Overview – What are the effects, and withdrawal symptoms for Heroin?
Serious Side Effects:
- Reduced Skin Temperature
- Constricted pupils
- Respiratory Distress
- Low Heart Rate
- Cold Sweats
- Depression and anxiety
- Intense Cravings
- Early symptoms 12 Hours
- Symptoms Peak 24-48 Hours
- 1 Week symptoms subside
- Week 2 and beyond: psychological symptoms, may continue for weeks or months
The Drug Enforcement Agency classifies heroin as a Schedule I drug. Substances in this category are easily abused and highly addictive.
As with many drugs that are so highly addictive, withdrawal from heroin can begin quickly after the user’s last dose. Once physical dependence develops, even a short time without the drug will set the withdrawal process in motion because the brain is prepared to detect even a small drop in the heroin level in the system.
As an opiate, heroin slows heart rate and respiration, and lowers blood pressure and body temperature as it stimulates the brain’s pleasure center.
As the body becomes accustomed to heroin in its system, it attempts to stabilize in its absence, resulting in withdrawal symptoms.
As with all opiates, medical detox is recommended for heroin withdrawal due to the severe discomfort that often accompanies the withdrawal process.
In general, heroin use has increased across the country over the past several years. The Centers for Disease Control and Prevention states that heroin use has doubled among people ages 18-25 in the past 10 years. In addition, as many as 8,200 people died from a heroin-related overdose in 2013.
Symptoms of Heroin Withdrawal
There are many physical symptoms of withdrawal from heroin. Not everyone will experience the same negative effects, and the timeline of withdrawal will vary somewhat from person to person, depending on body composition, co-occurring medical issues, co-occurring mental health disorders, the severity and length of the addiction, and the standard dosage used. General heroin withdrawal symptoms include:
- Nausea and vomiting
- Cold sweats
- Excessive yawning
- Muscle cramps
- Sleep disturbances
- Depression and anxiety
As mentioned, the withdrawal timeline depends on the length and severity of the heroin abuse or addiction. The longer the user has abused heroin and the more heroin generally used, the longer and more severe the withdrawal process. Those who inject heroin tend to become more highly addicted to the drug and often have worse side effects when stopping use than those who smoke or snort it.
Those with long-term addiction problems may anticipate withdrawal, probably having experienced it before. For some, the anticipation of withdrawal can be almost as uncomfortable as the withdrawal itself, leading to ongoing depression, anxiety, and intense cravings. These factors contribute significantly to continued heroin use.
Potential for Overdose
While withdrawal from heroin is usually not fatal or life-threatening, the effects on the body can be harsh. They are often described as similar to a severe case of the flu. One of the dangers for those experiencing these symptoms is that the level of pain and discomfort can be so intense that people may try to alleviate those symptoms with a quick hit of heroin or another addictive drug. Relapse during withdrawal is more likely to lead to overdose, due to the body’s decreased tolerance for heroin, or the user taking a bigger dose than normal in an effort to quell uncomfortable withdrawal symptoms.
An overdose is considered a medical emergency, and prompt medical care is needed to avoid serious health complications, including death.
Signs of a heroin overdose include low blood pressure and heart rate, reduced skin temperature, constricted pupils, respiratory distress, seizures, or coma.
In cases of heroin overdose, emergency medical responders may administer naloxone, a medication that can essentially reverse an overdose, per WebMD. Naloxone can be administered via an injection or nasal spray, and it displaces heroin from opioid receptors in the brain. The medication has a shorter half-life than heroin, however, so medical care is still required after naloxone is administered. If follow-up care is not given, the person could return to an overdose state after the naloxone wears off.
General Timeline and Ongoing Withdrawal Symptoms
While the timeline will vary on an individual basis, symptoms of heroin withdrawal typically begin within 12 hours following the last dose. They peak at 24-48 hours, subsiding after about a week, with milder symptoms still occurring for as long as several months.
The persistence of withdrawal symptoms over an extended time has been called post-acute withdrawal syndrome. These tend to be milder symptoms of withdrawal and may include:
- Rapid mood changes
- Inability to think clearly
- Sleep disturbances
- Poor concentration abilities
- Difficulty managing stress
- Memory deficits
- Difficulty getting along with others
Medications Used in Heroin Addiction Treatment
Due to the discomfort of heroin withdrawal symptoms and the high potential for relapse during withdrawal, medical detox is recommended. In medical detox programs, 24-hour medical supervision is given, ensuring the safety and comfort of clients during the process. Medications are often given to treat specific withdrawal symptoms, such as anti-nausea medications to address vomiting and nausea, and antidepressants to deal with sadness and mood issues.
In addition, replacement medications are sometimes used during medical detox from heroin to slowly wean the person off opiates. Medications that have been approved to treat heroin addiction include methadone, buprenorphine (Subutex and Suboxone), and naltrexone.
Methadone is a longer-acting opioid used to relieve withdrawal symptoms and cravings; however, it does still have potential for abuse and dependency.
Subutex, a brand name for buprenorphine, is a partial opiate antagonist that is believed to have less abuse potential than methadone. Even so, buprenorphine can still be abused by altering its method of intake, such as by snorting or injecting the crushed substance. Suboxone contains buprenorphine and naloxone. The naloxone blocks opioid receptors, thus reducing the ability to abuse the medication.
Naltrexone, also known by the brand names ReVia and Vivitrol, works as a maintenance medication to discourage heroin relapse. The medication binds to opioid receptors in the brain but does not stimulate pleasure or euphoria. If a person takes heroin or another opiate, they will not experience the effects of the drug due to naltrexone’s place on the opioid receptors. As a result, naltrexone serves as a deterrent to abuse heroin and aids in relapse prevention.
The use of any medication during heroin withdrawal or ongoing recovery should be determined on a case-by-case basis by supervising physicians. Medication is never considered effective treatment on its own; it should always be used in combination with therapy.