Withdrawing from heroin may cause symptoms similar to the flu (influenza).

Drugs such as heroin affect the reward system in the brain, thereby increasing one’s tolerance to their effects with continued use.  As a result, people dependent on heroin have to constantly increase their dosage to experience the same highs they experienced before.  If they stop using the drug altogether, they may experience heroin withdrawal symptoms.

Individuals who are struggling with heroin addiction may continue using the drug to avoid experiencing withdrawal symptoms.  Heroin abuse can create similar effects to hydrocodone and oxycodone abuse, but effects of heroin are often stronger than the other two drugs.  Withdrawal symptoms to heroin are usually more intense compared to withdrawal symptoms from prescription painkillers.

What Are the Symptoms of Heroin Withdrawal?

Drug-dependent individuals usually start experiencing heroin withdrawal symptoms within six to twenty-four hours after their most recent use of heroin. In some ways, heroin withdrawal resembles withdrawal from prescription opioids. One difference is that heroin leaves the body faster compared to other painkillers, so withdrawal occurs more quickly.

To many people, heroin withdrawal feels like a bad case of the flu. The discomfort and pain of withdrawal could last for weeks and its symptoms are typically at their worst by the second or third day.

Some common black tar heroin withdrawal symptoms or symptoms related to the withdrawal from other types of heroin include:

  • Abdominal cramping

  • Agitation

  • Anxiety

  • Diarrhea

  • Dilated pupils

  • Insomnia

  • Muscle aches

  • Nausea

  • Sweating

  • Vomiting

Signs and Symptoms of Heroin Withdrawal

Regarding the above-mentioned general withdrawal symptoms and other effects, it may be helpful to list the withdrawal symptoms based on their severity.

Minor heroin addiction withdrawal symptoms:

  • Abdominal cramps

  • Bone aches

  • Chills

  • Frequent yawning

  • Muscle aches

  • Nausea

  • Runny noses

  • Sweats

  • Teary eyes


Moderate smoking heroin withdrawal symptoms:

  • Agitation

  • Diarrhea

  • Fatigue

  • Goosebumps

  • Restlessness

  • Tremors

  • Trouble concentrating

  • Vomiting


Severe withdrawal warning signs:

  • Anxiety

  • Depression

  • Drug cravings

  • Hurried heart rate

  • Hypertension

  • Impaired respiration

  • Inability to feel pleasure

  • Insomnia

  • Muscle spasms


Aside from these, heroin may worsen the following mental conditions:

  • Anxiety

  • Bad/adverse/foul moods

  • Flat emotional affect

  • Low energy

  • Nervousness

  • Social isolation

  • Suicidal thoughts


Though heroin withdrawal might not be life-threatening on its own, its accompanying psychological and medical symptoms might create life-threatening complications. This is why it is good to look for red flags and seek professional help to address them as soon as possible to cope with heroin withdrawal symptoms.

Drug and heroin withdrawal symptoms are often fatal. Heroin withdrawal symptoms in newborns are also possible if people took the drug during pregnancy. It is important to monitor babies born to drug-addicted parents to check for signs of withdrawal and other health conditions.


Heroin Withdrawal Duration

Durations of heroin withdrawal may depend on various factors. Lengths of withdrawal may differ based on the severity of a person’s addiction, on a person’s physical and mental conditions, and other factors.  The time frame and the amount of heroin taken over a period can affect the length of the person’s withdrawal symptoms.

Depending on the length of drug use and the level of usage, individuals who are recovering from heroin addiction might suffer from post-acute heroin withdrawal symptoms. Extended heroin usage may alter the chemical make-up of one’s brain.  These behavioral and mood changes may continue for months, even after other withdrawal symptoms end.  A few of these far-reaching symptoms may include irritability, insomnia, fatigue, depression, and anxiety.


Timeline for Heroin Withdrawal

  • 1st to 2nd days: Heroin withdrawal symptoms may start as early as six hours after a person’s last dose of heroin. Muscle pain may begin on the first day and intensify over the next forty-eight hours. Other early symptoms may include diarrhea, shaking, insomnia, panic attacks, and anxiety.

  • 3rd to 5th days: On the 3rd to 5th days, people’s withdrawal symptoms may intensify. During this period, symptoms may include vomiting, nausea, shivering, sweating, and abdominal cramping.

  • 6th to 7th days: This is the end of the acute withdrawal period. During this time, symptoms such as nausea and muscle aches may fade. Recovering users might feel tired or worn down.

  • PAWS or Post-Acute Withdrawal Syndrome: Withdrawal symptoms may continue for some time, even months, after a person’s acute withdrawal symptoms end. PAWS symptoms are a result of heroin-induced neurological changes. Common symptoms during this time may include irritability, insomnia, fatigue, depression, and anxiety.

Heroin Detox

Heroin detox may provide a safe space for former heroin users to manage their withdrawal symptoms.  Complications from heroin withdrawal may occur and gravely injure people who are undergoing detox, so medical supervision is a must.  People undergoing heroin withdrawal may also become severely dehydrated or experience problems relating to vomiting. It is always best to seek medically supervised and managed medical detox.

Inpatient program doctors also need to look for psychological withdrawal effects such as depression and anxiety.  Relapse and self-harm may also occur during the withdrawal period. Medical detox after heroin use can decrease the risk of complications.

Detox Medications

Outpatient and inpatient drug treatment clinicians may prescribe certain drugs to help ease withdrawal symptoms in addicted clients. Such medications may help people recover by reducing cravings and withdrawals.


Methadone is a low-strength and slow-acting opioid utilized to taper individuals off heroin and other opioid drugs. It can help avert withdrawal symptoms.


Buprenorphine is one of the more common drugs prescribed for patients undergoing heroin withdrawal.  It may curb cravings as well as physical symptoms such as muscle aches and vomiting.


Naltrexone blocks brain receptors which react to heroin and other opioids. This drug is not sedating or addictive but may help curb cravings. Naltrexone works best for people who are already finished with detox.

Heroin Detox Duration

Since it is a short-acting type of opioid, heroin takes effect rapidly but also leaves the bloodstream quickly.

According to the National Highway Traffic Safety Administration (NHTSA), heroin withdrawal often begins six to twelve hours after the user’s last heroin dose. Withdrawal symptoms typically reach their peak within two to three days and often last five to ten days.

Taking such symptoms into consideration, heroin detox should start even before the drug leaves the user’s system and should usually last around five to seven days.  If the person in detox is heavily dependent on the drug, his or her detoxification process might take longer than usual and perhaps last for around ten days.

Heroin Addiction Treatment

Withdrawal might make addiction a hard cycle to break. This does not mean that ending heroin addiction is impossible.  Substance abuse treatment facilities offer various outpatient and inpatient detox options and recovery programs.

Inpatient detox includes 24-hour supervision and observation from designated medical professionals in addiction treatment facilities. Such care improves the chances of recovery from moderate or severe levels of heroin addiction.

Residential treatment in rehab centers is ideal for those with severe addictions or those with underlying mental conditions. This type of treatment offered by substance abuse treatment centers can be long-term or short-term.

Long-term treatment can last for three to six months or more, depending on the severity of a person’s condition.  On the other hand, short-term care can run from three weeks to six weeks or other short periods of time. Again, the duration of short-term care depends on the person’s need and condition.

Outpatient recovery treatment options require participants to meet regularly with doctors, therapists, and other treatment providers for counseling and checkups.  Recovering people in outpatient programs can live and sleep in their homes. This treatment program may work for people who have completed inpatient rehab but still need help maintaining their sobriety in the outside world.  This treatment also may be more effective if people have the support of their family and friends.

Treatment programs and aftercare services may include the following:

  • 12-step treatment options (such as Alcoholics Anonymous and Narcotics Anonymous meetings)

  • Alcohol treatment centers

  • Religion-based treatment programs

  • Dual diagnosis treatment (care that treats drug abuse and mental illnesses)

  • Luxury rehab

  • Non- 12-step rehab options (including meetings affiliated with groups such as SMART Recovery, LifeRing Secular Recovery, Secular Organizations for Sobriety [SOS], and Women for Sobriety)


Management of Withdrawal Symptoms at the Heroin Detox Facility

According to The American Society of Addiction Medicine (ASAM), approximately 591,00 Americans battled heroin addiction in 2016. The Drug Enforcement Administration (DEA) classified it as a Schedule I drug, meaning it has a high potential for abuse and no medicinal worth.

Various medication options may help people treat their dependency on heroin. Some of these treatment options can be used during detox to help curb uncomfortable emotional and physical withdrawal side effects while curbing a person’s cravings.  Ideally, the detox process should occur under the supervision of professionals in heroin detox facilities.

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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