Heroin withdrawal includes the set of symptoms that appear after a person builds up a dependence on the drug with regular use. Withdrawal symptoms from heroin can be significant, and the drug should not be stopped “cold turkey,” or suddenly, for this reason.

The severity of the emotional and physical withdrawal symptoms and cravings make it difficult to stop using the drug without professional help. The National Highway Traffic Safety Association (NHTSA) states that heroin withdrawal begins within 6-12 hours after the last dose of the drug, generally peaks within the first 2-3 days, and lasts about 5-10 days on average.

Heroin Withdrawal

Heroin is a central nervous system depressant drug that slows heart rate, respiration levels, and blood pressure, and lowers body temperature. It also increases levels of dopamine in the brain, which is what is responsible for the intense, euphoric, and rapid “high” the drug can produce.

When heroin is taken on a regular basis, the brain can become dependent on the drug and stop producing normal levels of dopamine on its own. This can cause extreme emotional lows, depression, suicidal thoughts, and anxiety during withdrawal, or when the drug wears off. Physically, blood pressure, respiration and heart rate, and body temperature may spike without the drug’s suppression of these autonomic functions. Other symptoms of heroin withdrawal include:

    • Insomnia
    • Restlessness
    • Agitation
    • Irritability
    • Loss of appetite
    • Difficulties concentrating
    • Watery eyes
    • Runny nose
    • Tremors

Replacement Medications and Impact on Withdrawal

Medical detox programs, which often use substitute medications during withdrawal, impact the withdrawal timeline and decrease the intensity of the negative side effects. During medical detox, heroin may be replaced with a different, longer-acting opioid drug, such as methadone or buprenorphine, to control the severity of the withdrawal symptoms.

Buprenorphine is considered to be safe and effective as a replacement for heroin during treatment for dependency, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) when it is combined with therapeutic and supportive methods. Buprenorphine is a partial opioid agonist, meaning that it fills opioid receptors, like heroin does but to a lesser extent. This can keep cravings and intense withdrawal symptoms at bay without producing a euphoric high.
When a replacement medication is used during detox, it will be slowly tapered off over a set period of time until it is no longer taken at all. This method of detox ultimately lengthens the withdrawal timeline since a person isn’t technically fully detoxed until they are no longer taking the replacement medication, which can take months or even years. That being said, replacement medications can greatly alleviate the intensity of heroin withdrawal and promote long-term abstinence.

Some withdrawal symptoms, such as executive functions, anxiety, sleep disturbances, and depressed moods, may extend for a few months after stopping a drug like heroin, and SAMHSA refers to this extended form of withdrawal as protracted withdrawal. Medications for specific symptoms, therapy, and ongoing supportive care can help to control and manage these withdrawal symptoms.

In general, heroin withdrawal is optimally managed through medical detox and continued therapeutic, supportive, and pharmacological methods.