Heroin Withdrawal Symptoms and Timeline- Slaying the Dragon
Heroin Withdrawal- Heroin Hell
Many people, especially those without substance abuse issues, have a hard time understanding the feelings a heroin user experiences when faced with imminent withdrawal. Making matters worse, Hollywood rarely portrays opiate withdrawal accurately. I am sure this is not intentional. After all, even if the actors portrayed the physical withdrawal symptoms accurately, there is no way to show the actual length of time these symptoms persist. It is simply impossible to fit even the first 3 days, of the seemingly endless first month of withdrawal, into a 2-hour movie. Plus, heroin withdrawal is far from glamorous!
In Neil Armfeld’s film Candy, starring Heath Ledger (Dan) (RIP :() and Abbie Cornish (Candy), you will see one of the most accurate portrayals of heroin withdrawal ever filmed.
Tragically, Heath Ledger died, two years after the release of Candy, from prescription drug overdose. The toxicology report, obtained during autopsy, confirmed the presence of hydrocodone, oxycodone, diazepam, temazepam, alprazolam, and doxylamine, in Ledger’s blood. (Mixing opiates and benzodiazapines is often a death sentence and most doctor’s will not prescribe these medications in tandem. It is one of the most dangerous drug combinations possible, as both drugs suppress your breathing.)
I can not help but wonder whether Ledger’s opiate addiction made him the perfect actor for this part, allowing him to recreate the actual symptoms he had during his own withdrawals. This personal experience may have given Ledger the edge needed to play the role of a heroin addict so realistically.
Without further ado, here is the clip:
If you have personal experience with heroin or opiate withdrawal, I would like to hear your feedback on this video clip. Do you think they have left anything out as far as symptoms go? If you were directing this film, what else would you add to this scene? Leave your answers in the comments below.
Heroin Withdrawal Symptoms Timeline
The symptoms described in this article apply to withdrawal from heroin, as well as OxyContin, Percocet, and other oxycodone, hydrocodone, opiate-based pain pills. When a user abuses opiates for a long enough period, they risk dealing with many of the following symptoms during withdrawal. Every person responds differently, but a physical addiction can develop in as little as ten days of opiate use.
For those of you with no experience on the subject, here is a non exhaustive list of symptoms experienced during the first 1-5 days of heroin withdrawal:
Stage 1: Physical Withdrawal Symptoms (Days 1-4 or 5)
- sweating profusely
- vomiting uncontrollably, mostly stomach acid and bile
- constant yawning
- extreme watery eyes
- constant runny nose
- muscle and full body aches
- (Note: Females seem to experience this symptom with much greater intensity. It may have to do with our hormones, but the body aches experienced by females in opiate withdrawal have been equated to the pain felt by late stage bone cancer patients.)
- restless legs
- extreme drowsiness
- (As a user passes the 24-hour mark of withdrawal, extreme drowsiness kicks in. This is not a blessing however, as it is accompanied by extreme insomnia. The other symptoms a user is experiencing during this time makes it hard to get any rest.)
Without 8 hours of sleep per night, 3-4 days of tossing and turning in bed with these symptoms, feels like an eternity.
Stage 2: Emotional Withdrawal Symptoms
After the initial 3-5 day period of extreme physical withdrawal symptoms, the battle continues. Stage 2 starts between days 3 and 5 and can last anywhere from 6 months to 3 years depending on the person.
A Glimmer of Hope
Between days 3 and 5 of heroin withdrawal, loved ones will start to recognize a change in a user’s eyes, almost as if a light has been switched back on. This will give loved ones hope, especially when the user has been on a lengthy binge, because they have lived in constant fear that this light had been extinguished forever.
I remember, on a few occasions, being told how much better I looked around Day 5. My parents would start to smile and tell me how much they had missed the ‘real’ me. This was hard to hear at this stage because, even though I may have started to look like my old sober self, I felt worse than ever inside. I remember thinking, if this is what I have to feel like to stay sober and keep everyone off my back, I don’t want any part of it!
During the first week of Stage 2, a user starts to develop an appetite for healthy meals again. It is extremely important to eat healthy when this happens because most users have failed to take good care of themselves while using, leaving their bodies under- and malnourished.
Don’t be a Fool!
Do not mistake a glimmer in the eye and a return of appetite for the end of withdrawal. It will take many healthy meals to replenish all the vitamins and minerals a user has been lacking. Replenishing nutrients, while the user’s body detoxifies, helps heal the body and mind, so the user has the best chance of giving his all to recovery.
Days 4-6 are the most dangerous, delicate time of withdrawal. It is nearly impossible for a user, on days 4-6 of withdrawal, to abstain from looking for a fix. I know, from personal experience, a user will do almost anything to get ‘one last high.’ The extreme guilt of letting his family down coupled with, what the user perceives as, unavoidable failure, causes the brain to ‘double down’ in an effort to find relief from the physical and emotional pain. Chemicals in the brain go haywire, intensifying urges until a user gives in and does what users in pain do best, get their fix.
As discussed in “What is the Cause of Drug Addiction,” this urge is triggered in the brain. Constant use carves deep neuropathways into a user’s brain and after few days of feeling sick, the brain resorts to what it has grown accustomed to, using heroin to feel better. This urge is completely chemical and will not go away until new neuropathways are formed over time. This can only happen if the user forces himself to make healthy choices, new habits, for a lengthy period.
Feeling the Feels
Muscle aches can continue during this stage, most commonly in the back or shoulder area. A user will find it difficult to sleep for more than a few hours at a time. For many, regular sleep patterns do not start to return for years.
Although the user seems coherent and clear-headed, he is not out of the woods yet. Emotional symptoms peak during this stage of withdrawal. These emotional symptoms are present deep inside the user’s psyche so they are not easy to identify through physical observation of the user alone. A user will experience emotional extremes, in quick succession. Extreme anxiety followed by extreme depression followed by extreme emptiness and so on.
A skilled mental health professional will be able to help the user identify these symptoms (emotional trauma, depression disorder, insomnia, general anxiety disorder and so on) and develop healthy ways to cope with them. Without proper symptom management, a relapse becomes much more likely.
Factors influencing how long a person remains in Stage 2 include, length of time on heroin, quantity of heroin used (tolerance), whether heroin was used as a way to self-medicate, what type of treatment program attended, how much effort is put into recovery and whether the user has a support system to help get his life back together.
Recovery: A Family Affair
Often overlooked, yet incredibly significant to preventing relapse, is the recovery of a user’s loved ones. It is less common for family members and friends to seek psychological help during a loved one’s recovery process. However, it is extremely important. Although unintentionally, loved ones may be enabling the user or triggering urges. An experienced professional can identify and stop any enabling behavior, while addressing family dynamic issues that increase the recovering user’s risk of relapse if not dealt with.
After intense physical withdrawals, Stage 2 is accompanied by the seemingly never-ending symptoms of Post Acute Withdrawal Syndrome. (PAWS) PAWS is defined by the lingering symptoms experienced after getting off of drugs.
For a heroin user, symptoms include insomnia, nausea, fatigue, depression, anxiety, irritability, mood swings, and more. Then there are the less painful, but sure to drive a person nuts, symptoms of PAWS, including excessive yawning, watery eyes, and sneezing.
The latter is the symptom I remember the most. I completed a three day suboxone taper at a detox center. Upon discharge, I was given seroquil to help with my insomnia, but other than that, I was on my own. Two weeks out of detox, I started having sneezing fits. Literally, I would sneeze 9 times in a row. This would happen up to 4 times a day! I know, it doesn’t even sound possible, but trust me it is. Another month or so and the fits decreased to six sneezes in a row, a few more weeks and a decrease to four sneezes, and so on and so on for the next six months! I almost considered seeing a doctor until I was reassured by others in recovery that this was to be expected.
Anyway, enough about me. Reader, I hope you are starting to understand how scary it is for a user to go into cold-turkey withdrawal. Even considering medical detox, where symptoms can be managed, is frightening. If we truly want to help stop the opioid epidemic in its tracks, we need to start understanding this fear of going into withdrawal and focus on making the experience as comfortable as possible for the user.
I recently read an article about the kindling effect. The study proposing the Kindling theory was based on alcohol withdrawal, but many have theorized it also applies to drug withdrawal. The kindling theory purports that withdrawal symptoms get worse with each relapse. Relapse serves as kindling and withdrawal is the fire. Intensity of withdrawal symptoms increase with each relapse, as a fire grown more intense with added kindling. If interested in reading more about this theory, I suggest this article: The Kindling Effect
Can You Die From Heroin Withdrawal?
Many believe it is not possible to die from heroin withdrawal. I was frequently told, even by nurses in jail, that a user can only die during withdrawal from alcohol and bezodiazepines (xanax, lorazepam, etc.) When a user gets arrested and tells a nurse he is a heroin user, the nurse does not prescribe any medication. Therefore, the user is left to suffer cold turkey withdrawal in a cold, dirty jail. However, when an alcoholic or benzo user get arrested, they are given medication to ease the side effects of withdrawal, prevent insomnia, and avoid seizures.
I used to say, “Detox off alcohol and benzos may be the only life-threatening withdrawal, but detox off heroin is the only withdrawal that makes you feel like you wish you were dead.” This was not an exaggeration. However, it was based on incorrect information.
Recently, I discovered it is VERY possible to die from heroin withdrawal. As noted above, heroin withdrawal symptoms include vomiting and diarrhea which, if left untreated, can result in dehydration, hypernatraemia (elevated blood sodium level) and resultant heart failure. This is very important information. Hopefully people will stop belittling the dangers associated with heroin withdrawal so more lives can be saved.
If you have any questions about heroin withdrawal, or need any advice, please feel free to leave a comment below. Thank you for reading and remember to hug your loved ones.