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Heroin Withdrawal Timeline

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 01/24/2021

Number of References: 10 Sources

Heroin withdrawal generally lasts about a week and common symptoms include vomiting, shakes, insomnia, and severe anxiety. Continue reading to find out more about heroin withdrawal including the symptoms, withdrawal timeline, the physical and psychological effects of withdrawal, and more.

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Heroin Withdrawal Symptoms

While the symptoms of heroin withdrawal are fairly standard, there may be minor differences between individuals. For the most part, everyone who undergoes heroin withdrawal can expect to experience similar symptoms. These are both mental and physical, and while the “acute” phase of heroin withdrawal has a variety of very intense symptoms, the “post-acute” phase has milder symptoms which are mostly psychological in nature.

The onset of withdrawal symptoms will depend, to a degree, on how much someone used heroin but more importantly the route that they chose to use it. For someone using upwards of a gram a day by injection, the symptoms may begin within 6 to 8 hours of their last use. Conversely, if someone had snorted more than a gram per day, it may take 12 to 24 hours before withdrawal symptoms began. The earliest signs of withdrawal can often be a feeling of hollowness or unnatural cold and can progress to the full set of symptoms within 24 hours of these first signs.

A general overview of the heroin withdrawal timeline may look something like this:

Week 1

Symptoms of heroin withdrawal can begin 12 hours or less from the last time someone used the drug. Some of the first symptoms to emerge often include chills, sweating, increased anxiety, and stomach issues. These usually increase over the first few days and will be joined by a host of other, more intense symptoms.

Some of the symptoms of heroin withdrawal that someone may expect during the first week may include:

  • Pain in the Muscles, Joints, and Bones
  • Intense Cravings for Heroin
  • Nausea and Vomiting
  • Abdominal Cramping and Diarrhea
  • Allodynia (perception of pain from a normally non-painful stimulus)
  • Lack of Appetite
  • Severe Fatigue and Lethargy
  • Tremors and Muscle Spasms
  • Rhinorrhea (extremely runny nose)
  • Dilated Pupils
  • Piloerection (goosebumps)
  • Intense Chills and Hot Flashes
  • Repeated Yawning
  • Diaphoresis (heavy, constant sweating)
  • Hyperreflexia and Hyprevigilance (increased reflexes and startle response)
  • Severe Insomnia
  • Severe Restlessness and Anxiety
  • Severe Depression
  • Tachycardia (rapid heart rate)
  • Hypertension (elevated blood pressure)
  • Hyperthermia (increased body temperature)

These symptoms usually worsen throughout the first week, typically plateauing around the fourth day. They may begin a slow improvement from that point on, but the end of the first week is often a very difficult time.

Week 2

The beginning of the second week usually marks a significant improvement in physical symptoms. The psychological symptoms are usually still present and intense, and the resolution of physical symptoms may make these psychological symptoms seem more intense. Without the physical symptoms to distract someone, they may be more aware of their psychological distress. As the second week progresses, these psychological symptoms may improve somewhat, but they should be expected to persist throughout the week.

Some symptoms commonly experienced during the second week of heroin withdrawal can include:

  • Minor Aches in the Muscles, Joints, and Bones
  • Nausea
  • Diarrhea
  • Reduced Appetite
  • Fatigue and Lethargy
  • Rhinorrhea (extremely runny nose)
  • Dilated Pupils
  • Piloerection (goosebumps)
  • Chills and Hot Flashes
  • Repeated Yawning
  • Diaphoresis (mild, constant sweating)
  • Hyperreflexia and Hyprevigilance (increased reflexes and startle response)
  • Insomnia
  • Restlessness and Anxiety
  • Deep Depression
  • Irritability
  • Strong Cravings for Heroin

Weeks 3 & 4

Typically, the physical symptoms of heroin withdrawal will be resolved by this time, although the psychological symptoms are often still present. The third week may show minor improvement in the psychological symptoms, but they often persist well into the fourth week. Insomnia may resolve completely by the middle or end of the fourth week, as will sweating and chills. Yawning may persist for some time, but will gradually resolve over the next few weeks.

Some symptoms that may be expected during the third and fourth weeks of heroin withdrawal may include:

  • Fatigue
  • Piloerection (goosebumps)
  • Chills and Hot Flashes
  • Repeated Yawning
  • Insomnia
  • Cravings for Heroin
  • Anxiety
  • Depression
  • Irritability

Post-Acute Withdrawal

This is a much longer-lasting form of heroin withdrawal which may take weeks, months, or in rare cases years to fully resolve. The term “post-acute” simply means that it is after the acute phase, therefore it is milder and lacks physical symptoms. The post-acute symptoms are psychological in nature, but nonetheless still extremely unpleasant to experience. Different people experience these symptoms to different degrees, and some people may experience combinations of symptoms or isolated symptoms.

Some of the most commonly reported symptoms of post-acute withdrawal syndrome from heroin can include:

  • Depression (with or without suicidal ideation)
  • Anxiety (particularly social anxiety)
  • Mood Swings
  • Insomnia
  • Vivid Dreams or Nightmares
  • Cravings for Heroin
  • Low Energy Levels

Some of these symptoms may be fairly long-lasting and may require medication and clinical therapy to manage until the body and mind return to balance. While everyone’s experience with post-acute withdrawal is distinct, there is a treatment for many of the symptoms which may arise.

What Factors Influence the Intensity of Heroin Withdrawal?

The acute phase of heroin withdrawal is almost entirely influenced by the amounts of heroin someone used as well as the length of time that someone used. Even though use habits span a wide range among users, acute withdrawal very rarely lasts shorter than 4 days or longer than 7 days. Someone’s heroin use habits are probably the largest contributor to the intensity and duration of heroin withdrawal symptoms, but there are other contributors as well, including:

  • Amounts of heroin used
  • Duration of heroin use
  • Genetic predisposition to addictive behavior
  • Co-occurring mental health issues

The intensity of the withdrawal symptoms is most greatly affected by the amounts of heroin that someone used as well as the route that they chose to do it. Shooting up heroin delivers much more of the drug directly into the brain. By more heroin reaching the brain more quickly, greater downregulation takes place, and therefore the greater the withdrawal symptoms once heroin is removed. Likewise, since downregulation occurs to a greater degree, more time is needed for the brain to correct this imbalance once heroin is removed.

Likewise, the length of time that someone used plays a role as well, although that mostly affects the length of time before the brain is able to regain balance. Neurological remodeling, while beginning alongside downregulation, takes time to occur, and subsequently to reverse. The longer someone used heroin, the more remodeling their brain performed, and thus the longer it will take them to experience relief from these symptoms once heroin use is ceased.

Both genetics and co-occurring mental health issues may play a role in heroin withdrawal symptoms as well, although these contribute in a more indirect way. Addiction tends to run in families, and if someone is genetically predisposed to addiction, then they may begin using heroin earlier in their life or begin using more heroin more quickly whenever they do begin using it. This can subsequently impact their withdrawal symptoms. Mental health issues may also contribute to the severity or duration of symptoms. Since depression and anxiety are such common symptoms of heroin withdrawal, if someone were already struggling with mental health issues of this nature, they may experience worse psychological symptoms than someone with no such pre-existing mental health issue. Likewise, it is possible that these psychological symptoms may persist for longer than in someone with no such mental health issue.

More About Heroin Addiction

Prolonged heroin addiction produces a series of changes in the body over time. Heroin is an extremely potent depressant and slows or dampens many of the vital processes in the body. This is achieved through potent stimulation of opioid receptors in the body and brain, particularly the mu (µ), kappa (κ), and delta (δ) opioid receptors. This causes a cascade of other neurotransmitter effects which include changes in norepinephrine, dopamine, serotonin, and GABA systems. When heroin is suddenly removed, the body becomes hyperactive in an attempt to regain neurotransmitter balance.

After extended exposure to heroin, the body will respond by decreasing the sensitivity and number of these receptors through a process called downregulation. After downregulation has occurred and heroin is removed, the normal opioids produced by the body (known as endogenous opioids) will have an extremely reduced effect. This has the result of boosting many of the normal biological processes into overdrive since the powerful depressants whose presence they had adapted to are now missing. While heroin withdrawal is rarely fatal, there have been deaths attributed to heroin withdrawal.

The brain is capable of correcting the imbalances caused by chronic heroin use but this is a slow process. While the timeline of recovery from heroin addiction is unique to everyone, depending on several factors including genetics, there are a few rough roadmaps for the time required. The time for “acute” detox, or the most dangerous phase of detox, is fairly standard at between 4 to 10 days depending on someones using habits. If someone had used small amounts (less than 1 gram per day) then this may be around 4 to 5 days while if someone used larger amounts (1+ grams per day) then this could lean towards 7 to 10 days.

The Importance Of Detox

Finding a competent heroin detox center can make all the difference in the world when it comes to successful heroin addiction recovery. Modern heroin detox facilities are equipped with the most effective medications, therapies, and support treatments for minimizing the detox symptoms and reducing the risk of relapse. Aside from the immediate benefits of detox, the connections that most detox centers have with the larger recovery community can act as an invaluable resource for continuing treatment after a heroin detox program has been completed.

Heroin Detox Centers

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