What Are the Phases of Heroin Withdrawal?

People who are hoping to stop using heroin often hesitate because they have experienced the beginning symptoms of withdrawal and become nervous, wondering if the whole process is as uncomfortable as it starts out to be. In many cases, this is enough to discourage individuals from taking the potentially lifesaving step of withdrawing from heroin, and then moving on to treatment and recovery. However, to ensure that one isn’t part of the skyrocketing numbers of heroin overdose deaths, it is vitally important that people make the effort to quit using the drug.

According to the Centers for Disease Control and Prevention (CDC), between 2002 and 2013, heroin overdose deaths increased by a factor of four, and they have only continued to increase since then. This heroin overdose epidemic has become a serious issue for public health and safety; nevertheless, heroin use is still on the rise, and people continue to avoid getting help to quit using the drug.

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What are the Phases of Heroin Withdrawal

  1. Coming down
  2. Stopping use
  3. Early symptoms
  4. Peak symptoms
  5. Decreasing symptoms
  6. Continued recovery

It can help for people who are struggling with heroin abuse to know exactly what the process of heroin withdrawal entails. First and foremost, realizing that a person is far more likely to die from using heroin than from stopping heroin abuse can mark the turning point that enables these individuals to finally make the decision to get help and quit the drug.

The Steps to Heroin Withdrawal

Below is further detail about these steps and how the individual can manage and get through them, making it easier to continue on a path to treatment and recovery

1. Coming Down

Heroin is a high-potency opioid drug that, according to the National Institute on Drug Abuse, interacts with certain pathways in the brain to create a feeling of relaxation, wellbeing, and euphoria. These powerful feelings are the first reason people may find it difficult to stop using the drug, because when the high is over and the individuals come down, the euphoria can transform to a feeling of emptiness. Because of this, in many ways, the process of coming down off a heroin high and the desire to remain in a euphoric state can be the first barriers to stopping use.

The National Highway and Traffic Safety Authority states that some people who use heroin inject or otherwise use the drug up to four times or more per day. This is because people who abuse heroin generally build a quick tolerance to the drug, meaning that they need higher or more frequent doses to get the same effect as the first dose. Avoiding the emotional and mental discomfort of coming down is the reason most people don’t want to stop using the drug. For this reason, the first real step of withdrawal is realizing that it is more important to be able to feel pleasure and wellbeing without the drug than to risk overdose or other complications of using heroin just to stay high.

2. Stopping Use

Once the person has made the decision to take the first step and get off heroin, the next step is undertaken: stopping use. Heroin is considered to have a pretty short high, which is based on its half-life. According to Mental Health Daily, it may be as short as 3-8 minutes, or it can be as long as 30 minutes. Generally, this depends on whether it is injected, inhaled, ingested, or smoked. Regardless, the half-life is something of an indicator of how long it will take for the symptoms of withdrawal to start. Some of these symptoms – identified as part of the come-down process – can begin within hours of stopping use.

Once use is stopped, the combination of losing the high and anticipating the discomforts of withdrawal symptoms can cause a person to preempt the process and return to drug use. However, being prepared to endure the challenges of withdrawal can help the individual stick to the plan and continue to avoid heroin use.

In this case, it is helpful to make sure that the individual has obtained professional help to support the withdrawal process. Working with people who professionally help clients get through the challenge of detox and withdrawal makes it easier to stick to the treatment plan.

3. Early Symptoms

The first phase of withdrawal symptoms starts within about 12 hours of quitting use, according to MedLine Plus. These symptoms include:

  • Agitation, anxiety, and irritability
  • Muscle aches and pains
  • Increased tearing in the eyes and runny nose
  • Sleep disturbances and restlessness
  • Sweating
  • Yawning

There may also be cravings during this phase, which make the individual feel very tempted to start using again, even if the desire to quit is strong. This is the nature of a heroin addiction: The discomfort of the body and mind can often override the desire to quit. Working with a professional to stop using the drug provides methods of relief to avoid relapse during this stage.

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4. Peak Symptoms

Peak symptoms mark the most uncomfortable phase of the withdrawal process. At this point, the digestive system becomes upset, and the individual may experience diarrhea, nausea and vomiting, and stomach cramps. This stage can present the greatest challenge to withdrawal. Various self-care methods can help the individual get through this phase, which can last up to a week, but is usually a few days long. In a medical detox program, staff members will employ a variety of techniques to keep individuals as comfortable as possible.

Some nonaddictive medications, such as antidiarrheal preparations, can mitigate the worst symptoms during this stage. While detoxing at home is not recommended and less successful than getting help with withdrawal, some home remedies suggested by Health Line and other groups can be helpful in easing the peak symptoms. In particular, finding ways to distract from the discomfort can help. Watching funny movies, reading, or engaging in hobbies can be extremely helpful at this point.

In some cases, replacement medications, such as buprenorphine, may be used during heroin withdrawal. The use of these maintenance therapies will essentially eliminate or significantly lessen withdrawal symptoms. Over time, clients will gradually be eased off these medications. Though it lengthens the true detox process, it is the best choice in many instances as clients are able to fully focus on therapy and avoid relapse.

5. Decreasing Symptoms

After a few days, the peak symptoms will begin to subside and the individual may begin to feel that the other side is within reach. Still, the individual can experience some mild symptoms for up to an additional week or so as the body readjusts to functioning without the drug, making the total period of acute withdrawal last 1-2 weeks. This duration mostly has to do with the individual’s particular metabolism, severity of use, and other factors. The Journal of Opioid Management states that, in particular, the duration and severity of individual symptoms depend mostly on the individual’s main symptoms and how severe they are to begin with.

While the main withdrawal symptoms will continue to decrease over time, it is important to note that some symptoms can last for months or even years after ceasing use of the drug. These symptoms include:

  • Cravings
  • Mood swings or depression
  • Some physical symptoms
  • Anxiety

These long-term symptoms – known as post-acute withdrawal syndrome – are another reason that it is important to get help with withdrawal and follow up with comprehensive substance abuse treatment. The support of professionals can help individuals learn to manage the symptoms and avoid relapsing to use due to discomfort.

6. Continued Recovery

The final phase of withdrawal is following through with the decision to get treatment and stay abstinent from further heroin use. This is important, because returning to use after going through withdrawal can result in high potential for overdose.

When an individual stops using a substance that has been abused, the body quickly loses tolerance to the drug. If the person then returns to using the same amounts of the drug as before withdrawal, the body is not able to handle it, resulting in overdose. This is one of the biggest risks of heroin abuse and addiction.

Because of this, completing a treatment program is the most important next step after withdrawal, to provide the person with tools and skills to avoid relapse and remain abstinent. By getting help, treatment, and support, the individual struggling with heroin addiction is more likely to avoid becoming a statistic in the heroin overdose epidemic and has brighter hope for a future of recovery.

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