What Is Heroin Withdrawal Like?

Early recovery from heroin (opioids) feels like you’re going to die. Fortunately, it’s extremely rare to die detoxing from heroin. detoxing from heroin or any opioids is not pleasant but you can get through it. Getting through the first 30 days of detox is not easy, but countless others (including myself) have been through it. 

Once I got through the first 2 weeks, the light at the end of the tunnel began to come into view. Many people (myself included), think that we will feel normal after the initial withdrawal is over. We expect to go through withdrawal and that’s it. Anyone who has been through those first few months of detox knows it’s going to be a roller coaster of physical and emotional symptoms. Every day that goes by without drugs and alcohol is one more day your body and mind have to repair themselves and get back to a state of equilibrium. 

What Heroin Detox Is Like (Heroin Withdrawal Symptoms):

Heroin withdrawal is often compared to having the Flu. Although the symptoms of both the flu and withdrawal are very similar they are much worse during heroin withdrawal. Nausea, vomiting, cold/hot sweats, chills, muscle aches, and fever are common. These symptoms will peak 48-72 hours after last use. These symptoms typically last 5-7 days, up to 10 days in some cases.  During the first week of heroin withdrawal, the physical symptoms will be the worst. The duration and intensity of withdrawal symptoms will vary based on the amount of drugs used and the period of time over which they were consumed.

Heroin (Opioid Detox) Days 1-10:

Acute withdrawal symptoms will start 8-12 hours after last use. Days 1-10 are going to be the most physically demanding part. These symptoms will resemble Flu symptoms but substantially worse. These may include:

• Nausea
• Diarrhea
• Vomiting
• Chills
• Anxiety
• Muscle aches
• Insomnia 
• Restless Leg Syndrome
• Upset Stomach
• Hot cold flashes
• lack of sleep/Excessive sleep
• Runny Nose
• Agitation
• Cramps
• Goosebumps

During these first 10 days, the urge to get high is going to be through the roof. Your body is going through extreme withdrawal. It will be screaming at you to stop the madness. There are only 2 ways to stop the pain:

1. Get high (start the cycle all over again)
2. Push through this and know there is relief on the other side

Choose To Use

If you choose to use during the withdrawal period, your withdrawal symptoms will temporarily go away, but they won’t be gone. When we use heroin or opioids during withdrawal all we are doing is starting the process all over again. As soon as we run out again…the symptoms will return worse than before. It can be very tempting to use during this period. Your body and brain will be pleading with you to just get high once more. Don’t do it! All it will do is prolong your suffering.

Anxiety

Now that the physical symptoms have subsided the psychological effects of coming off of heroin will increase. Anxiety is very common. Your brain is not used to functioning without drugs. Your brain is confused trying to run normally but doesn’t have the chemical (heroin) that has been flooding it over the past few months or years. This will cause anxiety. This anxiety can range from slight discomfort to full-blown anxiety attacks.

Drug Cravings

Drug cravings during this period become more psychological than physical. Your brain will tell you to get high, that you need more dope. This is due to the fact that during your use your brain slowed down its production of certain chemicals (endorphins, dopamine) because it was getting plenty of them from the opioids. Now that you are not taking opioids, it will take your brain time to start producing endorphins naturally again. Until that period cravings will be more frequent and more powerful.

Cravings are the number one reason people relapse in the first 60 days of withdrawal. You can get through a drug craving. You can get through a drug craving. Remember a craving is only temporary, if you relapse the process will start over. 

Depression

It’s very common for someone coming off heroin or opioids to be very depressed. As explained in the paragraph above, your brain will still be a state of imbalance. It will take time for the brain to start working normally and creating feel-good chemicals again. The key is to continue to do things that naturally help boost your mood (exercise, bonding, healthy diet, fun activities).

Make sure you talk to your support system if you have any thoughts of suicide. If you experience this, do not believe this is permanent. This feeling will pass and become much more manageable as your sobriety continues. More importantly by day 20 the black cloud hanging over your head will start to disappear.

Lack of Energy/Boost of Energy

Most people will experience a lack of energy during this period. This time is similar to coming off of a really bad Flu. You are feeling better from the physical symptoms, but your body and brain are still working overtime to rebuild their energy. Low to moderate activity can help with your energy level. Get outside and go for a long walk or swim a few laps at the local pool. This will help give your body a push back to normal energy levels.

Some people will have the opposite effect during this period. Now that you are on days 11-20 and the physical symptoms have gone away you may get a boost of energy. Getting a boost of energy can be a great motivator during this tough time. I will caution you don’t expect that this is your new normal state. Depending on how long you were using heroin the long-term effects can last months. Although you may get an energy burst on day 14, on day 25 you could slip back into depression, low energy. I tried to take everything slow during my first few months of recovery.

Mood Swings

Mood swings will be common during the first month or two of detox. Many of us addicts spent so many years using drugs and alcohol that we don’t know how to live life sober. One moment we are happy to be alive and happy to be sober, the next we are miserable and depressed. Activities like exercise and meditation can help regulate our moods during this period. 

The longer a person abstains from drugs the more stable their mood will become. The mood swings will not be permanent in most cases. Positive connections with family, friends, and a support group will make these mood swings more manageable. 

Talk with your doctor, medication may be required for some people. 

Days 11-20 of Heroin Withdrawal: 

By day 11 your physical symptoms should be all through, or at the very least subsiding drastically. PAWS (Post-Acute Withdrawal Syndrome) usually begins around this time. At this point, the psychological aspects of withdrawal start to really ramp up. This period is typically when many users relapse due to extreme anxiety and drug cravings. It is very beneficial to have a solid support system to lean on during this time. 

PAWS (Post-Acute Withdrawal Syndrome) usually begins once the acute withdrawal is over.  Common symptoms of PAWS may include

• Anxiety
• Depression
• Drug Cravings
• Insomnia
• Irritability
• Fatigue
• Lack of Energy/Increased Energy
• Mood Swings

PAWS symptoms tend to be more mental and emotional than physical. These symptoms may persist for weeks or months.

Days 21-30 of Heroin Withdrawal:

Post-acute Withdrawal Syndrome will typically continue due to the neurological effects caused by prolonged heroin (opioid) use. Symptoms such as irritability, mood swings, and intense emotions may get worse. Intense heroin (opioid) cravings can persist for months. Certain medications are usually prescribed to help overcome cravings. Cravings will usually lessen and become more manageable with time.

Relief Will Come 

“A little relief…finally. A little bit of normalcy started to creep back into my life at this point. The sun was starting to look bright yellow again, I had a little pep in my step finally.” AR – Recovering Heroin Addict

You will start to feel much better, but don’t get complacent and think it’s all smooth travels. Cravings, depression, anxiety can and will creep up. Post-Acute Withdrawal Syndrome can last months. During this period put your pride away and ask for help if and when you need it.

Having a good recovery program and staying connected is the key to a long and healthy recovery. Outpatient rehab, AA meetings, NA meetings, community groups or just working with or talking with others in recovery can be a huge help. 

Medical Assisted Detox

The best option for coming off of heroin or any substances is under medical supervision at a detox center. These facilities can offer medications to help with the withdrawal symptoms and cravings as well as mental health treatment to deal with anxiety and depression. Drugs like suboxone and methadone are often given to addicts to treat the withdrawal symptoms and cravings. Medically assisted detox has helped thousands of people get off heroin and other opioids. 

PLEASE SEEK PROFESSIONAL MEDICAL SUPERVISION BEFORE BEGINNING ANY MEDICAL TREATMENT OR MEDICATIONS

Related Questions

What can loved ones do to help during detox? It is very important for loved ones to support the person going through detox as well as each other. Family can help make the environment as comfortable as possible for the person detoxing, but do not enable the user. An addict in withdrawal may ask for money to get rid of the pain. Do not give it to them, it will just prolong the misery. It’s up to the addict to get clean. The family needs to be supportive and calm during this period. The person detoxing will be on an emotional and physical roller coaster, having a stable rock to lean on is essential.

Won’t Suboxone or Methadone just be a substitute? Suboxone and Methadone are both powerful prescriptions used in aiding a person detoxing from opioids (heroin). Both of these medicines are physically and mentally addicting. Both of these medicines can also be abused. Using either of these medicines can be considered a substitute or crutch. The pros and cons need to be considered with a medical professional. Considering most people who continue to use heroin end up dead or in jail, I believe choosing suboxone is the better option.