Heroin is an illicitly manufactured opioid drug and morphine derivative. Both the pain-relieving and pleasurable properties of heroin are initiated through the drug’s interaction with opioid receptors in the brain. It is most often distributed on the street market as a white or brown powder, which is then commonly dissolved in liquid to then be used intravenously. Heroin can also be smoked or snorted. When used, heroin can relieve pain, reduce anxiety and create a sense of euphoria.
The acute withdrawal syndrome associated with heroin (and other opioid drugs, for that matter) is rarely fatal, but can be sufficiently unpleasant to discourage recovery efforts and trigger immediate relapse. Supervised detoxification can help minimize relapse risk while also providing medical assistance in the event of any complications.
Professional, supervised detox can provide a safe, comfortable and medically monitored environment in which you are able to rid yourself of the drug and its toxic influences. A formally supervised program may include the use of certain medications that lessen the severity of withdrawal symptoms. This type of treatment, involving both the use of medication during detox and the prescribing of a post-detox treatment plan is called medication-assisted treatment, or MAT. The Substance Abuse and Mental Health Services Administration (SAMHSA) endorses MAT as an effective method of treating heroin and other forms of opioid abuse.
Signs of Heroin Withdrawal
When your body has become dependent on heroin, a number of unpleasant withdrawal symptoms will arise when the drug hasn’t been used for a certain amount of time. Physical dependence means that your body has grown so accustomed to being repeatedly subjected to a drug that it begins to function as if it requires it just to feel normal.
Avoidance of withdrawal symptoms frequently motivates continued heroin abuse even after an individual has resolved to quit. The severity of withdrawal symptoms will depend on a variety of factors, including the average amount, potency and frequency of heroin having been used prior to the attempt to scale back, or quit altogether. Symptoms of heroin withdrawal include:
- Muscle aches.
- Abdominal cramping.
- Dilated pupils.
What Happens During Heroin Detox?
A supervised detox generally entails a medically monitored detoxification period designed to ensure comfort, address any physical or psychological complications that arise during withdrawal and, ultimately, minimize the chance of relapse.
Supervised detoxification may or may not be accompanied by the administration of medication. Medications like methadone and buprenorphine work to decrease the severity of withdrawal symptoms and are associated with lower relapse rates; however, patients can choose to not receive medication.
Intake and Initial Evaluation
The first step for anyone entering a heroin detox program will be intake. This is where you’ll be given a medical evaluation that will help quantify your level of heroin use and outline an appropriate plan for detox and treatment.
Your evaluation will often include questions like the following:
- How long have you been using heroin?
- What, if any, other drugs are you taking?
- Do you drink alcohol, and, if so, how often?
- Have you ever received treatment?
- Do you have other mental and/or physical health problems?
During intake, you’ll be given a thorough physical exam to assess your current health status. Your medical history and physical examination findings, in combination with your general evaluation, will help to guide your treatment, so it’s extremely important to be honest about your health and avoid downplaying your drug use and physical/mental symptoms.
Afterward, tailored treatment options are laid out and goals for treatment are discussed.
Depending on the program and your needs, your treatment plan may incorporate the use of medications to manage withdrawal and cravings. These may include:
- Methadone – Methadone is a relatively long-acting synthetic opioid agonist medication, most frequently administered for oral use – either in solution or as tablets. A single dose of methadone lasts anywhere from 24-36 hours, and facilitates the controlled stabilization of a heroin-withdrawing patient. Methadone maintenance therapy requires users to regularly visit methadone clinics for administration. Methadone is available in a number of doses, and in most cases, will be slowly tapered off as recovery progresses.
- Buprenorphine – Buprenorphine is another synthetic opioid, with only partial opioid receptor agonist properties. Like methadone, buprenorphine is most commonly taken orally. In the case of buprenorphine, however, it is taken sublingually (under the tongue). Buprenorphine only partially activates the brain’s opioid receptors, providing stabilizing relief from opioid withdrawal but discouraging misuse by introducing a ceiling to the euphoric effects that might otherwise be experienced with a full opioid agonist (e.g., continued heroin use).
- Naltrexone – A compound that blocks opioid receptors – minimizing the risks of overdose, but potentially precipitating the sudden onset of heroin withdrawal symptoms. After heroin detox is successfully completed, naltrexone may be used in the longer-term to discourage opiate abuse by blocking the pleasurable sensations associated with them. In order for it to be effective as a preventative medication, the individual in recovery must be diligent about taking it (either daily by mouth or as a monthly intramuscular injection).
- Suboxone (buprenorphine and naloxone) – Specifically designed to discourage misuse. When administered properly, the individual will experience the effects of buprenorphine. If crushed and injected, naloxone is released, producing significantly unpleasant withdrawal symptoms.
The opioid agonist treatment drugs (methadone, buprenorphine, Suboxone) will be delivered on a tapered schedule, meaning that the dosage and frequency of administration will decrease over time. The goal is to first rid the body completely of heroin, then carefully and comfortably rid it of any opioid influence over time. How long this takes depends on the user’s individual reaction to withdrawal symptoms and the tenacity of their opioid dependence.
Precise treatment design will be tailored to each individual. Physical and psychological assessments, as previously stated, will determine treatment protocol, including the type of medication and dosage.
It’s important to note that you can elect to go through supervised detoxification without medication. Termed “social” detox, this non-pharmacologic approach is available at some inpatient or residential programs. You’ll be given supportive care to help you through the process of withdrawal and may be provided natural remedies to ease your symptoms. Good social detox programs will have medically trained staff and quick access to emergency care in the event that it is needed. The main benefit of inpatient social programs is that the environment will be drug- and alcohol-free so you can begin recovery without environmental temptations to relapse.
Rapid detoxification involves the concurrent administration of anesthesia, so the individual does not experience the discomfort of initial withdrawal symptoms, and naloxone, which counteracts opioids in the body to initiate the withdrawal period. In theory, this method may speed up the withdrawal process, though recent research has proven this statement inconclusive. In fact, NIDA states that this process offers “no advantage” and that it may actually cause dangerous consequences in certain individuals.
Post-Detox Addiction Treatment
Detox is only the first step in recovery from addiction. Once detox is complete, treatment for addiction can begin. This will typically involve therapy to uncover and address the underlying causes of your substance use.
Therapy will vary depending on:
- The treatment center.
- The treatment philosophy of the center, for example, whether the center uses the 12-step philosophy.
- Patient preferences.
- Any co-occurring psychiatric disorders present.
Behavioral therapies are the most common therapies, addressing the user’s incentive to start and continue using substances. They may be administered in the form of:
- Group therapy (in the presence of other addicts).
- Family therapy (involving family members).
- Individual therapy (one-on-one).
Therapy will also address cravings during and after treatment. Therapy may occur on an inpatient or outpatient basis.
Patients may elect to continue taking medications as part of medication-assisted treatment. Remember, MAT is not just the use of medication; it is medication plus therapy. Medications are used to maintain stability and sobriety while therapy works to address the reasons for the drug use and build the skills to live in recovery.
Why Should I Enter a Heroin Detox Program?
The risks of continuing heroin use are significant and every hit puts you in danger. Treatment can help you clear your body of these drugs and begin a new healthy life.
While it is possible to detox alone, the withdrawal syndrome can be sufficiently intense as trigger relapse even in the most well-intentioned person.
Supervised detoxification not only ensures physical comfort and safety during the withdrawal process, it also keeps you safe from relapse and potential overdose.
How to Find a Heroin Detox Program
Detoxification for prescription painkillers can occur in an inpatient or outpatient setting. Inpatient detox and treatment provides around-the-clock care and supervision. Given the highly addictive nature of heroin, this kind of treatment presents the best chance for recovery.
Residential treatment centers provide inpatient care as well as varying amenities and comforts. Residential treatment centers commonly offer programs that range from 30 to 90 days (or longer) that include detoxification, medication, and counseling. Certain programs may provide extra amenities and alternative therapies like yoga, meditation, or even equine therapy.
If you choose to get treatment in an outpatient program, you’ll find many of the same benefits such as trained medical staff, detoxification, and counseling, among others. These services, however, are given on a periodic basis, depending on the patient’s schedule.
Outpatient care might not be right for you if you are suffering from a particularly severe addiction or live in an environment with little support and numerous triggers to relapse. If you plan to receive outpatient therapy because you are worried about missing work, talk to your employer about your options — a number of employers provide paid leave for drug abuse treatment.
The following points are important to consider when choosing the right treatment program for you:
1. Does the treatment program provide supervised detox?
2. Does the program incorporate the use of medications?
3. Does the treatment program employ highly trained staff, including licensed psychologists and psychiatrists?
4. Do I want inpatient or outpatient treatment?
5. Does the treatment program offer all the services I need in one place?
6. Can I take time off work to attend treatment?
7. How close do I want to be to home? Will being closer or further away from home provide the best chance for successful treatment?
8. How much will treatment cost? Inpatient treatment, including residential treatment, can be expensive. Consult with your insurance provider and the centers you’re interested in to determine what your out-of-pocket expenses will be.
- National Institute on Drug Abuse. (2014, October). Drug Facts: Heroin. Retrieved March 10, 2016, from https://www.drugabuse.gov/publications/drugfacts/heroin
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Center for Substance Abuse Treatment, U.S. Department of Health and Human Services, & Substance Abuse and Mental Health Services Administration. (2011). Medication-Assisted Treatment: Facts for Families and Friends. Retrieved March 4, 2016, from http://store.samhsa.gov/shin/content/SMA09-4443/SMA09-4443.pdf
- Harvard Medical School. (2009, June). Treating opiate addiction, Part I: Detoxification and maintenance. Retrieved March 9, 2016, from http://www.health.harvard.edu/mind-and-mood/treating_opiate_addiction_detoxification_and_maintenance
- Whelan, P. J., & Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of neurosciences in rural practice, 3(1), 45.
MedlinePlus. (2016, March 2). Opiate Withdrawal. Retrieved March 10, 2016, from https://www.nlm.nih.gov/medlineplus/ency/article/000949.htm