Timeline Of Heroin Withdrawal


Heroin addiction is characterized by tenacious seeking and compulsive use of heroin, plus an inability to control intake. On the other hand, heroin dependence refers to a person who is susceptible to heroin withdrawal whenever he or she stops using heroin. In other words, heroin addiction is a behavioral syndrome, while heroin dependence is a biological condition.

The other side of heroin dependence is heroin withdrawal, the characteristics of which are a wide range of signs and symptoms that develop following heroin discontinuation. The symptomatology ranges from negative mood to diarrhea to insomnia.

Onset of heroin effects

The onset of heroin’s effects is dependent upon the method of administration. Taken by injection, the effects begin within seconds and typically peak within a couple of minutes. When heroin enters the bloodstream it metabolizes almost instantaneously into 6-monoacetylmorphine (6-MAM) and then crosses into the brain. Once in the brain, it rapidly metabolizes into morphine. Both 6-MAM and Morphine molecules bind to and activate opioid receptors in the brain, and this is what produces the unique heroin high.

How long will heroin withdrawal last?

 Timeline of heroin withdrawal

Onset of heroin withdrawal

Heroin use suppresses the brain because it is a depressant. Conversely, heroin withdrawal hyper-activates the brain. That is why heroin addicts feel restless and suffer long bouts of insomnia during heroin withdrawal. The onset of heroin withdrawal typically begins within 8 hours after the last dose, but for heavy users, withdrawal may begin as quickly as 4 hours after the last dose. The time differences in the onset of symptoms from addict to addict is due to opposing-processes within the brain that develop over time to counter-act the depressant effects of heroin. Consequently, the onset of heroin withdrawal is more aligned with the timing of the next habitual use.

Intensity of heroin withdrawal

The intensity of heroin withdrawal varies by dosage, frequency and duration of use, and the person’s general health.

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, heroin withdrawal will last about a week.

Signs and symptoms of heroin withdrawal

The first signs of heroin withdrawal are typically anxiety, heroin craving and pupil dilation, followed by increased resting respiratory rate (greater than > 16 breaths/min), usually with runny nose, sneezing, loss of energy, hyperkatifeia, 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.

General Order Of Withdraw Symptoms

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

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.


Treatment for heroin withdrawal

Withdrawal 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 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.
  4. Loperamide a.k.a. “Imodium” helps to reduce diarrhea.

Heroin withdrawal treatment a.k.a. heroin detox can take place in a number of 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