As of 2014, 586,000 Americans had a heroin-related substance use disorder. Compared to the 21.5 million people who had a substance use disorder of any kind in the same year, this figure may seem low, but heroin use is incredibly dangerous. 23% of those who use heroin develop an addiction and 40% of all lethal overdoses in 2014 were caused by heroin.
With this in mind, seeking treatment should be a high priority, but many addicts are put off by the known intensity of heroin detox and withdrawal. However, there are many ways to prepare yourself for and cope with the symptoms of withdrawal, as well as multiple methods of treating a heroin addiction after withdrawal is complete.
Important information about heroin
Heroin is processed from morphine and when it crosses the blood-brain barrier, reverts back into morphine. However, heroin passes this barrier faster than morphine does, making it more effective — and more addictive — than morphine alone.
The heroin’s ability to bind to opiate receptors in the brain is responsible for sensitization (a reaction in the brain’s motivation center that results in higher drug-seeking behavior) and dependence (a state where you can only function normally when regularly using). When you use heroin often enough, your body stops producing endorphins on its own, relying on the drug to make you feel normal and happy.
Heroin is especially hazardous to your health. Short-term effects include:
- Impaired brain functions.
- Slow breathing rate.
- Slow heart rate.
Long-term effects are much more dangerous. These include:
- Clogged blood vessels.
- Collapsed veins.
- Contracting infections like HIV or Hepatitis B or C via used needles or bacteria-laced additives.
- Deterioration of the parts of the brain affecting decision-making, behavior regulation, and response to stress.
- Irregular menstrual cycles (women).
- Liver and kidney disease.
- Sexual dysfunction (men).
These are all reasons to face the fear of withdrawal and seek treatment so you can return to a healthy life again.
What are the symptoms of heroin withdrawal?
You may want to prepare yourself for withdrawal beforehand so you can have access to necessary resources when it hits. Symptoms of heroin include:
- Abdominal cramps.
- High blood pressure.
- Muscle aches and spasms.
- Increased urination.
- Rapid heart rate.
- A runny nose.
These symptoms will usually begin 6-12 hours after the last time you used heroin, will peak in 2-4 days, and end within a week. The experience is intense — it is sometimes referred to as the “super-flu” because of its many flu-like symptoms — but withdrawal is manageable in either an inpatient or outpatient setting.
Inpatient vs. Outpatient: Which is best?
When deciding where to go through withdrawal, there are a few factors to consider. Inpatient withdrawal in a hospital or rehab center is best for addicts with:
- A history of medical or psychiatric conditions.
- An unstable home environment.
- The need to withdraw from multiple drugs.
- Uncertainty about and/or a need for close monitoring.
- Unsuccessful attempts at outpatient withdrawal in the past.
Outpatient withdrawal in home-based settings is best for addicts with access to a safe environment free of drug users and with access to support from friends or family during the process. Preparation for this type of withdrawal should not be taken lightly. Access to a doctor, drug counselor/worker, or another health professional is key.
Ambulatory withdrawal is also a possibility. This is an outpatient service that uses regularly prescribed medications along with counseling and referral services for addicts who meet the qualifications for home-based withdrawal, but would prefer regular contact with a rehab center or hospital.
What medications are available?
Medication-based treatments are often used to help with withdrawal. Methadone, a synthetic opiate, is usually prescribed for heroin addicts in withdrawal and the dose is decreased over the course of a week. Sometimes clonidine, a medication for high blood pressure, is added to shorten the time of withdrawal and relieve some of the physical symptoms.
After withdrawal is over, medications can be prescribed to help heroin addicts deal with their illness. Sometimes addicts are placed on methadone maintenance — continuing to provide the addict with a synthetic opiate to keep them from using heroin. While this treatment is controversial, it is highly monitored by medical staff, has the most scientific support than any other treatment, and has been shown to improve mood, job performance, family life, legal status, and overall health. There are also many options within this course of treatment: 25% of those on methadone maintenance therapy become completely abstinent from opioids over time, 25% continually use the drug, and 50% go on and off methadone.
Buprenorphine, a partial opioid agonist, is another medication that can be used to combat addiction. It suppresses withdrawal and cravings, but it does have a “ceiling effect,” or a point where a higher dose does not provide a higher level of relief.
Buprenorphine can also be combined with naloxone, an opioid antagonist, to keep addicts from dissolving Buprenorphine and injecting it; the naloxone triggers immediate withdrawal symptoms if you try. Naloxone on its own has also been proven to improve sobriety when taken monthly (90% of those who did remained abstinent after 24 weeks, compared with 35% who did not take it).
What other treatment options exist?
Stress is the greatest contributor to relapse, so finding ways to reduce it are extremely important when entering recovery.
Both contingency management, a program that uses vouchers as rewards for negative drug tests, and cognitive-behavioral therapy, which increases coping skills, have been incredibly successful for heroin addicts, especially combined with medicinal treatments.
Studies involving the combination of ketamine with psychotherapy have also been promising. Ketamine is a drug for general anesthesia, but in lower doses, it can produce a hallucinogenic effect. High-doses of hallucinogenic-level Ketamine (2.0 mg/kg) combined with psychotherapy produced the greatest level of abstinence after a six-month follow-up: it reduced the intensity and duration of heroin cravings while improving mood, social life, feelings of fulfillment and personal independence, and lowering anxiety and depression levels. While these are still early findings, the outlook is certainly interesting.
Other long-term treatments after withdrawal can include:
- Inpatient treatment.
- Intensive outpatient treatment.
- Outpatient counseling.
- Narcotics Anonymous, a 12-step program.
- SMART Recovery, a self-help group.
Feel free to mix, match, and experiment with different treatments until you find the one that works best for you. Heroin addiction is powerful, and withdrawal can be painful, but ultimately recovery is beyond worth it.
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