The timeline of heroin detox depends upon each individual and their drug use, but most people overcome withdrawal in between four and ten days. Professional medical detox supports you through this process, helping you to manage symptoms and paving the way for long-term recovery.
Heroin is a potent opioid drug derived from the seeds of opium poppy plants. It comes as a white or brown power or in a black, sticky substance called black tar heroin. Heroin is a highly addictive, illicit drug, classified as a schedule I controlled substance by the Drug Enforcement Agency.
People smoke, sniff, snort, and inject heroin. Injecting heroin comes with additional risks associated with needle sharing, including blood-transmitted diseases like HIV and hepatitis.
Opioid drugs like heroin work by binding to and activating opioid receptors in the brain, spinal cord, and other areas of the body. Our bodies' opioid system regulates many important functions, including pain, pleasure, respiration, motivation, and reward. By activating opioid receptors, heroin can block pain signals and produce the feelings of euphoria that many heroin users seek.
Heroin addiction is when you compulsively seek and use heroin, despite any negative consequences. Heroin is a highly addictive substance and addiction can develop after only a few uses.
Heroin addiction develops due to interactions with our bodies' natural reward systems. Our reward systems are pathways in our brains designed to reinforce life-seeking behaviors such as eating or having sex. When we engage in these behaviors, our bodies release small amounts of neurotransmitters, including dopamine and endorphins (natural opioids), which signal to our brain to repeat the activity.
When you take heroin, your body metabolizes it to make morphine, which quickly travels across the blood-brain barrier, flooding your brain with opioids and dopamine. This alters neuronal connectivity networks, creating strong connections in the brain that produce intense urges to use the substance again. These urges are extremely difficult to resist without effective support.
Changes in neuronal connectivity can be long-lasting or even permanent, triggering urges to use a substance even after years of abstinence. However, addiction treatment programs can go some way to reversing these changes and provide individuals with the skills to manage them.
Physical dependence happens when you repeatedly use heroin over time. Your body gets used to the presence of the substance in the body and begins to adjust its own functions in response. You begin to need more heroin to feel the same effects (known as tolerance) and become dependent on the drug to feel normal.
If you then suddenly stop taking heroin, you experience withdrawal symptoms as your body readjusts. Heroin withdrawal symptoms can be uncomfortable and even dangerous, but with professional medical support, you can safely overcome withdrawal and pave the way for long-term recovery.
Heroin withdrawal can involve emotional, psychological, and physical symptoms. Symptoms can be mild to moderate, depending on several factors including:
Everyone's experience of withdrawal is different, but there are some common symptoms that people typically experience. Physical symptoms are often flu-like, and may include:
Common psychological and emotional withdrawal symptoms include:
While opioid withdrawal is not normally life-threatening, some people can experience severe withdrawal symptoms that are extremely uncomfortable and require medical support. You should never try to quit heroin alone, and always seek the advice of a medical professional.
The timeline of opioid withdrawal depends on an individual's drug use and mental and physical health. For short-acting opioids like heroin, the onset of withdrawal symptoms happens between 8-24 hours after the last use. Acute withdrawal symptoms typically persist for 4 - 10 days.
Some people experience psychological symptoms that persist for several months or even years after they quit the drug. These symptoms are known as post-acute withdrawal symptoms (PAWS). PAWS symptoms are usually mild and often resemble symptoms of mood disorders like anxiety or depression. While experiencing PAWS can be difficult, it is not uncommon, and a mental health professional can help you to manage PAWS and keep your recovery on track.
During medically-assisted heroin detox, medical professionals guide you through the withdrawal process, helping you to safely manage symptoms and cravings.
Medical detox can be inpatient or outpatient. During inpatient detox, you stay in a specialized detox facility for the duration of the withdrawal process. Medical professionals are by your side 24/7 to ensure you are as comfortable as possible and intervene in the case of any medical complications. They may prescribe you medications if necessary.
An outpatient detox involves close monitoring and regular check-ups by a trained professional, while you continue to live at home. Outpatient detox is suitable for milder cases of withdrawal. Because of the potential severity of heroin withdrawal, however, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends 24-hour medical supervision to ensure your safety at all times.
Both inpatient and outpatient detox include an individualized detox plan, requiring the gradual tapering of heroin dosage (as opposed to quitting heroin cold turkey). This helps to reduce withdrawal symptoms, making the process safer and easier.
During heroin withdrawal, doctors will closely observe and monitor your progress, usually involving at least 3 or 4 check-ups a day. They may use the Short Opioid Withdrawal Scale to determine the appropriate management strategy.
The short opioid withdrawal scale lists several symptoms of heroin withdrawal, for which the doctor rates their severity from 0-3 (not present, mild, moderate, and severe).
Clients experiencing mild opioid withdrawal should drink 2-3 liters of water each day to avoid dehydration caused by excessive perspiration and diarrhea. They may also take vitamin B and C supplements and symptomatic treatment.
Treatment for moderate to severe symptoms is the same as with mild symptoms, plus clonidine or opioid medications such as buprenorphine and methadone.
During the withdrawal, doctors may administer both symptomatic and opioid medications.
Some examples of opioid medications are listed below.
Buprenorphine is a partial opiate agonist that binds to opioid receptors instead of heroin, helping to reduce withdrawal symptoms and cravings.
Doctors may start prescribing buprenorphine once withdrawal symptoms begin to show - usually around 8 hours after the last dose of heroin. The dosage should be tailored according to each person's heroin use and reviewed daily, considering how well it controls symptoms and the presence of any side effects.
Because buprenorphine is only a partial opiate agonist, it has a "ceiling effect" whereby the opioid effects level off once an individual reaches a certain dosage. This reduces the potential for misuse and negative side effects.
Methadone is an opiate agonist that works similarly to buprenorphine. However, as a full agonist, it lacks the "ceiling-effect", increasing the risk of misuse. This makes it a less safe treatment for people with mild to moderate opioid disorder, but more effective for severe opioid addictions.
Codeine phosphate helps to alleviate heroin withdrawal symptoms and cravings. It is effective for 90-98% of people. Like other medications, people who have used higher doses of heroin typically need to take higher doses of codeine phosphate, but this should be adjusted according to each individual's response throughout the process.
Clonidine is a non-opioid substance that blocks chemicals in the brain that trigger central nervous system activity, decreasing the length of the heroin detox. Clonidine should not be given at the same time as an opioid substitute.
Clonidine can help alleviate many opioid withdrawal symptoms, including:
Detox facilities are separated from other addiction treatment facilities, offering a quiet and calm atmosphere. You should be able to sleep, rest, meditate, or engage in moderate activities like walking, according to your wishes.
There is no evidence that physical exercise improves withdrawal; on the contrary, it may make symptoms worse and lengthen the heroin detox timeline. You shouldn't be made to do physical exercise if you don't want to.
It's normal to feel anxious or scared during withdrawal. To help alleviate anxiety, staff members should offer accurate and realistic information about the withdrawal process.
You will not be asked to engage in counseling or other psychological therapy at this stage. People in withdrawal often feel vulnerable and confused and wouldn't benefit from counseling. Instead, detox helps get your mind and body ready to engage in the treatment, giving you the time and energy you need to focus on introspection and positive change.
As explained by the National Institute on Drug Abuse in their "Principles of Effective Treatment", detox alone is rarely sufficient to overcome heroin addiction and maintain lasting abstinence. Instead, detox from heroin paves the way for long-term addiction treatment approaches that address the underlying causes of addictive behavior and promote life-long recovery.
In recent decades, extensive scientific research has led to the development of several evidence-based treatment methods proven to help individuals overcome heroin abuse. These include:
Cognitive-behavioral therapy (CBT) is an evidence-based substance abuse treatment proven to help individuals overcome addiction. CBT focuses on the interactions between our thoughts and behaviors, helping to identify negative patterns and change them into more positive ones.
During CBT sessions, you will learn skills and coping mechanisms, such as how to identify triggers and strategies to manage cravings. Research shows that the skills learned in CBT stay with clients after the end of the treatment process, promoting lasting recovery.
Support groups are self-organized meetings where people in recovery come together to share advice and inspiration, and find comfort in shared experiences. Having a strong support system of sober friends or family is an essential part of long-term recovery, and support groups often form an important part of this. Support groups are free and accessible online or in local groups, constituting a reliable source of ongoing support.
Many addiction treatment programs introduce clients to support groups early on in the treatment process to help familiarize them with the setting and fully benefit from the experience. They may also connect you with local groups once you have left the center to guide you through the rest of your recovery journey.
Over half of people living with a substance use disorder also struggle with a co-occurring mental health condition like anxiety or depression. These conditions can drive substance use, which may offer temporary relief from emotional distress. However, in the long run, it often makes symptoms even worse, leading to destructive cycles of poor mental health and substance abuse.
Dual diagnosis programs treat co-occurring disorders alongside addiction, addressing the root causes of drug use. They promote holistic and long-lasting healing that nurtures lasting overall well-being and helps individuals stay away from drugs in the long term.
As with heroin detox, heroin addiction programs offer varying levels of care. Some people stay in a residential treatment center for the duration of treatment, while others continue to live at home throughout the process. Many clients begin in inpatient care before transitioning to outpatient.
If you're unsure what level of care is suitable for you, you can contact your practitioner, a treatment center, or other mental health professionals for expert advice.
The Neuro-Psychiatric Addiction Clinic (NPAC) offers the compassionate and comprehensive care you need to achieve long-term recovery. Our individualized programs support every client to reach their personal goals through a combination of evidence-based treatments and holistic therapies.
As one of the leading addiction treatment and detox centers in the United States, we are committed to offering the highest quality of care alongside state-of-the-art, pioneering treatments from the forefront of addiction science. We complement these methods with traditional therapy approaches and mind-body healing techniques to cater to each client's every need.
Our modern and welcoming center offers 24-hour supervision from medical healthcare professionals, dedicated to your recovery journey.
If you or someone you know is struggling with heroin addiction or dependence, contact us today. We'll guide you to a better future.
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