Heroin is a powerful and addictive drug, and it’s safe to say that most people who use it are either already suffering from an opioid use disorder or will become addicted to the drug. According to the National Institute on Drug Abuse (NIDA), approximately 1.1 million people use heroin and 2022 and 1 million had a heroin use disorder (HUD).[1] 

Unfortunately, once you start using heroin, it’s extremely difficult to stop. Shortly after the effects of the drug wear off people who are addicted to it experience uncomfortable, and painful withdrawal symptoms. 

This article discusses what to expect during heroin withdrawal. You will learn: 

• What causes heroin withdrawal and common symptoms
• How long withdrawal lasts
• What to expect during each phase of the heroin withdrawal timeline
• How to cope with withdrawal symptoms
• Why medical detox is necessary

If you are someone you love struggling with her addiction don’t hesitate to reach out to our team at Moving Mountains Recovery to explore your treatment options. Our admissions team is available 24 hours a day.

Symptoms of Heroin Withdrawal

Heroin is an opioid that is derived from morphine, a medication used to manage pain.[2] Symptoms of opioid withdrawal are often compared to a case of the common flu, and include symptoms like body aches, sweating, and gastrointestinal upset.

Heroin withdrawal symptoms may include:[3]

• Cravings
• Anxiety
• Restlessness
• Irritability 
• Excess yawning
• Watery eyes (lacrimation)
• Muscle aches
• Body pain
• Sweating
• Chills
• Goosebumps
• Insomnia
• Vivid dreams and sleep disturbances
• Tremors
• Reduced appetite
• Nausea
• Vomiting
• Diarrhea
• Abdominal cramping

In most cases, heroin withdrawal is not life-threatening. The most concerning risks are that of dehydration caused by reduced appetite, sweating, and vomiting/diarrhea as well as the potential for relapse.[4,5] Relapse is common during withdrawal because of the distressing symptoms and intense drug cravings that occur.

By seeking help from a heroin detox center, individuals can detox safely and comfortably, while avoiding the potential risks.

What Causes Heroin Withdrawal?

Heroin withdrawal occurs because of how heroin, an opioid, affects the brain and body over time. 

Heroin binds to and activates opioid receptors in the brain, which slows down the central nervous system (CNS). This leads to effects like pain relief, relaxation, and a sense of euphoria.[6]

To maintain balance and overcome these CNS depressant effects, the body compensates by working harder to counteract the opioid-induced slowdown. It increases the activity of certain systems to keep normal function.

With regular heroin use, the body becomes accustomed to functioning in this heightened, compensatory state. The body essentially “expects” the presence of the drug to maintain balance.[7] Then, when heroin use suddenly stops, the body remains in that heightened compensatory state, but without the CNS-slowing effects of the drug. This imbalance leads to withdrawal symptoms, which can include anxiety, agitation, muscle pain, sweating, nausea, and cravings.

This process is what makes heroin withdrawal so intense and difficult to manage without medical assistance.

Protracted Withdrawal

People who use heroin heavily or have a long history of being addicted to it may experience long-term withdrawal symptoms. These symptoms, known as protracted withdrawal or post-acute withdrawal (PAWS), are mostly psychological, but can significantly affect daily life.

Common symptoms of protracted withdrawal from heroin are:[3]

• Depression
• Anxiety
• Dysphoria (inability to feel pleasure)
• Irritability
• Fatigue
• Sleep disturbances
• Reduced attention span
• Impaired concentration
• Drug cravings
• Loss of interest in hobbies or activities
• Lack of motivation

These symptoms can make it tempting to return to heroin use, but it’s important to note that those in protracted withdrawal have detoxed and may have a lowered tolerance to opioids. As a result, starting to use opioids again comes with a greater risk of overdose.

Protracted withdrawal can be effectively managed with behavioral therapy, counseling, medications, and lifestyle modifications.

How Long Does Heroin Withdrawal Last?

The heroin withdrawal timeline looks different for everyone, but for most people, withdrawal begins 8-24 hours after the last dose. Symptoms peak and are at their worst around 36-72 hours, after which time they will gradually subside in intensity. After three days, symptoms begin to resolve, and most acute withdrawal symptoms will subside within 10 days.

Early withdrawal symptoms that appear just hours after the last dose wears off may include:[3,4]

• Irritability
• Anxiety
• Yawning
• Watery eyes
• Body aches
• Cravings

Between 36-72 hours when symptoms reach peak intensity, individuals can expect:

• Sweating
• Chills
• Goosebumps
• Nausea
• Vomiting
• Diarrhea
• Restlessness
• Sleep difficulties
• Muscle aches

Symptoms resolve over time, but some symptoms may fluctuate in intensity. Many people experience continued anxiety, irritability, cravings, and sleep difficulties for several weeks to months after quitting heroin. Having ongoing support is essential for long-term recovery.

Medical Detox and Treatment

Medical detox is a crucial first step in treating heroin addiction, focusing on safely managing withdrawal symptoms as the body rids itself of the drug.

During detox, healthcare professionals closely monitor individuals to ensure safety and comfort during withdrawal. Medications like methadone, buprenorphine, and naltrexone are commonly used to help ease symptoms and reduce cravings.[4] 

Methadone and buprenorphine act on the same opioid receptors as heroin, but in a more controlled way, reducing withdrawal symptoms without producing a high. Naltrexone, on the other hand, blocks opioid receptors to prevent the euphoric effects of heroin if used again.[4,8]

Medical detox is not a standalone treatment. Once detox is complete, long-term recovery requires comprehensive addiction treatment. This may include therapy (individual, group, or family), counseling, and support groups.

In addition to therapy, ongoing medication-assisted treatment (MAT) may be used to help prevent relapse. Holistic approaches, such as mindfulness, exercise, and nutrition, can also support recovery by improving mental and physical well-being. Detox, combined with tailored treatment plans, offers the best chance for long-term recovery and preventing relapse.

Start Your Recovery With Heroin Detox

If you’re struggling with heroin addiction, detox is the safest way to cleanse your body of the drug and begin the healing process. Trying to quit on your own can be overwhelming and risky due to the intensity of withdrawal symptoms. However, in a professional detox program, you’ll be surrounded by medical experts who can provide 24/7 support, ensuring your safety and comfort.

Get started with a confidential, risk-free assessment by contacting the admissions specialists at Moving Mountains Recovery today.