Timeline of Heroin Withdrawal

Timeline of heroin withdrawal

What is Heroin Dependence?

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


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 a few specific areas in the Central Nervous System, especially the brainstem and spinal cord. When these areas are suppressed they inhibit the functions that are controlled by those areas, such as respiration, heart rate and pain awareness. That is why when a person administers heroin, he or she breathes fewer and shallower breathes, has fewer heartbeats per minute, and feels 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, he or she breathes more, has a higher pulse rate and feels pain.

We now know that during heroin detoxification, the addict’s Central Nervous System (CNS) goes into a hyperactive state, because there is less and less heroin available to offset the high levels of norepinephrine. The overabundance of norepinephrine often lasts about a week, as the brain slowly adjusts back to normal. It’s probably the main reason why heroin withdrawal lasts about a week. The typical symptoms of heroin withdrawal include wakefulness, increased respiration, elevated heart rate, temperature dysregulation (chills and goose bumps) and more.


Onset of Heroin Withdrawal Symptoms

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, 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 Withdrawal Last?

The duration of heroin withdrawal is related to its clearance rate, such that withdrawal symptoms generally escalate for the first couple of days, peaks between 48 to 72 hours, and then recedes over the next several days. Generally, from start to finish, the length of heroin withdrawal lasts about a week. However, some individuals have shown persistent withdrawal signs for months. Extended duration of withdrawal is known as Post Acute Withdrawal Syndrome (PAWS).


How does heroin 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.


List 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 Syndrome

The intensity of heroin withdrawal varies by dosage, frequency and duration of use, as well as the person’s general health.The severity of heroin withdrawal symptoms may fluctuate, even among people of similar body mass index, gender and age. Furthermore, a phenomenon known as “hyperkatifeia” may develop which increases the intensity of negative emotional states that occur during heroin withdrawal.


Treatment for Heroin Withdrawal Syndrome

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 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.


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