Heroin Withdrawal and Detoxification Timeline

Heroin Dependence vs Heroin Withdrawal

Heroin Dependence

A biological condition characterized by the development of heroin withdrawal symptoms whenever heroin consumption is discontinued, or more specifically, when heroin blood levels fall below a critical level.

Heroin withdrawal

A cluster of symptoms that develop shortly after cessation. Severe heroin withdrawal is typically treated with medications, vitamins, electrolytes and rest.

Symptoms of Heroin Withdrawal

Most symptoms of heroin withdrawal are somatic (physical in nature). Though a few, such as “restlessness” and “negative emotional state,” are categorized as psychological. One of the more difficult withdrawal symptoms to categorize is insomnia, which is currently categorized as both a somatic and psychological symptom.

What Causes Heroin Withdrawal?

Heroin suppresses different areas within the Central Nervous System, especially the brainstem and spinal cord. When these areas are suppressed they inhibit the functions that these areas control, such as respiration, heart rate and pain awareness. That is why when you administer heroin, you breathe fewer and shallower breathes, have fewer heartbeats per minute, and feel less pain.

Over time, the brain compensates for the presence of heroin by producing stimulants, in particular norepinephrine. Norepinephrine acts in such a way, that it opposes the depressant effects of heroin. Consequently, when a heroin addict quits heroin, the addict’s Central Nervous System (CNS) goes into a hyperactive state. Heroin withdrawal is basically a cluster of after effects caused by a hyper-stimulated Central Nervous System and a lower pain threshold. A lower pain threshold, also known as hyperalgesia, is an unavoidable reaction to taking painkillers, in this case heroin.

How does withdrawal develop?

Heroin withdrawal syndrome typically begins as anxiety, craving and pupil dilation, followed by increased resting respiratory rate (greater than > 16 breaths/min), usually with runny nose, sneezing, loss of energy, negative emotional state, chills, physical pain, and stomach cramps. Later, goosebumps, muscle aches, elevated heart rate in excess of 100 BPM, loss of appetite and energy, nausea with or without vomiting, diarrhea and insomnia.

Intensity of Withdrawal

Heroin withdrawal symptoms can fluctuate among people of similar body mass index, gender and age. But for the most part, the intensity of heroin withdrawal is predicated upon the frequency and duration of use, average daily dose, and the person’s general health.

Range of Symptoms

1 Anxiety
2 Heroin craving
3 Dilated pupils
4 Increased respiration
5 Sneezing
6 Runny nose
7 Loss of energy
8 Negative emotional state
9 Chills
10 Stomach Cramps
11 Physical Pain
12 Goosebumps
13 Muscle Aches
14 Nausea
15 Vomiting
16 Diarrhea
17 Insomnia

Onset of Heroin Withdrawal Symptoms

The timing of the onset of heroin withdrawal typically begins within 7 hours after the last dose. But for heavy longer-term users, withdrawal may emerge within 4 hours after the last dose. The difference between the two is caused by opposing-processes, to wit, epinephrine levels, that get greater over time.

In the beginning of heroin addiction, the onset of heroin withdrawal is directly linked to the rate at which the body metabolizes heroin. Yet as the addiction career progresses, opposing processes, such as the production of norepinephrine, make many of heroin’s effects less and less noticeable, which leads to shorter and shorter dormancy periods between injections. In other words, opposing processes mask heroin’s effects more quickly than the body can metabolize heroin. The result is that the onset of heroin withdrawal becomes more so aligned with the timing of the next habitual use. That’s why new heroin addicts prefer administering heroin approximately 2 or 3 times a day, while longer-term heroin addicts prefer 5 or 6 times a day.

How Long Does Heroin Detoxification Last?

The duration of heroin detoxification is related to heroin’s clearance rate, such that withdrawal symptoms generally escalate for the first couple of days. Peak between 48 – 72 hours, and then recede over the next several days. Generally, from start to finish, the length of heroin detoxification will last about a week.

Post Acute Withdrawal Syndrome (PAWS)

Some individuals show persistent withdrawal signs for months. Extended withdrawal is known as Post Acute Withdrawal Syndrome (PAWS).

Treatment for Heroin Withdrawal

Patients should drink at least 2-3 litres of water per day during heroin withdrawal to replace fluids lost through perspiration and diarrhea. Also provide vitamin B and vitamin C supplements.

Can heroin withdrawal kill you?

It is not a secret that heroin withdrawal is unpleasant, but it is rarely, if ever, life-threatening. Especially if you are in good health. Heroin addicts are much more likely to die from using heroin than from quitting heroin. However, specific symptoms may complicate accompanying medical conditions.

Proxy measuring withdrawal symptoms

One of the secrets of heroin withdrawal is that it can be proxy measured simply by measuring the size of the addict’s pupils. Large pupils are indicators of acute heroin withdrawal, but as time passes and withdrawal symptoms recede, the person’s pupils will inevitably get smaller and return to normal.

Heroin intoxication can also be measured by pupils size. Small pupils are indicators of heroin intoxication. Pinpoint pupils are so consistent with acute heroin intoxication that it is one of the primary indicators of heroin overdose.


Detoxification from heroin can be difficult and can only be mediated within the Central Nervous System, with the exception of diarrhea. This is why “detoxification from heroin” typically involves pharmacotherapies.

  1. Buprenorphine for detox helps reduce the intensity of withdrawal symptoms, and it may shorten the duration of detox.
  2. Methadone for detox helps reduce the intensity of withdrawal symptoms.
  3. Clonidine helps to reduce anxiety, chills, muscle aches, and cramping. It does not help reduce cravings. Clonidine is an alpha-2 adrenergic agonist, that can provide relief to many of the symptoms of heroin withdrawal, including anxiety, insomnia, sweating, diarrhea, vomiting, abdominal cramps, chills, anxiety, insomnia, and tremor. It may also cause drowsiness, dizziness and low blood pressure.
  4. Loperamide a.k.a. “Imodium” helps to reduce diarrhea.

Heroin Detoxification Programs

The primary objectives of detoxification programs are to ease withdrawal, suppress cravings, minimize negative thoughts and avoid relapse. Heroin detox typically utilizes medications, nutrition, including supplementation, hydration, including electrolyte therapy and rest, including the principles of sleep hygiene, to ultimately suppress withdrawal syndrome.

  • At-home, using medicines and a strong support system. (This method is difficult, and should be done under supervision of a medical doctor.)
  • Detoxification facility set up to help people with Heroin Use Disorders.
  • Hospital, if heroin withdrawal symptoms are severe.


Heroin Detoxification Options

A variety of treatment options are available to help men and women kick a heroin habit. The paradigm of heroin detoxification protocols includes; inpatient heroin detox with pharmacotherapy, nutrition, hydration, rest and counseling. This proven strategy helps restore a degree of normalcy to both brain function and behavior, which also decreases the risk of contracting HIV, Hepatitis C and other infectious diseases.