Heroin Withdrawal Symptoms: How Long Do Symptoms Last?

Chronic use of opioids like heroin can lead to the development of heroin cravings and opioid dependence, which can trigger withdrawal symptoms within hours of a person’s last use.

While heroin withdrawal is rarely fatal on its own, symptoms can be severely uncomfortable. Complications can also arise without medical supervision.

For those who will be entering a drug rehab program, it can help to know common symptoms of heroin withdrawal and the average drug withdrawal timeline.

Learn more about heroin abuse and addiction.

Understanding Heroin Withdrawal Symptoms

Heroin withdrawal symptoms can affect a person physically, psychologically, and affect behavior.

Mild symptoms and moderate symptoms of heroin withdrawal tend to occur during early and late withdrawal, while the most severe symptoms tend to occur during the peak of heroin withdrawal.

Mild heroin withdrawal symptoms:

• muscle pain
• insomnia
• sweating
• chills
• runny nose
• anxiety
• tremors
• nausea

These symptoms may occur during early withdrawal and last throughout the detox period.

Moderate heroin withdrawal symptoms:

• vomiting
• fever
• diarrhea
• depression
• anxiety
• cravings
• fatigue
• changes in heart rate

Moderate withdrawal symptoms may occur as symptoms begin to peak, as well as toward the end of withdrawal.

Severe withdrawal symptoms:

• trouble breathing
• dehydration
• high sodium levels in the blood (hypernatraemia)
• heart failure

These symptoms tend to happen during the most severe part of heroin withdrawal.

Heroin Withdrawal Timeline And Duration

Acute withdrawal from heroin can last up to 10 days, on average.

Post-acute symptoms of withdrawal, such as heroin cravings and depression, can continue for up to a year after a person has stopped using heroin.

Early Heroin Withdrawal Symptoms (6 to 12 hours after the last dose)

Heroin only stays in the body for about six hours. After this, a person will have less than 12 hours before their withdrawal symptoms start.

Symptoms during this stage might include:

• runny nose
• muscle aches
• nausea
• chills
• sweating
• anxiety
• excessive yawning

Peak Of Heroin Withdrawal Symptoms (2 to 3 days after onset of symptoms)

After two or three days have passed on the heroin detox timeline, the physical symptoms are often described as being flu-like.

Symptoms during the peak of heroin withdrawal might include:

• vomiting
• diarrhea
• fever
• depression
• stomach cramps
• goosebumps
• dilated pupils

Several of these symptoms, particularly diarrhea and vomiting, can cause someone to become dehydrated very quickly.

Without medical support, this can potentially lead to high sodium levels in the blood that can contribute to heart failure.

Total Duration Of Symptoms (5 to 10 days)

Most people can get through the bulk of opioid withdrawal symptoms within 10 days if they have a severe addiction. Others may be able to complete the process in only five days.

The total heroin withdrawal timeline for a person will depend on their physical and mental state at the time they begin detox, and whether they receive treatment or medications to help them.

Factors that can affect the timeline and severity of withdrawal include:

• how long someone was addicted to heroin
• how much heroin was normally used
• the delivery method used to get heroin into the body
• whether any other addictive substances were being used with heroin (e.g. benzodiazepines, prescription opioids)

PAWS

Persistent symptoms beyond acute withdrawal are often referred to as post-acute withdrawal syndrome (PAWS).

PAWS can include mood instability, sleep disturbances, difficulty concentrating, anxiety, and intermittent cravings for months after detox.

Understanding PAWS can help people in recovery recognize these experiences as part of the neurological healing process rather than signs of treatment failure. It can also reduce the risk of relapse during this vulnerable period.

Heroin Withdrawal Tips

Withdrawing from heroin can be a distressing and potentially dangerous process, particularly for those with a severe addiction.

Here are heroin withdrawal tips for reducing discomfort:

• Seek support: It’s never a good idea to try and detox from heroin alone.
• Eat and hydrate: Symptoms of heroin withdrawal can be dehydrating and affect appetite.
• Mentally prepare: Getting off heroin isn’t easy. You may feel restless, agitated, depressed, and physically sick during this process. Acknowledge that this may occur and prepare in a way that feels comfortable for you.
• Have a back-up plan: Have emergency numbers nearby, and consider seeking out a detox program for full medical support to help you through this process.

Are Heroin Withdrawal Home Remedies Safe?

Home remedies for heroin withdrawal, such as over-the-counter (OTC) medications for symptoms and herbal supplements, can help alleviate some of the discomfort.

One commonly misused home remedy is loperamide (Imodium), an over-the-counter anti-diarrheal medication. At standard doses, loperamide can help manage withdrawal-related diarrhea safely.

However, high doses, which some people use to try to manage withdrawal symptoms more broadly, can cause life-threatening cardiac arrhythmias. Use only as directed on the label and do not exceed the recommended dose.

Any home remedy alone will not be an adequate treatment for heroin addiction or heroin use disorder. There’s also no telling how the body may react to home remedies.

Within an inpatient program, individuals can be medically supervised, with healthcare professionals on standby should medical complications arise.

Deaths Due To Heroin Withdrawal

Deaths due to heroin withdrawal are rare but can occur under certain circumstances.

This is more likely among people with severe drug addiction or those who lack medical support during detox.

Primary risks of heroin withdrawal include:

• severe dehydration
• electrolyte imbalances

Detox Programs For Heroin Withdrawal

For a person to detox safely from heroin, they should be in a medically supervised setting.

This is the safest and most effective way to stop using heroin, for two primary reasons:

• Preventing relapse: The pain and discomfort of withdrawal can be a trigger for someone to relapse to their drug use, as a means of avoiding or relieving symptoms.
• Medical concerns: It is also important to detox in a rehab center because medical personnel will be available to monitor and treat any health issues that might arise, such as dehydration or high blood pressure.

Within a rehab center, a therapist will be available to discuss and address the additional psychological and behavioral side effects of getting through the heroin withdrawal process.

One of the most dangerous periods for people with opioid use disorder is immediately after completing detox. Tolerance drops significantly during withdrawal, meaning the amount of heroin or fentanyl previously used can now cause a fatal overdose.

Anyone completing detox should have naloxone on hand, inform trusted people in their life of this risk, and be connected to ongoing support before leaving a detox program.

Medication-Assisted Treatment For Heroin Withdrawal

Several opioid treatment medications have been approved for use by the FDA to treat heroin withdrawal.

These medications can:

• ease the discomfort of withdrawal
• stave off drug cravings
• encourage a person to complete detox

Read more about medication-assisted treatment for heroin withdrawal.

Medications used in MAT and detox programs for heroin withdrawal include:

Methadone (Methadose)

Like heroin, methadone is an opioid. Unlike heroin, it is long-acting, meaning it has a longer half-life.

In order to use it, a person has to start out with a high dose at first. Gradually, a health care provider will then decrease this amount, as they monitor the person’s vital signs and symptoms.

Buprenorphine (Suboxone, Zubsolv)

Buprenorphine works similarly to methadone. It is also known under the brand name Suboxone, which contains both buprenorphine and naloxone.

Buprenorphine is a partial opioid agonist. It activates opioid receptors but with a ceiling effect that limits misuse potential and reduces overdose risk compared to full agonists like methadone. It also reduces cravings and withdrawal symptoms, and is available as Suboxone (buprenorphine/naloxone combined) or as a standalone formulation.

Naltrexone (Vivitrol)

Naltrexone (Vivitrol) is an opioid antagonist that blocks the euphoric effects of heroin and other opioids, reducing the risk of relapse.

Unlike methadone and buprenorphine, naltrexone must only be started after a person has completed detox and is opioid-free for at least 7-10 days. Starting it earlier will precipitate severe withdrawal.

Another option is extended-release injectable naltrexone (Vivitrol), which is administered monthly and removes the need for daily dosing.

Clonidine

Clonidine is a medicine that is sometimes used off-label to treat runny nose, sweating, nausea, pain, and anxiety during heroin withdrawal. It does not reduce heroin cravings.

Heroin Withdrawal And Addiction Treatment

Browse our directory or reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) for more information about addiction recovery.

Written by the Addiction Resource Editorial Staff