Addiction and recovery are commonly oversimplified. People often think that if someone admits they have a problem with addiction, that is the only remaining barrier to getting clean and recovering successfully.
In reality, there are many reasons recovery from substance addiction is complicated. One of the largest is detox and the accompanying process of withdrawal.
There are countless reasons to fear detox, and heroin withdrawal is notoriously jarring. It is the reason many people who are addicted to heroin and other opiates keep using, even when they recognize the benefits that getting clean will bring to their lives.
This piece walks step by step through the stages of heroin withdrawal, the symptoms to expect, and the strategies that help you manage them.
What Is Withdrawal?
As you use an addictive substance, it creates a dependency in your system. Different substances take hold through different pathways, but generally they convince the brain, through exposure and adaptation, that you need a specific drug to function.
Withdrawal syndrome, known commonly as “withdrawal,” occurs when your body suddenly stops getting the substance in question. A physical reaction occurs in response to the sudden absence of the substance, and functions that were suppressed while using the drug suddenly become overactive.
Specifics of Heroin Withdrawal
Withdrawal from heroin and other opiates is more severe, due in part to the fact that the drug is more powerful than some others. Heroin, morphine, fentanyl, and prescription painkillers suppress the nervous system heavily, so the response to a sudden lack of opiates makes the system react in a harrowing way.
The channel through which heroin and similar drugs affect the brain is a set of structures called opioid receptors. When molecules of an opiate like heroin enter the brain, they bind to two parts of these receptors: one that activates a response, and one that decreases the presence of a substance called GABA, which inhibits dopamine.
Other opiate molecules bind to dopamine receptors, releasing dopamine, the substance that produces feelings of pleasure and euphoria. The therapeutic purpose of drugs like morphine and prescription opioids is that this chemical process dulls the body’s response to pain. When people misuse opiates, they enter a sort of dream-like, comatose state.
This chemical process is important to understand for two reasons:
- It gives insight into the process of heroin withdrawal. When parts of the brain are satisfied by new chemicals, they adapt to the change and begin to expect it.
- The other reason is one we will come back to: the drugs that use this same chemical process can help a patient during detox through medication-assisted treatment.
The Stages of Heroin Withdrawal
Withdrawal from some substances is very predictable and takes place over a series of discrete stages. The stages of heroin withdrawal are not quite so clear, but generally the process follows the path below.
Stage 1: Onset of Heroin Withdrawal
Unlike some substances, there is no set time after a person’s last heroin use when symptoms begin. With heroin it depends on the size of the dose, but typically withdrawal begins in 12 to 24 hours.
With other opiates this timeline varies. Extended-release pain medications have a longer chemical half-life, for example, so withdrawal symptoms may take as long as 36 to 48 hours to appear.
Stage 2: The Beginning (the first 48 hours)
The first 48 hours after onset cover the phase in which the symptoms of heroin withdrawal begin to present. The earliest symptoms include worsening nausea, fever, insomnia, and muscle aches. People often describe the early days of withdrawal as feeling like the stomach flu, getting worse as time goes on.
Stage 3: The Peak of Heroin Withdrawal (48 to 72 hours)
At some point, typically between the third and fourth days, people hit the peak of the symptoms. The physical symptoms include those present in the previous stage, plus the following:
- Stomach cramps
- Fever, chills, and sweating
- Vomiting
- Elevated and irregular heart rate
- Elevated blood pressure
This is also when the psychological side of heroin withdrawal reaches its peak, and that should not be overlooked. People report intense cravings during this stage. Combined with the fact that taking heroin at this point provides instant relief from the severe physical symptoms, this is where most relapses occur during detox.
Stage 4: The End (72 hours to the end of withdrawal)
If a patient can make it through the peak of heroin withdrawal, the symptoms, both physical and mental, become less severe over the following days, until the drug’s effects are out of the body.
This does not mean cravings for heroin and other opiates subside completely, only that the body’s physical need for these substances has passed.
Opioid Withdrawal Symptom Timeline
The symptoms of opioid withdrawal typically develop along the following timeline.
1–2 Days
- Aches and pains
- Nausea
- Loss of appetite
- Agitation
- Flu-like symptoms
3–5 Days
- Sweats
- Nausea
- Goosebumps
- Loss of appetite
- Cramping
6–7 Days
- Difficulty eating
- Cravings
- Anxiety
- Insomnia
- Depression
7–14 Days
- Symptoms usually start to taper
- Insomnia may persist
Other symptoms that may occur during withdrawal include diarrhea, restlessness, and seizures. Getting support during withdrawal is important to stay safe.
The Dangers of Heroin Withdrawal
Heroin withdrawal is severe and uncomfortable, but it does not carry the same risk of fatality that withdrawal from some other substances does. Some cases can still complicate a patient’s health.
The scale of the broader opioid crisis underscores the stakes. In 2023, more than 105,000 people in the United States died from drug overdoses, with opioids involved in the majority of those deaths.
A Heightened Risk of Overdose
Heroin withdrawal is part physical and part psychological, accompanied by intense cravings for the drug. During withdrawal the body is already losing its tolerance for heroin, but most people do not realize it.
When a relapse occurs, the risk of overdose is at its highest, because a person may take too much. Their tolerance is now lower, so taking the same amount they had been taking right before beginning their heroin detox can cause an overdose.
While communities continue to expand their supplies of Narcan and other life-saving overdose interventions, these only help if someone witnesses the overdose or it happens in public. Because most relapses happen in private, overdoses under those circumstances are thought to carry a higher risk of death.
Post-Acute Withdrawal (PAWS)
After the acute period of heroin withdrawal, some people continue to experience post-acute withdrawal symptoms, or PAWS. These symptoms are typically milder than the acute phase, but they can persist for several months and may require an appropriate treatment plan and ongoing support to manage. Symptoms during this period are often psychological, including mood changes, anxiety, and disrupted sleep.
Managing Heroin Withdrawal
There are several effective ways to counteract the symptoms of heroin withdrawal and reduce the risk of relapse.
Medication-Assisted Treatment
Using medication to accompany detox is not a new practice, but the drugs used for MAT are more effective than they once were. Where methadone, a full opioid, was once the drug of choice, medications containing buprenorphine have largely taken its place. Buprenorphine is a partial opioid agonist, meaning it competes with opiate molecules in the brain and produces a dulled version of the effects that heroin, morphine, and similar drugs have on the user.
Common medications used in heroin detox include:
- Buprenorphine and methadone, which bind to opioid receptors to reduce cravings and symptoms without producing the same high as heroin (brand names include Suboxone and Subutex)
- Naltrexone, which blocks opioid receptors so heroin no longer produces a high (brand name Vivitrol)
- Lofexidine, a non-opioid, FDA-approved medication that reduces the intensity of opioid withdrawal symptoms
Medical supervision is important while taking these medications. Contact a medical detox facility that can design a program suitable for your individual needs.
Medical Detox
Medical detox means undergoing withdrawal under the supervision of doctors and other medical professionals. Most often this happens at a dedicated detox facility or as part of residential treatment. A facility like FHE Health can keep patients as comfortable as possible, improving the odds of a successful detox.
Self-Care That Supports Recovery
Alongside medical treatment, several everyday practices can ease withdrawal and strengthen long-term recovery:
- Get emotional support. Counselors and therapists can help you work through difficult emotions and break harmful thought patterns without turning to drugs.
- Build a strong support network. Lean on supportive family and friends, and step back from relationships that trigger the desire to use.
- Stay hydrated. Symptoms like diarrhea deplete fluids, and thirst can feel very similar to cravings, so drinking plenty of water matters.
- Eat well. A balanced, nutritious diet replenishes the vitamins and minerals that addiction often depletes and supports the body’s repair.
- Stay physically active. Exercise releases endorphins, eases anxiety and insomnia, and supports cardiovascular recovery. Research suggests exercise programs can be a useful part of opioid addiction recovery.
Heroin Detox at FHE Health
Going through withdrawal from heroin is nearly impossible to do on your own. If you or a loved one is trying to find lasting recovery from heroin or other addictive substances, contact FHE Health to learn about your options for effective treatment. Speak with a member of our team at (833) 596-3502.
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