The early symptoms of the withdrawal include anxiety, agitation, increased tearing, runny nose, yawning, insomnia, sweating, and muscle aches. Late symptoms of the withdrawal are abdominal cramping, diarrhea, goose bumps, nausea, vomiting, and dilated pupils. Though the reactions of heroin withdrawal are usually uncomfortable, these effects are not life-threatening. The symptoms of this withdrawal last for 12 hours of the last usage of the drug [6].

• Chills

  Clonidine helps to reduce anxiety, chills, muscle aches, and cramping. It does not help reduce cravings. [howtokickheroin.com]

  Some effects of heroin addiction include: Irritability Depression Loss of appetite Liver damage Respiratory depression Difficulty swallowing Circulatory problems Nausea and vomiting Intense sweating Sleep apnea Joint pain Chills Body weakness Runny nose [acadianaaddiction.com]

  […] symptoms of heroin withdrawal include: 2 Sweating, cold sweats Mood changes like anxiety or depression Restlessness Sensitization of genitals Feeling of heaviness Cramps in the limbs or abdomen Excessive yawning or sneezing Tears, running nose Insomnia Chills [healthyplace.com]

  Agitation Anxiety Muscle aches and pains Bone pain Tearing in the eyes Insomnia Runny nose Sweating Yawning Abdominal cramps Diarrhea Dilated pupils Goose bumps Chills Nausea Vomiting Hypothermia Withdrawal symptoms will ease with time. [newlifehouse.com]

• Fever

  Fever A fever is a raised body temperature. [addictions.about.com]

  If you experience a fever over 103 F, you should seek medical assistance immediately. [addictions.com]

  Some individuals going through heroin withdrawal will experience a fever. [heroin.ws]

  Common Symptoms of Heroin Withdrawal Intense stomach cramps and aches Fever Intense muscle cramps Aching bones and tendons Migraines Restlessness and total inability to sleep Hallucinations Extreme anxiety Paranoia Depression Thoughts of suicide Inability [thehillscenter.com]

• Collapse

  Some of these include: Liver Disease Abscesses around injection Infection of valves and lining of the heart HIV Hep B / Hep C Collapsed Veins Blood Clots If you choose to detox from home, be sure to consult a physician and schedule a blood test to ensure [newmethodwellness.com]

  Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease. [castlecraig.co.uk]

  The next day, Herr collapsed on the floor of her housing unit and went into cardiac arrest. She was transported to a hospital where she died five days later. [broadly.vice.com]

  Most often, heroin overdose typically involves respiratory depression and collapse, which can quickly become fatal. [deltamedcenter.com]

• Fatigue

  Intense symptoms of heroin withdrawal usually subside within five to seven days, but some symptoms — such as depression and fatigue — can continue for months. [crchealth.com]

  Common long-lasting symptoms include anxiety, depression, fatigue, insomnia and irritability. Ready to get help? Our phone number is available 24/7 to help you or your loved one find a treatment center that suits your needs. [addictioncenter.com]

  When the body doesn’t get the drug, users will often experience an increased resting respiratory rate, a runny nose, sneezing, fatigue and physical pain. [theriversource.org]

  Former heroin users describe the mental fatigue, depression, and anxiety they suffer as the most challenging hurdle of kicking their addiction. [harptreatmentcenter.com]

• Rigor

  Currently, hernia mesh devices can be approved if they are similar to older products, which themselves may not have been required to undergo any rigorous testing or clinical trials in order to assess their safety or efficacy. [bbc.com]

  None of them have gone through rigorous testing for safety or efficacy. It’s important to keep your mind occupied and engaged. Try to do things you enjoy to increase your body’s endorphins. This can improve your chances for long-term success. [healthline.com]

  Though appealingly simple, this proposal has yet to be rigorously tested. Much remains to be learned about the regulatory mechanisms governing assembly of this membrane-organizing center. [mmbr.asm.org]

• Yawning

  You yawn every 5 seconds and that hurts your jaw because it’s an awkward yawn. Your body temperature won’t regulate, you’re sweating bullets outwardly but you’re freezing on the inside (cold sweats). Your whole body is shaking. [killtheheroinepidemicnationwide.org]

  Other symptoms of heroin withdrawal include: 2 Sweating, cold sweats Mood changes like anxiety or depression Restlessness Sensitization of genitals Feeling of heaviness Cramps in the limbs or abdomen Excessive yawning or sneezing Tears, running nose Insomnia [healthyplace.com]

  Agitation Anxiety Muscle aches and pains Bone pain Tearing in the eyes Insomnia Runny nose Sweating Yawning Abdominal cramps Diarrhea Dilated pupils Goose bumps Chills Nausea Vomiting Hypothermia Withdrawal symptoms will ease with time. [newlifehouse.com]

  Heroin withdrawal symptoms may include but are not limited to: nausea, vomiting, insomnia, profuse sweating, rapid heart rate, diarrhea, severe muscle aches and joint pain, stomach cramps, restless legs, chills, depression, anxiety, dilated pupils, and yawning [greatoaksrecovery.com]

• Rhinorrhea

  MEASUREMENTS: Withdrawal symptoms, such as mydriasis, insomnia, rhinorrhea, arthralgia, muscular pain, tooth pain, vomiting, diarrhea, dysphoria, and drug craving were monitored. MAIN RESULTS: Withdrawal symptoms ceased within 10 days. [ncbi.nlm.nih.gov]

  Heroin withdrawal symptoms include: Increased sweating, lacrimation [shedding tears], rhinorrhea [runny nose], urinary frequency Diarrhea, abdominal cramps, nausea, vomiting Muscle spasm leading to headaches, backaches, e.g. cramps, twitching, arthralgia [withdrawal.org]

• Vomiting

  Complications The complications of the withdrawal are as follows: Vomiting and aspiration, which can cause dehydration, lung infection and electrolyte disturbances. [symptoma.com]

  Although rare, it is possible for someone to vomit and inhale stomach contents, which can cause lung infection. Relapse and overdose. [withdrawal.net]

  Vomiting and diarrhea can also lead to dehydration, which can involve chemical and mineral imbalances. [greenhousetreatment.com]

  They can even inhale stomach contents after vomiting and asphyxiate. [addictioncenter.com]

• Nausea

  Late symptoms of the withdrawal are abdominal cramping, diarrhea, goose bumps, nausea, vomiting, and dilated pupils. Though the reactions of heroin withdrawal are usually uncomfortable, these effects are not life-threatening. [symptoma.com]

  Peppermint Oil The smell of peppermint oil is refreshing and helps treat nausea in many people. If you are trying to leave heroin addiction, you are sure to face nausea in the initial days. [findhomeremedy.com]

  Side effects of passionflower may include dizziness and nausea; the article also cautioned that some species may contain chemicals associated with liver toxicity. [livestrong.com]

  Individuals will still experience some mild nausea or appetite loss, shivering or goosebumps, some abdominal cramping, and maybe even periods of vomiting. [recoveryfirst.org]

  Nausea and vomiting. Symptoms The symptoms of heroin withdrawal are rarely life-threatening. But they are sometimes so uncomfortable that relapse is very common without professional treatment. [withdrawal.net]

• Diarrhea

  Later, goosebumps, muscle aches, elevated heart rate in excess of 100 BPM, loss of appetite and energy, nausea with or without vomiting, diarrhea and insomnia. [howtokickheroin.com]

  Late symptoms of the withdrawal are abdominal cramping, diarrhea, goose bumps, nausea, vomiting, and dilated pupils. Though the reactions of heroin withdrawal are usually uncomfortable, these effects are not life-threatening. [symptoma.com]

  Diarrhea treatments include loperamide preparations. Hydrocortisone cream or diaper rash ointment may soothe irritated perianal tissues. A good multivitamin with extra vitamin C can help provide nutritional support. [livestrong.com]

  MEASUREMENTS: Withdrawal symptoms, such as mydriasis, insomnia, rhinorrhea, arthralgia, muscular pain, tooth pain, vomiting, diarrhea, dysphoria, and drug craving were monitored. MAIN RESULTS: Withdrawal symptoms ceased within 10 days. [ncbi.nlm.nih.gov]

• Abdominal Cramps

  Late symptoms of the withdrawal are abdominal cramping, diarrhea, goose bumps, nausea, vomiting, and dilated pupils. Though the reactions of heroin withdrawal are usually uncomfortable, these effects are not life-threatening. [symptoma.com]

  It reduces the intensity of withdrawal symptoms by up to 75 percent, and it’s particularly effective for reducing anxiety, muscle aches, abdominal cramps, sweating and runny noses. [rebostreatment.com]

  These symptoms intensify with time and by the 6th day; the user is usually experiencing abdominal cramping, sweating, and vomiting. These symptoms are some of the reason why an addict might have such a hard time getting off heroin. [addictionresource.com]

  Heroin Withdrawal: Day 3 to 5 You’ll likely continue to experience vomiting, shivers and abdominal cramping during this time, but much of the muscle and bone discomfort should have passed. [graciouscarerecovery.com]

  Common symptoms of withdrawal include: Nausea and vomiting Insomnia Agitation Diarrhea Dilated pupils Sweating Anxiety Abdominal cramping Muscle aches Duration of Withdrawal The length of withdrawal from heroin depends on several factors. [addictioncenter.com]

• Loss of Appetite

  […] of appetite, nausea, sweating, and muscle pain. [withdrawal.net]

  More severe symptoms can include depression, muscle spasms, cold sweats, loss of appetite, unstable moods, trouble breathing, and intense heroin cravings. [owlsnestrecovery.com]

  Some of the most common symptoms include muscle aches and pain around the body, insomnia, loss of appetite, anxiety and also diarrhea. [opiateepidemic.com]

  Intellectual disability, gastrointestinal symptoms (e.g. nausea, abdominal fullness, and loss of appetite), dilated cardiomyopathy and renal colic have also been reported. [orpha.net]

• Hypertension

  Diarrhea, nausea, vomiting, abdominal cramps, muscle spasms, piloerection, hypertension, tachycardia, anxiety, irritability, disturbed sleep and increased craving for heroin are some other symptoms associated with heroin withdrawal. [symptoma.com]

  Hypertension, rapid heart rate, anxiety and seizures are all serious health risks that can develop during heroin withdrawal. For most users, the withdrawal period is extremely uncomfortable but rather short. [owlsnestrecovery.com]

  Previous Medical History: Hypertension Previous MI Coronary artery disease 2 coronary stents No known allergies Medications: Lisinopril Plavix Pravachol Depakote Methadone Initial Vital Signs: Heart Rate: 72 beats/min Respiratory Rate: 22 breaths/min [ems12lead.com]

  Typical moderate withdrawal symptoms include: Restlessness Tremors Fatigue Diarrhea Vomiting Agitation Difficulty concentrating Goosebumps Severe Withdrawal Symptoms Typical severe withdrawal symptoms include: Insomnia Depression Anxiety Muscle spasms Hypertension [graciouscarerecovery.com]

  […] cramps Tearing Runny nose Sweats Chills Yawning a lot Muscle and bone aches Moderate withdrawal symptoms: Vomiting Diarrhea Agitation Restlessness Tremors Trouble concentrating Goose bumps Fatigue Severe withdrawal symptoms: Anxiety Insomnia Depression Hypertension [americanaddictioncenters.org]

• Tachycardia

  Diarrhea, nausea, vomiting, abdominal cramps, muscle spasms, piloerection, hypertension, tachycardia, anxiety, irritability, disturbed sleep and increased craving for heroin are some other symptoms associated with heroin withdrawal. [symptoma.com]

  Learning Points: TdP is a form of polymorphic ventricular tachycardia associated with a prolonged QT. [ems12lead.com]

  Depression Loss of appetite Liver damage Respiratory depression Difficulty swallowing Circulatory problems Nausea and vomiting Intense sweating Sleep apnea Joint pain Chills Body weakness Runny nose Increased blood pressure Increased respiratory rate Tachycardia [acadianaaddiction.com]

  […] rhinorrhea [runny nose], urinary frequency Diarrhea, abdominal cramps, nausea, vomiting Muscle spasm leading to headaches, backaches, e.g. cramps, twitching, arthralgia [joint pain] Piloerection [goose bumps], pupillary dilatation, elevated blood pressure, tachycardia [withdrawal.org]

• Muscle Cramp

  Common Symptoms of Heroin Withdrawal Intense stomach cramps and aches Fever Intense muscle cramps Aching bones and tendons Migraines Restlessness and total inability to sleep Hallucinations Extreme anxiety Paranoia Depression Thoughts of suicide Inability [thehillscenter.com]

  When an individual stops taking heroin, the withdrawal symptoms like dilated pupils, tremors, watery eyes and runny nose, nausea, diarrhea, muscle cramps, insomnia, chills and irritability, are very hard on the person. [findhomeremedy.com]

  Heroin withdrawal symptoms can include: Nausea Vomiting Stomach cramps Diarrhea Sweating Dilated pupils Muscle cramps/ aches Insomnia Yawning Runny nose Anxiety Depression Restlessness An individual may not experience all of these symptoms or may experience [summitbhc.com]

  Some doctors prescribe Clonidine which reduces anxiety, agitation, muscle cramps, sweating. Buprenorphine has also been said to shorten detox. Some have used a method called, “detox under anesthesia” or “rapid opiate detox”. [drug.addictionblog.org]

  Some withdrawal symptoms include: Cold sweats Depression Anxiety Unstable moods Loss of appetite Diarrhea Seizures Painful & Excessive Vomiting Muscle cramping Irritability and discomfort Restlessness (Including Restless Legs and Arms) Trouble Sleeping [killtheheroinepidemicnationwide.org]

• Muscle Twitch

  Muscle twitches Intense cravings Inpatient Heroin Detox The goal of an inpatient detox is to cleanse the body of the toxins accumulated from heroin abuse. [watersedgerecovery.com]

  The symptoms may include: Cold flashes, including chilly, “goose” flesh Muscle twitches, including random kicking movements Bone and muscle pain Restlessness and insomnia Diarrhea Vomiting These symptoms are sometimes referred as being, “dope sick,” and [axisresidentialtreatment.com]

  At eighteen hours after my last dose of heroin, I began to have muscle twitches, loss of strength and energy, profuse sweating, diarrhea, agitation, and an overall feeling of agony. [rxmarijuana.com]

  Muscle twitches and spasms. Muscle and joint pain. Headaches. Insomnia. Tearing. Runny nose. Increased sweating. Increased urination. Frequent yawning. Stomach cramping and diarrhea. Nausea and vomiting. [choosehelp.com]

• Arthralgia

  MEASUREMENTS: Withdrawal symptoms, such as mydriasis, insomnia, rhinorrhea, arthralgia, muscular pain, tooth pain, vomiting, diarrhea, dysphoria, and drug craving were monitored. MAIN RESULTS: Withdrawal symptoms ceased within 10 days. [ncbi.nlm.nih.gov]

  Heroin withdrawal symptoms include: Increased sweating, lacrimation [shedding tears], rhinorrhea [runny nose], urinary frequency Diarrhea, abdominal cramps, nausea, vomiting Muscle spasm leading to headaches, backaches, e.g. cramps, twitching, arthralgia [withdrawal.org]

• Fracture

  Heroin use disorder can also strain relationships to the breaking point, ending marriages, causing separations, damaging children, fracturing friendships, and leaving individuals without meaningful social support. [timberlineknolls.com]

  The procedure is scheduled to take place in the Garden Grove Hospital and Medical Center's intensive care unit, which Peterson now shares with a burn victim, a barely breathing obese woman, and a screaming elderly lady with multiple bone fractures. [wired.com]

• Increased Sweating

  The early symptoms of the withdrawal include anxiety, agitation, increased tearing, runny nose, yawning, insomnia, sweating, and muscle aches. [symptoma.com]

  Users experience a wide range of heroin withdrawal symptoms, including aches and pains, diarrhea, increased sweat and tears, nausea, vomiting and flu-like symptoms. Heroin withdrawal can also cause depression, sleeplessness and restlessness. [thediscoveryhouse.com]

  Some of the early symptoms of withdrawal include: Anxiety Muscle aches and spasms Insomnia Increased sweating Nausea and abdominal cramping Chills The National Drug Strategy of Australia reports that the physical symptoms of withdrawal from heroin can [greenhousetreatment.com]

  Heroin withdrawal symptoms include: Increased sweating, lacrimation [shedding tears], rhinorrhea [runny nose], urinary frequency Diarrhea, abdominal cramps, nausea, vomiting Muscle spasm leading to headaches, backaches, e.g. cramps, twitching, arthralgia [withdrawal.org]

  Increased sweating. Increased urination. Frequent yawning. Stomach cramping and diarrhea. Nausea and vomiting. Quickened heart rate and increased blood pressure. Dilated pupils. Goosebumps. Insomnia and heroin cravings. [choosehelp.com]

• Piloerection

  Diarrhea, nausea, vomiting, abdominal cramps, muscle spasms, piloerection, hypertension, tachycardia, anxiety, irritability, disturbed sleep and increased craving for heroin are some other symptoms associated with heroin withdrawal. [symptoma.com]

  […] symptoms include: Increased sweating, lacrimation [shedding tears], rhinorrhea [runny nose], urinary frequency Diarrhea, abdominal cramps, nausea, vomiting Muscle spasm leading to headaches, backaches, e.g. cramps, twitching, arthralgia [joint pain] Piloerection [withdrawal.org]

• Suicidal Ideation

  To best address women struggling with multiple and complex symptoms, like BPD, suicidal ideation, Substance Use Disorder, etc., New Roads offers a comprehensive DBT program, which has been proven effective by more than 30 randomized controlled trials. [newroadstreatment.com]

  ideation Trouble with the law Incarceration Respiratory arrest Coma Death Though heroin abuse and addiction can inflict profound damage on a person’s mental, physical, social, and emotional wellbeing, heroin abuse can be successfully treated with therapy [acadianaaddiction.com]

  The risk of hallucinations, tremors, and suicidal ideations are multiplied in an unmonitored, home-based setting. Your chances of recovery are far greater if you seek professional treatment than if you attempt to detox at home on your own. [michaelshouse.com]

• Hot Flushes

  The Effects of Heroin After an intravenous injection of heroin, users report feeling a surge of euphoria (a “rush”) accompanied by a dry mouth, hot flushes, heaviness of the hands and feet, and clouded mental functioning. [castlecraig.co.uk]

• Insomnia

  An antihistamine, such as diphenhydramine, may be effective for insomnia or to reduce anxiety. Diarrhea treatments include loperamide preparations. Hydrocortisone cream or diaper rash ointment may soothe irritated perianal tissues. [livestrong.com]

  Clonidine is an alpha-2 adrenergic agonist, that can provide relief to many of the symptoms of heroin withdrawal, including anxiety, insomnia, sweating, diarrhea, vomiting, abdominal cramps, chills, anxiety, insomnia, and tremor. [howtokickheroin.com]

  MEASUREMENTS: Withdrawal symptoms, such as mydriasis, insomnia, rhinorrhea, arthralgia, muscular pain, tooth pain, vomiting, diarrhea, dysphoria, and drug craving were monitored. MAIN RESULTS: Withdrawal symptoms ceased within 10 days. [ncbi.nlm.nih.gov]

  Benadryl (diphenhydramine) and trazodone (Desyrel) for insomnia. Tylenol (acetaminophen) or ibuprofen (Motrin) for headaches. Over-the-counter anti-diarrheal agents (e.g., Pepto Bismol). [heroin.net]

• Irritability

  Hydrocortisone cream or diaper rash ointment may soothe irritated perianal tissues. A good multivitamin with extra vitamin C can help provide nutritional support. [livestrong.com]

  Diarrhea, nausea, vomiting, abdominal cramps, muscle spasms, piloerection, hypertension, tachycardia, anxiety, irritability, disturbed sleep and increased craving for heroin are some other symptoms associated with heroin withdrawal. [symptoma.com]

  The first stage of withdrawal often includes: cravings, anxiety, depression, irritability, sleeplessness, restless legs, and suicidal thoughts. [theshoresrecovery.com]

• Agitation

  To paraphrase Colonel Kurtz, make friends with anxiety and agitation. If you don't, they are enemies to be feared. [ranker.com]

  Heroin cravings alone makes it difficult to cope with withdrawal symptoms – coming off the euphoric high and feelings of depression and agitation make it difficult to combat symptoms. [drug.addictionblog.org]

  When attempting to detox, users will often be faced with overwhelming agitation or depression. [owlsnestrecovery.com]

  Management of heroin withdrawal symptoms can be done with the following medications: 3 Clonidine - Reduces anxiety, agitation, muscle aches, sweating, runny nose and cramping Buprenorphine - a pain medication that blocks withdrawal symptoms, thought to [healthyplace.com]

  Agitation Anxiety Muscle aches and pains Bone pain Tearing in the eyes Insomnia Runny nose Sweating Yawning Abdominal cramps Diarrhea Dilated pupils Goose bumps Chills Nausea Vomiting Hypothermia Withdrawal symptoms will ease with time. [newlifehouse.com]

• Tremor

  Tremors. Increased heart rate and blood pressure. Body aches. Insomnia. Depression. Abdominal cramping. Diarrhea. Goose bumps. Nausea and vomiting. Symptoms The symptoms of heroin withdrawal are rarely life-threatening. [withdrawal.net]

  Tremors. Vomiting. Diarrhea. Muscle cramps. Increased blood pressure. Chills. Intense cravings. Suicidal thoughts. [mentalhelp.net]

  The best reason to consider medically assisted withdrawal treatment from a reputable drug detox center is to avoid painful withdrawal symptoms like: Muscle and joint pain Cold chills, tremors and digestive issues (diarrhea & vomiting) Nervous behavior [watersedgerecovery.com]

  Infants born to opioid addicts are often afflicted by neonatal abstinence syndrome (NAS), which presents itself as host of withdrawal symptoms that include tremors, hyperactive reflexes, vomiting, dehydration, the inability to gain weight and seizures [thespec.com]

• Hyperactivity

  Opiate withdrawal symptoms may include sweating, runny nose, body aches, abdominal cramps, diarrhea, vomiting, dilated pupils, watery eyes, restlessness, anxiety, nervousness, hyperactivity, goose pimples, hot flashes, fever, chills, weight loss, leg [livestrong.com]

  Infants born to opioid addicts are often afflicted by neonatal abstinence syndrome (NAS), which presents itself as host of withdrawal symptoms that include tremors, hyperactive reflexes, vomiting, dehydration, the inability to gain weight and seizures [thespec.com]

  Opiates depress this area and it would therefore be expected to become hyperactive during withdrawal. [druglibrary.org]

  […] appearance Drug-seeking behaviors Changes in normal behavior patterns Failure to fulfill major life responsibilities “Nodding off” Problems at work or school Lying Lack of protective measures Hiding the drug in various places Physical symptoms: Cravings Hyperactivity [acadianaaddiction.com]

  Alternating sweating and chills Anxiety Dehydration Dilated pupils Fever Gagging General body aches Hot flashes Hyperactivity Increased blood pressure Increased heart rate Irritability Leg cramps: Muscles that have been relaxed by the drug tighten and [heroin.ws]

• Laboratory Studies: For abuse and dependence, urine drug screen, and detection of drug in sweat and hair is suggested. In patients with withdrawal, concentration of electrolytes, complete blood counts and urine drug screen are used. For intoxication, comprehensive urine drug testing, enzyme immunoassay, radioassay, gas-liquid chromatography, and gas chromatography-mass spectrometry (GC-MS) are performed. These tests are specific and sensitive, but time consuming and expensive. Blood alcohol levels (BAL) are also tested in patients with symptoms of heroin withdrawal. Addiction is tested by rapid plasma reagent (RPR), hepatitis viral test, HIV test, and blood cultures.
• Imaging: X-ray of the lungs must also be performed [5].

Though heroin withdrawal rarely causes severe morbidity and mortality, detoxification can be performed as a therapy in most of the patients. Alpha-2 adrenergic agonists have shown to be highly effective in the suppression of mediated signs and symptoms. In one study, it was concluded that the use of naltrexone implant is effective in combating the relapse of the regular heroin use.

Apart from the medication therapy, psychotherapy and support groups can help support these patients. Cognitive behavior psychotherapy focuses on the thoughts and behavior of the patients; hence the introduction to such therapeutic measures becomes important. Group therapy is the most effective method to manage heroin withdrawal as it targets the social stigma. The support and acknowledgement of the condition from the group members can help in abstinence. Aversion therapy, where the aversive stimuli to cognitive images of the drug use is also recommended [7] [8] [9] [10].

Though the withdrawal of heroin is painful, it is not life-threatening.

Complications

The complications of the withdrawal are as follows:

• Vomiting and aspiration, which can cause dehydration, lung infection and electrolyte disturbances. 
• Return of drug use: Overdose deaths are common in this group of population, due to the reduction of tolerance of the drug. Longer treatment is recommended for the people who follow withdrawal. 
• Patients who are in the phase of withdrawal must be checked for depression or other mental conditions. 
• If a patient suffers from withdrawal repeatedly, the methadone maintenance is recommended [6].

Heroin causes physical dependence. Over a period of time, the amount of the drug to produce the same effect increases. This time varies with each individual. After the discontinuation of the chronic use of heroin, the body needs the time to recover, and manifests as withdrawal symptoms [2] [3].

About 9% of the population across the globe misuses opiates in their lifetime, which includes illegal drugs such as heroine and other prescription drugs. Opioid is powerful painkiller, but is also highly addictive.

Heroine dependence leads to approximately 17,000 deaths each year. USA, though forms just 4.6% of the world’s population, accounts for 80% of the consumption of the opioid. Prescription opioids form an important gateway drug [4].

About 20 medications bind to the mu opioid receptor, and most of them are the prototypical mu receptor full agonists, often associated with the constellation of effects such as pain relief, mood alteration, respiratory and cough, depression, decreased gastrointestinal motility, pinpoint pupils, nausea and vomiting.

The euphoria associated with this receptor activation is high, and the rush is a brief, intense and pleasurable sensation. Patients with addiction often try to avoid the unpleasant withdrawal symptoms. Short term use of opioid is associated with gray matter changes in patients with chronic pain. Mu receptor agonists have the potential for the destructive addictive behavior. The following destructive behavioral pattern is seen:

• IV injection of heroin causes a rapid high followed by unpleasant withdrawal symptoms within hours.
• Unpleasant symptom of the withdrawal symptom is seen with the use of heroin.
• This entire cycle is repeated until the patient no longer access heroin.

Long-term potential for relapse is common in heroin addiction. The cause of this type of relapse is stress, administration of a dose of drug with similar properties and exposure to the conditioned cues, which is related to the past drug use. It is known that the long-term use of heroin can alter the density of dendritic spines. These permanent changes can have long-lasting vulnerability to relapse [5].

Dependence on heroin can be prevented by being careful of the dosage and frequency of opioid analgesics. Most of the teenagers, under peer pressure, start using these drugs, but the impact of the same on their body is understood only later. Hence, the vulnerable group must be sensitized about the signs and manifestations of heroin dependence.

The heroine-specific syndrome, which occurs due to the reduction of the prolonged and heavy usage of the drug, is called heroine withdrawal. Heroine withdrawal causes symptoms of distress and impairment of the social well-being. Some of the characteristic features of heroin withdrawal are: increased sweating, urinary frequency, lacrimation or rhinnorhea.

Diarrhea, nausea, vomiting, abdominal cramps, muscle spasms, piloerection, hypertension, tachycardia, anxiety, irritability, disturbed sleep and increased craving for heroin are some other symptoms associated with heroin withdrawal. Psychological features of this withdrawal are dysphoria, sleep disturbances, and increased cravings for the drug, which can continue for weeks or months. It is a life-threatening condition even in physically fit people [1].

Definition

Heroin can cause a sense of well-being, which attracts people towards it. There is a suspension from reality and people suffering from failures or loneliness resort to its usage. However, prolonged and heavy dose of the drug can cause withdrawal symptoms and impair the general functioning of the body. 

Cause

Heroin causes physical dependence, which means that the patient is dependent on the drug to prevent the symptoms of dependence. 

Symptoms

Increased sweating, urinary frequency, rhinnorhea, diarrhea, nausea, vomiting, abdominal cramps, muscle spasms, hypertension, tachycardia, anxiety, irritability, disturbed sleep and increased craving for heroin are some of its symptoms. There are some psychological features of this withdrawal such as dysphoria, sleep disturbances, and increased cravings for the drug. 

Diagnosis

Laboratory studies including urine drug screen, concentration of electrolytes, CBC count, immunoassay and radioassay are some of the important tests. X-ray of the lungs may also be performed.

Treatment

Though heroin dependence rarely causes significant morbidity and mortality, the dependence can destroy families. Some drugs (Alpha-2 adrenergic agonists) have shown to be highly effective in the suppression of mediated signs and symptoms. Group therapy and aversion therapy are also effective methods to manage heroin withdrawal as it targets the social stigma. 

1. Doyon S. Opiods. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 167.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Ed. Arlington, VA: American Psychiatric Association; 2013:541-46.
3. Paulozzi LJ, Mack KA, Hockenberry JM. Vital signs: variation among States in prescribing of opioid pain relievers and benzodiazepines - United States, 2012. MMWR Morb Mortal Wkly Rep. Jul 4 2014;63(26):563-8.
4. Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
5. Younger JW, Chu LF, D'Arcy NT, et al. Prescription opioid analgesics rapidly change the human brain. Pain. Aug 2011;152(8):1803-10.
6. Bohnert AS, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. Apr 6 2011;305(13):1315-21.
7. Gowing L, Ali R, White J. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2004.
8. Gowing L, Farrell M, Ali R. Alpha2 adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev. 2004
9. [Best Evidence] Hulse GK, Morris N, Arnold-Reed D, Tait RJ. Improving clinical outcomes in treating heroin dependence: randomized, controlled trial of oral or implant naltrexone. Arch Gen Psychiatry. Oct 2009;66(10):1108-15.
10. Marsch LA, Bickel WK, Badger GJ, et al. Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial. Arch Gen Psychiatry. Oct 2005;62(10):1157-64