Heroin Withdrawal Timeline


Heroin use in the United States has been rising since 2007.1

What Is Heroin?

Heroin is an illegal, highly addictive opioid drug that’s processed from the seed pod of certain varieties of poppies.2 It’s often a white or brownish powder, but may also be a thick, sticky substance that’s known as “black tar.”3 Heroin can be injected, inhaled, or smoked.3 When administered, the user feels a surge—or “rush”—of pleasure as the drug quickly enters the brain and binds to the mu-opioid receptors.4 These receptors help to regulate pain, hormone release and feelings of wellbeing.4

According to the 2018 National Survey on Drug Use and Health, approximately 5.1 million Americans aged 12 or older reported using heroin at least once in their lives in in 2018, and about 526,000 people aged 12 or older in 2018 had a heroin use disorder.5 The average age of first use of heroin in 2013 was 24.5 years.6

Effects of Heroin Use

The rush user’s experience is also accompanied by dry mouth, skin flushing and a feeling of heaviness in the extremities.7 Some people also experience nausea, vomiting, and severe itching.7 The person’s mental function is clouded, their heartrate and breathing slows and they feel quite drowsy for several hours.7 The withdrawal timeline varies depending on a person’s history of heroin use, the doses regularly taken, and the person’s body composition, among other factors.

Repeated exposure to heroin changes the structure and chemistry of the brain. It can affect abilities in the areas of decision-making, behavior regulation, and responses to stressful situation.8

The body eventually begins to adapt to the drug and tolerance occurs when more and more heroin is required to achieve the same effects.8 When the body starts to rely on heroin to maintain normal functioning, a dependence on heroin has developed. At this point, stopping or reducing heroin use leads to profound withdrawal symptoms.8

Withdrawal Symptoms and Timeline

Once a person who is dependent on heroin stops taking the drug—or any other opioid—the heroin user’s body attempts to readjust.

Heroin withdrawal symptoms appear as early as 4 hours after the last dose of heroin.9 The distressing and uncomfortable withdrawal symptoms are accompanied by anxiety and a craving for the drug, as well as:

  • Sweating.
  • Yawning.
  • Tearing up.
  • Runny nose.
  • Stomach cramps.

These initial symptoms are followed by gooseflesh/goose pimples, tremors, muscle twitching, low blood pressure, nausea, vomiting, stomach cramps, and diarrhea. These symptoms peak within 48 to 72 hours and persist for about a week.9

Although heroin withdrawal can be very unpleasant, it is not typically life-threatening.

Psychological symptoms may linger, and even after withdrawal is over, a heroin user may still feel significant anxiety, trouble sleeping, and drug cravings, which can last for weeks or months.19

Treatment

The first part of treatment includes heroin detoxification, or medically managed withdrawal, which typically includes the following objectives:

  • Alleviate distress and unpleasant physical and psychological symptoms.
  • Prevent life-threatening complications of withdrawal.
  • Provide long-term treatment after withdrawal has subsided.
  • Break the pattern of drug use.

Complications can sometimes occur during withdrawal management increasing the associated health risks. Withdrawal may cause vomiting, which puts a person at risk for aspiration, or breathing stomach contents into the lungs. Aspiration can lead to lung infections. In addition, vomiting and diarrhea can also lead to dehydration, which can involve chemical and mineral imbalances.

Treatment for heroin may also involve medication. A variety of different medications may be used to lessen the symptoms of withdrawal.10 The most commonly used medication is clonidine, which reduces anxiety, muscle aches and cramping, and sweating. Other medications may be employed to treat vomiting and diarrhea.10

In addition to medication, peer-support groups, such as 12-Step programs and others, can assist individuals experiencing withdrawal from heroin and other opiates. Long-term treatment for drug addiction is also recommended after withdrawal has subsided. This may involve self-help programs, inpatient or outpatient treatment, and participation in individual and group therapy.

References

  1. National Institute on Drug Abuse. (2020). Research Report Series: Heroin: Overview.
  2. National Institute on Drug Abuse. (2018). What is heroin and how it is used?
  3. U.S. Drug Enforcement Agency (2020). Drugs of Abuse: Heroin.
  4. National Institute on Drug Abuse. (2018). What effects does heroin have on the body?
  5. Center for Behavioral Health Statistics and Quality. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  6. Lipari, R. N., & Hughes, A. (2013). Trends in Heroin Use in the United States: 2002 to 2013. In The CBHSQ Report. Substance Abuse and Mental Health Services Administration (US).
  7. National Institute on Drug Abuse. (2018). What are the immediate (short-term) effects of heroin use?
  8. National Institute on Drug Abuse. (2018). What are the long-term effects of heroin use?
  9. O’Malley, G. F., O’Malley, R. (2018). Opioid Toxicity and Withdrawal. Merck Manual Professional Work.
  10. Whitten, L. (2006). NIDANotes: Three serious adverse events among 35 ultrarapid procedures were all related to unreported preexisting medical conditions.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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