Heroin withdrawal, although not deadly like alcohol and benzodiazepine withdrawal, can be excruciating, resulting in frequent relapse. Many users experience such painful withdrawals that they feel as though they must use a little heroin in order to take the edge off. As a result, it is strongly recommended that heroin addiction is not treated at home via the “cold turkey” method. Detoxification should take place in a controlled and safe setting where medications can be used to minimize the withdrawal effects.
Heroin withdrawal symptoms
Avoidance of withdrawal symptoms frequently motivates continued heroin abuse even after an individual has resolved to quit. The severity of withdrawal symptoms depends on a variety of factors, including the average amount, potency, and frequency of heroin used previously. Symptoms of heroin withdrawal include:
- Muscle aches
- Abdominal cramping
- Dilated pupils
- Bone pain
Heroin withdrawal timeline
Heroin withdrawal symptoms begin 6-12 hours after the last dose, peak in two to three days, and last five to ten days in total. Medical detox, formally known as medication-assisted treatment (MAT) usually begins before heroin completely leaves the body. Depending on the severity of the addiction, MAT can be administered for days to weeks.
What causes heroin withdrawal?
Withdrawal from heroin can occur even after just a few uses. The initial hangover from first-time use can be so painful and intense that individuals will seek more heroin in an effort to relieve their withdrawal symptoms. While addiction does not generally occur until after a few uses, the initial withdrawal can be horrific enough to spiral someone into addiction in a matter of weeks.
Heroin affects the part of the brain that is responsible for pleasure and motivation. Repeated use weakens these areas in the brain, leading to tolerance. This means the individual needs more and more in order to feel the same effect. Over time, the brain decreases production of natural opiates, because it now depends on heroin to feel normal. As a result, withdrawal is extremely painful. The body seeks more opiates in the form of heroin just to maintain a baseline level of well-being.
Heroin withdrawal treatment
Medication-assisted treatment (MAT) incorporates medications and therapy to help the brain and body recover from dependence on heroin. The client is placed under direct medical supervision and is monitored for safety and comfort.
Medications approved to treat opioid prescription abuse include opioid receptor blockers such as naltrexone, opioid receptor activators such as methadone, and partial opioid agonists, which both block and activate the opioid receptors such as buprenorphine.
- Naltrexone: Eliminates the euphoric and sedative effects of heroin by blocking opioid receptors. It curbs heroin cravings and prevents the feeling of getting high if an individual uses heroin while on this medication. It also is used to treat alcohol addiction.
Naltrexone is a long-term medication, and can only be given to someone who has abstained from heroin for at least 7-10 days. It comes in a pill or injectable form. Naltrexone is not to be confused with naloxone, which is used to prevent or reverse heroin overdose.
- Methadone: A low strength, long-acting opioid that helps prevent heroin withdrawal effects. Its use is controversial in some areas because, since it is also an opioid, it can also be addictive to some individuals. It is possible for former heroin addicts to become addicted to methadone. Therefore, a doctor must carefully determine if using methadone to ease withdrawal is appropriate for the client.
In a methadone-based treatment center, healthcare professionals will administer small doses of methadone to heroin-addicted clients. This minimizes heroin withdrawal effects, and over time, the dose of methadone will decrease. Eventually, the individual will be substance-free.
- Suboxone: Contains both naloxone and buprenorphine. Since 2013, it has sold more units than Viagra and Adderall, making it an incredibly popular prescription. Buprenorphine is a partial opioid agonist, meaning that it somewhat increases the actions of opioids, including heroin. Because of this, it minimizes the withdrawals associated with heroin.
Naloxone is an opioid blocker, so if the user is still taking heroin, they will experience withdrawals within minutes. Since naloxone carries too many risks for it to be administered by itself, it is combined with buprenorphine, which eases withdrawal symptoms. The result of the combination is Suboxone.
Opioids such as Suboxone and methadone can reduce the debilitating effects of heroin withdrawal and the strong cravings for more opioids. Although there is also some potential to become addicted to Suboxone, the benefits of safely detoxing from heroin generally far outweigh the risk of addiction.