Attempting a heroin detox at home raises the questions of its safety. The withdrawal symptoms are very unpleasant and practising self-medication to obtain relief can lead to serious or fatal consequences.
Heroin is one of the most potent and highly addictive opioids. In the United Kingdom, where it is classified as a Class A drug, the greatest health and social problems arising from use of illicit drugs are from heroin. Further, the highest number of drug users seeking treatment are people addicted to heroin.
Detoxing from heroin at home without medical and mental supervision is not recommended.(1) As an opiate, it is one of the deadliest drugs and its withdrawal symptoms have a higher degree of intensity compared to other drugs. This may lead to the person self-medicating to alleviate the symptoms and have an overdose.
To learn more about the dangers of a heroin detox at home, it’s helpful to have a background about the drug and its effects, how heroin detox works, what its withdrawal symptoms are and how they are managed.
Heroin use and effects
Heroin is derived from the poppy plant. In the UK, these plants are brought in from Afghanistan, Iran, and Pakistan.(2)
The substance comes in white or brown powder, or black sticky substance. The most common method of use is by intravenous injection of the powder form. In black tar, it is smoked or snorted.
When injected, the effect is immediate. The user experiences a “rush”, a sudden flood of pleasurable feeling, accompanied by a warm flushing of the skin, dry mouth, and heaviness on the arms and legs. Nausea, vomiting and severe itching may also be felt.
Heroin dependence is classified as follows, based on usage:
- Mild: 1-2 bags/day
- Moderate: 3-6 bags/day
- Severe: more than 6 bags/day
In mild dependency, the suggested treatment is outpatient rehab or partial hospital. Moderate dependency cases are recommended for partial hospital with inpatient backup, and severe dependency requires inpatient rehab treatment.(3)
After the short-term effects, the user seesaws between wakefulness and drowsiness, and mental functioning becomes clouded. Breathing and heart function slow down. These last for several hours and if severe, may lead to coma or death.
In the long term, frequent heroin use creates tolerance, and the individual has to take higher doses to feel the desired effects. Changes occur in the brain, affecting decision making, behaviour regulation, and response to stressful stimuli.(4)
Heroin detox and withdrawal
Detoxification is the flushing out of the drug from the body. It is the first step in a drug or alcohol treatment programme to prepare the physical body prior to initiating multidisciplinary interventions aimed at long-term recovery. It is a 3-step process involving the following:(5)
1.) Evaluation of the physical, psychological and social conditions to check for:
- presence and concentration of heroin in the blood
- existing or co-occurring psychological or mental disorders
- social circumstances
The information gathered will help determine the type and level of treatment to be given after a successful detox.
2.) Stabilisation of the individual’s physical and mental states, to include management of withdrawal symptoms with medications and providing psychological support.
3.) Fostering the patient’s entry into treatment, via an explanation of the interventions planned for successful recovery and maintained abstinence, and the acquiescence of the patient.
Detoxification from an addictive drug will result in withdrawal symptoms. There is no single method for treating drug addiction. (6)
The withdrawal symptoms of heroin detox vary in intensity and duration from person to person. Factors that determine their severity include:
- Duration of use
- Dose at each use
- Frequency of use
- Method of use
- Presence of other medical or psychiatric conditions
With heroin, which is a short-acting opioid, withdrawal symptoms typically appear at 6 to 24 hours after last use. Acute symptoms are at their highest on Days 2 and 3, and taper off between Days 4 to 10. But the post-acute withdrawal symptoms (PAWS) can last for weeks or months.(7)
Heroin withdrawal symptoms
Heroin withdrawal symptoms resemble a flu-like illness. The syndrome for milder withdrawal is manifested by nausea, tearing, runny nose, sweats and chills, frequent yawning, muscle aches and abdominal cramps.
Moderate withdrawal symptoms will include irritability, fatigue, insomnia, goose flesh and dilated pupils in addition to the flu-like symptoms. In severe withdrawal, the person will experience anxiety, depression, high blood pressure, rapid heart rate, tremors, deficient respiration, dysphoria, and intense cravings. (8)
Although heroin withdrawal is not life threatening by itself, some of the symptoms associated with it may be caused by underlying medical illnesses and not by withdrawal. Another challenge to heroin withdrawal are the symptoms such as depression that may lead the person to consider suicide, or having a relapse due to the cravings.
The dangers of an at-home heroin detox
A person on heroin detoxification cannot foresee the degree of severity of the withdrawal symptoms. In most cases, the individual has muscle pains, nausea, sweat and chills, diarrhoea, and vomiting, along with other physical symptoms. Detoxing is an intense experience and without proper symptoms management, the individual on a drug rehab goes through great discomfort.
Other withdrawal symptoms are diarrhoea and vomiting. Without intervention, they result in dehydration and electrolyte imbalance that increase sodium levels and lead to cardiac arrest, heart failure or brain damage. These are conditions that may bring about coma or death.
Psychological symptoms of withdrawal are anxiety, insomnia, depression and dysphoria, or the inability to find pleasure in activities once enjoyed.
The pain and suffering that these symptoms bring are preventable with medications. But these medications can only be prescribed by medical doctors and are not accessible to individuals who are doing a heroin detox at home.
One way to ease the symptoms when professional intervention is absent is to take the drugs again and relapse. That is why at home detox of illicit substances is seldom successful.
In a relapse, the dose taken is generally higher than the regular dose prior to detox and the person overdoses. Another common occurrence is mixing heroin with other substances. If taken with a sedative, the result can be respiratory distress, which is life threatening.
Heroin detox withdrawal symptoms such as anxiety and depression can lead to suicide thoughts that the person may carry out, resulting in death or hospitalisation.
Heroin detox and withdrawal symptoms treatment
A professional heroin addiction rehab can make the difference between a life ruined by addiction and a life of sobriety and productivity. Two options for detox and rehab under medical supervision are outpatient and inpatient rehab.
An outpatient treatment for detox and withdrawal has a good chance of success because there is a professional evaluation, supervision, and management of the patient in a science-based programme. In this option, the patient lives at home and sees the therapist, counsellor, or psychiatrist at the rehab centre for medication and individual or group counselling.
In an outpatient setting, the cost is not as expensive since there is no room and board expense. The patient can also continue with work and other normal activities. Sessions usually take place at night outside of working hours.
Detox is only a component of the recovery programme, and treatment will follow to achieve long term sobriety and recovery. The patient typically spends 12 hours a week for medical monitoring and management of withdrawal symptoms. Psychological support and behavioural management techniques are also given.
Other activities in an outpatient programme may include:
- Drug abuse education
- Training for skills in all aspects: employment, communication, financial responsibility, anger, and stress management
- Training in relapse prevention
- Participation in 12-step groups such as Alcoholics Anonymous and Narcotics Anonymous
Outpatient rehab programmes work best for persons with mild addiction, has strong family and social support, and has no underlying medical conditions.
Inpatient rehab, where the person lives in the facility, is the best option for people with moderate to severe addiction, those with a co-morbid condition or has another drug addiction, and those who have tried treatment and have relapsed. Detox and withdrawal in an inpatient rehab have a higher percent of recovery compared to an outpatient rehab.(7)
For inpatient rehab, supervision and monitoring is available 24 hours a day. Withdrawal symptoms are treated immediately, and accessibility to medications and psychological support is always present. Individual and group activities support the physical, mental, and spiritual needs of the patient.
The schedule in inpatient rehab facilities is highly structured, including sleep and wake up time, meals, one on one therapy, and group sessions. Nutrition and physical activities are planned, and time for spiritual sessions are included.
Inpatient rehab for heroin addiction typically lasts for 30, 60 or 90 days. The main drawback to inpatient rehab is the cost. But the recovery and regaining productivity makes the cost worthwhile.
Medications for heroin detox and withdrawal symptoms
In NIDA’s Principles of Effective Treatment for Drug Addiction, medications are recognized as playing an important role in the total addiction recovery programme that includes behavioural therapies, counselling, and social support.
This dispels the myth that medications given as a substitute for the addicting substance is like replacing one addiction with another.
It also bears saying that medications for heroin abuse treatment cannot be bought over the counter and must be prescribed by a physician because dosage varies for each patient. The strength of these medications is determined based on factors like severity of dependency, level of opioid tolerance, genetic background and presence of other diseases.
The unavailability of medications for heroin detox at home makes this option unsafe, as the patient has no pharmacologic assistance to manage intense withdrawal symptoms and may resort to dangerous measures.
These are the drugs that are used for heroin addiction treatment:
Methadone is an opioid agonist. It mimics the effects of heroin but does not cause the alarming “high” which causes the individual to become addicted to it. It acts to reduce the craving and stabilise the withdrawal symptoms to a manageable level.
Methadone is given to achieve a gradual cessation of dependence leading to abstinence. It is usually taken for a minimum of 12 months to as long as several years.
In the UK, it is given once daily in a 1mg/1ml oral solution. The common starter dose is 10ml to 30 ml gradually increasing until the craving for heroin stops. Methadone tablets and injections are not licensed for use in opioid detox and withdrawal and will need the approval of an NHS Foundation Trust like NICE.
Buprenorphine is a partial opioid agonist; hence, it has a less sedating and less euphoric effect than methadone. It is given sublingual in 200 mcg and 400 mcg strengths and is the drug of first choice for heroin dependent users who have not tried methadone.
Methadone and buprenorphine are usually given daily under the direct supervision of a professional to prevent deviation.
Lofexidine has recently been approved as a medication for heroin addiction treatment and recovery. It is the first non-opioid medication and may be given for symptomatic relief of withdrawal symptoms. However, it will not reduce the cravings for the drug. It is a non-addictive medication and cannot be bought over the counter. It has to be prescribed by a doctor.
Naltrexone is an opioid antagonist that blocks the effects of heroin for up to 72 hours. The patient must be physically free of opiates in the system before the administration of naltroxene; otherwise, sudden, and severe withdrawal symptoms may come up. To ensure that the patient is heroin-free, a urine test is done before commencing naltrexone treatment.
For the safety of the patient, naltrexone treatment should only be given 3-4 days after buprenorphine, 7 days after heroin, and 10 days after methadone. (10)
Several studies have shown that a heroin at home detox without medical assistance is seldom successful. The withdrawal symptoms are too intense to endure and the recommended and approved medications require a prescription that is only available in a professional rehab treatment.
Self-medication in an at-home heroin detox, if medication is obtained illegally, has serious consequences because doses of these medications must be measured based on predetermined factors unique to each person. Oftentimes, an overdose is lethal or puts the person in danger of death.
Relapse is common in heroin detox done alone. The patient will experience strong cravings because of heroin withdrawal and has a strong tendency to go back to using the drug because the medications that would have helped lessen the cravings are not accessible.
A detox alone without social support brings on depression and dysphoria and results in suicide thoughts. Further, a 2016 study contradicts the assumption that heroin detox and withdrawal are not life-threatening (11) If symptoms like diarrhoea and vomiting are not medically managed, they lead to dehydration and increased blood sodium levels that can cause heart failure.
If in the UK and looking for addiction treatment facilities for rehab, Scotland has professionally managed drug recovery centres that have a track record for success.