Heroin is an extremely potent and powerfully addictive illegal opioid drug. The American Society of Addiction Medicine (ASAM) reports that in 2015 almost 600,000 Americans battled addiction to the drug and warns that nearly a quarter of those who abuse heroin will struggle with addiction to it.
Heroin binds to opioid receptors in the brain and can create a rush of pleasure, or a high, due to the increased levels of dopamine it causes with its interaction. Opiates are central nervous system depressant drugs that lower stress and anxiety, promote sedation, and slow down the fight-or-flight response. This means that breathing, heart rate, and blood pressure slow down and body temperature drops with heroin abuse.
Heroin is considered the fastest acting of all the opiate drugs, according to the Drug Enforcement Administration (DEA). This means that the drug takes effect rather quickly but also wears off within a few hours. Individuals may be keen to reproduce the intense high heroin induces, and drug cravings and low moods can occur when it wears off. Taking heroin regularly can cause the brain to become tolerant to its effects, however, and a person will then need to take more of it for the desired impact. Regular use, and escalating dosage, can quickly lead to drug dependence.
Perils of Heroin Withdrawal
Drug dependence sets in when heroin makes physical changes to the functionality and chemical makeup of the brain. Dopamine levels are now dictated by heroin’s disruption, and the brain no longer processes rewards or regulates emotions in the same way it did before. Without heroin, significant drug cravings and withdrawal symptoms can set in.
The National Highway Traffic Safety Association (NHTSA) reports that heroin withdrawal generally begins within six to 6-12 hours of the last dose and can last 5-10 days on average. Withdrawal symptoms are both psychological and physical, and typically peak within the first 2-3 days and then slowly taper off over time.
Heroin withdrawal typically has two main phases: early withdrawal, which lasts the first few days, and late (or acute) withdrawal, which picks up on the second or third day. Depression, sleep issues, drug cravings, and cognitive issues can last longer than 10 days, up to several weeks or months during protracted withdrawal.
Early symptoms of heroin withdrawal include:
- Watery eyes
- Runny nose
- Muscle aches
Acute withdrawal or late symptoms of heroin withdrawal include:
- Stomach cramps
- Nausea and vomiting
- Elevated heart rate and blood pressure
- Muscle, back, and joint pain
- Dilated pupils
- Chills or goosebumps interspersed with sweating
- Muscle spasms
- Loss of appetite
- Trouble feeling pleasure
- Drug cravings
- Significant depression
Heroin withdrawal is not generally considered life-threatening in and of itself; however, it can be intense and tough to manage without professional care. Relapse rates are very high due to the manner in which heroin impacts the brain and its functions. In general, drug addiction relapse rates are between 40 percent and 60 percent, the National Institute on Drug Abuse (NIDA) publishes; however, the Irish Medical Journal reported on a study that followed opiate-dependent individuals following discharge from a detox program and found that 91 percent relapsed, with nearly 60 percent relapsing within the first week.
Relapse during or after detox can be potentially fatal, as the risk for overdose increases. Opioid overdose is one of the biggest public health concerns in America right now. The Centers for Disease Control and Prevention (CDC) reports that 91 people suffer a fatal opioid overdose every day in the United States. A medical detox program followed with a comprehensive treatment program that teaches relapse prevention tools can help to minimize relapse and enhance ongoing abstinence.
Medical Detox for Stability
Heroin withdrawal is physically and mentally draining, feeling like a really bad case of the flu combined with powerful cravings and emotional lows that are especially intense. It may seem easier to go back to using heroin in order to make the symptoms stop.
A medical detox program can minimize the chance of relapse by helping to manage the side effects of withdrawal. A combination of pharmacological, therapeutic, holistic, and supportive measures are beneficial during the withdrawal process. Vital signs and mental health can be supervised and monitored around the clock as medical providers stabilize a person physically.
Malnutrition and poor sleep habits often accompany heroin addiction and dependence, and these issues can be corrected during detox. Behavioral therapies can help a person to better cope with cravings, manage stress, and learn how to deal with potential triggers for relapse.
Medical detox is generally an inpatient program that offers support and care 24/7 for 5-7 days, or however long is needed. Once a person is physically stable, they can progress into a complete heroin addiction treatment program where the bulk of treatment takes place.
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Medications for Heroin Withdrawal
Physical and emotional discomfort are often optimally treated with medications during heroin withdrawal. Opiates like heroin are not recommended to be stopped “cold turkey,” and replacement opioids are often employed instead. These medications can then be slowly tapered off in a controlled fashion to avoid the major shock to the system that can occur when opioids are stopped more suddenly.
Methadone and buprenorphine are prescription opioids that have a longer duration of action than the illegal and fast-acting opiate heroin, and they are often used during detox and opioid addiction treatment. Methadone is generally dispensed once a day through federally regulated clinics, as it is still a controlled substance with abuse potential. Buprenorphine is only a partial opioid agonist; while it does bind to opioid receptors in the brain, it only activates them to a certain extent and therefore does not produce the same high that full agonists like heroin do. It also has a “plateau” effect wherein the opioid agonist action stops working after levels of the drug reach a set amount in the brain.
Buprenorphine is commonly combined with naloxone, an opioid antagonist, to further deter abuse. Combination buprenorphine/naloxone products (Bunavail, Suboxone, or Zubsolv) are typically reserved for later on in opioid addiction treatment, after detox, in order to avoid precipitating withdrawal symptoms.
Medications that are specific to certain side effects of heroin withdrawal are helpful as well. Sleep aids for insomnia, antidepressants to stabilize moods, gastrointestinal medications for stomach upset, and nonsteroidal anti-inflammatory and analgesic medications for pain relief may be used. Some of the central nervous system hyperactivity that is created during heroin withdrawal (e.g., high blood pressure, anxiety, sweating, muscle tension, and agitation) may be reduced by taking clonidine, which is technically a high blood pressure medication. Individuals who also suffer from co-occurring medical or mental health issues may need additional medications to manage those symptoms during detox.
It is important for all medical providers to work together during heroin detox and treatment to design and carry out the ideal treatment plan for the individual. This plan may include medications and various therapeutic interventions.
Holistic Measures to Help Heroin Withdrawal
Medications are not the only avenue for helping to manage heroin cravings and withdrawal symptoms. There are many natural, or holistic, methods that can be beneficial, too. These measures are typically employed as adjunctive, or complementary, to traditional pharmaceutical and therapeutic tools, which means that they are usually used in addition to them and not as replacements for research-based options. Things like nutritional therapy, herbal medicines and supplements, and integrated mental, physical, and spiritual methods can all be beneficial during detox.
Holistic methods may include:
- Yoga and mindfulness meditation: Yoga is a practice that helps individuals to control breathing and body postures in order to ground themselves and work to strengthen the connection between body, mind, and soul. Mindfulness meditation helps a person to be more in tune with their body and emotional state, helping them to recognize when things are off. Meditation may help to alleviate pain, boost the immune system, reduce stress and tension, ease anxiety, and improve moods, Yoga Journal All of these aspects can be beneficial to manage side effects of heroin withdrawal during detox.
- Massage therapy: The act of touch can help to work out muscle tension, reduce stress, and lessen physical pain, helping a person to be better able to concentrate on emotional wellbeing during detox and withdrawal.
- Chiropractic care: This type of therapy is performed by trained professionals who manipulate the body to set things back into alignment. Chiropractic care can help to minimize physical pain and tension, and help the body to function more smoothly.
- Acupuncture: This is the practice of inserting needles into specific points along the body to enhance blood flow as well as the flow of energy, or “chi.” Acupuncture may also improve regulation of the brain’s neurotransmitters like dopamine, which are significantly impacted by heroin addiction, the journal Evidence-Based Complementary and Alternative Medicine
- Biofeedback: A treatment method that can help to rebalance the body and restore natural order, biofeedback and neurofeedback methods can be helpful during detox and addiction treatment. The journal Applied Psychophysiology and Biofeedback reports that EEG (electroencephalographic) biofeedback methods can positively impact brainwaves to help with withdrawal symptoms during acute heroin withdrawal and detox.
Coping strategies and methods for staying busy and occupying the mind can also be beneficial in minimizing relapse and managing cravings during detox. Getting enough sleep and eating balanced and healthy meals can help to restore physical health and enhance healing as well.
During heroin detox, treatment professionals can design an individual treatment plan that uses the optimal combination of various treatment methods for personal recovery. Medical detox can provide a safe and secure environment to allow heroin to process out of the body as smoothly as possible while using pharmacological, therapeutic, holistic, and supportive measures to manage withdrawal symptoms. In addition, medical detox supports readiness for admission into an addiction treatment program that can facilitate and promote long-term recovery.