Heroin Withdrawal: Symptoms, Timeline, & Treatment

What Is Heroin Addiction?

Heroin is a semi-synthetic opioid made from morphine derived from opium poppy plants.¹ People can sniff, smoke, snort, or inject heroin or mix it with other drugs, including methamphetamine, crack cocaine, and different opioids. In recent years, dealers began lacing heroin with fentanyl, an opioid 50x stronger than heroin.² This has been driving the opioid overdose epidemic.

Heroin can be incredibly addicting because it creates a euphoric, rush-like effect when it enters the bloodstream. Repeated use causes someone to build a tolerance, which can result in developing physical dependence. Over time, this can lead to addiction, as drug use begins interfering with relationships and daily functioning. Suddenly stopping causes withdrawal symptoms, which can be incredibly uncomfortable and distressing.

What Is Heroin Withdrawal?

The body quickly habituates to opioid use, meaning people must take more heroin in higher quantities to achieve the desired effect. Stopping heroin triggers both physical and psychological reactions because the brain has adjusted to receiving and functioning on opioids. Withdrawal looks different for everyone, but it tends to be more intense for individuals experiencing severe addictions.

Heroin Withdrawal Symptoms

Heroin withdrawal symptoms range from mild to severe. All types of opioid withdrawal can be challenging, although some individuals report that withdrawing from heroin is the most uncomfortable. How long someone uses heroin, how often they use it, how much they use it, and withdrawal from other substances will impact the detox process. Heroin withdrawal is unlikely to lead to death, but it can be fatal in rare cases.³

Short-Term Heroin Withdrawal Symptoms

Short-term heroin withdrawal includes the most acute symptoms someone experiences after stopping heroin. These symptoms can occur anywhere from 6 to 12 hours after the last use, gradually progressing every day. The most intense, distressing symptoms last anywhere from two to eight days. During this window of time, people tend to be vulnerable to relapse.

Short-term heroin withdrawal symptoms may include:

• Insomnia
• Nausea and vomiting
• Sweating
• Elevated body temperature
• Dilated pupils
• Goosebumps
• Muscle spasms and body aches
• Diarrhea
• Increased blood pressure
• Runny nose
• Seizures
• Bone pain
• Depressed mood
• Heightened anxiety
• Appetite changes

Long-Term Heroin Withdrawal Symptoms

Long-term heroin withdrawal symptoms refer to the emotional and physical symptoms that persist after the body has detoxed from opioids. Post-acute withdrawal syndrome (PAWS or protracted withdrawal) can last several weeks or months after the last heroin use, and up to 90% of opioid users experience some symptoms.⁴

Long-term heroin withdrawal symptoms may include:

• Persistent anxiety
• Sleep disturbances
• Chronic depression
• Irritability
• Obsessive-compulsive behaviors
• Cognitive impairments
• Persistent opioid cravings
• Enhanced sensitivity to stress
• General sense of apathy or doom
• Relationship problems

How Long Does Heroin Withdrawal Last?

The withdrawal process begins within the first day of stopping heroin use. Most people find their symptoms peak in intensity within one to three days. After about one week, the most acute withdrawal symptoms tend to subside. However, PAWS can linger for several weeks or months. Every withdrawal process looks different (even when someone has had multiple detox experiences).

Heroin Withdrawal Timeline

Heroin withdrawal symptoms first start emerging several hours after ceasing opioid use. The initial symptoms may feel mild but will increase in intensity. The strongest symptoms occur generally within 48-72 hours. Detox can take about a week, but other medical or psychological symptoms may complicate the process. Withdrawal medications may ease the intensity of some symptoms.

The typical progression of withdrawal symptoms includes: 

• First 48 hours: Initial symptoms may include mood swings, headaches, appetite loss, stomach problems, and insomnia.
• 3-5 days into withdrawal: Physical pain can peak, and people may experience nausea, vomiting, bone pain, muscle aches, and general cramping.
• 6-7 days into withdrawal: Symptoms toward the end of withdrawal can include fatigue, depression, ongoing sleep problems, and persistent cravings.
• PAWS: PAWS may include ongoing depression and anxiety, fatigue, sleep problems, cravings, and relationship distress. People may continue to feel like something is “off.”

Treatment for Heroin Withdrawal

Heroin withdrawal is generally best treated via integrative medical care. People can and do quit on their own, but many need various support, such as individual therapy, group programs, detox support, inpatient/outpatient care, or medication to manage their recovery. Some doctors recommend a safe opioid taper rather than quitting opioids cold turkey.

Medical detox offers ongoing support, supervision, and monitoring during withdrawal. After detox, you may benefit from seeking treatment through an addiction

rehabilitation center (rehab), and your health insurance may subsidize care. Most treatment programs focus on all types of drug addictions and co-occurring mental health issues, as it’s common for people to experience polysubstance use.

At-Home Care for Heroin Withdrawal

It is possible to detox at home, but it’s critical to have a safe environment optimized for your success. Physicians recommend having a supportive person available to help you and keep you accountable. That said, most professional experts agree that, whenever possible, it’s best to seek medical detox when withdrawing from heroin.

Here are tips to help alleviate heroin withdrawal symptoms:

• Stay hydrated: Withdrawal can cause excessive perspiration and diarrhea, sometimes leading to dehydration. Ensure you stay on top of drinking water and consider implementing electrolytes.
• Eat regularly: You need to consume sufficient calories during the withdrawal process. If large meals trigger nausea, eat smaller snacks throughout the day.
• Practice gentle movement: Exercise can be beneficial for your mental health. Even if you just do a few gentle stretches or take a short walk, it can help you feel better.
• Practice self-care: Self-care is a fluid concept, but focus on your emotional needs and wellness during this vulnerable time.
• Stay connected to people who support your recovery: Connection can be vital during the initial stages of detox. Reach out to people who support your recovery goals.
• Try journaling: Sometimes, it can be helpful to unpack your emotions and needs on paper. People often find they feel better after letting it all out.

Treatment for Heroin Abuse & Addiction

Completing detox is the first step toward beginning recovery from heroin addiction. However, detox alone is not sufficient treatment. Opioid treatment success rates vary, but some research shows that over 30% of people who receive treatment remain abstinent from all opioids. Another 30% of people remain sober from heroin while receiving medication-assisted treatment.⁵

Treatment options for heroin addiction may include:

Intensive Outpatient Programs

Intensive outpatient programs (IOP) provide structured clinical support for people recovering from addictions. These programs typically last up to a year, and clients receive individual therapy, group therapy, case management, and ongoing drug testing. These programs allow clients to continue living their usual lives while receiving effective treatment. Many people transition into IOP after completing residential treatment.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) includes medication to support opioid recovery. The FDA has approved buprenorphine, methadone, and naltrexone for people recovering from heroin addiction to manage cravings.⁶ Some may take these medications for just a few months, whereas others take them indefinitely. Many experts recommend combining MAT with therapy and other lifestyle changes to ensure optimal success.

Therapy & Support Groups

Therapy can provide emotional support and practical coping tools to help you during your recovery process. Therapy can also help you unpack the underlying variables, such as trauma, depression, or anxiety, that may have perpetuated your addiction. Group therapy or support groups offer a sense of camaraderie and validate that you aren’t alone in your experiences.

Some therapies that can address addiction and withdrawal symptoms include:

• Cognitive behavioral therapy (CBT): CBT helps people identify and change negative thought patterns, which can help support addiction recovery.
• Dialectical behavior therapy (DBT): DBT focuses on emotional regulation, mindfulness, and distress tolerance, all of which can support heroin withdrawal and recovery.
• Motivational interviewing (MI): MI helps people explore their ambivalence toward change, and it can benefit people struggling with resistance in recovery.

In My Experience

Heroin withdrawal isn’t for the faint of heart, but continuing to use heroin will result in serious emotional and physical consequences. It is possible to heal from addiction, and many people experience a profound sense of transformation during their recovery. If you’re struggling, reaching out for help can be the first step toward dramatic change.