The Pain of Addiction: Heroin Withdrawal Timeline

Written By Bobby Oerzen BS MA - February 28th, 2017
The Pain of Addiction: Heroin Withdrawal Timeline

It’s no secret that heroin addiction is on the rise. An epidemic of abuse is plaguing the country and is prevalent in all states. Even in today’s day and age, the number of people using heroin for the first time is high; nearly the number of people who started heroin use in 2016 is nearly double the amount of first-time users in 2006 (National Institute on Drug Abuse, 2018).

To comprehend the power of heroin addiction, the timing and intensity of heroin withdrawal must be understood. After an addict injects, snorts or smokes heroin, the initial euphoric feeling can be described as a “rush” – an upwelling of sensation that can be accompanied by a dry mouth as well as a “warm” sensation. After a while, the user experiences feelings of apathy and decreased bodily movement (Fareed et al., 2011).

Any euphoric feelings or sought-after high are indeed short-lived. Heroin is a short-acting drug, which means that while the desired high takes effect rapidly, it also leaves the bloodstream quickly. Because of this short-acting nature, it can lead to a quick-onset of withdrawal symptoms. These symptoms usually occur as soon as 8-12 hours after the last dose of heroin (Fareed et al., 2011).

Within these hours, once the drowsiness and apathy have begun to fade, the craving for more heroin begins to take hold. This dependency is a result of neurochemical and molecular changes in the brain. If the addict does not inject or take another hit of heroin, he or she will start to experience intensely unpleasant withdrawal symptoms (Korsten & George, 2002).

As previously stated, the withdrawal symptoms usually occur within 8-12 hours. Yet, for some heavy users, symptoms can begin as quickly as 4 hours after the last “hit”. These symptoms can range from mild to severe. Intensity of heroin withdrawal will vary by the amount of heroin consumed, duration and frequency of use, as well as the user’s overall health. Some of the effects of withdrawal may include (Fareed et al., 2011):

  • Sweats
  • Chills
  • Nausea
  • Cramping
  • Vomiting
  • Diarrhea
  • Anxiety
  • Depression
  • Rapid heart rate
  • Muscle spams

The peak of withdrawal occurs two to three days after the last dose of heroin, with the symptoms beginning to subside after about a week (Fareed et al., 2011).

However, some symptoms can persist for weeks or even months, often leading to return to active use of the drug. This is coined Post-Acute Withdrawal Syndrome (or Protracted Abstinence Syndrome). Symptoms of Post-Acute Withdrawal include insomnia, depression, impaired concentration, anorexia and fatigue. These prolonged symptoms quickly lead to relapse. Therefore, awareness and management of these protracted symptoms is fundamental to maintaining sobriety (Substance Abuse and Mental Health Services Administration, 2016).

The timeframe or severity of heroin withdrawal can actually be proxy measured, by measuring the size of the addict’s pupils (Substance Abuse and Mental Health Services Administration, 2016). If the user’s pupils are large (or dilated), that is an indication that they are experiencing acute heroin withdrawal. However, as time passes and withdrawal symptoms fade, the pupil’s will get smaller and eventually return to normal. This measurement is observed in the Clinical Opiate Withdrawal Scale as one of the items to score a user in terms of withdrawal severity (Substance Abuse and Mental Health Services Administration, 2016).

Withdrawal from heroin isn’t considered life-threatening in and of itself. Heroin addicts are most likely to die overdosing from heroin, rather than from quitting heroin and experiencing withdrawal (Darke & Hall, 2003). However, withdrawal symptoms may still be medically significant and/or lead to complications. Heroin withdrawal is not something that should be taken lightly, or attempted alone. It is highly recommended that an addict get the support of professional medical and/or mental health professionals who can help manage the side-effects from withdrawal in a safe environment (Kleber, 2007).

The potential for crippling withdrawal symptoms within hours is why heroin proves to be such a dangerous drug. This quick onset of withdrawal compels the addict to consume more and more, perpetually, in order to avoid this excruciating state.  The very drug causing the pain becomes the only recourse to alleviate it. One of the most frightening aspects of heroin is the reality that a user can become sucked into this cycle of addiction after only one use (Fareed et al., 2011).

The dated perception of the heroin addict as a junkie in an ally is no longer applicable. The drug knows no economic, racial or gender boundaries. This increase in abuse is in large part due to the fact that it is now more easily available throughout cities as well as suburbs, in forms that are easier to consume by smoking or snorting. However, while inhaling something through the mouth or nose may make the drug appear less dangerous than injecting it, heroin is just as addictive regardless of how the high is achieved (National Institute on Drug Abuse, 2018).

The intense desire to recapture that initial euphoric sensation, coupled with the pain of withdrawal closing in on the addict within hours and lasting for days, leads to a deadly combination ending in heroin addiction. The horror of experiencing heroin withdrawal propels addicts to continue using, even as their bodies, minds and lives catastrophically deteriorate. It is an extremely addictive drug that enslaves its users in a cycle of dependency and more often than not ends in a fatal overdose.



Darke, S., & Hall, W. (2003). Heroin overdose: research and evidence-based intervention. Journal of Urban Health80(2), 189-200.

Fareed, A., Stout, S., Casarella, J., Vayalapalli, S., Cox, J., & Drexler, K. (2011). Illicit opioid intoxication: diagnosis and treatment. Substance Abuse, 5, 17-25

Kleber H. D. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in Clinical Neuroscience9(4), 455-70

Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatment. Science & practice perspectives1(1), 13-20.

National Institute on Drug Abuse. (2018). What is the scope of heroin use in the United States? Retrieved 27 March, 2019 from

Substance Abuse and Mental health Services Administration. (2016). Medication-Assisted Treatment of Opioid Use Disorder Pocket Guide. Retrieved 27 March, 2019 from


Chief Editor

Dr. Ashley Murray


Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practices in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.



Bobby Oerzen BS MA