The home videos of heroin detox proliferate on YouTube. Like a flashing, red-lettered warning about the dangers of drug addiction, they show what quitting heroin cold turkey is really like when attempted on one’s own.
A grown man sweating in a bathtub moans, holding his head between his hands. Another man writhes in pain alone in his jail cell. A teenaged girl cries uncontrollably into the camera, promising this will be the last time…
What many of these brave but misguided souls either don’t know or won’t say is that heroin detox at home is a scary, debilitating and distressing enterprise, because of the various medical issues that arise. They run the gamut from mild to severe. And if heroin detox is to be effective, these symptoms, risks and complications require treatment by drug addiction-certified health professionals in a recovery center or rehab facility, contrary to what the do-it-yourself pros may claim. Here are seven things you should know about the process.
Heroin Withdrawal Syndrome and Symptoms
What’s it like to withdraw from heroin? The answer depends on whom you talk to. Some recovering addicts compare the physical withdrawal symptoms of quitting heroin to a bad case of the flu. Others use the term “hell,” with descriptions that make any one of the nine lowest levels of Dante’s Inferno sound like a vacation.
Heroin detox patients can experience a wide spectrum of physical symptoms. These can also vary from person to person, depending on the length and severity of their substance abuse and other underlying medical diagnoses. Common symptoms of heroin withdrawal include:
- Profuse sweating
- Excessive tears
- Runny nose
- Frequent urination
- Abdominal cramps
- Nausea and vomiting
- Muscle spasms
- Joint pains
- Dilated pupils
- Elevated blood pressure
- Rapid heart rate
- Severe anxiety and restlessness
- Irritability and dysphoria (a state of general unease and dissatisfaction with life)
- Intensified cravings
Complications of Heroin Detox at Home
The complications of detoxing from heroin at home can be very serious.
- A return to heroin use in the presence of intensified cravings is the most common complication. One’s risks of an overdose are especially high at this juncture. That’s because the body can’t tolerate as much heroin as it did prior to detox. Studies show that for newly clean heroin users, the risks of dying from overdose actually go up. Those risks before detox are already roughly one in 10, meaning one fatality for every 10 overdoses.
In the aftermath of withdrawal, even “a little” heroin can be too much for a returning heroin user—and too much heroin in the system in effect causes the body to forget to breathe.
Dr. Karen Drexler, a professor in addiction psychiatry at Emory University, describes it this way: “Usually when you are sleeping, your body naturally remembers to breathe. In the case of a heroin overdose, you fall asleep and essentially your body forgets.”
- Aspiration is another potential complication. Aspiration occurs when the lungs inhale an object other than air (like food, saliva, liquids or vomit), losing their air supply. In such cases, lung infection can also become a complication.
- Detox can trigger or exacerbate an underlying medical or psychiatric condition. Those with a dual diagnosis like schizophrenia may experience an acute psychotic episode, for example. Others with diabetes or poor nutritional health may suffer severe dehydration, which is a medical emergency.
The reality is that many heroin users have been self-medicating a dual diagnosis they’re not aware of. The sudden elimination of heroin from their system can intensify the risks of these potentially life-threatening issues—yet another reason why heroin detox in a trusted rehab facility is so imperative.
How Long Does Heroin Detox Take?
The physical symptoms of heroin withdrawal typically set in as early as six hours after one’s last use of the drug. They generally peak in severity days two to four of detox and subside by day seven, by which time the psychological symptoms of detox can begin to surface with greater intensity. These can last much longer than the physical symptoms, continuing for weeks and even months, and often requiring an integrated plan of long-term treatment.
Medical Detox: Management of Withdrawal Symptoms
Because heroin withdrawal causes significant distress, impairment and potential complications, most heroin users trying to get clean once and for all need medical detox in a drug rehab facility and professional management of their withdrawal symptoms.
At a recovery center, heroin patients can receive a full medical work-up prior to detox by an addictions-certified psychiatrist. This comprehensive assessment is the basis for developing an individually tailored plan of care that includes 24/7 medical monitoring by a team of medical professionals in a safe, supportive environment. The assessment can also alert professional caregivers to any other underlying psychiatric condition, or “dual diagnosis,” that could be co-occurring with a substance use disorder and worsening withdrawal symptoms. A co-occurring disorder like major depression or schizophrenia may benefit from medical treatment.
Medication-Assisted Treatment (MAT): Suboxone and Subutex
In many cases, recovery from a heroin or opioid addiction can benefit from medication assistance, whether in the short-term detox phase or in a long-term residential treatment program, or in both.
During detox at a recovery center, an addiction-certified doctor may prescribe medications like Suboxone (buprenorphine and naloxone) and Subutex (buprenorphine) to ease withdrawal symptoms like insomnia and reduce the intensity of cravings. In short-term recovery, these medicines can help restore normal sleep patterns and daily biorhythms for heroin users in early withdrawal.
Long-Term Residential Treatment Programs: Medication-Assisted Treatment (MAT) and Behavioral Therapies
Physical detox from a substance one has come to depend on is only the beginning of finding freedom from a heroin dependency. Social and psychological withdrawal takes far longer, lasting weeks, months, and for some recovering heroin users, years.
One’s best prospect of staying clean is therefore a long-term residential treatment program that integrates Medication-Assisted Treatment with behavioral therapies.
In long-term treatment, medications like Suboxone can boost resilience to relapse, by alleviating heroin cravings and drug seeking compulsions. In some instances, an opioid user at high risk of relapse may benefit from a maintenance medication like Suboxone, but always in combination with counseling and other therapies, and always with the goal of eventually tapering off the assisting medication. These psychiatric evaluations occur on a case-by-case basis.
MAT is most effective when integrated with other behavioral therapies (hence the descriptor “medication-assisted”). Behavioral interventions that have proven most effective in treating heroin and opioid addiction include:
- Cognitive Behavioral Therapy (CBT): Changing the thought patterns and behaviors that feed substance abuse
- Family Therapy: Addressing the dysfunctional relational patterns in a family of origin
- Motivational Interviewing (MI): The optimization of a patient’s desires to recover via goal setting and other strategies
- Contingency Management (CM): The use of positive incentives to motivate progress in recovery