As heroin addiction becomes more prominent in North Carolina, the risk of addiction and withdrawal increases. If you are choosing to seek treatment for the substance or are supporting a loved one with addiction, understanding the signs and symptoms of heroin withdrawal and detox can help provide perspective on the recovery journey ahead of you.
If you or a loved one is struggling with heroin withdrawals or addiction, Tree House Recovery can help. Our Wilmington rehab center’s team can provide you with a fast, free assessment to help build your recovery plan today.
What Is Heroin Withdrawal?
Opioid withdrawal syndrome, which includes heroin withdrawal, can be extremely uncomfortable and challenging. Like other opioid drugs, heroin has high potency, and its effects on the opioid receptors in the brain and central nervous system make the substance highly addictive, even after one use.
When someone reduces or discontinues heroin use, withdrawal symptoms may begin to emerge. These symptoms often resemble a severe case of the flu, much like those from other opioids, and doctors generally do not consider them life-threatening.
Understanding the Heroin Use Disorder
While withdrawal from heroin is not usually dangerous, specific symptoms can lead to dehydration and potentially life-threatening symptoms based on the possible effects. Dosage, duration of use, time between doses, and use of other substances all influence the effects.
Who Is at Risk With Heroin Withdrawal?
People who are physically and mentally dependent on heroin are at risk for withdrawal (this includes individuals diagnosed with opioid use disorder). Even individuals who have used opioids for a short amount of time to manage pain are at risk.
Some individuals whose risks for health complications increase because of heroin withdrawal, including:2
- Pregnant women: Women who are pregnant and opioid-dependent are not recommended to undergo heroin withdrawal because it can cause miscarriage or premature delivery. However, there are other treatment options available.
Heroin Addiction and Withdrawal Statistics in North Carolina
While heroin is not as widespread in the United States as some other substances, it is still a significant public health concern.1,3
0.4%
People aged 12 or older in 2021 are addicted to heroin
9,173
People died from overdose involving heroin in 2021
0.33%
Adults in North Carolina used heroin between 2022 and 2023
Heroin Withdrawal Symptoms and Signs
Symptoms of heroin withdrawal can vary from person to person and mainly depend on factors like the amount used, length of use, and history of abuse. Signs of withdrawal from heroin can start 4-12 hours after the last dose and can continue throughout the detox phase.
Short Term Heroin Withdrawal Symptoms
Acute (short-term) symptoms of heroin withdrawal, which can last between 3 to 10 days, can include:4
- Increased breathing rate
- Increased heart rate
- Elevated body temperature
- Insomnia
- Dilated pupils
- Sweating
- Jumpiness
- Goosebumps
- Watery discharge from eyes and nose
- Muscle pain, cramps, and/or spasms
- Bone pain
- Nausea
- Diarrhea
Long Term Heroin Withdrawal Symptoms
Protracted withdrawal, also known as long-term or post-acute withdrawal symptoms (PAWS), can occur after the acute withdrawal phase.
Common symptoms of long-term heroin withdrawal may include:
- Anxiety
- Depression
- Fatigue
- Dysphoria
- Anhedonia
- Sleep disturbances
- Irritability
- Memory loss
- Hypersensitivity
- Decreased attention
- Inability to make decision
These symptoms may persist for weeks or even months and can significantly increase the risk of relapse if individuals do not seek continued treatment following heroin detox.
Heroin Withdrawal Timeline
Withdrawal from heroin can begin just a few hours after the most recent use. Various factors can impact the severity of withdrawal and its timeline. However, the discomfort of heroin withdrawals may lead to relapse, which is why finding a detox can help in the recovery process.
A timeline of heroin withdrawal includes:
Heroin Withdrawal Stage 1: 4 to 6 Hours After Last Dose
Short-term symptoms of heroin withdrawal begin as soon as 4 hours after the last heroin dose. Mild symptoms like restlessness, anxiety, irritability, and aches and pains can begin appearing at this time.
Heroin Withdrawal Stage 2: 24 to 48 Hours After Last Dose
Depending on the amount and length of use, some individuals may experience peak withdrawal symptoms. Some symptoms can intensify, while others, like watery eyes, diarrhea, high blood pressure, and increased heart rate, may appear.
Heroin Withdrawal Stage 3: Days 3 to 7
By the third or fourth day, the peak point of withdrawal has passed. However, mild symptoms will remain present, like cramping, sweating, chills, diarrhea, and nausea.
Heroin Withdrawal Stage 4: Days 7 to 14
After a week, the acute withdrawal symptoms of heroin typically pass. The body will likely return to normal in about a week, and severe symptoms will taper off. Physical symptoms will fade, but cravings and mental symptoms can present for weeks.
Post Acute Withdrawal Symptoms (PAWS)
Heroin can cause long-lasting PAWS symptoms like cravings, anxiety, and exhaustion. For people who experience moderate or severe withdrawal symptoms, the likelihood of experiencing PAWS is increased.
Heroin Detox in Wilmington, NC
Opioid detoxification, commonly known as medically supervised detox, can be the first step in a comprehensive treatment plan for heroin addiction. During detox, patients have 24/7 supervision to help manage withdrawal symptoms, such as anxiety, nausea, or more severe complications.
Detox is tailored to each individual’s needs, with ongoing monitoring of vital signs and mental health support to ensure safety throughout the process. Medical professionals may use FDA-approved medications like buprenorphine, methadone, or clonidine to reduce cravings and ease withdrawal discomfort.
It is important to understand that detox alone is not treatment for heroin use or opioid use disorder—it is just the first step.
Continuing care, such as counseling, therapy, and medication-assisted treatment (MAT), is essential for long-term recovery and relapse prevention. After detox, clients are encouraged to transition into treatment programs that build the skills and support needed for lasting sobriety.
What Medications Help with Heroin Detox?
Licensed healthcare providers may prescribe medications during heroin detox or inpatient/residential treatment to provide short-term relief from withdrawal symptoms. These medications include:
- Clonidine (Catapres)
- Buprenorphine (Subutex)
- Methadone (Dolophine)
- Trazodone (Desyrel)
- Baclofen (Ozobax)
- Ondansetron (Zofran ODT)
- Mirtazapine (Remeron)
- Metoclopramide (Reglan)
- Codeine Phosphate
Talking with a medical professional about the best treatment options for your recovery—and following their recommendations for any prescribed addiction medications—is essential.
The Benefits of Heroin Detox
Because heroin withdrawal poses certain risks like dehydration, relapse risk, and suicidal ideation, having medication management and supervision to help monitor withdrawal symptoms and ease the discomfort can help reduce the risk of relapse.
Medical detox can be the first step to a more comprehensive treatment plan for heroin addiction or substance use disorder.
After Heroin Detox: Treatment for Addiction in North Carolina
After completing medically supervised withdrawal at a detox center, individuals often benefit from additional levels of care—such as Inpatient Care, Partial Hospitalization Programs (PHPs), Intensive Outpatient Programs (IOPs), and Outpatient Care. These programs offer behavioral therapies designed to address the lingering effects of heroin addiction and any co-existing mental health conditions.
If you are searching for a “heroin rehab near me,” Tree House Recovery’s treatment facility in North Carolina offers an Evening Intensive Outpatient Program (IOP) that integrates evidence-based and holistic therapies, including:
- One-on-one therapy
- Private gym and fitness therapy
- Cognitive behavioral therapy
- Relapse prevention counseling
- Additional support for family members
At our Wilmington treatment center, our addiction counselors collaborate with you to build a strong, sober community and develop life skills that support lasting recovery.
Get Help After Heroin Withdrawal at Our Rehab in Wilmington, NC
Withdrawal from heroin can be an uncomfortable consequence of addiction, but we are here to help you. We offer an effective drug and alcohol rehab for heroin addiction in North Carolina to manage long-term heroin withdrawal symptoms and avoid the dangers of relapse.
Call our admissions team today to start building your treatment plan today.
- SAMHSA Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health: 2022‑2023 state-specific tables of model-based estimates (totals and percentages). Accessed June 4, 2025. https://www.samhsa.gov/data/sites/default/files/reports/rpt56188/2023-nsduh-sae-state-tables_0/2023-nsduh-sae-state-tables.htm.
- Withdrawal Management. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. January 1, 1970. Accessed June 4, 2025. https://www.ncbi.nlm.nih.gov/books/NBK310652/.
- What Is the Scope of Heroin Use in the United States? National Institutes of Health. December 14, 2023. Accessed June 4, 2025. https://nida.nih.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states.
- Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. Substance Abuse and Mental Health Services Administration. 2006. Revised 2015. Accessed June 4, 2025. https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4131.pdf.