Withdrawal and detox are terms that are often used interchangeably, but they do refer to different things. Detox is the process of removing or processing toxins from the body, while withdrawal is the set of symptoms that may occur after a person is dependent on a drug and the substance wears off.

What Is Heroin?

Heroin is a powerful opioid narcotic drug that is considered illegal in the United States by the Drug Enforcement Administration (DEA), as it has no accepted licit use and a high potential for abuse, dependency, and addiction. The American Society of Addiction Medicine (ASAM) reports that close to 600,000 Americans who are over the age of 11 suffer from a heroin use disorder, which includes heroin dependence as a symptom.

Heroin works by filling opioid receptors in the brain and causing a surge of dopamine, which is one of the brain’s neurotransmitters that signals a person when to feel happy. This surge causes the intense “high,” or euphoric feeling that accompanies heroin use.

Heroin is the shortest acting opioid, according to the DEA, and depending on the way it is taken, it can take effect almost immediately. Heroin’s effects typically peak in 1-2 hours and wear off after 3-5 hours the National Highway Traffic Safety Association (NHTSA) reports. Once heroin’s effects wear off, withdrawal can start.

Symptoms of Heroin Withdrawal

Heroin withdrawal is a side effect of heroin dependence, which occurs when the brain becomes used to the presence of heroin in the bloodstream. Heroin is a central nervous system depressant and slows down respiration, heart rate, body temperature, and blood pressure. It also lowers anxiety and stress, and produces feelings of pleasure. These effects are caused in part by changes to the brain’s chemistry that heroin induces.

Since heroin is a quick-acting drug, an individual can rapidly develop a tolerance to certain amounts of the drug and then needs to take more to keep feeling these desired effects. After regular use for a period of time, the brain expects the changes that heroin makes and stops working normally without it. A drug dependence is then formed. NHTSA publishes that heroin withdrawal may begin within 6-12 hours after the last dose of the drug, and major symptoms will peak within 48-72 hours, tapering off in 5-10 days.

Heroin Withdrawal Timeline

Heroin withdrawal may differ from person to person in severity, duration, and exact symptoms; however, a general timeline is highlighted below:

  • Yawning
  • Sweating
  • Tearing up
  • Runny nose
  • Anxiety
  • Muscle aches
  • Agitation
  • Insomnia
  • Restlessness
  • Stomach cramps
  • Nausea
  • Vomiting
  • Diarrhea
  • Dilated pupils
  • Chills and goosebumps
  • Irregular heart rate and blood pressure
  • Depression
  • Drug cravings

Opioid withdrawal is partly caused by hyperactivity of the autonomic nervous system (ANS), the journal Practical Pain Management suggests. The ANS is partly suppressed with heroin use and springs into action when the drug is removed after dependence has formed. Heroin withdrawal may be similar to a really bad case of the flu on a physical level and includes several emotional and psychological symptoms as well.

Heroin withdrawal syndrome can vary, depending on various mitigating factors. For instance, the length of time someone has been using the drug, the manner in which they abused it (smoking, snorting, or injecting it), and the dosage level used may lead to increased or significant drug dependence, which can lengthen withdrawal and potentially lead to more intense withdrawal symptoms.

Anything that makes a person more prone to developing a higher level of drug dependence can also influence withdrawal. Family history of addiction, age at first use, and environmental factors can all serve to exacerbate drug dependence and therefore withdrawal as well. Underlying, or co-occurring, medical or mental health concerns can also play a role in the length and severity of withdrawal, as a dual diagnosis may come with increased or heightened symptoms.

Managing Withdrawal Symptoms

Heroin withdrawal can be both physically and emotionally difficult; it is optimally treated with medical detox. During medical detox, a team of mental health, substance abuse treatment, and medical professionals all work
together to ensure a person’s safety and overall wellbeing while heroin leaves the body. Mental health professionals attend to a person’s state of mind, while medical personnel monitor vital signs and administer medications when needed.

Medications that target specific symptoms of withdrawal can be helpful during detox to manage certain side effects, such as gastrointestinal upset, muscle aches, insomnia, high blood pressure, etc. Heroin may also be replaced with a longer-acting opioid in order to slowly wean a person off opioids to minimize the withdrawal syndrome. The White House publishes that the U.S. Food and Drug Administration (FDA) approves the following drugs for the treatment of opioid dependence: methadone, buprenorphine and buprenorphine combination products, and naltrexone.

Both methadone and buprenorphine are long-acting opioid drugs that still activate opioid receptors. Methadone can be administered in low doses once a day and remain in the system longer, and it can be slowly tapered down until it is not needed at all. This can reduce the intensity of opioid withdrawal.

Managing Heroin Withdrawal Symptoms

Buprenorphine is a partial opioid agonist, which means that it also activates opioid receptors in the brain, just to lesser extent than heroin does. Buprenorphine is not thought to make people “high” in the same way that heroin can, and it also has a kind of ceiling effect after a certain dosage is taken, meaning that it stops having any effect after a specific amount. Buprenorphine is also often combined with a partial opioid antagonist, naloxone, which doesn’t take effect unless the drug is altered for abuse. Then the naloxone will precipitate opioid withdrawal, meaning that it serves as an abuse deterrent and preventative measure. Naltrexone is another opioid agonist used after detox to help prevent relapse and treatment compliance.

Medical detox is considered the safest method for managing heroin withdrawal and helping to reduce possible side effects. In general, a medical detox program likely lasts between 5-10 days in an effort to help individuals achieve physical stability.

Dangers of Relapse

Heroin overdose is a national epidemic, as the Centers for Disease Control and Prevention (CDC) reported over 8,200 heroin overdose fatalities in 2013. This number has been growing in recent years.

Someone who has been through detox, or stopped using heroin for a period of time, and then returns to the drug is at a potentially higher risk for a fatal overdose. The National Institute on Drug Abuse (NIDA) estimates that relapse rates for drug addiction are between 40 and 60 percent, and relapse is often a common component of substance abuse treatment. Once a person has stopped heroin and then returns to it, however, they may try to take the drug at the same level that they once did, and the risk for a life-threatening adverse reaction is very high.

Detox helps to regulate the brain and body, and provide a level of physical stability without heroin. In so doing, drug tolerance levels often drop. This means that if a person then tries to take heroin at levels they were accustomed to before, the body will no longer be able to break the toxin down as readily, and an overdose may be the result. Due to the complex nature of heroin dependence and addiction, detox should be followed with a more comprehensive substance abuse treatment program that teaches methods for preventing relapse and sustaining recovery down the line.