Heroin Addiction Treatment

Substance use disorder seems to come in waves. Opioids have been the scourge du jour for more than a decade. The marketing and promotion of new opioids such as oxycodone and hydrocodone blazed the trail, but an old dark horse has reemerged: heroin.

In 2016, at the peak of the opioid crisis, almost one million (948,000) Americans used heroin, an illegal opioid that was once sold by Bayer as a nonaddictive cough suppressant. Not that heroin was the only, the main, or the most potent illicit opioid. The number of total illicit opioid users that year was 12 times as high (11.5 million).

But heroin is special. It no longer has any recognized medical uses in the United States, unlike the newer opioids that triggered the crisis. You can’t get it at the pharmacy or at semilegal sanctioned dispensaries. Its primary method of use is by liquefying it in a spoon then injecting it.

The Opioid Epidemic

Heroin made a comeback, in part, because Big Pharma made opioids too acceptable. So many people used OxyContin, Vicodin, and Percocet, then became addicted to them, that the politicians and law enforcement agencies stepped in. They began to tightly regulate how much and how many pills people could get.

It became almost impossible to get prescription opioids on the black market. Even when they were available, the cost was high. But heroin was still around. It was unregulated, so supply could meet demand. And it was less expensive.

Even though heroin wasn’t as strong as some opioids on the market — most notably fentanyl, which also benefited from a low price and easier availability — heroin is far stronger than prescription painkillers. It also does not undergo quality control procedures like legal pharmaceuticals.

Heroin Dependence and Addiction

It doesn’t take long for heroin users to realize that it is not a viable long-term lifestyle or solution to their problems. The physical and mental side effects are evident, as are the costs in financial, professional, and personal terms.

By that point, they may not feel they have a choice, however.

Heroin is a powerful opioid, a type of drug derived from or synthesized from the opium plant. It floods the brain with feel-good chemicals, disrupting their normal production and distribution.

Once heroin use stops, users feel worse than they did before. Worse, they start to go through withdrawal, a process so painful that many resume use.

What Is Withdrawal?

Withdrawal is part of a cycle started by long-term and frequent use of heroin and other drugs.

First, there are the wanted effects, such as euphoria, pain relief, and as a social lubricant for the shy. Yet heroin also causes deterioration of the brain’s ability to make decisions, control behavior, and handle stress.

Next, as the body adjusts to the effects of heroin, it can develop a tolerance for it. The body tends towards homeostasis. It wants to return to normal functioning.

A heroin user’s body adjusts to the increase in feel-good chemicals, so it becomes necessary to increase the dosage of heroin to achieve the same effects as earlier. This increases the risk of dependence, mental and physical, and heroin use disorder (HUD) or addiction.

How Long Is Heroin Withdrawal?

Once dependence or addiction develops, when the users stop taking heroin or reduce the dosage, withdrawal begins. The heroin withdrawal timeline can begin within eight to 12 hours of the last use of heroin, peak after one day (or as much as two), and usually drops to a manageable level in about a week.

There is no standard answer to how long does heroin withdrawal last, however. It can take months.

A relapse can happen anytime, even after years of sobriety, due to an emotional, mental, or physical trigger.

Difference Between Withdrawal and Detoxification

Withdrawal is what happens when a person stops taking heroin, other drugs, or alcohol. It is a natural, usually painful consequence of dependence. All it takes is abstinence and time.

Detoxification (detox) is the process of cleansing a system of poisons and impurities, a process that is naturally performed by the liver.

Technically, what happens in a doctor’s office, hospital, or rehab is not heroin detox. It is withdrawal management: gradual, controlled withdrawal, sometimes by reducing the dosage of heroin over time.

To achieve this reduction, doctors sometimes replace heroin temporarily with a less potent or dangerous opioid until it is safe for a person to stop drug use completely. The replacements include methadone, buprenorphine, or Suboxone (a combination of buprenorphine and naloxone).

Another drug, lofexidine, is not an opioid but may reduce heroin withdrawal symptoms.

Dangers of Sudden or Rapid Withdrawal

Withdrawal from heroin or other opioids isn’t usually fatal. Too much of an opioid is more likely to kill than too little. (Alcohol and benzodiazepines are almost unique in that stopping suddenly can kill you.) But heroin withdrawal cold turkey isn’t risk-free.

For one thing, vomiting and diarrhea can cause dehydration, elevated levels of sodium in the blood, and consequently, heart failure. For another, withdrawal makes some users contemplate or attempt suicide.

Also problematic is the use of opioid antagonists such as naltrexone (Vivitrol) or naloxone (Narcan) to undergo rapid detox, sometimes coupled with anesthesia. In this process, clients withdraw while unconscious and so do not suffer the pains of withdrawal.

Unfortunately, there have been cases where the client requires hospitalization for complications of rapid withdrawal treatment, and at least one where someone died. There is little evidence, too, that such rapid withdrawal has better long-term results.

The difficulty and length of recovery may be a necessary part of the process. Individuals with heroin use disorders may want their lives to return to normal as quickly as possible, maybe before their resolve fails, but it may not be that easy.

It took time to damage and rewire the brain. It takes time to recover.

The safest way to come down from drug abuse is slowly, gradually, and under medical supervision.

Treatments for Heroin Recovery

Completing rehab and heroin recovery means going through withdrawal and coming out on the other side, but stopping drug use is not enough. The chances of success are greater with the help of professional addiction specialists and a personalized treatment plan.

For one thing, heroin use might not be the only problem.

Approximately half of all individuals with a substance use disorder (SUD) also have a co-occurring mental health disorder. When both occur, it is sometimes known as a dual diagnosis.

The heroin use might be an attempt to self-medicate for depression, anxiety, trauma, bipolar disorder, or borderline personality disorder. If only one of the disorders is diagnosed and treated, both may recur.

Recovery also requires behavioral changes. If individuals continue going to the same places and hanging out with the same people as they did when using heroin, they may be exposed to reminders, triggers, or peer pressure to resume.

According to the National Institute on Drug Abuse (NIDA), the most effective treatments for heroin and other opioids addiction are:

Medication-Assisted Treatment (MAT)

While some lawmakers, judges, and doctors resist pharmacological treatments for addiction, rejecting them as trading one addiction for another, the use of medication-assisted treatment (MAT) keeps individuals in treatment programs.

Drugs prescribed as part of MAT programs include methadone, an opioid agonist; buprenorphine (Suboxone), an opioid partial agonist; and naltrexone (Vivitrol), an opioid antagonist. MAT treatment also decreases:

• Drug use
• Infectious disease transmission
• Criminal activity

Behavioral Therapies

MAT is not and is not intended as a stand-alone treatment. It must be coupled with behavioral therapies. The most effective for opioids, including heroin, are:

• Cognitive behavioral therapy (CBT). Not just psychotherapy or talk therapy, CBT teaches the individual to think differently about problems and how to cope with them, to learn how to handle obstacles better.
• Contingency management (CM). Abstinence (as verified by drug testing) is rewarded with cash or other prizes, points, chances at prizes, and other incentives (sometimes just affirmations such as “Good work!”). The size of the reward doesn’t seem to make a difference.
• Twelve-step facilitation. Twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous aren’t therapy—they are peer fellowships of people with the same substance use disorder, with no medical or psychological practitioners or officers—but 12-step facilitation accepts that they can be of benefit and encourages individuals to join and engage with the program.

Withdrawal from heroin is difficult, can be painful, and is best attempted with professional assistance. Even if someone with a heroin use disorder tries it on their own, they shouldn’t think that recovery is that simple.

Heroin dependence has multiple possible causes, co-occurring disorders, and a strong likelihood of relapse. A custom-designed treatment plan can greatly increase the odds that people can become abstinent and remain so in recovery.

Sources

• drugabuse.gov – What is the scope of heroin use in the United States?
• drugabuse.gov – What are the long-term effects of heroin use?
• medlineplus.gov – Opiate and opioid withdrawal
• ndarc.med.unsw.edu.au – Yes, people can die from opiate withdrawal
• asam.org – National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
• cdc.gov – Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012
• drugabuse.gov – What are the treatments for heroin use disorder?
• drugabuse.gov – 12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates)