Heroin Detox Centers

Written by: Editorial Staff

Last updated on February 2, 2019

Heroin detox symptoms can be very uncomfortable and hard to manage without medical oversight. Though withdrawal seldom causes serious complications, the symptoms are miserable for most people.

Many people who try to undergo heroin withdrawal at home relapse. If a person relapses after a period of abstinence, their tolerance may have diminished, and they may be at a high risk of accidental overdose. The Centers for Disease Control and Prevention (CDC) reports that heroin overdose deaths quadrupled from 2000­–2015, and almost 13,000 people died in 2015 alone.¹

Withdrawal Symptoms

Detox symptoms vary from person to person, and people may not experience symptoms in the same exact way or with the same level of intensity.

Most people experience some of the following symptoms:^3,5

• Bone or joint aches
• Diarrhea
• Anxiety
• Insomnia
• Restlessness
• Yawning
• Sweating
• Runny nose
• Tearing of eyes
• Dilated pupils
• Goose bumps, or hair standing on end
• Tremors
• Muscle spasms

The severity of these symptoms also depends on age, overall physical health, co-occurring psychiatric disorders, and addiction to other substances, such as alcohol or cocaine.  

How Long Does Heroin Detox Take?

In a typical heroin detox timeline, the first symptoms occur 8–12 hours after the last dose, with the worst of the withdrawal symptoms ending between 3 and 5 days after last use.^3,5

The early symptoms of withdrawal are:²

• Insomnia.
• Agitation.
• Anxiety.
• Aching muscles.
• Runny nose.
• Tearing up of the eyes.
• Sweating.
• Yawning.

The later symptoms are:²

• Dilated pupils.
• Goose bumps.
• Stomach cramps.
• Nausea.
• Vomiting.
• Diarrhea.

Some users may experience protracted or post-acute withdrawal symptoms that can last for weeks after the initial withdrawal phase. These symptoms include fatigue, inability to experience pleasure, insomnia, and low appetite.⁵

Treatment Centers and Facilities

Some heroin detox centers provide a stand-alone detox program and transfer participants to another long-term program for follow-up addiction treatment. Other detox facilities provide both a detox program and subsequent addiction treatment.

Beyond medical care and medications, these facilities can also provide a thorough physical assessment that screens for co-occurring medical issues such as sexually transmitted diseases (STDs), tuberculosis, HIV/AIDs, and hepatitis.

Inpatient withdrawal treatment programs offer detox followed by recovery services such as individual therapy, family therapy, 12-step meetings, group activities, and aftercare planning. The person remains at the program full-time during treatment, which can last anywhere from 30 days to 90 days, on average.

However, not everyone seeking treatment for heroin detox will require a 24/7 program. Other programs provide detox and rehab on an outpatient basis. People participate in a program that may be only a few hours per day, 2–3 days per week, though some outpatient programs can meet daily. The outpatient setting enables people to live at home and continue their daily routine.

Some of the factors that may determine a person’s suitability for a particular treatment can include:

• Overall physical and mental health.
• Addiction to other substances.
• The amount of support available at home.
• How many other attempts at treatment the person made in the past.

A thorough assessment by a substance abuse professional can help determine the best program to suit your needs or those of your loved one.

After Detox

A heroin detox program is the first step in treating addiction. Detox is short-term and will only get the drug out of a person’s body and help manage the symptoms of physical withdrawal. A person with a heroin dependence needs detox followed by more intensive treatment for addiction. Treatment beyond detox is necessary to achieve ongoing recovery and to avoid a relapse.⁵

Medications

Several medications assist with withdrawal from heroin and other opioids. However, not all detox centers have these drugs available. Methadone, for example, can only be prescribed in programs that the Substance Abuse and Mental Health Services Administration (SAMHSA) has certified. Methadone and other medications are most effective when combined with other forms of treatment, such as counseling.⁴

Medications used for detox from heroin and other opioids include:

• Methadone, which helps ease the symptoms of heroin withdrawal as a person works to end their physical dependency upon heroin. Methadone has the potential for abuse and can result in an overdose if used incorrectly. Many people use methadone for long-term maintenance therapy.^2,3,5
• Buprenorphine, which eases the symptoms of physical withdrawal and can shorten the length of time it takes to detox. Buprenorphine can be used to taper people off heroin and other opioids or be used long term, like methadone. It can also be prescribed in a doctor’s office.^2,3,5
• Suboxone, which is the brand name for a drug that combines buprenorphine and the drug naloxone, which blocks the effects of any opioid a person might ingest. The naloxone component blocks the pleasant and addictive effects of opioids, thereby discouraging future abuse of those drugs, including Suboxone itself.²
• Clonidine, which is prescribed in some detox programs to control symptoms such as anxiety, agitation, muscle aches, sweating, and runny nose.²
• Other medications, which may be prescribed for specific symptoms. Non-addictive sleep aids may be used for insomnia; acetaminophen, ibuprofen, and aspirin may be used for headaches and bone pain; and other over-the-counter preparations (e.g., Pepto Bismol, Maalox) may be used to alleviate gastrointestinal complaints (e.g., diarrhea, heartburn).³

Cold Turkey and Rapid Detox

Regardless of the method of detox a person receives, merely getting heroin out of one’s body does not usually halt the progression of addiction on its own.Many people are reluctant to enter a formal detox facility and instead attempt to go cold turkey. Heroin withdrawal is seldom medically dangerous, but occasionally, people can have depression and suicidal thoughts. The lack of medical oversight when someone attempts detox alone is an unnecessary risk to take.

Further, many people find it difficult to make it through a cold turkey detox without using heroin again to relieve the symptoms. A dangerous part of using again after attempting to detox is the potential for overdose if someone begins using his or her usual dose. Given a long enough withdrawal interim, a person’s tolerance can significantly decrease.²

Vomiting, nausea, and diarrhea can also lead to dehydration and electrolyte imbalance.²

Rapid detox and ultra-rapid detox are treatment approaches to opioid detox. They are said to lessen withdrawal symptoms and shorten the detox process, and they have gained popularity in recent years for these reasons. Patients are sedated or put under general anesthesia and given an opioid receptor antagonist, such as naltrexone, to cause them to begin withdrawal. The procedures are generally considered unproven and controversial.³

• One literature review revealed that there had been some adverse medical complications possibly linked to ultra-rapid detox, namely pulmonary edema, suicidal ideation, and diabetes complications.
• In the same review, some evidence suggested earlier peak of and lower scores for withdrawal symptoms, and higher rates for beginning and continuing maintenance treatment, in patients receiving ultra-rapid detox.
• There were no real differences on the rate of abstinence at the 12-week mark following detox, as compared to the usual methods of heroin detox.
• Further, there were no significant differences in the rates of detox completion, or in the length of ongoing treatment, for persons who underwent ultra-rapid detox vs. those who received a more conventional form of treatment.⁶

Regardless of the method of detox a person receives, merely getting heroin out of one’s body does not usually halt the progression of addiction on its own. The underlying reasons for the addiction need to be addressed and resolved through treatment so that those issues do not trigger a relapse.

Sources

1. Centers for Disease Control and Prevention. (2017). Today’s Heroin Epidemic.
2. U.S. National Library of Medicine. (2016). Opiate and Opioid Withdrawal.
3. Substance Abuse and Mental Health Services Administration (SAMHSA). (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45).
4. Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Methadone.
5. Schuckit, M. (2016). Treatment of Opioid-Use Disorders. New England Journal of Medicine. 375: 357–368.
6. Canadian Agency for Drugs and Technology in Health. (2016). Rapid and Ultra-Rapid Detoxification in Adults with Opioid Addiction: A Review of Clinical and Cost-Effectiveness, Safety, and Guidelines.