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Heroin Detox Guide: Timeline, Symptoms & Effects

Sad man sitting at table thinking about heroin detoxHeroin is a highly addictive opioid drug classified as a Schedule I controlled substance by the Drug Enforcement Administration (DEA), meaning that it has no currently accepted medical use and a high potential for abuse and addiction 8. Despite significant efforts to combat the heroin abuse epidemic, heroin use in young adults aged 18-25 has doubled in the last decade 1. Furthermore, overdose deaths related to heroin abuse increased nearly four-fold 1.

Repeated abuse of this illicit opioid increases the risk for developing physiological dependence. Dependence is the body’s adaptation to the presence of heroin, which means that it requires the drug to function at an optimal level. When someone who has a heroin dependence abruptly discontinues or decreases use, physical and psychological withdrawal symptoms will likely emerge 2.

Heroin addiction rates are climbing in the United States, and many people who require professional addiction treatment don’t receive it.

It is important to understand that physical dependence and heroin addiction, while they may occur together, are not the same. While people who are addicted to a drug are typically physically dependent on it, addiction is far more complex than dependence. Heroin and other types of opioid addiction involve compulsive drug use that cannot be controlled, despite any negative consequences that may occur in one’s life as a direct result of use 2. Heroin addiction rates are climbing in the United States, and many people who require professional addiction treatment don’t receive it 1.

If you are addicted to or dependent on heroin, it is not wise to attempt to detox at home. Heroin withdrawal symptoms can be severely unpleasant and may increase your chance of relapse and overdose. Attending a professional heroin detox program can help mitigate withdrawal symptoms, reduce cravings, and ensure your safety and comfort during the heroin detox process.

Choosing a Detox Center

Woman with back turned thinking about choosing a detox centerIf alcohol or drugs have taken over your life or the life of a loved one, you may wonder where you can turn for help. A detox clinic can provide the help you or your loved one need during this difficult time. Read More

What are the Effects of Heroin Addiction?

Abusing heroin can be very dangerous and can significantly impair a user’s ability to function in many areas of life, such as work, school, and home. The sooner you seek treatment for heroin abuse or heroin addiction, the more likely you are to prevent consequences, such as 9:

  • Severe constipation.
  • Dry mouth and nose.
  • Vision problems due to pupil constriction.
  • Puncture marks or track lines.
  • Cellulitis.
  • Abscesses.
  • Scars and lesions.
  • Tetanus.
  • Infection of the heart lining.
  • Hepatitis.
  • HIV.
  • Tuberculosis.
  • Difficulties in sexual functioning.
  • Irregular menses in women.
  • Increased risk of overdose, due to an increased tolerance.
  • Severe drowsiness or coma.

Another consequence of chronic heroin abuse is the development of a dependence, which means that the body relies on the presence of heroin in order to function normally. Someone who is dependent on heroin is likely to experience withdrawal symptoms with the cessation of or reduction in use. Many users are unable to cope with the unpleasant heroin withdrawal symptoms on their own and may be at risk of relapse during the detox process. A formal detox program can provide users with the support and care necessary to detox comfortably.

What are the Risks of Withdrawal?

As previously stated, suddenly reducing or quitting heroin use often results in distressing withdrawal symptoms that can cause significant impairment in a user’s life. Commonly reported heroin withdrawal symptoms include 4,5:

  • Nausea.
  • Vomiting.
  • Diarrhea.
  • Stomach cramps.
  • Muscle aches.
  • Agitation.
  • Anxiety.
  • Insomnia.
  • Hot and cold flashes.
  • Goose bumps.
  • Runny nose.
  • Teary eyes.
  • Excessive sweating.

Attending a professional heroin detox program can increase your comfort, reduce the risk of relapse, and prevent complications. While the symptoms listed above can be painful and uncomfortable, they are not typically life-threatening. However, heroin detox poses many potential risks and complications that can be dangerous. These include 4,5,9:

  • Dehydration and electrolyte disturbances from vomiting and diarrhea.
  • Aspiration (vomiting and breathing stomach contents into lungs), which can lead to lung infection.
  • Increased risk of relapse and overdose. Overdose is much more likely to occur upon relapse as people may not realize that their tolerance has decreased and the relapse dose may be too high for them to handle.
  • Increased risk of suicide due to depression.
  • Self-medication with other potentially harmful drugs in order to relieve withdrawal symptoms.

Heroin is a relatively short-acting opioid, which means it will be processed and removed from the body faster than many long-acting opioids, such as methadone 6. When the heroin effects wear off, withdrawal symptoms typically emerge within 6-12 hours of the most recent dose, peak in intensity within 1-3 days, and gradually resolve within 5-7 days 6.

After the acute phase of heroin withdrawal concludes, many individuals experience a period of extended or protracted withdrawal symptoms 10. As a part of the post-acute withdrawal syndrome (PAWS), these ongoing withdrawal symptoms can last for 6 months marked by effects like 10:

  • Depression.
  • Anxiety.
  • Fatigue.
  • Irritability.
  • Sleep disturbances.
  • Emotional blunting.

It can be incredibly difficult to endure heroin withdrawal symptoms and cravings and resist the urge to use during this time. Attending a professional heroin detox program can increase your comfort, reduce the risk of relapse, and prevent complications.

The Benefits of a Detox Program

People sitting in group therapy session following detox treatmentQuitting heroin on your own can be challenging and unpleasant without the proper support and treatment. While people may be hesitant to seek formal drug detox, there are many benefits of attending a professional detox program, such as:

  • Medical monitoring (24 hours a day in inpatient detox facilities).
  • Safe and supportive environment.
  • Access to medications for symptom management and craving reduction.
  • Access to appropriate mental health care.
  • Drug abuse treatment planning following completion of detox.

What Types of Programs are Available for Heroin Detox?

For safety and humanitarian concerns, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that anyone detoxing from heroin seek 24-hour medical care in a hospital or residential facility 6. While this is the recommended level of care, detox can take place in a number of settings, such as a(n):

  • Hospital.
  • Inpatient drug detox facility.
  • Outpatient drug detox facility.
  • Physician’s office.

Each level of care has its own benefits and drawbacks. Just as each person’s heroin addiction is unique, different detox methods and settings will work for different people. Because heroin addiction is chronic and debilitating, hospitals and inpatient drug detox facilities that provide round-the-clock care are usually the safest option. Outpatient detox may be preferred by those who wish to continue working, going to school, or fulfilling other responsibilities during the detox process. However, outpatient detox should only be sought after a physician has determined that the patient is not at risk for experiencing a complicated withdrawal.

Withdrawal Medications

Medications exist that can provide comfort and safety during the detox period by minimizing withdrawal symptoms and reducing cravings for heroin. There are 3 medications commonly used for heroin withdrawal 7:

  • Buprenorphine: This partial opioid agonist activates the same opioid receptors as heroin, but to a lesser degree. It can relieve cravings and withdrawal symptoms without producing the euphoric high, unless misused or abused. Because it is an opioid agonist, physical dependence can occur and patients will need to be weaned off the drug slowly if is taken over an extended period of time. A common combination formula called Suboxone contains buprenorphine and naloxone—an opioid antagonist—which helps to deter potential abuse of the medication.
  • Methadone: This long-acting opioid agonist helps to minimize withdrawal symptoms and reduce cravings. It also increases tolerance to other opioid drugs (such as heroin) so that their use is less rewarding should misuse of such drugs occur while on methadone treatment. Similar to buprenorphine, long-term use of methadone does create physical dependence.
  • Naltrexone: This opioid antagonist works by blocking the action of opioids, making them ineffective. This drug is not sedating like methadone and buprenorphine and does not create physical dependence. That said, it may not be as effective as these therapies; patients may have difficulty complying with treatment, and as a result, be more likely to relapse.

Sources

  1. Centers for Disease Control and Prevention. (2015). Today’s Heroin Epidemic.
  2. National Institute on Drug Abuse. (2012). Is there a difference between physical dependence and addiction?
  3. National Institute on Drug Abuse. (2011). Treatment Statistics.
  4. Heller, J. (2016). Opiate and Opioid Withdrawal. U.S. National Library of Medicine.
  5. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva.
  6. Substance Abuse and Mental Health Services Administration. (2013). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol TIP 45.
  7. National Institute on Drug Abuse. (2014). What are the treatments for heroin addiction?
  8. Drug Enforcement Administration. (n.d.) Drug Fact Sheet: Heroin.
  9.  American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  10. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
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