Heroin is, notoriously, one of the most addictive drugs people can take. Even after only a few doses relatively close to each other, the user can start to build up a dependence on heroin: this means that their body and mind become used to the presence of heroin in the system, and begin acting as though that is the “normal” state of affairs. When a user has developed a dependency, and then suddenly stops taking heroin, their body and mind react to its absence and need a period of time to readjust, during which a number of symptoms – some extremely unpleasant – may manifest themselves. This period of readjustment is known as withdrawal.
The type, severity and duration of withdrawal symptoms will vary according to a number of factors including the physiology of the user and, crucially, how long they have been taking heroin, the size of their doses, and the method/s of consumption (someone using heroin intravenously will usually expect worse withdrawal symptoms than someone who has been smoking or snorting it). As a result, each person’s experience of withdrawal is different. Generally, however, withdrawal symptoms may include:
As noted above, the intensity and duration of heroin withdrawal symptoms will be affected by numerous factors. While each experience of withdrawal is unique, however, generally speaking, most addicts will experience it more or less in accordance with the following timeline:
Heroin addiction has been a problem for many decades and a wide range of approaches exist to tackle it. In general, the most effective course of action is normally deemed to be a combination of residential rehab and ongoing therapy, although each addict will have different requirements and limitations and treatment needs to reflect those.
There are a large number of confidential residential rehab facilities catering to heroin addicts as – unfortunately – this form of addiction is widespread throughout the UK. Typically, rehab takes place in an attractive, relaxed setting designed to set patients at ease and provide them with an environment conducive to recovery; it begins with a medically supervised detoxification (as the addict’s system is cleansed of heroin) before the addict is able to move onto a variety of therapies. They will be given dietary and fitness programmes tailored to their individual requirements, which will set them on the road to living a healthy life (all the better a foundation on which to build a recovery).
Rehab can be experienced on either an inpatient or outpatient basis. The former has a number of important advantages, including providing the addict with a safe environment in which they will not be able to access heroin (and undo all their good work), while also giving 24/7 access to medical professionals able to help the addict through withdrawal. Outpatient rehab may be more appropriate for people with overriding family and/or work commitments but does not provide that same level of insulation from the temptation to return to using heroin once in the outside world. It is crucial that an addict selects the option which makes most sense for their own life circumstances.
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There are a number of medications which can be used to help fight heroin addiction. However, some of these have potentially dangerous side effects and others can be habit-forming, so it’s vital not to self-medicate: addicts should only use medication prescribed for them by a doctor.
Methadone is a prominent drug used to treat heroin addiction. It is taken orally and is slow-acting; it helps to prevent withdrawal symptoms whilst also reducing the heroin “high” to disincentivise users from taking the drug. Buprenorphine (known by the brand-name Subutex) removes the cravings for heroin without prompting the side-effects of opioid substitutes. Suboxone acts to discourage intravenous heroin use by negating the effects and creating unpleasant side-effects. Meanwhile, naltrexone blocks the action of opioids within the brain, rendering heroin use effectively pointless.
There are also various medications which can be prescribed to treat specific withdrawal symptoms, which might include sedatives, antipsychotics and antidepressants (though these last are unlikely to be prescribed to treat short-term symptoms such as those manifesting during peak withdrawal). Again, these should only ever be used in accordance with a doctor’s instructions: some might be habit-forming themselves, while others may be extremely dangerous if an addict has certain pre-existing conditions.
Therapy lies at the heart of treating heroin addiction: whilst detoxification is a necessary step, and medication can have valuable benefits in terms of making withdrawal easier and moving off heroin initially, the root causes of an addiction can only be dealt with via therapy – and without those causes being addressed it’s likely that an addict will relapse. Various therapy models have been demonstrated to show great efficacy in treating heroin addiction, including cognitive behavioural therapy (CBT) and motivational therapy (MT), and individual rehabs may offer several different models: an addict may need to try a few before settling on one which feels right for them.
Group therapy is another valuable form of treatment, enabling heroin addicts to share experiences, learnings and advice in a non-judgemental environment and possibly to develop a peer group which can provide ongoing support including helping to prevent relapse, and which understands the specifics of heroin addiction (including possible triggers). Because, sadly, heroin addiction is such a widespread problem, groups (such as Narcotics Anonymous) exist across the country so an addict can access this type of support long after any potential stay in rehab comes to an end.
It is never advisable to attempt to detox from heroin (or indeed any other substance of abuse) independently. While withdrawal itself is rarely fatal (usually as a result of other complications) it is a deeply unpleasant experience and without medical assistance (preferably within the safe environment of a rehab facility) an addict could be overwhelmed by the symptoms and give in to any suicidal ideation which may occur. The impact of withdrawal on an addict’s body can also leave them at much greater risk of accidents (especially falls) which can cause significant damage, while drugs they might take to self-medicate through withdrawal could themselves prove dangerous or even fatal, especially if obtained illicitly with no guarantee of quality control.
Another issue which has contributed to a great many deaths is that once an addict begins to detox, the body is less able to tolerate the dosages to which the addict may previously have become accustomed. If the addict relapses and consumes their usual dose after they have begun to drop their tolerance, they might well overdose which can prove fatal. Detoxing with the assistance of medical professionals removes these risks, whilst also potentially making withdrawal itself a less unbearable experience thanks to medication and therapy.
Because withdrawal and detoxification from heroin can be such an unpleasant experience, and because of the potential impact on the family and work life of an addict who goes to stay in rehab for, potentially, several weeks, there have been numerous attempts to devise “rapid detox” options whereby an addict is given a range of medicines in an intensive effort to purge their body of heroin and speed up the withdrawal process; this may involve the addict being placed in a medically induced coma so they are not forced to experience the extremely unpleasant effects of the treatment. However, rapid detox is not accepted by the majority of medical professionals as being a viable alternative to the traditional combination of detox and therapy, as it involves significant risks to the health of the addict and has not been shown to have a greater efficacy than other approaches. The best way to ensure the greatest possible chance of complete, lifelong recovery is to undergo a medically supervised detox (perhaps with the assistance of some of the medication discussed above) and therapy within the safe environment of rehab; the worst impact of withdrawal is over within a few days, and the therapy provided will set a recovering addict up with the tools they need to avoid relapse going forward.
In general, coming off heroin does not pose a direct risk of becoming fatal (unlike withdrawal from alcohol and benzodiazepines, for example). However, some addicts do die during the process as a result of factors indirectly caused by withdrawal. For example, they may find themselves weakened by the process and faint, injuring themselves in the fall. They may obtain other drugs illicitly (as in, without their being prescribed by a doctor) which they think will help ease them through withdrawal, but to which they might have extremely adverse reactions (especially if the drugs have been sourced through illicit means such as the dark web and contain damaging impurities or even different drugs altogether). They may entertain suicidal thoughts and, at the peak of withdrawal and/or when very depressed about their life, may give into them.
One very prominent risk is that a user will go through a period of detoxification, during which their body loses some of the tolerance to heroin it has built up over time, and then relapse; if they take the same dose they have been used to, their body may not be able to cope with it and they may overdose with potentially fatal results.