Heroin is an illegal narcotic drug that is injected, smoked or snorted. All heroin addicts experience symptoms of withdrawal when they are abstinent from the drug, unable to obtain sufficient quantity of the drug or when the quantity has less than expected potency, as is common with street drugs “cut” with other, cheaper ingredients. Compared to other routes of ingestion, snorting heroin can lead to delayed onset of withdrawal symptoms. Symptoms of withdrawal from heroin snorting can be divided into three stages.
Early Withdrawal Symptoms
Symptoms of heroin withdrawal typically present within 8 to 16 hours of the last use.
For all heroin users, symptoms of withdrawal are initially mild and may resemble the flu. Common complaints include nasal stuffiness, watery eyes, blurred vision, sweating, muscle spasms or restless legs, nausea and goose bumps. In addition, patients also report a generalized feeling of agitation, anxiety, restlessness or insomnia which is initially mild, but increases progressively in severity over the course of a few hours. Other common symptoms include localized, aching pain in the back, abdomen and legs, and hot or cold flashes.
Peak Withdrawal Symptoms
Within 36 hours after the last dose, symptoms of withdrawal may be quite severe. Symptoms peak between 48 and 72 hours, and then gradually subside. Patients commonly complain of agitation and anxiety which is severe and obvious to others. Agitation may be accompanied by nausea, vomiting and diarrhea, although vital signs remain in the normal range.
Patients may complain of severe abdominal pain, while some show evidence of pancreatitis as demonstrated on ultrasound. In rare cases, agitation may precede seizures; however, seizures are characteristic of withdrawal from alcohol and other drugs, so their occurrence should prompt reevaluation of the patient’s history.
Unlike withdrawal from alcohol and other drugs, heroin withdrawal is generally considered life-threatening only in infants. However, polysubstance abuse is the rule, rather than the exception, among illegal drug users. Treatment-seeking opioid users
often meet criteria for comorbid alcohol, nicotine, cannabis, stimulant and sedative dependence.
The duration of heroin withdrawal symptoms may be reduced by the administration of opioid antagonists such as naltrexone (Revia®) and naloxone (Narcan®), but it does so at a cost of intensification of the subjective symptoms.
Long-term Effects
After 7 to 10 days, physical signs of withdrawal have typically resolved. Psychological and psychosomatic symptoms of withdrawal, including insomnia, nervousness, weakness and muscle aches, may persist for up to 1 year. Heroin addiction is often a chronic, relapsing condition, regardless of method of ingestion. In one study, fewer than 25 percent of heroin addicts remained abstinent even with methadone treatment. Self-help groups such as Narconon (see Resources below) offer social support to heroin addicts and their families, and provide information on local treatment programs and health care professionals who specialize in addictions.
References
- • Ropper AH, Samuels MA, "Chapter 43. Disorders of the Nervous System Caused by Drugs, Toxins, and Other Chemical Agents" (Chapter). Ropper AH, Samuels MA: Adams and Victor's Principles of Neurology, 9th ed.New York : McGraw-Hill Medical Publishing Division, 2008.
- • Gehlbach Brian, Kress John P, "Chapter 14. Pain Control, Sedation, and Use of Muscle Relaxants" (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3rd ed. New York : McGraw-Hill Medical Publishing Division, 2005.
- Veilleux JC, Colvin PJ, Anderson J, York C, Heinz AJ. A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction. Clinical Psychology Reviews. October 30, 2009.
