Heroin withdrawal, although not deadly like some other substances such as alcohol and benzodiazepines, can be extremely unpleasant resulting in frequent relapse. Many individuals 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 but is rather treated in a controlled and safe setting where medications can be used to minimize the withdrawal side effects.
Heroin withdrawal signs and symptoms
Avoidance of withdrawal symptoms frequently motivates continued heroin abuse even after an individual has resolved to quit. The severity of withdrawal symptoms will depend on a variety of factors, including the average amount, potency and frequency of heroin having been used prior to the attempt to scale back or quit altogether. Symptoms of heroin withdrawal include:
- Muscle aches
- Abdominal cramping
- Dilated pupils
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 and depending on the severity of the addiction can last days to weeks.
What causes heroin withdrawal?
Withdrawal from heroin can occur only after 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 dangerous enough to trigger an addiction. Addiction usually takes several weeks, depending on the individual and overtime heroin affects the part of the brain that is responsible for pleasure and motivation. Repeated use over time can weaken these areas in the brain, resulting in the individual needing more and more in order to feel the same effect. After the brain is exposed to heroin over time, the brain decreases the production of its natural opiates because it now depends on heroin to feel normal and as a result goes into withdrawal, begging for the body to take in more opioids (heroin) to feel pleasure and motivation.
Heroin withdrawal treatment
Medication-assisted treatment incorporates medications and therapy to help the brain and body recover from its dependence on heroin. The client is placed under direct medical supervision and is monitored from his/her 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: Blocks the euphoric and sedative effects of heroin by blocking opioid receptors. It is given to clients as a means to prevent heroin cravings and can prevent the feeling of getting high if a client uses heroin while on this medication. It is considered a long-term medication and therefore is given to the client only if he/she has abstained from heroin for 7-10 days. It comes in a pill or injectable form and although it sounds similar to naloxone, which is used to prevent heroin overdose, it is considered a very different medication. Naltrexone can also be used to treat alcohol dependence.
- Methadone: Methadone is considered a low strength long-acting opioid and can be given to help prevent heroin withdrawal side effects however its use is controversial because it can lead to further addiction since it is an opioid. It is possible for users who have been treated for heroin abuse with methadone, to become addicted to methadone, even though they have quit heroin and therefore using methadone to prevent withdrawal side effects can be dangerous in itself. In a methadone-based treatment center, healthcare professionals will administer small doses of methadone to heroin-addicted clients with the idea that the withdrawal side effects will be minimized over time and simultaneously the dose of methadone will decrease.
- Suboxone: Contains both naloxone and buprenorphine and since 2013, 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 (heroin) and therefore can minimize the withdrawal side effects associated with heroin. Naloxone is an opioid blocker so if the user is still taking heroin, they will experience withdrawals. Since naloxone carries too many risks for it to be administered by itself, it is combined with buprenorphine to give clients an easier process of weaning away from stronger narcotics. 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 a potential to become addicted to Suboxone, the risk is far less than the benefits of safely detoxing from heroin.