Heroin Detox & Medication-Assisted Treatment for Opioid Use Disorder

Once a person develops an addiction or physiological dependence to an opioid like heroin, they will likely experience withdrawal symptoms when they stop using.¹ Heroin withdrawal can be extremely uncomfortable—imagine feeling symptoms of the flu, food poisoning or gastroenteritis, anxiety, and depression all at the same time—and without continued treatment following detoxification, most will start using heroin or other illicit opioids again.

There are treatment programs that leverage both medication and other treatment modalities and support services to help you or your loved one complete detox and formal OUD treatment.

Read on to learn more about:

• The symptoms of heroin withdrawal.
• Medically supervised withdrawal and the medications that can help throughout detox
• What MAT (medication-assisted treatment) is and the medications that can help with continued recovery.

Heroin Withdrawal

As a person’s body gets used to the presence of a substance like heroin in their system, they can develop a physiological dependence. This means that they will experience withdrawal symptoms if they abruptly discontinue use or substantially reduce their use of heroin (or another opioid).

Generally, heroin withdrawal is not life-threatening, but it can be extremely uncomfortable, with symptoms that can include (but aren’t limited to):^{1, 2}

• Restlessness.
• Anxiety.
• Insomnia or other sleep difficulties.
• Muscle and bone pain.
• Diarrhea.
• Vomiting.
• Cold flashes with goose bumps.
• Uncontrollable leg movements.

People may experience some withdrawal symptoms in as little as a few hours after their last dose of heroin. Withdrawal symptoms typically peak 24-48 hours after a person’s last dose.¹

Although on average the symptoms subside after about a week, some people experience withdrawal symptoms from heroin that persist for weeks or months after their last dose.¹

Because withdrawing from a substance like heroin can be unpleasant, choosing to detox in a medically-assisted detox program could be a more comfortable experience.

What is Medical Detox?

Medically supervised detox happens in a treatment facility, hospital, or another medical facility. The patient is monitored by medical professionals and receives medication to reduce or possibly eliminate symptoms of withdrawal and reduce cravings for heroin.

Doctors may offer a full opioid agonist, like methadone, or a partial opioid agonist, like buprenorphine, to aid the patient in the discontinuation of illicit opioid use.

Both these medications can be continued following detox for as long as someone diagnosed with an opioid use disorder needs or requires it.

Read on to learn about the specific types of medication that are used to aid with heroin detox and subsequent treatment for opioid use disorder.

Methadone for Heroin Detox and OUD Treatment

Methadone for withdrawal and treatment of heroin addiction has been used since the 1950s.³ It’s a long-acting full opioid agonist that is taken daily (typically orally, as a liquid) by the patient to help manage withdrawal symptoms and cravings for opioids.⁴

It does this by binding with the same receptors throughout the body that heroin binds to, essentially blunting or blocking the effects of illicit opioids like heroin.

Because of its longevity, there is a lot of data for methadone’s effectiveness. Numerous clinical trials have shown that methadone treatment, sometimes called methadone maintenance treatment (MMT), can help reduce mortality, criminal behavior, and rates of HIV in patients who use heroin intravenously.⁵

Methadone has also led to both higher rates of a patient remaining in treatment and lower rates of opioid use versus no treatment and a placebo.⁵

Methadone does carry potential side effects, the most common of which include:⁵

• Constipation.
• Vomiting.
• Sweating.
• Dizziness.
• Sedation.

Methadone also carries several limitations or caveats to use. As a schedule II controlled substance, which means it has a high potential for abuse and dependence,⁶ there are strict guidelines for its use and administration to patients. It’s only available at federally certified opioid treatment programs and in the acute inpatient hospital setting for OUD treatment.

It is important to know, though, that when administered by a healthcare professional and taken as directed, it is much lower in risk that taking an illicit opioid like heroin.³

Buprenorphine for Heroin Detox and OUD Treatment

Buprenorphine is a more recently approved medication for opioid withdrawal and treatment of OUD. It’s a partial opioid agonist that lowers or blocks altogether the effects of other opioids.⁵

Because buprenorphine has a ceiling effect on opioid activity, it is one of the few options for addiction treatment that can be both prescribed and administered outside of specialized opioid treatment programs.⁵

Buprenorphine is available as:⁵

• Buccal film, which a patient sticks to the inside of their cheek and it dissolves over time.
• Tablet that is placed under a patient’s tongue, where it dissolves.
• An implant.
• An injection that is administered right under the skin.

Most common side effects include:⁵

• Constipation.
• Vomiting.
• Headache.
• Sweating.
• Insomnia.
• Blurred vision.

Buprenorphine is commonly found under the brand names Suboxone (a combination of buprenorphine and naloxone) and Subutex.

Buprenorphine is a schedule III controlled substance, which means it has a potential for abuse.⁶ It is generally considered to be safer than methadone, and less likely to be diverted for illicit use. And, like methadone, the risks of continuing heroin use far outweigh the potential for abuse with buprenorphine, if it is taken as prescribed.

What is Medication-Assisted Treatment?

The use of medications in tandem with other treatment modalities, such as behavioral therapy, to treat opioid addiction is known as medication-assisted treatment (MAT).

There are three drugs that may be used during MAT for opioid use disorder:

• Buprenorphine (a partial opioid agonist).
• Methadone (a full opioid agonist).
• Naltrexone (an opioid antagonist).

Medications used during MAT may be continued indefinitely, as patients who stop using OUD medication generally return to illicit opioid use.

When MAT begins during medically supervised detox, buprenorphine or methadone not only ease withdrawal symptoms and cravings, they also are effective in preventing relapse and in retaining patients in treatment programs. Both buprenorphine and methadone are also associated with reduced risk of overdose death.

Naltrexone for Heroin Addiction Treatment

Unlike buprenorphine and methadone, which are opioid agonists that can be used to minimize withdrawal symptoms, naltrexone is an opioid antagonist that blocks the effects of opioids.⁵

When taken prior to an opioid clearing the body (i.e., prior to detoxification), it can precipitate and prolong withdrawal, resulting in unpredictable and life-threatening medical consequences.⁷

Because patients must not be currently dependent on opioids prior to taking their first dose, naltrexone is not often used when a patient enters a drug treatment program with a physiological dependence on opioids.⁵

Naltrexone is available as a tablet taken orally or an intramuscular injection administered every 4 weeks. Studies have shown that oral naltrexone (Revia), which must be taken daily, is not effective in retaining OUD patients in treatment or reducing illicit opioid use (likely due to poor medication compliance).⁵

Injectable naltrexone (Vivitrol), however, is administered every 4 weeks, and has been shown to be effective in both retaining OUD patients in treatment as well as in reducing illicit opioid use.⁵

Naltrexone is not on the DEA’s schedule of controlled substances because the medication does not have abuse or dependence potential.⁵

Medical Detox & Rehab Centers for Heroin Addiction

Medication can be a critical component in treating opioid use disorder, however, other medical, mental health, addiction counseling, and recovery support services can play just as critical a role in recovering from an addiction to heroin or to prescription opioids.

If you or a loved one are ready to stop using heroin or another type of opioid, and are interested in medically supervised withdrawal or medication-assisted treatment, our Admissions Navigators are standing by to answer your questions.