Heroin Withdrawal

As the opioid crisis in the United States rages on, heroin remains a key player, with both incredibly high addiction rates and overdose deaths. Currently, the American Society of Addiction Medicine estimates that at least 517,000 Americans are battling an addiction to heroin, while it is calculated to have been the cause of about 15,500 overdose deaths in 2016.

Heroin is what’s known as an “opioid,” which used to mean any synthetic drugs created to work the same way as naturally-derived “opiates” like morphine or codeine, which were themselves made from opium. Today; however, the term opioid is now used to refer to the entire family of opiate drugs, both natural and synthetic.   

Heroin is derived from morphine and was originally created for and marketed as an over-the-counter cough medicine in the late 1800s. It was actually meant to be a safer and less addictive alternative to using morphine, but it was not long after that heroin had a far higher addiction rate than morphine among those that used it.

Eventually, in 1924, the United States banned all sales, imports, and manufacturing of heroin. It is now classified by the DEA as a Schedule I substance, which means that because of its high potential for abuse and no recognized medical use, it is illegal to either possess or manufacture.



Heroin is also more dangerous now than it ever was before as it is increasingly being cut with fentanyl, a synthetic opioid that is much cheaper and easier to make than heroin, as well as significantly stronger and deadlier.

Most heroin users are unaware that what they’re buying is partially, and sometimes even completely, fentanyl, and since a lethal dosage of fentanyl is roughly the size of a single snowflake, the risk of death from accidental overdose is high.

While the severe health issues associated with heroin abuse have certainly never been trivial, this new danger only highlights how important it is to get treatment and break from heroin dependence. As such, the first step is detoxification and going through the process of heroin withdrawal.

What are the Heroin Withdrawal Symptoms?

Heroin works by rapidly entering the brain and binding to its opioid receptors. Your opioid receptors are neurotransmitters that are responsible for acting as natural painkillers, modifying stress levels, and more.

What heroin does when it binds to these receptors is heighten this effect, blocking the brain from receiving pain signals and also increasing the levels of dopamine, which is a neurotransmitter that controls the brain’s pleasure centers. This is why using heroin creates such a huge spike in feelings of euphoria and pleasure while at the same time masking pain and discomfort.

man distraught due to negative side effects from drug abuse

When the body becomes physically dependent on heroin providing a certain amount of dopamine and blocking out pain, it also builds up a tolerance, so you need more and more to achieve the same effects. This is why when someone who has regularly been abusing heroin stops, their body “crashes” and struggles to cope with the sudden loss of dopamine, which is what causes heroin withdrawal symptoms.  

heroin withdrawal are consistent with general opioid withdrawal symptoms, which are extremely uncomfortable and sometimes even painful but rarely ever fatal. In the early stages of heroin withdrawal, someone in heroin detox is most likely to experience at least some of the following mild, flu-like symptoms:

  • Excessive sweating
  • Muscles aches and pains
  • Chills
  • Runny nose
  • Excess tears
  • Abdominal cramping

These are typically followed by more moderate heroin withdrawal symptoms that start and eventually reach their full intensity at the peak of the withdrawal timeline and include:

  • Difficulty concentrating
  • Exhaustion and fatigue
  • Tremors
  • Nausea
  • Restlessness
  • Insomnia
  • Agitation and mood swings
  • Vomiting
  • Diarrhea

Finally, the most intense symptoms that someone in heroin detox might experience during heroin withdrawal, especially if they have been abusing large amounts of heroin for a long time, include:

  • Impaired breathing
  • Irregular heartbeat
  • Dangerously high blood pressure
  • Anxiety and panic attacks
  • Severe depression
  • Uncontrollable muscle spasms
  • Inability to experience feelings of pleasure
  • Intense heroin cravings

While these are the typical heroin withdrawal symptoms, if someone attempts to immediately stop using heroin altogether, usually referred to as “cold turkey,” heroin withdrawal can cause hallucinations, seizures, and convulsions. For these reasons, it is never recommended that someone who has been dependent on heroin for a long time attempt to detox by going cold turkey.

someone identifying the signs of drug abuse in a friend or sibling

Can Heroin Withdrawal Kill You?

Like we mentioned before, heroin withdrawal is rarely, if ever, deadly.

However, heroin withdrawal symptoms can be very painful and unpleasant to deal with, which can cause someone attempting a heroin detox to relapse and go back to using.

Since intense heroin cravings are one of the major symptoms of heroin withdrawal. Someone relapsing while trying to flush the drug from their body is likely to do a larger dose of heroin than usual, which puts them at an increased risk of overdose.

Another dangerous symptom of heroin withdrawal is depression, as it can provoke suicidal thoughts and an increase in suicidal behavior, which, if not carefully monitored, can have fatal consequences.

So while heroin withdrawal will not kill you, the side effects of some heroin withdrawal symptoms can indirectly result in death.

Pregnant women should be especially careful, as heroin withdrawal can cause miscarriages, and greatly increases the risk of having one. Because of this, it is recommended that pregnant women who are dependent on heroin or other opioids slowly taper use with methadone maintenance treatment, which we’ll explain more about further down.

What Are the Stages of the Heroin Withdrawal Timeline?

The main question people detoxing from heroin have is, “How long can heroin withdrawal last?” The answer is that the length and also the intensity of heroin withdrawal is going to be a bit different for any given person and is based on how dependent on heroin someone has become, as well as other factors such as:

  • How long someone has been abusing heroin
  • How much heroin they have been taking
  • How they were taking it (injecting, snorting, etc.)
  • If they have a history of mental health issues or previous addictions
  • The state of their overall current health
  • If they are using a tapering schedule to slowly stop using or stopping cold turkey
  • If they are detoxing with the aid of medication-assisted opioid treatment or maintenance treatment
  • Whether they were using other drugs or alcohol at the same time (according to the CDC, more than 9 in 10 people who use heroin are also using one to three other addictive substances)

While those factors will ultimately determine the exact length of an individual’s heroin withdrawal process, the established timeline for heroin withdrawal based on common opioid withdrawal symptoms and length as well as how long heroin remains in your system, is generally as follows:

6-12 HOURS

Because heroin enters the brain and take effects so quickly, that means it has a short half-life and that heroin withdrawal symptoms can start as soon as six hours after someone has taken their last dose, and usually will have within at least 12 hours. At this point, you can expect the milder, mostly physical, flu-like symptoms to start.

24-48 HOURS

Over the course of the next couple days, the more moderate-to-severe heroin withdrawal symptoms, such as exhaustion, vomiting, depression, and drug cravings will start and eventually reach their peak strength. This is the time when those undergoing heroin detox are most vulnerable to relapsing.


Usually seven but sometimes as long as ten days after the last dose, the majority of the physical symptoms of heroin withdrawal should have stopped, or at least greatly diminished. Cravings may still be present but will have become more manageable. Some of the psychological symptoms will have also faded but others, like anxiety or depression, may still persist.


Past the first ten days of heroin withdrawal, the body will have finished detoxing from heroin, but cravings, depression, and other mental health-related symptoms can still continue for weeks or even sometimes many months after someone has stopped using heroin.  

It is also possible that someone who has undergone heroin withdrawal may experience a secondary withdrawal phase known as Post-acute-withdrawal syndrome, or PAWS. Some signs of PAWS that can occur months after withdrawal include:

  • Sleep disturbances
  • Difficulty concentrating
  • Suicidal thoughts
  • Increased sensitivity to pain
  • Poor coordination
  • Unstable moods

PAWS is typically more common in individuals who have detoxed from alcohol or benzodiazepines, but if you are experiencing symptoms of PAWS after your heroin detox, know that there are many resources available to you.

Why Should I Detox from Heroin?

Like we mentioned before, while a heroin detox is generally not life-threatening, you should still avoid attempting to detox from heroin at home or on your own, as some of the symptoms of heroin withdrawal can pose a significant danger. Because of this, it is much safer to detox from heroin in the care of a medical detox center.

Heroin also has an incredibly high relapse rate, with many users relapsing not only after detoxing and getting clean but before they have made it all the way through the withdrawal process. Part of why this happens is that people detoxing on their own will try to quit cold turkey, which, as previously stated, can cause complications like hallucinations and seizures.

When someone who has been abusing heroin long enough for the brain and body to become dependent on it in order to function abruptly stops using completely, they will experience a sudden and  immediate cessation of heroin’s effects on the brain.

The rush of pleasure disappears, and the brain’s dopamine levels bottom out. Even without the risk of seizures, the intensity of this experience is more than enough to cut a detox short and drive someone back to using.  

Detoxing under the supervision of expert medical professionals in a detox facility gives you a much higher likelihood of completing a heroin detox safely and successfully, as they can provide you with medications to decrease the amount of discomfort caused by the symptoms of heroin withdrawal as well as put you on a tapering schedule with medication-assisted treatment.

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What Can Help Heroin Withdrawal?

Many detoxification centers will opt for medical maintenance therapy when treating patients with an opioid dependency. This can allow them to slowly weaning off of heroin instead of all at once, through the use of other drugs that can provide similar effects but at a much weaker level to decrease drug cravings.

The typical medications used to help people with heroin withdrawal taper down their usage include:


Methadone, which lessens cravings while blocking the euphoric effects of heroin (although this medication requires strict doses and monitoring, as it carries its own addictive qualities)


Buprenorphine is what’s known as a “partial opioid.” It works like methadone but has less potential for addiction.


Suboxone, the brand name for a combination of buprenorphine and naloxone, a drug that completely cuts off the effects of opioids like heroin and is only used on its own to reverse overdoses.


Naltrexone, a drug that works differently from the ones mentioned above in that it is not addictive and carries no opioid qualities. Instead, it completely negates the feeling of getting high. Naltrexone is also available in the form of an extended-release injection called Vivitrol.


Clonidine, which is primarily a blood pressure medication but has been shown in several studies to help with stress-induced cravings.

What Is the Next Treatment Step?

Successfully recovering from heroin addiction is simply not possible without first detoxing. However, detoxing from heroin is only the beginning of the rehabilitation journey.

Choosing to go without any aftercare treatment or rehab programs once you have completed the heroin withdrawal process is a sure path to relapse. Studies show that 91 percent of people who completed heroin detox but did not follow up with any kind of aftercare treatment suffered a relapse, with 59 percent using heroin again just one week after being discharged.

Rehabilitation treatment is crucial to remaining abstinent from heroin use. There are many different kinds of recovery treatment programs available, including counseling, therapy, support groups, and even sober living communities. Your treatment program will be customized based on what works best for you. The important thing is to not stop at detox and instead move on to the next phase of treatment.

Start Your Journey to Recovery Today

If you or someone you love had been suffering from heroin dependency, help is available at The Palm Beach Institute. Our medical professionals and addiction specialists will be there every step of the way on the path to sobriety, starting with detox. Call us today at (855) 960-5456 to get started, or contact us online for more information.