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The Dangers of Quitting Heroin Cold Turkey

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Although quitting heroin is one of the best things you can do for yourself, attempting to do so by quitting cold turkey is often difficult, distressing, and painful.

Heroin is a powerful opioid derived from morphine. It may be encountered in white or brown powder form or as a black, sticky, tar-like substance, known as black tar heroin.1 People use heroin for its calming and euphoric effects. Like many other substances, heroin can be used in a variety of ways, such as by snorting, smoking, or injecting it.1

Heroin is highly addictive. Addiction refers to the inability to abstain from substance abuse despite significant consequences, such as medical, psychological, interpersonal, financial, or legal issues. Once someone becomes addicted to heroin, it can be challenging to quit due to the emergence of painful withdrawal symptoms.1 Many people who attempt to stop abusing heroin on their own relapse in order to alleviate the unpleasant symptoms. For this reason, many people will need a professional detox setting to withdraw from heroin safely.

Signs and Symptoms of Addiction

Because of the power of deceit and denial, it can be difficult to discern whether you or a loved one has developed an addiction to heroin. Some signs and symptoms of heroin abuse, which are likely to be seen in some combination in those with addiction, may include:

  • Physical symptoms:1,3,4,5
    • Constricted pupils.
    • Slowed movements.
    • Slurred speech.
    • Profound drowsiness.
    • Intermittent loss of consciousness.
    • Severe itching.
    • Weight changes.
    • Diminished personal hygiene.
    • Sweating.
    • Impairment of memory or attention.
    • Track marks, collapsed veins, or abscesses from injecting the opioid.
    • Nose bleeds from snorting.
  • Emotional and behavioral symptoms:3,4,5
    • Mood swings or angry outbursts.
    • Unexplained change in personality or attitude.
    • Sleeping at unusual times.
    • Neglecting friends or social activities.
    • Lack of energy.
    • Apathy.
    • Dysphoria, or feelings of dissatisfaction or unease.
    • Impaired judgment.

When someone struggles with a heroin addiction, they will likely exhibit the following:4

  • Continuing to use heroin despite attempts to stop or control use.
  • Experiencing strong and recurrent cravings to use heroin.
  • Using heroin despite interpersonal or social consequences caused by use.
  • Using heroin despite legal, financial, psychological, or medical problems caused by use.
  • Spending a great amount of time acquiring and using heroin.
  • Using higher or more frequent doses of heroin than originally planned.

Heroin users can experience some or all of these symptoms, depending on the severity and longevity of their addiction. An important step towards recovering from an addiction is first recognizing that you have a problem. Acknowledging that your heroin use has negatively impacted you and those around you can help further you down the road toward recovery.

What Happens When You Attempt to Quit?

Heroin dependence, which is the body’s natural adaptation to the presence of the drug, develops as a result of chronic use. Once the body adjusts, a heroin user will require heroin or other opioid drugs to feel and function normally, and if heroin use is dramatically reduced or stopped altogether, unpleasant withdrawal symptoms will emerge.

These symptoms can range from mild discomfort to severe pain and distress. Heroin withdrawal symptoms may emerge within 6–12 hours after the last heroin dose, peak within 1-3 days, and dissipate within 5-7 days.4

Common heroin withdrawal symptoms include:4,6

  • Severe muscle and bone pain.
  • Cold flashes with goosebumps.
  • Diarrhea.
  • Vomiting.
  • Uncontrollable leg movements.
  • Severe heroin cravings.
  • Dysphoric or depressed mood.
  • Anxiety.
  • Sweating.
  • Fever.
  • Insomnia or hypersomnia.

These symptoms can be wildly unpleasant and difficult to endure. Many people continue using heroin or other opioids to avoid or relieve them, thus creating a vicious cycle of use. This is why professional detox and addiction treatment can be so beneficial in helping people stop that cycle and become clean and sober.

Risks of Quitting Heroin On Your Own

While heroin withdrawal is not inherently fatal, complications can arise because of various symptoms. These potential risks include:6

  • Gastrointestinal problems: People may experience severe gastrointestinal symptoms due to vomiting and diarrhea, and these symptoms can cause electrolyte imbalance or dehydration, which can be dangerous when left untreated.
  • Cardiac illness: People with underlying cardiac illness are at risk for complications due to the likelihood of increased blood pressure, pulse, and sweating occurring during withdrawal.
  • Anxiety disorders: People with anxiety disorders or a history of panic attacks may have increased symptoms and safety risk during withdrawal.
  • Intravenous Medical Risks: People who intravenously use heroin are at increased risk for HIV infection, abscesses, injection site infections, and pneumonia, all of which require immediate medical attention and may exacerbate withdrawal syndrome.

Thus, quitting heroin on your own, while achievable, can be risky and potentially life-threatening due to the potential of medical complications.

Where to Get Help

The Substance Abuse and Mental Health Service Administration (SAMHSA) recommends 24-hour medical care as the preferred detox setting for heroin withdrawal. This is recommended on basic principles of medical safety and ethical humanitarian concerns.6

Heroin users can receive detox services in a variety of settings, including:

  • Outpatient detox: This form of detox protocol can be managed out of a healthcare office or in-home setting. In outpatient detox, trained clinicians will conduct regular evaluations and provide referral services when needed. This method is typically reserved for people who have positive, prosocial supports in their home environment.
  • Hospital: Many people detox from heroin in the hospital after experiencing a medical emergency, like an overdose. Staff can provide 24-hour psychiatric and medical monitoring and care.
  • Inpatient detox: Inpatient detox provides around-the-clock support in a detox facility or substance abuse treatment center.

An important component of heroin detox is the use of opioid detox medications. The following drugs may be used throughout the withdrawal process:6

  • Methadone: A full opioid agonist that alleviates withdrawal symptoms and decreases opioid cravings. Since it is an opioid, there is potential for abuse.
  • Suboxone: A combination formula containing buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. Suboxone also reduces withdrawal symptoms and cravings. The addition of the naloxone is designed to deter the user from diversion and misuse.
  • Clonidine: A non-opioid medication that when used in combination with other medications can be effective in managing some withdrawal symptoms.

Detox itself is not a substitute for comprehensive drug addiction treatment, as it does not rectify problematic behaviors associated with heroin abuse. Furthermore, detox alone does not equip the drug user with appropriate coping skills for distress tolerance and mood management. As a result, detox often represents the first step, but it cannot be used to promote long-term sobriety.

Entering a comprehensive addiction treatment program can help heroin users understand more about their addiction, how to cope with triggers, and how to successfully reintegrate back into society.

Sources

  1. National Institute on Drug Abuse. (2017). What is Heroin?
  2. Substance Abuse and Mental Health Service Administration. (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
  3. National Institute on Drug Abuse. (2017). Signs of Heroin Use and Addiction.
  4. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington, D.C.: American Psychiatric Association Publishing.
  5. HelpGuide.Org. (N.D.). Drug Abuse and Addiction.
  6. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment.

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