Heroin Detox Treatment
Heroin is an extremely potent and powerfully addictive illegal opioid drug. According to the 2015 report by American Society of Addiction Medicine (ASAM), 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.1
However, even if heroin abuse has progressed to addiction, there are options for effective treatment, and detoxification is often the first step.1
Detoxification is the process of letting the body rid itself of heroin,2 as well as of other associated illicit substances used to cut heroin which may also be present.3
What Challenges Do Heroin Detox Programs Face?
Detoxification is not the same as treatment, nor is it considered sufficient to help a person recover: without subsequent treatment, detox alone is not likely to be effective and the person may quickly resume drug use.4
One of the key challenges to providing effective heroin detox is matching patients to appropriate care.5 Another key challenge heroin detoxification and treatment programs face is that only patients who receive continuing care are likely to have better outcomes in terms of drug abstinence and long-term recovery.5
Perils of Unassisted Heroin Withdrawal
Drug dependence sets in when heroin makes physical changes to the functionality and chemical makeup of the brain.4 Dopamine levels are now dictated by heroin’s disruptive effects, and the brain no longer processes rewards or regulates emotions in the same way it did before.4 Without heroin, significant drug cravings and withdrawal symptoms can set in.4
All individuals struggling with heroin addiction experience similar withdrawal signs and symptoms. However, they may vary in:5
- Time of onset.
- Duration of symptomatology.
- The agent used.
- The duration of use.
- The daily dose.
- The interval between doses.
Heroin withdrawal typically begins 8 to 12 hours after the last heroin dose and subsides within a period of 3 to 5 days.5
Although heroin withdrawal is not generally considered life-threatening in and of itself, it can be intense and difficult to manage without professional care and medications which detoxification programs offer.5
Furthermore, the risk of relapse is high among individuals who attempt to detox from heroin on their own and those who fail to pursue further treatment following detox. According to some estimates, relapse rates among recovering heroin users are estimated to be at a similar level as relapse rates for other chronic diseases, between 40 percent and 60 percent according to the National Institute on Drug Abuse (NIDA).3
Relapse during or after detox from heroin can be potentially fatal, as the risk for fatal or non-fatal overdose increases.5 Currently, the US faces a crisis of overdose deaths from opioids.7
Medical Detox for Stability
Heroin withdrawal can be physically and mentally draining, as the patient undergoes potentially severe withdrawal symptoms and powerful cravings combined with emotional lows that can be especially intense.5 It may seem easier to the person to simply go back to using heroin in order to make these symptoms stop.4
A medical heroin detox program can minimize the chance of relapse by helping the patient manage the side effects of withdrawal. A combination of pharmacological, therapeutic, holistic, and supportive measures are beneficial during the withdrawal process:5
- 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.
One of the key benefits of inpatient detoxification is that it provides 24-hour supervision, observation, and support for patients who are intoxicated or experiencing withdrawal.5 The detox program may last for 5-7 days or longer, and once a person is physically stable and the drug is no longer present in their body, they can progress into a complete heroin addiction treatment program where the bulk of treatment takes place.5
Medications for Heroin Withdrawal Used in Detox Programs
Physical and emotional discomfort are often optimally treated with medications combined with other forms of support during heroin withdrawal. This approach to addiction treatment is known as Medication-Assisted Treatment or MAT.6
MAT uses medications, in combination with counseling and behavioral therapies, to provide an integrated, “whole-patient” approach to the treatment of heroin addiction. MAT relies on the following medications such as:6
- Buprenorphine, which suppresses and reduces cravings for opioids.
- Methadone, which reduces opioid cravings and withdrawal and blunts or blocks the effects of opioids.
- Naltrexone, which blocks the euphoric and sedative effects of opioids and prevents feelings of euphoria.
Medications that are specific to certain side effects of heroin withdrawal are helpful as well:5
- Sleep aids for insomnia.
- Antidepressants to stabilize moods.
- Gastrointestinal medications for stomach upset.
- Nonsteroidal anti-inflammatory and analgesic medications for pain relief may be used.
- Clonidine, while technically a high blood pressure medication, may be used to reduce central nervous system hyperactivity that is created during heroin withdrawal (e.g., high blood pressure, anxiety, sweating, muscle tension, and agitation).
- During detox, additional medications may be used on individuals who also suffer from co-occurring medical or mental health issues.
Holistic Measures to Help Heroin Withdrawal During Detox
Medications are not the only avenue for helping to manage heroin cravings and withdrawal symptoms.7 Holistic measures can be beneficial during detox, and their purpose is to help the patient achieve physical stability and the mental and emotional stability needed to move onto rehabilitation.5
It is important for treatment 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, and it is usually based on an assessment which relies on the ASAM Criteria.8
The ASAM Criteria use six dimensions to define a holistic biopsychosocial assessment of an individual to be used for heroin detox service and treatment planning: 8
- Acute intoxication or withdrawal potential
- Biomedical conditions and complications
- Emotional, behavioral, or cognitive conditions or complications
- Readiness for change
- Continued use or continued problem potential
- Recovery/living environment
Coping strategies and methods for staying busy and occupying the mind can also be beneficial in minimizing relapse and managing cravings during heroin detox.5 Getting enough sleep and eating balanced and healthy meals can help to restore physical health and enhance healing as well.5
During heroin detox, treatment professionals can design an individual treatment plan that uses the optimal combination of various treatment methods for personal recovery.5
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.5
In addition, medical detox supports readiness for admission into an addiction treatment program that can facilitate and promote long-term recovery.5
Frequently Asked Questions
Detoxification is typically the first step in the process of treatment for heroin addiction.2
Abrupt detoxification from heroin can be difficult because of how powerful and addictive the drug is, both physically and psychologically.2 Regular use and escalating dosage can quickly lead to drug dependence and addiction, as well as tolerance to the drug.3
Namely, heroin is a rapidly acting opioid.3 This means that:2
- The drug takes effect rather quickly but also wears off within a few hours, which is referred to as a twilight state.
- Individuals are drawn to reproduce the intense high heroin induces as quickly as possible.
- Drug cravings and changes in behavior can occur as soon as the drug wears off.
Repeated, chronic heroin consumption can cause the brain to become tolerant to the drug’s effects, which means the person will then need to take more of the drug for the desired impact.2
Individuals struggling with addiction may attempt to detox from the drug on their own, but this is unlikely to be successful, as they usually relapse and end up trapped in a vicious circle.2 This is why detoxification in a specialized treatment program typically includes 24/7 supervision and the use of medications.5
Educating patients on the process of withdrawal prior to admission to a heroin treatment program can be useful: typically, withdrawal includes symptoms that are the opposite of the effects of heroin, and the rebound effect can cause anxiety for patients.5
While each treatment-seeking individual is unique and has different needs, detox is often the first step in a drug treatment program.2
In a heroin treatment program, detoxification is the process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal.2
An alternative term for detoxification in a controlled, supervised setting is the term withdrawal management which refers to the process of withdrawing a person from heroin in a safe and effective manner. It encompasses the safe management of intoxication as well as withdrawal.8
After a patient has completed detox, they may be prescribed Naltrexone, which is an opioid antagonist medication.2
Detox has three key components:5
- Medical stabilization.
- Fostering patient readiness for treatment.
Effective detox requires medical stabilization of the patient, which entails a safe and humane method of withdrawal from heroin, followed by entry into treatment.5 If detox is successfully linked with treatment, the risk of repeated withdrawals and other health and safety risks will be much lower. One of the risks of relapsing back into drug use is heroin overdose, which can lead to a fatal respiratory depression.5
Managing withdrawal symptoms without medications is not considered a viable course of action, as it may not be safe or effective.5 What’s more, individuals struggling with heroin addiction tend to have lower tolerance to physical pain and discomfort.5
This is partly why the so-called cold turkey detox is ill-advised as it is not only seldom successful but may also be dangerous.5 In fact, individuals undergoing withdrawal without medications may also exhibit life-threatening symptoms, in addition to severe withdrawal signs and symptoms and great distress.5
Detox strategies are typically designed so as to help staff in a treatment center establish control over the withdrawal syndrome, after which dose reductions can be made gradually.5
Long-term heroin abuse typically has a detrimental effect on the body, but the detoxification process is not without risks either, which is recovering individuals require an adequate level of care during detox.5
Namely, during heroin detoxification, the body goes through withdrawal. Withdrawal can begin within 8-12 hours of the last dose and can last 5-10 days on average.5 Acute withdrawal symptoms may begin to subside within 3 to 5 days.5
Signs and symptoms of heroin withdrawal are both psychological and physical:5
- Rapid heart rate
- High blood pressure
- High body temperature
- Dilated pupils
- Abnormally heightened reflexes
- Increased respiratory rate
- Tearing, watery eyes
- Runny nose
- Muscle aches and spasms
- Abdominal cramps, nausea, vomiting, diarrhea
- Bone, joint and muscle pain
- Agitation, irritability, and anxiety
It is important that heroin detox is followed by subsequent treatment tailored to the person’s needs.4 A medical detox program followed by a comprehensive treatment program that teaches relapse prevention tools can help to minimize relapse and enhance ongoing abstinence.5
In other words, the success of a detoxification process can be measured, in part, by whether an individual who has undergone detox enters and remains in a heroin addiction treatment/rehabilitation program after detoxification.5
Namely, integrated approach to heroin treatment focuses on:4
- Helping patients stop drug use and treating withdrawal.
- Keeping patients in treatment.
- Preventing relapse.
Scientific research shows that pharmacological treatment of heroin addiction increases retention in treatment programs and reduces the risk of relapse:2
- Medications can help ease cravings and manage the potentially severe, overwhelming withdrawal symptoms during the detoxification stage.
- After a successful detox treatment, the person is more likely to pursue evidence-based treatment in a specialized program.
1. American Society of Addiction Medicine. (2016) .Opioid Addiction 2016 Facts & Figures.
2. National Institute on Drug Abuse. (2020).Research Report Series: Heroin.
3. Drug Enforcement Administration. (2017). Drugs of Abuse.
4. National Institute on Drug Abuse. (2020). Drugs, Brains and Behavior: The Science of Addiction.
5. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
6. Substance Abuse and Mental Health Services Administration. (2020). MAT Medications, Counseling, and Related Conditions.
7. Substance Abuse and Mental Health Services Administration. (2020). TIP 63: Medications for Opioid Use Disorder: 2020 Updated.
8. American Society of Addiction Medicine. (2020).The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update.