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

heroin detoxification treatment

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

  • Severity.
  • 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.

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).

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



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