Symptoms describe an individual's subjective experience of illness, and are different from signs of illness which are visible to others. Heroin addicts typically experience symptoms of withdrawal when they stop using the drug, when they are unable to obtain sufficient quantity of the drug and when the quantity has less than expected potency, as is common with street drugs "cut" with other, cheaper ingredients. Symptoms of heroin withdrawal can be divided into three stages.
Early Withdrawal
Symptoms of heroin withdrawal typically present within eight to 16 hours of the last use. In contrast to other prescription narcotics, the effects of heroin are characterized by "fast-on" and "fast-off" effects. Therefore, heroin users experience symptoms more quickly, and the symptoms are subjectively more severe than those experienced by prescription narcotics users.
Symptoms are initially mild and may resemble the flu. Common complaints include nasal stuffiness, watery eyes, blurred vision, sweating, muscle spasms or twitching, 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 early symptoms include localized, aching pain in the back, abdomen or legs, and hot or cold "flashes." Patients may alternate between requesting blankets and taking cold showers or baths.
Peak Withdrawal
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. As symptoms subside, patients may complain of ravishing hunger.
Occasionally, patients may complain of severe abdominal pain, and some patients do show evidence of pancreatitis as demonstrated on ultrasounds. In rare cases, agitation may precipitate seizures; however, seizures are characteristic of withdrawal from alcohol and other drugs and 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 at a cost of intensification of the subjective symptoms.
Long-Term Recovery
After seven to 10 days, physical signs of withdrawal typically resolve. Psychological and psychosomatic symptoms of withdrawal, including insomnia, nervousness, weakness and muscle aches, may persist for up to a year. Heroin addiction is almost aways a chronic, relapsing condition. In one study cited in the October 2009 issue of "Clinical Psychology Reviews," fewer than 25 percent of heroin addicts remained abstinent even with methadone treatment. Self-help groups such as Narconon offer social support to heroin addicts and their families, and provide information on local treatment programs and healthcare professionals who specialize in addictions.
References
- "Adams and Victor's Principles of Neurology, 9th ed."; Ropper, A.H. and Samuels, M.A. (eds.); 2008
- "Principles of Critical Care, 3rd ed."; Hall, J.B., Schmidt, G.A., Wood, L.D.H. (eds.); 2005
- "Clinical Psychology Reviews"; A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction; Veilleux, J.C., Colvin, P.J., Anderson, J., York, C., Heinz, A.J.; October 2009
