A range of treatments exist for heroin addiction, including medications, behavioral therapies. and support groups. Many centers are available to help those in need and can be found through a directory of drug rehab centers. Beyond this, science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop using heroin and return to stable and productive lives. Treatment often begins with medically assisted detoxification, to help patients withdraw from the drug safely. It is important to note that detoxification alone is not treatment and has not been shown to be effective in preventing relapse—it is merely the first step. Detoxification is often followed by cognitive-behavioral therapy, psychotherapy, marriage and family counseling, and/or any other form of psychotherapy that fits the patient’s needs. Lastly, being active in Narcotics Anonymous and other support groups can help the patient with reintegration into a lifestyle that is abstinent from heroin.
The withdrawal syndrome from heroin may begin within 6 to 24 hours of discontinuation of the drug; however, this time frame can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. Symptoms may include: sweating, malaise, anxiety, depression, priapism, extra sensitivity of the genitals in females, general feeling of heaviness, cramp-like pains in the limbs, excessive yawning or sneezing, tears, rhinorrhea, sleep difficulties (insomnia), cold sweats, chills, severe muscle and bone aches, nausea and vomiting, diarrhea, cramps, and fever.
Many users also complain of a painful condition, the so-called “itchy blood”, which often results in compulsive scratching that causes bruises and sometimes ruptures the skin, leaving scabs. Abrupt termination of heroin use often causes muscle spasms in the legs (restless leg syndrome). The intensity of the withdrawal syndrome is variable depending on the dosage of the drug used and the frequency of use. Very severe withdrawal can be precipitated by administering an opioid antagonist to a heroin addict.
Three general approaches are available to ease the physical part of opioid withdrawal. The first is to substitute a longer-acting opioid such as methadone or buprenorphine for heroin or occasionally another short-acting opioid and then slowly taper the dose.
In the second approach, benzodiazepines such as diazepam (Valium) may be recommended for opiate withdrawal especially if there is comorbid alcohol withdrawal. Benzodiazepines may temporarily ease the anxiety, muscle spasms, and insomnia associated with opioid withdrawal. The use of benzodiazepines must be carefully monitored because these drugs have a high risk of physical dependence as well as abuse potential and have little or no cross tolerance with opiates and thus are not generally recommended as a first line treatment strategy. Although heroin withdrawal is very unpleasant, it is rarely fatal.
Medications to Assist in Heroin Detox and Help Prevent Relapse
- Methadone has been used for more than 30 years to treat heroin addiction. It is a synthetic opiate medication that binds to the same receptors as heroin; but when taken orally, as dispensed, it has a gradual onset of action and sustained effects, reducing the desire for other opioid drugs while preventing withdrawal symptoms. Properly prescribed methadone is not intoxicating or sedating, and its effects do not interfere with ordinary daily activities. At the present time, methadone is only available through specialized opiate treatment programs.
- Buprenorphine is a more recently approved treatment for heroin addiction (and other opiates). It differs from methadone in having less risk for overdose and withdrawal effects, and importantly, it can be prescribed in the privacy of a doctor’s office.
- Naltrexone is approved for treating heroin addiction but has not been widely utilized because of compliance issues. It is an opioid receptor blocker, which has been shown to be effective in highly motivated patients. It should only be used in patients who have already been detoxified in order to prevent severe withdrawal symptoms.
- Naloxone is a shorter acting opioid receptor blocker used to treat cases of overdose.
- Ibogaine has shown preliminary efficacy for opiate detoxification and for short-term stabilization of drug-dependent persons as they prepare to enter substance abuse treatment. Studies show also that Ibogaine significantly decreased craving for cocaine and heroin during inpatient detoxification. Self-reports of depressive symptoms were also significantly lower after ibogaine treatment and at 30 days after program discharge.
- Kratom is used as an herbal supplement by individuals to taper off of heroin. Although, there are currently no research studies to support Kratom’s efficacy.