What Are the Most Common Heroin Withdrawal Symptoms?

For people who are trying to overcome addiction, the most difficult challenge is the symptoms of heroin withdrawal. Stopping or reducing dose of heroin after taking it regularly for some time can cause the body to react to the sudden absence of the drug. This reaction is what leads to the physical and psychological symptoms that are collectively known as heroin withdrawal symptoms.

Although the experience of heroine withdrawal can vary from person to person, it is important to understand what to expect. This knowledge can help seek proper medical care and support during recovery.

Why Does Heroin Withdrawal Occur?

Heroin is an opioid substance that works by binding to receptors in the brain that are responsible for pleasure, pain relief, and reward. Over time, the brain can adjust to the presence of heroin. This then reduces the body’s own natural production of the feel-good chemicals such as serotonin and endorphins. When the use of heroin is suddenly stopped, the brain is left unbalanced. This triggers withdrawal symptoms as the body tries to regain equilibrium. ^[1]

However, difficulty coping through withdrawal symptoms does not mean that the person is weak or lacks willpower. These symptoms are simply the body’s physiological response to dependence.

Common Heroin Withdrawal Symptoms

Symptoms of heroin withdrawal can be grouped into two categories. They can be either early acute symptoms that occur within hours after the last dose. The second category of symptoms are late symptoms that may appear a bit later in the withdrawal timeline.

Early Symptoms (6 to 24 Hours After Last Dose)

These symptoms may begin within the first few hours of stopping heroin. They may include:

• Muscle aches and joint pain are one of the earliest signs. They are caused by the body’s reaction to the absence of opioids.
  
• Restlessness and anxiety suggests that the nervous system has become hyperactive. If unchecked, it can lead to agitation and unease.
  
• Runny nose and watery eyes that are similar to flu-like symptoms may also occur as the body begins to react to opioid withdrawal.
  
• Yawning and excessive sweating are the body’s attempts to regulate temperature and stress.
  
• Insomnia or difficulty sleeping is one of the most common symptoms during early withdrawal.
  

Late Symptoms (24–72 Hours and Beyond)

As withdrawal progresses further, symptoms may typically intensify before they gradually improve over several days. They may include:

• Nausea and vomiting may occur as the digestive system becomes highly sensitive during prolonged abstinence from heroin.
  
• Diarrhea and abdominal cramps are also very common. They can lead to dehydration if they are left untreated.
  
• Goosebumps and chills are often described as some signs of going “cold turkey,”. This is caused due to instability of the nervous system.
  
• Dilated pupils and sensitivity to light are well-known to be hallmark signs of opioid withdrawal.
  
• Increased heart rate and high blood pressure are the body’s stress responses being heightened in response to heroin withdrawal.
  
• Depression and mood swings are psychological symptoms that often persist longer than the physical ones.
  

While withdrawal symptoms can feel severe, they are rarely life-threatening on their own. However, complications such as dehydration, malnutrition, or relapse can be dangerous without proper care.

The Heroin Withdrawal Timeline

The duration of withdrawal depends on factors like the length of addiction, frequency of use, dosage, and individual health status. ^[2]

A typical heroin withdrawal timeline may look like this:

• 6–12 hours: Early symptoms begin, including restlessness and anxiety.
  
• 1–3 days: Symptoms peak in intensity. Muscle pain, diarrhea, vomiting, and cravings are common.
  
• 4–7 days: Symptoms gradually decrease in severity. Fatigue and depression may linger.
  
• 1–2 weeks: Most physical symptoms subside, though psychological symptoms (e.g., cravings, low mood) can persist.
  

Some people may even experience Post-Acute Withdrawal Syndrome (PAWS). These are lingering emotional and cognitive symptoms such as irritability, anxiety, or difficulty concentrating, that may last for months.

Factors That Affect Withdrawal Severity

Withdrawal symptoms are not the same for everyone. There are several factors that can influence how intense or prolonged the symptoms of withdrawal can become.

• Duration and frequency of heroin use: Long-term heavy intake of heroin may cause greater physical dependence and more intense withdrawal symptoms. ^[3]
  
• Route of administration: Injecting or smoking heroin can cause addiction faster and even lead to stronger withdrawal symptoms.
  
• Polydrug use: Taking heroin in combination with alcohol, benzodiazepines, or other opioids can make withdrawal more difficult.
  
• Overall health: Co-existing liver, kidney, and mental health conditions can slow down recovery and prolong withdrawal symptoms.
  
• Access to medical support: Professional supervision can greatly reduce the severity of symptoms and increase the risk of relapse.

When to Seek Medical Help

Stopping heroin intake suddenly without proper medical supervision can be risky. There are medical detox programs that offer a safe and structured environment. In such programs, the symptoms of withdrawal are monitored and managed closely. 

If you or someone you know experiences any of these symptoms, it is important to seek medical help immediately.

• Persistent vomiting or diarrhoea
  
• Signs of dehydration such as dry mouth, dizziness, low urine output
  
• Suicidal thoughts or severe depression
  
• Uncontrollable cravings that increase relapse risk
  

Treatment Options for Heroin Withdrawal

Several evidence-based heroin treatment options are available that can help ease withdrawal symptoms and further support long-term recovery.

Medication-Assisted Treatment (MAT)

MAT combines medications approved by FDA with behavioral therapy. Some of the common medications used in MAT are:

• Methadone is a long-acting opioid that can help reduce cravings and symptoms of withdrawal.
  
• Buprenorphine is a partial opioid agonist. It can helps stabilize the brain’s chemistry which can prevent relapse.
  
• Clonidine is an alpha-2 adrenergic agonist that can be beneficial in MAT by reducing anxiety, muscle aches, and sweating.

Inpatient or Outpatient Detox Programs

Medical detox centres can provide around-the-clock care in cases going through severe withdrawal symptoms. Outpatient programs allow flexibility and are suitable for mild to moderate symptoms.

Behavioral Therapies

Cognitive Behavioral Therapy (CBT) and Contingency Management (CM) are behavioral therapies that can help individuals understand triggers, manage cravings, and develop coping skills for sustained recovery.

Support Groups

Narcotics Anonymous (NA) or SMART Recovery are peer-led support groups. They offer social support and accountability throughout the recovery process.

The Takeaway

Althought it can be highly challenging to recover from heroin addiction, it is absolutely possible with the right support. Overcoming withdrawal is only the first step of recovery. To manage addiction long-term, a combination approach using therapy, social support, and ongoing treatment to address the underlying causes of addiction is needed.