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Heroin Detox

Written By
Matt Gonzales
This page features
10 Cited Research Articles

Detoxification is the first and most painful step of heroin addiction treatment. People withdrawing from heroin may experience muscle cramps, anxiety or insomnia, which could last up to 10 days. But safely detoxing from heroin under medical supervision is an important step toward overcoming heroin abuse and entering recovery.

Detox clears toxins from the body of someone dependent or addicted to drugs, alcohol - quote

Detoxification clears toxins from the body of someone dependent on or addicted to drugs or alcohol. The first stage of addiction treatment, detox aims to reduce the effects of withdrawal and help people transition to recovery.

For a person battling heroin addiction, detox can cause painful withdrawal symptoms that start within a day of ceasing drug use. These symptoms can be mild, moderate or severe depending on the duration of heroin abuse. While heroin withdrawals are rarely life-threatening, detoxing alone without medical supervision can worsen symptoms.

However, many treatment centers in the United States offer comfortable settings for people to safely overcome heroin withdrawal. During detox, trained addiction specialists use medication-assisted therapy to treat heroin addiction.

Since the 1980s, public officials have increased funding for detox services, and detoxification has become an important aspect of heroin addiction treatment.

Woman speaking to medical professional

Heroin Detox: What to Expect

Detox begins with an evaluation that includes a physical and psychological examination. Trained medical professionals generally ask clients questions to learn more about their medical history and substance abuse problems. Evaluation results help medical staff craft an effective treatment plan.

Exams may include X-rays, electrocardiograms and urine and blood tests. Treatment facilities may also test for diseases associated with opioid abuse — including hepatitis C, HIV or tuberculosis — and screen clients for mental illness.

A number of treatment centers simultaneously treat addiction and co-occurring mental health disorders such as depression or post-traumatic stress disorder. Like substance use disorders, mental illness can cause physical and psychological distress. Treating both disorders can reduce the risk of relapse and help individuals prosper during recovery.

Once evaluation is complete, stabilization is the next step. During this phase, medical professionals assist clients with completely ridding heroin from the body and reaching a medically stable state, which may involve using medications. The goal is to help clients through withdrawal safely. When appropriate, practitioners may also attempt to get the client’s family, loved ones or employers involved in the treatment process.

After evaluation and stabilization, medical professionals prepare clients to enter treatment. For individuals who show a pattern of not seeking further treatment after completing detox, a written contract may be incorporated to encourage further treatment.

Heroin Withdrawal Symptoms

Heroin is a short-acting opioid that generally causes withdrawal symptoms between eight and 24 hours after last use. These symptoms usually peak in severity 48 to 72 hours after last use and remain from four to 10 days.

During heroin detox, withdrawal symptoms may include:

Clients can manage mild effects by drinking two to three liters of water each day during detox. This allows the body to replace fluids lost through sweating or diarrhea. Additionally, they should receive vitamin B and C supplements to make up for nutritional deficiencies.

Heroin withdrawal timeline: Starts hours after use, lasts up to 10 days - infographic

Medications Used During Heroin Detox

For those experiencing moderate to severe withdrawal symptoms, treatment centers may provide medications that can stabilize the brain and ease distressing effects, though some detox methods do not use medications.

Drugs used during heroin detox include clonidine, buprenorphine, codeine phosphate, naltrexone and methadone.


Clonidine is a medication often used to treat high blood pressure. It also can be used to alleviate opioid withdrawal symptoms such as anxiety, cramping, muscle aches, agitation, runny nose and sweating. However, the drug does not reduce cravings.

The medication should not be used alongside opioid replacement therapy, which involves substituting heroin or another short-acting opioid with a longer-acting opioid such as methadone.


Buprenorphine treats severe heroin withdrawal symptoms and shortens the length of detox. The medication reduces the euphoric effects of heroin, lowers the potential for misuse, blocks the effects of other opioids and decreases cravings.

However, buprenorphine should be given only to someone who is in the process of withdrawal. The process generally starts eight hours after the last dose of heroin.

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Methadone can be safely taken at the start of recovery. This long-acting medication displaces heroin from opioid receptors in the brain to prevent withdrawal symptoms. Over time, clients slowly wean off the drug. Methadone is often used to detox from longer-acting opioids, but it can be used to treat heroin addiction.

But the medication should be used with caution if someone has acute alcohol dependence, a head injury, a respiratory deficiency, severe liver impairment, Crohn’s disease or a condition being actively treated with monoamine oxidase inhibitors.

Codeine Phosphate

Codeine phosphate reduces withdrawal symptoms and drug cravings. However, codeine does not work for up to 10 percent of people, and it should be used with caution if someone has a respiratory deficiency or severe liver impairment.

Ultra-Rapid Detox May Be Ineffective

In the early 1990s, clinicians developed a technique called ultra-rapid detox to reduce severe opioid withdrawal symptoms and expedite recovery. This type of detox involves sedating clients and giving them medication that speeds the detox process.

However, a study funded by the National Institute on Drug Abuse found that ultra-rapid detox withdrawal symptoms were as painful as those experienced during traditional detox. And people with a pre-existing medical condition such as hepatitis, diabetes and some psychiatric disorders may be at risk for complications.

Traditional detox does not cure a substance use disorder. Between 40 and 60 percent of people treated for drug addiction experience relapse. Addiction counseling, education and other support services are needed to overcome heroin addiction and prevent relapse during recovery.

Two people holding hands, offering support

Support During Detox

Detoxing from heroin while alone can be dangerous. Individuals detoxing at home may not know how to properly overcome withdrawal symptoms and may not have access to medications that reduce these effects.

Additionally, suffering through withdrawal symptoms has damaging health effects and can lower a person’s chances of achieving sobriety. Treatment centers are equipped with trained professionals who monitor clients throughout the day and help them deal with these effects.

Recovering from heroin addiction involves gradually reducing opioid intake to avoid withdrawal. But potential health problems and strong cravings make this a difficult task. For these reasons, detoxing should always be done under the supervision of a medical professional.

Once detox is complete, counseling provides additional support and often motivates people to continue receiving treatment for heroin addiction. During counseling, trained mental health professionals help people learn more about addiction and how it has contributed to problems in their lives. It also teaches clients how to handle stress and make healthier life decisions.

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