The Three Stages of Heroin Withdrawal

  February 23, 2018    

What are the different stages of heroin detox, and what can I expect through this process?

The recovery process is different for everyone, and factors like age and length of usage can drastically impact the symptoms, the typical timeline for immediate heroin withdrawal is up to a week, with many symptoms persisting for at least three to six months. In some cases, a patient may deal with heroin withdrawal for years.

Heroin usage is an increasingly dire problem for the United States, with the Center for Disease Control and Prevention approximating that the abuse rates for people aged 18-25 has doubled in the last ten years. The number of opioid overdose fatalities was 42, 249 in 2016 which is five times the number of opioid related deaths since 1999.

Due to heroin’s highly addictive nature, the withdrawal process can not always be completed at home. Often, direct medical help from licensed detox specialists is needed to assist the user as he stops the addiction once and for all. This process is intense, and can lead to very violent withdrawal symptoms, including:

  • Anxiety
  • Sweating
  • Runny Nose
  • Apathy
  • Low Blood Pressure
  • Irritability
  • Depression
  • Restless Leg Syndrome
  • Nausea and Vomiting
  • Insomnia
  • Elevated Heart Rate

One of the main factors when dealing with heroine withdrawal is to distract the user from their pain. If an addict is focused on all the things that can go wrong with the process of detoxification, then often they will over-exaggerate the symptoms. Every twinge of their muscle is a heart attack, and every sad moment is a signal of oncoming depression.

Make sure the addict is near family or friends that are in recovery  for support, and may also benefit from a television, books, or music nearby. Alternatively, vigorous exercise may be beneficial for those who have already undergone the initial detox, or something as simple as going for a walk. Anything to take the mind off the physical symptoms that the body is going through.

Stage 1: Initial Detox

The first forty-eight hours of any drug treatment program are some of the worst in the whole process, but it is even more true with heroin. The body has amazing adaptive abilities to just about any circumstance in life. Removing something the body has come to be dependent on, such as heroin, can send a shock through the system. In this case, it is important to monitor the patient closely to avoid relapse or any accidental (or intentional) self-harm.

Some of the most obvious symptoms of this stage are aches and pains. Sometimes those symptoms  may be accompanied by diarrhea, loss of appetite and insomnia. It is also not unusual for a withdrawal patient to experience anxiety and/or panic attacks. If he or she has a history of mental illness in the family, the patient may need to be placed on a suicide watch as well.

Stage 2: Peak Detox

Heroin Detox peaks around the two-day mark, usually bringing about the most severe of all the symptoms as the body desperately tries to acclimatize to its new processes. For heroin users who have not been using a long time, these symptoms can be relatively mild; for those who have been using heroin for years, or even decades, the symptoms will be more intense.

Usually after the third or fourth day, the symptoms start to subside, and the user is on the path to full recovery, barring any unforeseen circumstances or further relapses. Shivers, prolonged cramping, and vomiting may also intensify during this stage. It is important to keep in mind, however, that every detox experience is different. What may be normal for one person may be completely different for someone else.

During this period, be sure to emphasize proper eating. Not only to help ease dietary distress such as aches and cramping, but also to boost the immune system responses as well. The user may be averse to food at first, but nutrients are vital to the recovery process, giving the body extra energy it needs to fight symptoms.

Stage 3: Downhill Detox

By the end of the first week, most of the symptoms have generally disappeared. Or the symptoms have at least subsided significantly. The user may begin to revert to normal. The user may still suffer from mental or emotional issues, such as anxiety or insomnia, but the physical symptoms, such as diarrhea, nausea, and cramping have most likely passed. At this point, a doctor may allow the patient to return home.

As mentioned before, every experience with heroin detox is different. Anyone may experience and endure these stages for different lengths of time. However, the only way to completely avoid going through them again is by becoming active in long term recovery.


Kurt Cobain, the lead singer of the 90’s grunge band Nirvana said it best in describing the effects that drugs have on the body: “Drugs are a waste of time. They destroy your memory and your self-respect and everything that goes along with your self-esteem.” Heroin detoxification are intense and fraught with temptations. But in the end, dealing with the detox is absolutely worth it.

Remember that there is no fixed point for any of these stages. Symptoms may peak for some people in the first twelve hours. Some may still have physical pains even after the first week. Moreover, there is never a time when the patient is completely “cured”. Most likely, the abuser will struggle with the possibility of a relapse for the rest of their life. Starting on the path to recovery and maintaining a long term recovery program is crucial for finding and maintaining success. A detox is a necessity in the beginning for someone dependent on heroin.

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Michael Satterfield

Michael is currently the Clinical Outreach Coordinator for Soba College Recovery. From the ages of 14-21 was frequently homeless and in drug treatment programs. Michael struggled with Substance Use Disorder. To support his drug habit he burglarized houses and committed robberies. He was arrested at the age of 21 for armed robbery and was sentenced to 10 years in state prison. Upon release, Michael became an active member of the recovery community. Michael graduated from Rutgers in May of 2017 with highest honors. Michael's brother died after buying heroin laced with Fentanyl and overdosing.

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