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The Heroin Journey

“What’s going to happen to me?” It’s one of the most common questions we hear when the heroin addiction treatment process is in its beginning moments. And that makes perfect sense! Something that your body depends on to feel “good” and “normal” isn’t going to be available anymore. What does that mean for you? What will your body and mind go through? And what does a treatment facility do to help in that process?

While everyone’s treatment journey is unique, a few generalities exist. These include things that can be highlighted to help answer some of those burning questions about your journey from addiction to recovery, and what happens in between.

Today, we’ll highlight one of the most difficult substances to break, heroin. Detox from heroin is often a rough journey, but it is not impossible to break free and live a recovered, healthy life.

Effects of Heroin Use

Once heroin enters the brain, it is converted to morphine and binds rapidly to opioid receptors. People who use heroin typically report feeling a rush of a pleasurable sensation. The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the opioid receptors.

With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities. Nausea, vomiting, and severe itching may also occur. After the initial effects, users usually will be drowsy for several hours. Mental function is clouded, heart function slows, and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent brain damage.

Heroin abuse has been growing in the United States, particularly among young women. There is also growing concern over heroin users contracting and spreading diseases like HIV and AIDS by sharing needles for injection.

Heroin Withdrawal

Heroin’s severe withdrawal symptoms make beating a heroin addiction difficult. Treating heroin addiction typically requires a combination of therapy and medications to help manage symptoms of withdrawal and cravings.

You will begin experiencing withdrawal symptoms between 6 and 12 hours after the last heroin dose. Withdrawal from heroin may resemble withdrawal from prescription opioids. Because heroin leaves the system faster than painkillers do, withdrawal symptoms come on more quickly.

Withdrawal (again, different for everyone) often feels like a horrible case of the flu. The worst pain and discomfort lasts about a week — about as long as a bad flu — with withdrawal symptoms peaking during the second or third day.

Common symptoms of heroin withdrawal include:

  • Nausea and vomiting
  • Insomnia
  • Agitation
  • Diarrhea
  • Dilated pupils
  • Sweating
  • Anxiety
  • Abdominal cramping
  • Muscle aches

The length of withdrawal from heroin depends on several factors, some of the most important being:

  • The length of time heroin was abused
  • The amount of heroin taken each time
  • Frequency of use
  • The method of taking heroin
  • The presence of underlying medical or mental health issues

Depending on the level and length of use, those recovering from heroin are likely to suffer post-acute withdrawal symptoms, or PAWS for short. These symptoms include poor sleep, poor concentration, increased anxiety, depression, panic attacks, fatigue, hypersensitivity, irritability, mood swings, restlessness, and memory loss. PAWS can last anywhere from 18-24 months. However, as time goes by and you remain drug-free, the symptoms will slowly begin to diminish until they disappear altogether.

Treatment During Withdrawal

Because of the severity of heroin withdrawal symptoms, almost every study and professional will strongly suggest that someone suffering from heroin addiction not undertake the recovery process on their own. Entering a treatment facility is almost always the absolute best option for success.

A variety of effective treatments are available for heroin addiction, including both behavioral and medical. Both approaches help bring back a normal life. Although behavioral and medical treatments can be extremely useful when utilized alone, research shows that for many people, integrating both types of treatments is the most effective approach. An effective treatment facility will have both of these approaches with ample supports built-in as well.

Medical Treatment

Scientific research has established that medical treatment of “opioid use disorder” increases retention in treatment programs and decreases drug use, infectious disease transmission, and criminal activity.

When people addicted to opioids, like heroin, first quit, they undergo withdrawal symptoms (see above), which may be severe. Medications can be helpful in this detoxification stage to ease cravings and other physical symptoms that can often prompt a person to relapse.

Medications developed to treat opioid use disorders work through the same opioid receptors as the addictive drug, but are safer and less likely to produce the harmful behaviors that characterize a substance use disorder. Three types of medications include: (1) agonists, which activate opioid receptors; (2) partial agonists, which also activate opioid receptors but produce a smaller response; and (3) antagonists, which block the receptor and interfere with the rewarding effects of opioids. A particular medication is used based on a patient’s specific medical needs and other factors.

Effective medications include:

  • Methadone (Dolophine or Methadose) is a slow-acting opioid agonist. Methadone is taken orally so that it reaches the brain slowly, dampening the “high” that occurs with other routes of administration while preventing withdrawal symptoms. Methadone has been used since the 1960s to treat heroin use disorder and is still an excellent treatment option, particularly for patients who do not respond well to other medications. Methadone is only available through approved outpatient treatment programs, where it is dispensed to patients on a daily basis.
  • Buprenorphine (Subutex or Suboxone) is a partial opioid agonist. Buprenorphine relieves drug cravings without producing the “high” or dangerous side effects of other opioids. Suboxone is a novel formulation of buprenorphine that is taken orally or sublingually (under the tongue) and contains naloxone (an opioid antagonist) to prevent attempts to get high by injecting the medication. If a person with a heroin use disorder were to inject Suboxone, the naloxone would induce withdrawal symptoms, which are averted when taken orally as prescribed. The FDA approved buprenorphine in 2002, making it the first medication eligible to be prescribed by certified physicians through the Drug Addiction Treatment Act. This approval eliminates the need to visit specialized treatment clinics, thereby expanding access to treatment for many who need it. Additionally, the Comprehensive Addiction and Recovery Act (CARA), which was signed into law in July 2016, temporarily expands prescribing eligibility to prescribe buprenorphine-based drugs for medication-assisted treatment to qualifying nurse practitioners and physician assistants through October 1, 2021. 

In February 2013, the FDA approved two generic forms of Suboxone, making this treatment option more affordable. The FDA approved a 6-month subdermal buprenorphine implant in May 2016 and a once-monthly buprenorphine injection in November 2017, which eliminates the treatment barrier of daily dosing.

  • Naltrexone (Vivitrol) is an opioid antagonist. Naltrexone blocks the action of opioids, is not addictive or sedating, and does not result in physical dependence; however, patients often have trouble complying with the treatment, and this has limited its effectiveness. In 2010, the injectable long-acting formulation of naltrexone (Vivitrol) received FDA approval for a new indication for the prevention of relapse to opioid dependence following opioid detox. Administered once a month, Vivitrol may improve compliance by eliminating the need for daily dosing.

Behavioral Therapies

The many effective behavioral treatments available for opioid use disorder can be delivered in outpatient and residential settings. Approaches such as contingency management and cognitive-behavioral therapy have been shown to effectively treat heroin use disorder, especially when applied along with medications. Contingency management uses a voucher-based system in which patients earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living.

Cognitive-behavioral therapy is designed to help modify the patient’s expectations and behaviors related to drug use and to increase skills in coping with various life stressors. An important task is to match the best treatment approach to meet the particular needs of the patient.

At Compass Detox, our staff of therapists and medical professionals are uniquely positioned in their ability to safely and effectively help you navigate the road to recovery. Reach out today with your own questions and concerns! We’re happy to answer and address them all. Call us today at 1.800.263.3869.