6 Heroin Withdrawal Symptoms
Heroin is a highly addictive opioid drug derived from morphine—and it can be incredibly difficult to quit. This is partially due to the intense opioid withdrawal symptoms many users experience as they begin to detox from heroin abuse.
However, heroin addiction symptoms can also be severe. In scenarios where both continuing to use and quitting heroin abuse are extremely hard on the body, giving up on heroin can feel like a zero-sum game early in addiction recovery. This is one of the many reasons why quality support systems are critical in opioid treatment programs.
While this article will touch on heroin addiction symptoms, its main focus will be heroin withdrawal symptoms. We’ll also explore some causes of heroin withdrawal and touch on a few ways users can start their addiction recovery and medical detox journey through a substance abuse treatment program as comfortably as possible.
What Is Heroin Withdrawal?
Opioids and opiates are intended to treat pain in clinical settings. But they’re highly addictive, and even patients who use opioids as prescribed can experience withdrawal symptoms.
Users often experience withdrawal once the concentration of a drug or substance begins to decrease in their bodies. As users build up a tolerance—meaning that they need to take more of the drug to experience their desired effects—their brains become so familiar with having heroin in their system that basic functions become more difficult without it.
For many heroin users, withdrawal exacerbates typical heroin addiction symptoms like irritability, agitation, and gastrointestinal (GI) distress, to name just a few.
The severity of withdrawal symptoms is one of many reasons why it can be so difficult to quit heroin. As they develop higher tolerances and experience more intense addiction symptoms, many users only continue using to find temporary relief from withdrawal.
Causes of Heroin Withdrawal
Let’s explore two major factors that cause heroin users to experience withdrawal:
- Physical dependence – Over time, heroin users develop a dependency on the drug—meaning it’s nearly impossible to function without it. We’ll explore why users become so physically dependent on heroin later in this section.
- Tolerance – We touched on tolerance above, but it’s one of the many underlying causes behind severe withdrawal symptoms. Because users need more of the drug every time they use to experience the same effects, eliminating the drug from their systems altogether can create more intense symptoms based on their previous tolerance increases.
The Brain’s Physical Dependence on Heroin
The brain’s responses to heroin—which facilitate heroin symptoms—can serve as an explanation for extreme physical dependence. When the brain is functioning normally, neurotransmitters bind to neuron receptors to send electrical signals. These signals “tell” the brain to perform various tasks.
But when users introduce heroin (or other opioids) to their system, they can wreak havoc on neuron signaling. Because heroin’s chemical structure is so similar to some neurotransmitters, it can bind to neuron receptors and attempt to send electrical signals. However, heroin only looks similar to neurotransmitters—but heroin doesn’t function in the same ways neurotransmitters do.
When heroin binds to neuron receptors, it disrupts normal signaling between neurons and neurotransmitters, leading to abnormal brain activity.
During heroin exposure, this abnormal activity occurs in three distinct areas in the brain:
- The basal ganglia – The basal ganglia plays a role in motivation and is a key player in the brain’s “reward circuit”—the system that lets the brain know that an activity or substance is pleasurable. Heroin can overload the reward circuit, producing a euphoric high and decreasing the circuit’s sensitivity. Over time, the circuit becomes less likely to identify other sources of pleasure, sending positive signals only when the drug is present in the brain.
- The extended amygdala – One of the roles of the extended amygdala is to manage stress-related emotions—anxiety, agitation, and irritability. Since heroin provides temporary relief from these feelings, the absence of the drug can make it more difficult for the extended amygdala to manage them.
- The prefrontal cortex – Among other roles, the prefrontal cortex powers critical thinking, problem-solving, decision-making, and impulse control. Since all parts of the brain function as a unit, abnormal signaling and activity in the extended amygdala and basal ganglia can diminish functions in the prefrontal cortex—particularly its ability to resist cravings and impulses.
While these abnormalities seem to precipitate mental consequences, these are the result of the brain’s physical dependence on heroin. This physical dependence—coupled with the fact that users can build tolerances quickly—makes withdrawal particularly difficult for heroin users.
3 Short-Term Heroin Withdrawal Symptoms
Let’s begin our exploration of heroin withdrawal symptoms by breaking down three short-term effects users might experience when heroin concentrations begin to decrease in their systems. Users might begin to notice these symptoms within hours of their last dose.
#1 Physical Symptoms
Common heroin addiction symptoms—like gastrointestinal (GI) pain—can become more severe during withdrawal. But, users might experience other physical symptoms unique to the withdrawal phase, including:
- Aching muscles
- Runny nose
- Excessive sweating
#2 Mental Symptoms
A few hours after their last dose, users will begin to experience more severe mental heroin symptoms, including anxiety and agitation.
As we discussed above, this typically occurs because the extended amygdala returns to its highly sensitive state once the concentration of heroin begins to decrease in the body. This abnormal sensitivity is one of many reasons why it can be so difficult to quit using heroin—users often administer another dose to seek temporary relief from increased agitation.
#3 Sleep Disturbance
One of the most common short-term heroin withdrawal symptoms is insomnia—a major disruption of sleep patterns.
Heroin users in withdrawal may have trouble:
- Falling asleep
- Staying asleep for extended periods
- Having quality, restful sleep
Since sleep can play such a central role in memory processing, insomnia can make it more difficult for people to develop self-regulation and coping skills early in their recovery.
3 Long-Term Heroin Withdrawal Symptoms
While short-term symptoms typically peak 24-48 hours after their most recent dose, long-term heroin withdrawal symptoms can persist for a week or more. Some people show signs of persistent withdrawal symptoms during recovery, experiencing the following symptoms multiple months into recovery.
#1 GI Disturbances
GI-specific symptoms during heroin use and withdrawal typically include:
- Nausea and vomiting
- Abdominal pain
Constipation is typically one of the most debilitating symptoms, and it can cause additional, significant issues if left untreated, like:
- Stercoral colitis – Hardening and impaction of fecal matter
- Ischemic colon wall necrosis – Tissue death due to blood flow restriction
- Stercoral ulceration – Infection development in the colon
- Colon perforation – Colon tissue tearing or separation
#2 Additional Physical Symptoms
In addition to GI symptoms, potentially persistent heroin withdrawal symptoms include:
- Cold flashes and goosebumps
- Restless or uncontrollable leg movements
- Dilated pupils
These physical symptoms could be attributed to the brain readjusting its signaling functions in the absence of heroin.
#3 Mental Symptoms
Longer-term mental symptoms of heroin withdrawal can include:,
- Intense cravings – It takes time for the brain to recover from drug addiction, and some brain functions may never be restored to normal. Damage to the prefrontal cortex—the part of the brain partially responsible for impulse control—can make it extremely difficult to resist cravings early in recovery.
- Depression – Since heroin can be so destructive to the brain’s pleasure circuit, withdrawal might produce persistent depression or low mood as the brain readjusts during recovery.3
- Anxiety – Suppression of extended amygdala functions during active heroin addiction can produce intense anxiety or restlessness during withdrawal.3
How to Safely Detox from Heroin
Heroin addiction symptoms can quickly become unmanageable. If you or a loved one experiencing the long-term effects of heroin addiction are ready for recovery, consider these three options for heroin detox—the process of managing the progressive elimination of heroin from the body.
Detox at Home (Most Challenging)
People ready to leave heroin symptoms behind can start their heroin detox at home—but addiction experts don’t recommend this route for everyone.
Detoxing at home can be difficult for a few reasons:
- Isolation – Overcoming withdrawal without a support system can be incredibly difficult—and it can be difficult to resist cravings without external accountability.
- Panic – Withdrawal symptoms can be severe for some. Since withdrawal can produce high anxiety, people detoxing at home alone could start to panic when their symptoms peak.
- Health risks – Vomiting and diarrhea are very common withdrawal symptoms. Diarrhea can put people at risk of severe dehydration. People experiencing intense vomiting could accidentally inhale some of their vomit in a process called aspiration, which could lead to an infection.
Detox in a Traditional Hospital (For Severe Withdrawals)
For people experiencing very severe withdrawals, detoxification in a traditional hospital is an option. Patients will receive supervision and potential treatments for intense symptoms, but social support in this environment might be limited.
Detox in a Treatment Center (For Optimal Support)
For an optimal combination of medical attention and social support, people ready to detox can turn to addiction treatment centers. Plus, treatment centers can provide additional support and services after the detox period—holistic rehab facilities, for instance, may provide:
- Additional social support – Talking with other former users can help newcomers navigate recovery.
- Counseling and mental health services – Drugs—especially heroin—can take a toll on your mental health. Access to mental health treatment or counseling can help newcomers to recovery cope with depression, anxiety, sleep difficulties, and other withdrawal symptoms.
- Accountability – Recovering from an addiction is no small feat. But external accountability in the form of social support or supervision can help prevent relapse.
Safely Detox from Heroin and Start Your Recovery Journey at Elevate Rehab
Heroin addiction symptoms—and symptoms of withdrawal—can be very challenging to overcome.
When it’s time to recover, you and your loved ones need a trusted, robust support system. At Elevate Rehab, we take a holistic approach to detox and recovery. Combining the power of medical treatment, mindfulness, and various rehabilitative therapies, we help people elevate their lives.
While most drug rehab programs only treat the addiction, we treat the whole person. If you’re ready to recover, contact us today.
- National Institute on Drug Abuse. Heroin DrugFacts. https://nida.nih.gov/publications/drugfacts/heroin
- Medline Plus. Opiate and Opioid withdrawal. https://medlineplus.gov/ency/article/000949.htm
- National Institute on Drug Abuse. Drugs and the Brain. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain
- National Institute on Drug Abuse. What Are the Long-Term Effects of Heroin Use?. https://nida.nih.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use
- National Institute on Drug Abuse. Connections Between Sleep and Substance Use Disorders. https://nida.nih.gov/about-nida/noras-blog/2020/03/connections-between-sleep-substance-use-disorders
- Cureus Journal. Spontaneous recurrent Pneumoperitoneum Due to Opioid-Induced Constipation: A Case Report. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303506/
- National Library of Medicine. Overview, Essential Concepts, and Definitions in Detoxification. https://www.ncbi.nlm.nih.gov/books/NBK64119/
- National Library of Medicine. Dehydration and Diarrhea. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791660/
- Medline Plus. Aspiration Pneumonia. https://medlineplus.gov/ency/article/000121.htm
Scott Friend, MSW, M.S.
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