If you are like most people entering a recovery program for heroin addiction, you are probably somewhat concerned about what is going to happen next. You may be feeling a great deal of anxiety about what detoxing from heroin and going through withdrawal is really like. But there are two pieces of information that may relieve much of your anxiety: FIRST – The days of horrific stories about “cold-turkey” drug withdrawal are over. Addiction science has progressed to a point that heroin withdrawal can be managed much more successfully and comfortably. SECOND, Because we know much more about the medical disease of addiction, there are now more pharmaceutical options that can help greatly reduce drug cravings and alleviate symptoms of heroin withdrawal. Knowing what to expect will help you start off your heroin-free journey of recovery in the best possible way. To that end, let’s look at what happens during your first day of heroin withdrawal.

Listing Heroin Withdrawal Symptoms—Is It Dangerous or Painful

Although heroin withdrawal symptoms can be uncomfortable and even painful, they are not particularly dangerous. In other words, heroin withdrawal will not kill you. Symptoms may be either physical or psychological in nature.

• Extreme anxiety
• Severe agitation
• Restlessness
• Inability to sit still
• Overpowering drug cravings
• Pronounced confusion
• Difficulty concentrating
• Loss of focus
• Demotivation
• Hot and cold flashes
• Aching muscles
• Painful cramping
• Overwhelming fatigue
• Uncontrollable yawning
• Insomnia
• Profuse sweating
• Dilated pupils
• Tearing
• Runny nose
• Sneezing
• Nausea
• Profuse vomiting
• Severe diarrhea
• Dehydration
• A skin-crawling sensation, as if bugs are crawling in or under the skin
• Goosebumps all over the body – the origin of the term “cold turkey”, because the skin will literally look like a freshly-plucked fowl

Perhaps the biggest complaint heard from newly-clean and sober heroin addicts is an almost-total feeling of being generally unwell, as if suffering their worst case of the flu ever. This sensation of being ill is the origin of the term “dope sickness”.

How Soon Does Heroin Withdrawal Begin?

The first symptoms of heroin withdrawal begin to manifest rather rapidly, within 4 to 12 hours following your last dose of heroin. The longer and more severe the addiction, the faster the symptoms will appear. The very first symptoms typically felt those related to anxiety, such as restlessness and agitation. These symptoms are characterized, not only by the feeling, but also by actual physical symptoms:

• An increased resting rate of respiration of greater than 16 breaths per minute.
• An elevated heart of over 100 beats per minute.

This is also when you will start to feel strong drug cravings that will intensify over the next few days. To be prepared for these, because these cravings will eat away at your self-confidence and resolve. Even at this early point, you might start wondering if you can make it through the process. You might start questioning if you have made a mistake in trying to give up heroin. Don’t worry – you haven’t. Those creeping doubts are just the addiction speaking.

Symptoms Start to Build

Over the course of the rest of the first day of heroin withdrawal, you will begin experiencing more and more symptoms – the confusion/mental fog, the inability to concentrate or focus, hot and cold flashes, sneezing, yawning, tears, and runny nose. On top of everything else, you will start to feel as if you are “coming down with something”, as the dope sickness begins to take hold. At the end of that first day, you might feel completely exhausted and you might not be able to stop yawning. You will probably find it difficult to fall asleep, however, and your insomnia might add to your anxiety and frustration. When you make it through your first heroin-free alive a relatively unscathed, you should rightfully feel a profound sense of accomplishment. You have taken a very difficult first step.

Looking Forward – How Long Does Heroin Detox/Withdrawal Take?

Between the second and third day, your severity of symptoms will peak and be at their worst. After the peak, your symptoms begin to slowly lessen in intensity. The entire initial heroin detox process typically lasts around five days. Again, this is dependent on your own personal history with heroin – length and severity of addiction, method of use, etc. In the rarest and most severe cases, detoxing from heroin may take up to two weeks. Of special relevance, some people will experience a condition known as Post-Acute Withdrawal Syndrome (PAWS). In this case, those individuals will experience withdrawal symptoms lasting for several months, albeit to a far lesser degree.

Should I Quit Heroin on My Own?

In the past, someone who was trying to completely quit heroin only had two choices – abruptly going cold turkey and stopping all opioid use or checking into a methadone program to gradually reduce cravings. Heroin is one of the most-addictive substances in the world and trying to stop using without taking advantage of every available tool at your disposal only makes your task that much harder. Addiction has been called a “cunning and baffling” disease that is too large a foe for you to face alone. This means there is NO REASON for you to withdraw from heroin without medication assistance. Because here’s the good news – with the right medications and with proper counseling and support, 95% of people in heroin recovery are able to significantly reduce their illicit opioid use, and two-thirds are able to abstain completely. Those are great odds in your favor.

What is Opioid Replacement Therapy?

Today, most addiction recovery professionals recommend a treatment option known as Opioid Replacement Therapy (ORT), a process in which opioids of abuse are replaced with a longer-acting opioid that produces less of a euphoric high, and therefore, has less potential for abuse. The replacement medication acts on the opioid receptors of the brain, satisfying cravings, and ORT is an effective treatment strategy because it allows you to achieve a large measure of stability in the other areas of your life because of reduced cravings and lessened withdrawal symptoms. In turn, this stability allows you to focus better on your continued recovery. Both the United Nations Office on Drugs and the World Health Organization endorse ORT as an effective first-line treatment option. Other general advantages of ORT are:

• Medically-assured dosage and purity.
• Maintenance programs provide structure and accountability, both necessary components of recovery.
• Helps reduce the spread of the infectious blood-borne diseases that are associated with intravenous drug use, such as Hepatitis, HIV, and AIDS.
• Connections to drug treatment programs.
• Reduces crime.

What Are the Approved ORT Medications?

There are three main ORT medications:

• Methadone– Methadone maintenance treatment (MMT) is the preferred option for heroin/opiate addicts who find it overly-difficult to maintain their sobriety. MMT allows you to resume a productive life.

Not only does MMT reduce cravings, daily attendance at a methadone clinic provides needed structure. Ideally, your methadone dosage can be slowly tapered over time, until you are able to maintain sobriety on your own.

• Buprenorphine– Growing in common usage,buprenorphine medications are considered first-line ORT options, equally valid as methadone. But because buprenorphine is a partial opioid agonist, it has advantages over methadone, a full agonist.

Methadone’s effects increase with dosage, bit buprenorphine’s effects eventually plateau.  This “ceiling affect” means they do not increase, even at higher dosages. This includes both the intoxicating and the respiratory-depressing effects. And when the chosen ORT medication is Suboxone, a buprenorphine/naloxone combination drug, it also acts as a deterrent, because any illicit opioid use can trigger opioid withdrawal.

• Naltrexone – The injectable formulation of this medication, known as Vivitrol, is a good deterrent option once heroin detox and withdrawal are complete. Not only does it completely block the effects of heroin and other opioids, it also triggers immediate withdrawal if ANY opioid is used at any point.

Determining which ORT medication—if any— is right for you is a conversation to have with your doctor and your addiction treatment team. But the #1 takeaway is this—unlike struggling heroin addicts of the past, you have OPTIONS.

Are There Any Other Heroin Withdrawal Medications?

Although they are not specifically for cravings, there are other medications that can be given to alleviate some of the uncomfortable symptoms of heroin withdrawal:

• Clonidine—Although it is primarily used to control high blood pressure, clonidine can help by reducing anxiety, hot and cold chills, and by regulating the nervous system.
• Loperamide—Commonly sold as Imodium, this over-the-counter remedy can help ease the diarrhea experienced during withdrawal.

What’s the Bottom Line About Undergoing Heroin Withdrawal?

There are two important things to keep in mind about detoxing from heroin. FIRST, you don’t have to do it alone. When you check into a medically-supervised detox facility, you will be looked after by a trained and experienced staff that will support you, encourage you, keep you safe, and make you as comfortable as possible during the entire process. SECOND, if you ever start to feel overwhelmed or unequal to the task—during withdrawal or any other point during your recovery—remember that other people have gone through this and came out the other side ready to move forward on a new sober path in life. If they could do it, so can YOU.