Heroin withdrawal symptoms and how long they last

13Why do withdrawal symptoms happen?

With repeated use, the body and brain adapt to the presence of heroin, so the brain reduces its natural production of endorphins and other systems become active to make up for the constant suppression. When use stops suddenly, this balance is upset and symptoms appear that are mostly the opposite of heroin's effects: instead of calm, drowsiness and small pupils, there is anxiety, insomnia, enlarged pupils and pain.

14Heroin withdrawal timeline

The length varies from person to person depending on how long and how much the person has used and their health, but the usual course is as follows:

1. 6-12 hours
   The start

   Anxiety and restlessness, frequent yawning, watery eyes and a runny nose, sweating, and a strong craving to use.

2. Days 1-3
   The peak

   Severe muscle and bone aches, abdominal cramps, diarrhea, nausea and vomiting, chills, enlarged pupils and severe insomnia.

3. Days 4-7
   Easing

   The physical symptoms ease gradually, while tiredness, insomnia, poor appetite and mood swings continue.

4. Week 2 onward
   Protracted withdrawal

   Psychological symptoms may continue for weeks or months: insomnia, anxiety, low mood, and cravings that come in waves.

15What determines the severity and length of withdrawal?

• How long the person has used: The longer the period, the more severe and longer the withdrawal.
• Amount and frequency of use: Larger amounts mean greater adaptation by the body.
• Mixing heroin with other substances: Such as sedatives or alcohol, which complicates withdrawal and makes it more dangerous.
• Physical and mental health: Chronic illness, depression and anxiety make withdrawal harder.
• How the person stops: Stopping suddenly without support is much harder than a planned, medically supervised withdrawal.

16Heroin withdrawal compared with other opioids

The timing of withdrawal depends on how long a substance acts: with short-acting opioids, withdrawal starts sooner and ends sooner, and with long-acting ones it starts later and lasts longer:

17Physical and psychological symptoms of heroin withdrawal

18Is heroin withdrawal dangerous?

Heroin withdrawal rarely threatens the life of a healthy person in itself, unlike alcohol and sedative withdrawal, but it is not completely safe:

• Dehydration and electrolyte imbalance from vomiting and diarrhea, especially in older people and people with heart or kidney disease.
• Choking on vomit and the pneumonia it can cause.
• Worsening of existing conditions such as heart disease, because of a faster pulse and higher blood pressure.
• Relapse to escape the pain, which is the most common reason home attempts to stop fail.

19Withdrawal during pregnancy: why is stopping suddenly not recommended?

If a pregnant woman uses heroin, stopping suddenly is not the safe solution, because acute withdrawal can expose the pregnancy to risks such as premature birth, fetal distress and miscarriage. This is why recent medical guidelines recommend approved medication treatment under medical supervision instead of detox during pregnancy.

After birth, the newborn may show what is known as neonatal withdrawal syndrome, an expected condition that the pediatric team monitors and treats. What matters is that the pregnant woman goes straight to a specialist doctor, without fear or shame, who will set up a plan that protects mother and baby together.

20Common myths about heroin withdrawal

21Why is it not recommended to withdraw from heroin at home?

Stopping suddenly at home without medical support means facing the hardest days of withdrawal without medication to ease the symptoms, without monitoring for dehydration and complications, and without protection against relapse. In a medical setting it is possible to:

• Use approved medications that ease pain, anxiety, insomnia and diarrhea.
• Monitor vital signs and fluids around the clock.
• Start medications that reduce cravings and prevent relapse when needed.
• Move straight into a psychological treatment and rehabilitation program.

22How can the family support a person going through withdrawal?

• Encourage them to withdraw under medical supervision instead of stopping alone at home.
• Treat irritability and agitation as part of the symptoms, not as a personal insult.
• Provide a calm environment, plenty of fluids, and light food.
• Do not leave money or opportunities around that make it easy to return to use in the first days.
• Learn the signs of overdose, since the risk rises if they relapse.

23Protracted withdrawal: what comes after the first week?

After the acute physical symptoms end, a person in recovery may go through a period of insomnia, anxiety, mood swings and low energy, with cravings that come in waves, especially when exposed to triggers such as places or people linked to drug use. This stage is one of the periods of highest relapse risk, and it is managed with psychological treatment, medication when needed, regular sleep and activity, and continued support. Knowing that it is a temporary and expected stage helps a great deal in getting through it.

24How are withdrawal symptoms eased medically?

The doctor sets the protocol for each case, and it may include medications that act on opioid receptors to ease withdrawal gradually, or medications that ease particular symptoms such as anxiety, sweating and cramps, along with medications for nausea, diarrhea and sleep, plus fluids, nutrition and rest. None of these medications should be used without medical supervision.