Top 10 Heroin Withdrawal Symptoms

Written by: Editorial Staff

Last updated on March 17, 2021

Repeated use of heroin significantly increases the individual’s risk for developing a physical dependence on the drug.² 

Physical dependence means that chemical and structural changes have occurred within the individual’s body as a result of having gotten used to receiving the drug.

In fact, it is not uncommon for individuals to continue using heroin – even though they would like to stop – in order to fend off symptoms of withdrawal.

Once established, the dependent individual will begin to experience unpleasant symptoms of withdrawal when the drug is not taken or administered at a smaller dose. While most symptoms of withdrawal from heroin that are not medically-induced are not usually life-threatening, they can be intensely uncomfortable and distressing both physically and psychologically.^{1, 2} 

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What Is Withdrawal?

Withdrawal from a substance refers to the group of psychological and physical symptoms that emerge when an individual reduces or stops use of the substance.³

In order for withdrawal to occur, the individual must have taken the substance repeatedly and have developed a physical dependence to the substance.

Physical dependence has developed when the body is no longer able to function at its normal level without the drug.

In most instances of physical dependency, the substance has been taken over an extended amount of time and in large doses. When the body suddenly no longer receives these regular, large doses that it has become used to, it will no longer seem to function normally and will cause a number of uncomfortable or painful symptoms.

10 Most Common Heroin Withdrawal Symptoms

Heroin withdrawal often involves 3 stages of symptoms that unfold over a rough timeframe that spans hours to days since the last instance of drug use.

The first stage of symptoms typically appears up to 6-12 hours after the last heroin dose. Second stage symptoms can appear 8-24 hours after the last dose, and third stage symptoms may appear up to 3 days after the last dose. Symptoms are usually at their worst 24-48 hours after first appearing but may continue for several days.^{3, 4}

Although each individual may experience a unique set of symptoms while going through heroin withdrawal, a few characteristic physiologic and psychological occurrences are seen. Below are some of the most commonly experienced symptoms.

Stage 1 – Heroin Withdrawal

• Cravings. Heroin-dependent individuals have acclimated to a persistent presence of drug in their system. As such, those in the midst of an acute withdrawal may experience intense cravings for the drug their body has grown so used to.¹
• Moodiness. “Moodiness” can include feelings of anxiety, fear of heroin withdrawal, irritability, depression and suicidal thoughts.¹

Stage 2 – Heroin Withdrawal

• Stomach cramps.
• Upper body secretions. You may experience runny nose, sweating and non-emotional tears as part of your stage 2 withdrawal symptoms.
• Restlessness. Your body’s inability to remain calmly still at this stage may also lead to difficulty sleeping through the night (“insomnia”) and yawning. You may be kept awake by symptoms of anxiety, nightmares, body aches, difficulty getting comfortable or restless legs.^{1, 5}

Stage 3 – Heroin Withdrawal

• Diarrhea.
• Fever / chills. You may feel feverish and experience chills and/or goose bumps when going through heroin withdrawal. In conjunction with muscle and joint aches and pains, which are also common symptoms of heroin withdrawal, this can feel much like the you are suffering from the flu.^{1, 5}
• Muscle spasms. Part of stage 3 withdrawal symptoms commonly includes muscle spasms, joint pains or tremors.
• Nausea / vomiting.
• Cardiovascular problems. Heroin withdrawal at this stage may also cause your heart rate and blood pressure to increase.

The Moodiness of Withdrawal

Anxiety

Symptoms of anxiety during heroin withdrawal are also prevalent. These symptoms are likely associated with feelings of withdrawal stress.

Individuals may feel anxiety about entering new territory (i.e., living without heroin) and may feel increasingly anxious or nervous thinking about abstinence.

Irritability

It is not surprising that an individual would experience increased feelings of irritability owing to the stress of enduring heroin withdrawal.

Even a friendly remark or gesture may “set off” the individual, leading them to frequently be rude, cold, or short with friends and family.

Depression

Depression occurs primarily because their body now lacks the ability to create its own sensations of pleasure without the help of heroin.

Some of these specific symptoms can include: negative or low mood, lack of motivation, social isolation and withdraw, anxiety, helplessness, and hopelessness.

Suicidal thoughts

In the most extreme instances of heroin withdrawal, the individual may suffer so much that they begin to feel helpless, hopeless, or lost.

If these symptoms of depression are not closely monitored, they have the potential to escalate to thoughts of suicide.

What Happens in the Body During Heroin Withdrawal?

When developing a physical dependence on heroin, the body begins to produce additional opioid receptors in response to the flood of additional opioids in the system from heroin.[1]

Additionally, a body that has been influenced chemically for so long – bolstered by a consistent presence of the drug – will function sub-optimally when this support is withdrawn. The normal endocrine environment will potentially be inadequate for subjectively normal experiences such as pleasure and pain control. As a result, a withdrawing individual may temporarily develop new disturbances in mood and hypersensitivity to pain.

Severity and onset of withdrawal symptoms, their time of onset and their duration will differ for each individual. The withdrawal syndrome experienced will also be dependent on whether it is accomplished by oneself or with professional help that may include the use of medications. If you are being evaluated for heroin withdrawal syndrome, you can expect to undergo a complete physical examination.¹ The physician may also request that you submit a urine or blood test to confirm heroin use.

Part of the beauty of seeking out professional help or a heroin rehabilitation for help with detox and withdrawal is that you will have a much stronger, immediately accessible support system available – with experienced counselors, supportive interventions and medical or pharmaceutical resources, if required.

Can You Die from Heroin Withdrawal?

Withdrawal from heroin that is not medically-induced is usually not life-threatening, despite the tremendous discomfort you may go through.

However, in emergency cases of heroin overdose or in settings of ultra rapid opioid detox where antagonistic medications (such as naloxone or naltrexone) are used to reverse the effects of heroin – some individuals’ bodies may not be able to handle the sudden chemical and blood flow changes that occur.⁶ 

While these drugs tend to generally have a low incidence of harmful effects, careful use of these drugs and cardiorespiratory monitoring are warranted. Catecholamines in the body can be released from high or rapid doses of naloxone – resulting in cardiac arrhythmias and pulmonary edema.⁷

It should be noted, however, that the medications more typically used used in non-emergency settings (such as methadone or buprenorphine) do not carry this same risk. These medications are more commonly opioid “agonists” that moderately mimic – and not reverse – the effects of heroin.

How to Get Rid of Heroin Withdrawal Symptoms

Withdrawal symptoms will be at their worst if you decide to go through withdrawal by yourself, naturally or unassisted. These uncomfortable symptoms can be greatly lessened, however, if you seek out medical help or a heroin rehab center. 

Heroin rehab programs can help by treating both the psychological and physical effects of drug addiction. There you will be more gradually and carefully weaned off heroin with the help of certain medications and other resources to ease your body’s heroin detox process.

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Sources

1. S. National Library of Medicine Medline Plus: Opiate withdrawal.
2. National Institute on Drug Abuse: Heroin.
3. Preston KI, Umbricht A, Epstein DH. Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance. Arch Gen Psychiatry 2000;57:395-404.
4. Farrell M, Ward J, Mattick R, Hall W, Stimson GV, des Jarlaid D, Gossop M, Strang J. Methadone maintenance treatment in opiate dependence: A Review. British Med J 1994;309:997-1001.
5. Li Q, Li W, Wang H, Wang Y, Zhang Y, Zhu J et al. Predicting subsequent relapse by drug-related cue-induced brain activation in heroin addiction: An event-related functional magnetic resonance imaging study. Addiction Biology 2015;20(5):968-978.
6. Nestler EJ. Under siege: The brain on opiates. Neuron 1996; 16:897.
7. Center for Substance Abuse Treatment. Incorporating Alcohol Pharmacotherapies Into Medical Practice. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2009. (Treatment Improvement Protocol (TIP) Series, No. 49.) Chapter 4–Oral Naltrexone.