tapering heroin use itself will not work because it is illegal in the U.S., and the substance rapidly leaves the body. MAT replaces the opioid with a longer-lasting drug, and this can begin to change the person’s behavior around compulsively taking several doses of the drug. At the same time, the replacement drug will be slowly tapered until the body no longer needs opioids to feel normal.
This detox process is slower than quitting cold turkey, but it is much more effective for lasting sobriety. The process of MAT combines therapy with a prescription drug approved by the U.S. Food and Drug Administration (FDA) as a tapering medication. There are three medications with FDA approval that can be used to treat opioid use disorder (OUD) or addiction to narcotics.
In May 2018, the FDA approved a new drug to manage opioid withdrawal symptoms. Lofexidine is an oral tablet that will be prescribed first under the brand name Lucemyra, which will be available for prescription use in the U.S. by August 2018. Initial drug trials on the medication have been very positive, but the substance has not, as of 2018, been fully integrated into detox and rehabilitation programs.
If you have questions about this medication’s potential, speak with your physician, psychiatrist, or addiction counselor. Other very effective approaches to MAT can help you get started on overcoming heroin addiction right now.
The best detox process involves a discussion between you and your physician or an addiction specialist. When you enter treatment for heroin addiction, the very first step is an assessment of your needs. A physician will likely ask you a series of questions.
A physician will begin to monitor you for withdrawal symptoms during your first day of detox. They may use a scale to understand the severity of your withdrawal, the most common of which is the Clinical Opiate Withdrawal Scale (COWS). This 11-item scale helps clinicians measure symptoms, so they can manage the detox process safely and effectively, which includes determining the appropriate starting dose of a medication like buprenorphine or methadone.
A scale like COWS will help your clinician understand if you need medication to manage withdrawal symptoms, and if so, which one is the most appropriate. Then, your physician will help you stabilize on the right dose of this drug, and slowly taper over a period of weeks or months. In the case of methadone, the tapering process may take years. It is important to know that, even if the tapering process seems like it will take a long time, stabilizing your body so you can participate in therapy to change your behaviors is crucial to your long-term sobriety and health.
Medication stabilization with buprenorphine or methadone are valuable tools to taper off heroin addiction. However, this approach to detox is not the only important step in overcoming addiction. The National Institute on Drug Abuse (NIDA) is clear that a “whole patient approach” must include behavioral counseling through a rehabilitation program. Aftercare and social support from friends, family, and mutual support groups are also key factors in staying away from addictive substances like heroin.
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