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Last Updated:
27 January 2026

Understanding Heroin Withdrawal and Detox

Heroin withdrawal occurs when your body has developed a physical dependence on the drug and begins reacting to its absence. Regular use of heroin may cause a range of both physical and psychological symptoms when you try to stop. Detox is the process of purging heroin from your system, and is an important first step toward recovery.

Without professional guidance, detox can be risky, especially if you have underlying medical or mental health issues. Withdrawal can be managed more safely and with far less discomfort with the right support.

How Heroin Dependence Leads to Withdrawal Symptoms

When you use heroin, over time, your brain starts to rely on the drug and slows its natural production of endorphins. If heroin use suddenly stops, your body may struggle to cope, resulting in withdrawal symptoms. These reactions aren’t just physical; they can affect your mood, sleep, and ability to function day to day.

Safety Concerns With Unsupervised Withdrawal

Attempting heroin withdrawal on your own can be challenging, both physically and emotionally. Without proper support, the intensity of symptoms can quickly become unmanageable. Heroin withdrawal is rarely life-threatening in itself, but serious risks like dehydration, existing medical issues, or self-harming behaviours can sometimes make the process a safety concern.

Recognising Heroin Withdrawal Symptoms

Heroin withdrawal symptoms can impact both body and mind, often beginning within just a few hours of the last use. These symptoms can vary widely in intensity and duration from person to person. Recognising them isn’t always easy, especially when you’re already feeling overwhelmed, but doing so is a brave and important step toward healing.

You or your loved one might experience symptoms in waves, often grouped into stages that shift over time. What starts with flu-like aches, chills, or restlessness can develop into emotional challenges like anxiety or low mood. Understanding what to expect can help reduce fear around the process and allow for better preparation, both mentally and physically.

Physical Symptoms of Heroin Withdrawal

Heroin withdrawal can place intense strain on your body, and it’s completely normal to feel overwhelmed by the physical effects. Common symptoms include muscle aches, chills, sweating, watery eyes, yawning, nausea, vomiting, diarrhoea, shaking, and physical restlessness. Many people also experience exhaustion and struggle to sleep during this period.

Psychological Symptoms and Emotional Effects

It’s common to feel anxious, irritable, or low in mood, sometimes swinging between agitation and deep sadness. Cravings may feel especially strong during peak withdrawal, adding to those moments of distress. These psychological effects aren’t a sign that something is wrong with you; they’re a natural part of the withdrawal process, and they are treatable.

Early Phase (6–12 Hours After Last Use)

The first signs of withdrawal usually appear within 6 to 12 hours after your last use. This early phase can bring a sense of unease with feelings of anxiety, restlessness, and muscle aches being common. You might also notice watery eyes, frequent yawning, and an intense urge to use again as your brain starts adjusting to the absence of opioids.

While this stage can feel uncomfortable, it’s relatively short and, with proper support, manageable. If you’re going through this phase, it’s important not to do it alone; medical supervision and emotional support can help ease symptoms and ensure your safety.

When is Medical Detox Recommended?

Although medical detox isn’t always required for cocaine withdrawal, it may be recommended if there are co-occurring mental health issues, a heightened risk of suicide, or the presence of other substances like alcohol or benzodiazepines. In these situations, a medically supervised setting ensures your safety and provides stabilisation before entering a structured residential programme.

Peak Phase (48–72 Hours)

This is often the most physically demanding stage of heroin withdrawal. Common symptoms, such as nausea, diarrhoea, sweating, chills, muscle aches, and a racing heart, tend to intensify during this time. Emotionally, you or your loved one may experience heightened irritability, restlessness, or a deep sense of discouragement.

With the right professional support and structured environment, symptoms become a little easier to manage. You do not face these challenges alone; supervision and support accompany you throughout this phase.

Post-Acute Symptoms (Up to Two Weeks and Beyond)

After the initial withdrawal phase, some people continue to experience lingering symptoms for weeks or even months. This is known as post-acute withdrawal syndrome (PAWS), and while it’s usually less intense than the acute stage, it can still affect your mood, sleep, focus, energy levels, and ability to manage cravings. PAWS can vary widely between individuals, but it’s manageable.

Our extended residential care and sober living options are designed to give you space, tools, and consistency as your body and mind recalibrate. Many people successfully move through this stage with the right strategies and a steady, personalised approach.

Heroin Withdrawal Timeline: What to Expect

While the exact timing varies from person to person, symptoms often begin within hours of the last use.

The timeline tends to unfold in several stages, each with its own emotional and physical challenges. We’ve highlighted these phases so you are aware and to reassure you that, while detox is managed externally for safety reasons, our team remains a steady source of support throughout the recovery journey. On completing the initial medical phase, we will guide you through the next steps with structure, compassion, and clinical care tailored to your longer-term needs.

Treatment Approaches and Medicines for Withdrawal

Medically supported treatments can help ease the symptoms of heroin withdrawal and make the process feel safer and less overwhelming. For example, in the UK, opioid substitution therapy, such as methadone or buprenorphine, remains a central part of care during detox. Other medications may also be used to manage specific symptoms, depending on the person’s needs.

For withdrawal management, we don’t provide detox services directly. Instead, we work closely with trusted medical providers to ensure you or your loved one receives safe, supervised withdrawal support before transitioning into our residential care. Effective medications can bring relief and mean you don’t have to face withdrawal without options.

Buprenorphine is one of the most commonly used and well-tolerated medications for managing opioid withdrawal. As a partial opioid agonist, buprenorphine can help ease withdrawal symptoms and significantly reduce cravings. It's usually administered under medical supervision during detox. Subutex contains pure buprenorphine, while Suboxone combines buprenorphine with naloxone to help discourage misuse.

Buprenorphine (Subutex/Suboxone)

Methadone is a long-acting opioid used in opioid substitution therapy (OST) to help reduce cravings and ease withdrawal. Typically taken as a daily oral dose, it can support stability for those with high levels of physical dependence on heroin or other opioids. While we don’t prescribe or manage methadone treatment directly, we regularly coordinate care with qualified medical providers and community-based OST services when needed.

Methadone and Opioid Substitution Therapy

Doctors may recommend additional medications that target specific symptoms. These supportive treatments can improve your comfort and stability when used under proper medical supervision. Depending on your needs, you might be prescribed lofexidine or clonidine to help manage anxiety and blood pressure, antiemetics to relieve nausea, loperamide for diarrhoea, non-opioid pain relievers, or sedating antihistamines for sleep issues.

Symptomatic and Adjunct Medications

Some individuals, such as pregnant people, older adults, or those with chronic health conditions, may need tailored detox plans to safeguard their health and wellbeing. For instance, during pregnancy, methadone is often recommended because it helps maintain more stable blood levels than some alternatives. In people living with cardiovascular or liver disease, medication options and monitoring must be adjusted with great care.

Special Considerations for Unique Populations

Levels of Care: Inpatient, Outpatient, and Home Management

Choosing how and where to manage heroin withdrawal can be daunting, especially with concern for safety or the risk of relapse. While some people may begin their detox through outpatient services or with support from a health provider, others need more structure and medical oversight in an inpatient setting.

We don’t offer medical detox onsite, but we work closely with trusted partners to support you in arranging the appropriate care. Our focus begins after detox, providing a stable, evidence-based residential environment where you can start working on the deeper layers of recovery.

When is Medical Supervision Recommended?

Medical supervision is typically recommended when there’s a strong physical dependency, ongoing mental health struggles, other health complications, or a history of difficult withdrawal attempts.

Inpatient Versus Outpatient Detox Settings

Inpatient detox provides a medically supervised environment with 24-hour clinical oversight and emotional support. Outpatient or community-based detox may be appropriate for those with lower medical risk and strong support systems at home.

Managing Dual Diagnosis During Withdrawal

When you’re also living with mental health struggles like anxiety, depression, or trauma, withdrawal can feel even more overwhelming. These co-occurring experiences, often referred to as dual diagnosis, tend to intensify withdrawal symptoms and require a thoughtful, integrated approach.

We understand the link between these conditions, which is the reason why our programme includes long-term support for both, helping you move through withdrawal and into deeper recovery with a team that sees the full picture.

Common Co-occurring Conditions (e.g. Anxiety, PTSD)

Many people experiencing heroin withdrawal also live with ongoing mental health challenges like generalised anxiety disorder, PTSD, or depression. In the early stages of withdrawal, these symptoms may appear as panic, restlessness, and a sense of emotional collapse.

Integrated Care for Mental Health and Substance Use

We take an integrated approach to treating both substance use and co-occurring mental health conditions, because addressing them together is essential for long-term recovery. Our multidisciplinary team collaborates to carry out coordinated assessments, develop unified therapy plans, and deliver care that reflects the complete picture of what you’re facing.

Recovery After Detox: Aftercare and Relapse Prevention

Detox is just the starting point; recovery truly begins afterwards. Long-term change requires consistent support across many layers: psychological care, behavioural structure, practical tools, and meaningful connection. We recognise how easily fear of relapse can creep in, especially once the intensity of detox passes.

We emphasise structured aftercare and sober living phases that help you keep growing, not just staying sober. Together, we help you build a routine that offers stability without feeling rigid, and accountability that feels empowering rather than punitive. These elements work in tandem to reduce relapse risk and reinforce your sense of direction and connection as you step back into daily life.

CBT, Peer Support, and Structured Recovery

After detox, we integrate evidence-based approaches like Cognitive Behavioural Therapy (CBT), group counselling, and peer-led recovery meetings such as Narcotics Anonymous to support this transition.

These tools help you explore emotional triggers, reshape thinking patterns, and strengthen the practical skills needed for long-term recovery.

Lifestyle Changes and Managing Ongoing Symptoms

Even after the intensity of withdrawal has passed, finding balance in your daily routine remains a key part of recovery.

We work closely with clients to build sustainable habits around sleep, nutrition, movement, and connection, each supporting your physical and emotional wellbeing.

Access to Heroin Withdrawal Treatment

If you or someone you love is facing heroin addiction, beginning treatment often starts with talking to your healthcare provider or connecting with local Drug and Alcohol services.

Alternatively, if you are considering private treatment, when evaluating treatment options, we encourage you to seek providers who are CQC-registered, uphold clear clinical standards, and offer integrated care that goes beyond short-term symptom management.

Our commitment to ethical, long-term recovery from opioid dependence means supporting you every step of the way, from your first contact with us to structured sober living and beyond.

Long-Term Recovery: Why Choose Liberty Home Group?

If you or your loved one is looking for long-term recovery after completing detox, Liberty Home Group offers a clinically grounded, ethical programme tailored to your next step. We provide structured residential treatment in Cape Town, with a calm, home-like environment designed to support sustained healing.

Our approach is especially well-suited for those who need continued mental health care alongside addiction recovery, offering a safe, supportive space to rebuild and move forward.

Next Steps: Starting Treatment with Liberty

When you’re ready to move forward after detox, we’re here to guide you. Contact us to explore admission timing, whether our programme is the right fit, and how we can support your long-term recovery in a structured, compassionate setting.

Frequently Asked Questions

What are the most common heroin withdrawal symptoms?

Common symptoms include muscle aches, sweating, anxiety, diarrhoea, nausea, vomiting, chills, restlessness, and intense cravings. Emotional symptoms such as depression and irritability are also frequent during withdrawal.

How long does heroin withdrawal last, with and without treatment?

Without treatment, acute symptoms often peak within 2 to 3 days and fade over about a week, though psychological symptoms may linger. With treatment, especially using medications like buprenorphine, symptoms can be milder and more manageable.

Which medications are used during heroin detox?

Medications may include methadone or buprenorphine for stabilisation, as well as adjuncts like anti-nausea drugs, pain relievers, and sedatives for sleep. Lofexidine or clonidine may help reduce certain withdrawal symptoms.

What level of care is needed during heroin withdrawal?

It depends on the individual’s health and support network. Some may manage with outpatient monitoring, while others benefit from inpatient care due to complex needs, mental health issues, or high relapse risk.

Is heroin withdrawal treatment covered by private insurance?

Private treatment is often self-funded, though limited insurance cover may be available for some aspects of care depending on your provider.