How to Get Off Heroin
People that use heroin quickly develop a strong physical dependence, which is one of the reasons why quitting heroin can be very difficult.1 Medication-assisted treatment (MAT) and medical detox can ease the withdrawal process and mitigate cravings.2
How to Cope with Heroin Withdrawal
Someone who is dependent on heroin will experience withdrawal symptoms when they quit heroin or reduce their use. These symptoms can prompt the person to continue to use to avoid them.3
Medical detox can make the withdrawal process safer and more comfortable, since medical staff is on-hand to monitor patients and administer care and medication when necessary.2
Heroin is considered a short-acting opioid. For this type of opioid, withdrawal symptoms usually begin in dependent individuals 6-12 hours after they use their last dose.4 Symptoms of heroin withdrawal can include:1
- Bone and muscle pains.
- Trouble sleeping.
Short-acting opioid withdrawal symptoms typically are their worst one to three days after use. They then usually lessen over the course of five days to a week. However, people can have some symptoms of withdrawal for weeks or months, such as anxiety, depressed mood, lack of pleasure, and insomnia.4
Cravings can occur during withdrawal and may lead to relapse.1,5 The risk of overdose is heightened in individuals who have gone through opioid withdrawal because their tolerance to opioids is decreased.5 Overdosing on heroin can be deadly.5
Avoiding triggers can help avert relapse. Triggers are activities, people, or locations which lead to the return of cravings.2
Medication is an important part of recovery for many people, especially people dealing with opioid dependence.6 Often, someone will continue taking prescribed medication to mitigate withdrawal and cravings for months or even years.7
Medications for Heroin Detox and Treatment
Heroin may be mixed with other substances.1 Because different samples may have different amounts of heroin, it is unwise to try to taper off heroin itself.
Medication-assisted treatment, or MAT, for addiction to opioids involves the use of an FDA-approved medication for opioid maintenance treatment and/or detoxification.7 A person may be on the medication for months, years, or the rest of their life.8
The Substance Abuse and Mental Health Services Administration states that MAT can:8
- Improve treatment retention.
- Raise survival rates.
- Better enable patients to find and keep a job.
- Reduce use of illegal opioids and other illegal behaviors in those who have substance use disorders (SUDs).
- Help decrease the likelihood of getting hepatitis C or HIV (through lowering the relapse risk).
- Foster better birth outcomes for pregnant women with SUDs.
Before a patient begins MAT, the medical provider will assess them to learn:13
- How long the patient has been misusing drugs.
- Family history as it pertains to addiction.
- If the patient has been taking other medications.
- About the patient’s social and financial situation and unique needs.
- About the patient’s general physical and mental health and any comorbidities or co-occurring disorders.
- Which substances are currently in the patient’s system.
They will then work with the patient to develop a treatment plan. This may include plans for medication, counseling, and follow-up visits. If the medication isn’t working or is causing side effects, the provider may change the dose or switch the patient to a different medicine.10,14
Whether opioid maintenance treatment or detoxification is appropriate for a MAT patient is impacted by whether the treatment is indicated, the patient’s choice, and practicality.2
Since addiction is a treatable chronic illness that encompasses more than physical dependence on a substance, MAT should also include some form of counseling/behavioral therapy.6
Side Effects of MAT Medications
Medication should not be stopped without talking to a medical provider. Some medications used in MAT have to be slowly stopped to avoid withdrawal.10 Each of these medications can have side effects.
Methadone may cause side effects such as:11
- Increased weight.
Buprenorphine may cause side effects such as:11
- Trouble sleeping.
- Trouble paying attention.
- Blurry vision.
- Tongue pain.
- Opioid withdrawal.
Naltrexone may cause side effects such as:12
- Stomach upset.
- Trouble sleeping.
- Muscle and/or joint pain.
Patients should let their medical provider know if they are having any side effects. Seek emergency help if any symptoms are severe.
Overdoses may be deadly. Using methadone or buprenorphine along with a benzodiazepine (such as Xanax or Valium) can increase the risk of deadly overdose.10 Call 911 if you think you or someone else may have overdosed.
Benefits of Medical Detox
Opioid withdrawal is not usually life-threatening. But it can be intense, and people can be affected differently. There are complications that could develop that should be treated quickly by professionals.2 Thus, if a patient is going to detox, it is a good idea to do so under medical supervision.
Whether detox should be done in an inpatient or outpatient setting is influenced by factors including other drug use, social support, physical health, and mental health.15
Suddenly stopping an opioid can cause powerful cravings, which can lead to relapse.16 People in withdrawal from opioids can become dehydrated or develop an electrolyte imbalance from vomiting or diarrhea, although this is uncommon. Heart conditions may be aggravated by some of the possible elements of the opioid withdrawal syndrome, such as increased blood pressure and heart rate. Withdrawal may also make underlying anxiety disorders and/or pain worse. Supervision during detoxification may avert complications.16
Health professionals may provide supportive care and prescribe medications, such as methadone, buprenorphine, or another medicine to ease symptoms.15
Of heroin users, over 90% had other drug use as well, according to the Centers for Disease Control and Prevention.17 Dependence on another drug type in addition to opioids can increase the complexity of detox. Other drug types may cause different withdrawal symptoms and/or may worsen symptoms if they are detoxed at the same time.18 Thus, it’s important for patients to disclose all drugs of use when entering a detox program, and detox programs should perform a urine drug screening. The patient typically should be detoxed from the substances they are dependent on consecutively, starting with the type that has the worst potential withdrawal syndrome.2
Additionally, people going through heroin detox should be screened for medical concerns associated with opioid dependence, such as hepatitis B and C and HIV.2 Rehab centers should provide or arrange for appropriate treatment for any identified medical issues.
Detox alone is often not enough to assist them to stay in recovery long term.19 Therapies such as contingency management or cognitive-behavioral therapy, which are integral parts of rehabilitation treatment are proven to be beneficial for many people with opioid use disorder.1,20 Naltrexone may reduce cravings for opioids and can avert or reduce effects of other opioids if the patient relapses.11
Opioid addiction is a manageable condition. Medication-assisted treatment, which should combine medication use with counseling and other forms of support, can assist a person with addiction to manage the disease.10,12