Understanding Heroin Withdrawal Symptoms – What to Expect and How to Manage

What is Heroin?

• Heroin is a highly addictive opioid that is 2-3 times more potent than morphine,
• It usually comes as a white powder which is injected, smoked or snorted.
• Another brown, sticky form called black tar is available. This is usually smoked or snorted.
• The actual potency of the drug and what it contains is unknown. It is often cut with fentanyl and carfentanyl increasing risk of accidental overdose and death.
• Heroin is harvested from the opium poppy plant.
• Afghanistan produces about 75% of the world’s heroin. It usually comes into the US via South America.

Overview of Heroin Withdrawal Symptoms 

Heroin causes respiratory depression, constricted pupils and nausea. Signs of overdose include slow shallow breathing, hypotension, kips / nails turning blue, muscle spasms, convulsions, coma and death.

IV drug use leads to other health issues largely due to sharing needles which increases the spread of HIV, Hepatitis. 

Other medical issues include:

• addiction
• abscesses and infections
• endocarditis (inflammation of the heart)
• pneumonia
• collapsed veins

Signs and Symptoms of Heroin Withdrawal

As a result of repeated use, tolerance sets in, requiring the user to take more heroin to get the same intensity or impact. Physical dependency and addiction grow with repeated use of larger amounts.

When someone has an opioid addiction, they utilize drugs to get high rather than to manage their discomfort.

When a drug is lowered or withdrawn, withdrawal symptoms may appear because the body has grown accustomed to its presence. This is known as physical dependence. 

Drug yearning, agitation, bone and muscle pain, insomnia, diarrhea, vomiting, goosebumps, kicking movements and other symptoms are signs of withdrawal, which in habitual abusers can start as soon as a few hours after the last use.

After the final usage, the most severe withdrawal symptoms peak 48 to 72 hours later and then go away after roughly a week. 

Although heroin withdrawal is thought to be significantly less harmful than alcohol or benzo withdrawal, sudden withdrawal in highly dependent users who are in poor condition can be deadly.

Physical symptoms include:

• Nausea and vomiting 
• Muscle aches and pains 
• Increased heart rate and blood pressure
• Fever, chills, and sweating
• Insomnia and fatigue
• Diarrhea and abdominal cramps
• Depression and anxiety
• Intense cravings for the drug 

How to Manage Heroin Withdrawal Symptoms 

Medication-Assisted Treatment (MAT)

• These medications used during MAR are very effective as they actually block the euphoric effects and take away the painful withdrawal symptoms.
• MAT is effective in helping to maintain abstinence and has an impact on reducing overdoses and deaths. 
• MAT should always be used with therapy (individual counseling and groups) as part of an inpatient or outpatient program.
• MAT provides a whole-patient approach and has much higher success rates than going cold turkey.

What medications?

1. Methadone – this medication has been around since the 1940s and has been used to treat OUD since the 1970s. It works well in reducing pain, cravings and withdrawal symptoms. Methadone has a higher risk for abuse and addiction. 
   
2. Buprenorphine(Suboxone, Subutex) – these medications reduce pain, cravings and withdrawal symptoms and also work on areas of the brain that cause feelings of pleasure. Buprenorphine has a decreased risk of abuse.
   
3. Naltrexone – this medication blocks the effects of opioids, reduces withdrawal symptoms but does not affect the pleasure centers of the brain which reduces the risk of abuse.

These drugs act as agonists, antagonists or a combination of the two by binding entirely or in part to the brain’s opiate receptors.

Agonists and partial agonists act at the same receptors as heroin or other opioids and imitate the effects of the drug. Reduced opioid receptor activation is caused by partial opioid agonists.

Antagonists prevent and counteract the effects of opiates.

These medications make it possible to withdraw from opiates more gradually when taken orally.
For use during opiate detoxification, long-acting intramuscular depot naltrexone (Vivitrol) is potentially a possibility.

Treatment for Heroin Addiction

In terms of treating addiction, there is no one size fits all solution. Optimizing your chances of long-term recovery requires individualized care. It takes into account a lot of the issues that can affect your ability to recover from addiction, such as your ethnicity, gender, age and culture. It also considers your medical, psychological, social, vocational and legal issues.

1. Detox – This is the beginning of the rehabilitation process for most people. It consists of a series of interventions created to assist you in quitting using the substance, remain secure and comfortable while your body goes through withdrawal and get you ready for more therapy.
2. Residential / Inpatient – Throughout the course of treatment, you reside on-site at a facility. You take part in various treatments and are given attention and assistance around-the-clock.
3. Outpatient / IOP – Even though you receive treatment at a facility, you only go there for your sessions or appointments. The care provided will range in intensity.
4. Group Therapy / Support Groups – creating support networks and bonds with peers who have been in your situation helps to create a sense of belonging which is crucial in addiction treatment and successful recovery. 
5. Continuing Care – Recovery is a lifelong commitment that doesn’t end when you leave treatment. Aftercare plans are crucial in helping to maintain relapse, avoid relapse and support long-term recovery. Continuing care options include attending groups, ongoing therapy, sober house program and engaging in self-care.

Behavioral Therapies

During the detox and treatment process, a professional team may use a variety of therapies. These are among the most successful:

1. Cognitive behavioral therapy (CBT) aids patients in altering their present-day mental and behavioral tendencies.
2. The goal of motivational enhancement therapy (MET) is to keep patients motivated while they are recovering.
3. Group / peer therapy is very effective and should be incorporated into all substance use treatment programs. Groups may be non-12-step organizations like SMART Recovery or 12-step based like AA or NA. You might be able to keep up your resolve to abstain from substances and conquer urges by getting support from others who are also in recovery and learning coping mechanisms.
4. Dual Diagnosis treatment – since co-occurring psychiatric disorders like depression or anxiety can affect cravings and your overall success in recovery, it’s crucial to address them.
5. Contingency management (CM) is a type of therapy that uses rewards-based learning. Positive habits are rewarded or exchanged for material products, which encourages you to continue abstaining.
6. Mindfulness-based relapse prevention (MBRP) – Incorporating mindfulness skills is proven to help with uncomfortable cravings and help you maintain a non-judgmental, positive attitude.
7. Distraction strategies or therapies like art and music therapy are helpful ways to relieve cravings and manage symptoms of addiction.
8. Stress management techniques as in yoga. Managing your stress can be a useful strategy for staying sober because stress can contribute to cravings and relapse. Everybody responds to treatment differently, but a study found that yoga may be effective for managing cravings and relapse triggers.

Get Help for Heroin Addiction

If you or a loved one are struggling with heroin addiction, you should seek professional help straight away. Give Luxe Recovery a call to discuss the situation and the treatment options available.