Heroin Withdrawal: Symptoms, Timeline, and Side Effects

heroin overdose
Heroin Withdrawal

Heroin is an opioid drug made from morphine. Morphine comes from the opium poppy plant, grown in Asia, Mexico, and South America. This very addictive drug has been illegal in the United States since 1924. It can come in the form of white or brown powder mixed with sugar, milk, starch, or an unrefined black substance called black tar heroin. It can be smoked, snorted, or injected into the veins.

 No matter the method of ingestion, heroin enters the brain very quickly. It binds to cell receptors affecting pain and pleasure as well as the reward system in the brain. The high right after taking heroin involves a rush of happiness and good feelings. Many users say it feels like walking in a dream, where everything in the world has slowed down.

Using heroin just one or two times can cause dependency and withdrawal symptoms immediately after use. With dependency, the user will need more heroin to reach the same high. When heroin addiction develops, withdrawal symptoms set in.

Heroin Withdrawal Symptoms

The experience of heroin withdrawal is not the same for every user. There are many factors that make it different, including the method of use, how long the abuse has been taking place, and how much heroin was taken each time. Body and brain chemistry play a part, too. Withdrawal symptoms depend largely on how dependent the brain receptors have become on the substance.

Heroin withdrawal reverses all its intoxicating effects. Wherein a heroin high will slow the heartbeat, relax the muscles, and lead to a feeling of pleasure, withdrawal brings anxiety, low moods, and a rapid heart rate.

Heroin is very addictive, so both the “high” and the withdrawal symptoms come on quickly. For the first 3 to 5 hours after use, heroin users feel intense pleasure and slowed breathing and heartbeat. The feeling of withdrawal dawns between 6 to 12 hours after the last dose.

For many users, withdrawal feels like the flu. The most intense pain and worst discomfort last about as long as a bad bout of flu, which is one week. Symptoms peak by the second or third day.

Common withdrawal symptoms include:

  • Nausea
  • Vomiting and diarrhea
  • Fatigue
  • Muscle spasms
  • Abdominal pain
  • Sweating
  • Shaking
  • Chills
  • Runny nose
  • Nervousness
  • Restlessness
  • Depression
  • Trouble concentrating
  • Agitation
  • Craving for more heroin

Withdrawal from any substance is not life-threatening on its own, but physical and psychological symptoms may have complications that can lead to severe illnesses and death. For example, a person with depression may be pushed to self-harm or suicide if they cannot get access to more heroin. A person with chronic heart issues will become sicker with heroin addiction and withdrawal.

This is why it’s best for heroin addicts to have the support of medical and mental health professionals to safely manage all the side effects that come with withdrawal.

Heroin Withdrawal Timeline

People who use heroin may develop mild heroin use disorder within a few months, and it can escalate from moderate to severe addiction in the span of weeks. The general heroin withdrawal timeline is as follows:

6 To 48 Hours

When a person reaches the point of physical dependency, withdrawal symptoms occur within six hours of the last dose. Early symptoms include sweating, nausea, chills, muscle aches, abdominal cramping, anxiety, panic attacks, and insomnia. These symptoms will intensify over the first 24 to 48 hours.

The First 72 Hours

The following 24 hours bring more intense psychological symptoms such as mood swings, depression, and difficulty sleeping. Digestive problems also occur, such as cramps, diarrhea, and vomiting.

Peak Heroin Withdrawal

From the fourth day onward, peak heroin withdrawal occurs. Symptoms include body dysphoria, shivers, spasms, and very intense stomach pain. These symptoms can last for two to three more days.

Acute Heroin Withdrawal

The duration of the initial physical and psychological withdrawal symptoms depends on how long a person has been abusing heroin and how dependent their body has become on the substance. People who consume a large amount of heroin for a long time are more likely to experience prolonged or protracted withdrawal, lasting for months and sometimes up to a year. 

how long does heroin stay in your system
Heroin Withdrawal Symptoms

Heroin Side Effects

When heroin enters the body, it quickly binds to opioid receptors in the brain. This is what leads to the quick high and the rush that comes with it. Heart function and breathing slow down, and mental function becomes clouded and hazy.

It is very easy to develop tolerance and a physical dependency on heroin. Long-term, repeated heroin use creates changes to the brain’s physiology and hormonal systems. These changes are very difficult to reverse even after a person stops using heroin. Deterioration in the white matter affects decision-making abilities and the psychological response to stressful situations.

Short-term heroin side effects include:

  • Warm, flushed skin
  • Dry mouth
  • Heavy limbs
  • Nausea and vomiting
  • Itching
  • Drowsiness
  • Euphoria

Long-term use of heroin may cause:

  • Insomnia
  • Collapsed veins
  • Skin infections and abscesses
  • Diseases in the heart, liver, kidney, and lungs
  • Miscarriage and other menstrual problems
  • Mental disorders
  • Overdose

Heroin slows down the respiratory system, so many long-term users develop lung complications. This can lead to pneumonia and even tuberculosis. Heroin purchased on the street often include additives that can clog blood vessels and may lead to infections in the lungs, liver, kidneys, or even the brain.

How Long Does Heroin Stay In Your System?

Heroin has a very rapid half-life. It is metabolized into morphine in as little as two minutes of ingestion or injection. Morphine has a half-life of 90 minutes to 7 hours. After four or five half-lives, the drug is eliminated from the system. The actual time for each individual depends on their height, weight, body fat content, metabolism rate, hydration, and health of the liver and kidneys.

Generally, heroin can be easily detected in the systems of long-term, heavy users. Excessive use means that heroin is stored in fatty tissues. When these traces of heroin are stored, it can take much longer for a person’s circulatory system to flush them out of the body.

Approved drug tests for heroin screening are done on urine, blood, saliva, and hair follicles.

Urine – Drug screening tests generally use urine because of the low cost and ease of administration. A standard urine test can detect heroin anywhere from one to four days after the last use. However, heroin may metabolize faster for people who don’t use it often and only use small amounts. 

Blood – Heroin metabolites are created when the liver metabolizes the drug. These metabolites stay in a person’s system for much longer than actual heroin. Blood tests can detect heroin metabolites for up to two days after last use. 

Saliva – Saliva tests aren’t often used for heroin because of their short half-life. It takes under six hours for the drug to become undetectable in saliva. 

Hair– Hair drug testing kits take about 1.5 inches of hair from the scalp. These tests can detect heroin up to 3 months after last use. Long-term users may have much longer hair detection windows.


Heroin is one of the most addictive drugs in the world. Thousands of people from all walks of life turn to heroin for the quick high and the feeling of euphoria that immediately follows injection or ingestion. Within six hours of last use, physical withdrawal symptoms can occur.

Long-term heroin addicts need professional medical and mental health assistance to guide them through weeks of intense withdrawal symptoms and get through to the other side with minimal damage to their bodily systems and psychological health.