Heroin withdrawal symptoms begin 6–12 hours after the last dose and peak at 36–72 hours. They include severe muscle pain, nausea, vomiting, sweating, insomnia, and intense cravings. While rarely directly fatal, heroin withdrawal is severely uncomfortable and almost always leads to relapse without medical support. Free NHS heroin detox is available — call Frank on 0300 123 6600.
Heroin withdrawal symptoms typically begin 6–12 hours after the last dose (or sooner for very heavy users). Short-acting opioids like heroin and codeine cause earlier onset of withdrawal than longer-acting opioids like methadone (24–36 hours onset) or buprenorphine (36–48 hours onset).
Acute heroin withdrawal peaks at 36–72 hours after the last dose and the worst physical symptoms typically resolve within 5–7 days. However, post-acute withdrawal syndrome (PAWS) — including fatigue, sleep disruption, mood instability, and psychological cravings — can persist for weeks or months. Sleep disruption is particularly persistent and can continue for 3–6 months.
Unlike alcohol or benzodiazepine withdrawal, heroin withdrawal is rarely directly fatal. However, it is severely unpleasant — making unassisted cessation extremely difficult — and the period after stopping is very high risk for overdose. People who relapse after a period of abstinence (even a short detox) have reduced tolerance and frequently overdose fatally on their previous dose. Medical supervision significantly reduces this risk.
Buprenorphine (Subutex) is widely considered the most effective medication for managing heroin withdrawal — it significantly reduces withdrawal severity by partially activating opioid receptors. Lofexidine (Lucemyra) reduces autonomic withdrawal symptoms like sweating, cramps, and insomnia. Methadone on a reducing dose is also effective. All are available free through NHS drug treatment services.
Community heroin detox — where you remain at home while receiving daily clinical supervision and medication — is available free through NHS drug services. This is different from attempting to detox alone at home without support, which is very difficult and carries significant overdose risk if you relapse. Always access proper medical support before attempting heroin detox.
Heroin withdrawal has been described as a severe flu combined with extreme psychological distress. Physically: severe muscle cramps and bone aches, goosebumps ("cold turkey" origin), sweating and chills, nausea, vomiting and diarrhoea, insomnia, yawning, watering eyes and nose, dilated pupils. Psychologically: intense anxiety, agitation, dysphoria, and overwhelming cravings.