Withdrawing Heroin

Timeline of heroin withdrawal

What is Heroin Dependence?

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

What is Heroin Withdrawal?

Heroin withdrawal symptoms may vary in intensity and duration, but generally the symptoms are somatic (physical in nature), though a few, such as “restlessness” and “negative emotional state,” are psychological. Insomnia, which is another common symptom of heroin withdrawal, is classified as both a physical and psychological symptom.


Opposing Processes

Heroin suppresses the brain and for that reason is classified as a depressant. But when a heroin addict quits, he or she winds up with a hyper-activate brain. This 180 degree shift is caused by “opposing-processes” within the brain, that develop over time, to counteract heroin’s depressant effects.

The brain’s reaction to heroin is to produce stimulants (opposing processes), in an effort to keep the body working as it should. But when heroin is discontinued, the brain continues to produce stimulants, which leads to a hyper-activate brain, which causes uncomfortable symptoms, such as wakefulness, increased respiration, elevated heart rate, temperature dysregulation (chills and goose bumps) and more.

Onset of heroin withdrawal

The onset of heroin withdrawal typically begins within 7 hours after the last dose, but for heavy longer-term users, symptoms may emerge within 4 hours after the last dose. The difference is caused by increased opposing-processes that get stronger 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 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 bring about discomfort more quickly than heroin metabolism. 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 2 or 3 times a day while long-term addicts prefer 5 or 6 times a day.

How heroin withdrawal develops

Heroin withdrawal develops over time. Typically, withdrawal symptoms begin within hours, get worse over the next two days, peak on day three, and then slowly fade away over the next several days.

Withdrawal symptoms may vary but they usually begin 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. The severity of these symptoms can fluctuate, even among people of similar body mass index, gender and age.

Range Of Heroin Withdrawal Symptoms

The range of heroin withdrawal symptoms may vary somewhat in intensity and duration, but the symptoms themselves are fairly consistent. A person may become nauseous and not vomit, but that is more so a variation in the intensity.

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


Intensity of heroin withdrawal

The intensity of heroin withdrawal varies by dosage, frequency and duration of use, and the person’s general health. In addition, a phenomenon known as “hyperkatifeia” may develop which increases the intensity of negative emotional states that occur during heroin withdrawal.



Duration of heroin withdrawal

The duration of heroin withdrawal is related to its clearance rate, such that withdrawal symptoms generally escalate for the first couple of days, peak between 48 to 72 hours, then begin receding. Generally, from beginning to end, the timeline of heroin withdrawal may be about a week.

How long does heroin withdrawal last?


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. Read More…

Proxy measuring

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.


Detoxifying from heroin can be difficult. The physical symptoms can only be mediated within the Central Nervous System, with the exception of diarrhea. This is why heroin detoxification treatment 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. It can provide relief to many of the physical symptoms of heroin withdrawal, including anxiety, insomnia, sweating, diarrhoea, vomiting, abdominal cramps, chills, anxiety, insomnia, and tremor. It can also cause drowsiness, dizziness and low blood pressure.
  4. Loperamide a.k.a. “Imodium” helps to reduce diarrhea.

Heroin Detox Settings

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


how heroin works