“Prophet of evil I ever am to myself: forced for ever into sorrowful auguries that I have no power to hide from my own heart, no, not through one night’s solitary dreams. 

The above quote comes from the 19th century novel Confessions of an English Opium Eater by Thomas De Quincy. Although the book is largely an unrealistic and rosy description of a someone in the midst of opiate addiction, the above passage is one of the few examples of De Quincy discussing the hell wrought by the withdrawal symptoms of the drug. 

         I was given this book by my father, a former heroin addict, with the advice to not get any closer to the drug than the descriptions provided within its pages. I heeded his warning and have only had my aversion to the substance bolster by the myriad of folks I have seen suffer while in the grip of their addiction as well as bearing witness to their struggle to free themselves from it. The common claim held by De Quincy, my father, and all the people I have helped in my career, is that opiate withdrawal is one of the most difficult challenges they have ever faced. 

         As with all medical conditions, heroin withdrawals are different for everyone, however the severity of symptoms and the length of time they persist is largely dependent on the amount used and duration of use. In general, most will begin experiencing withdrawal symptoms as soon as 6-12 hours after their last dose, their symptoms will peak 2-3 days later, and will decrease over the next week for most people. For some who used large amounts of heroin over long time periods the physical symptoms of heroin addiction can last up to a month and the psychological effects persisting for a year or longer. In my experience, folks who are former heroin addicts have stated that cravings for the drug continued to haunt them even a decade after their last use. Due to the persistence of these cravings, as well as the potential health risks of the withdrawals, the CDC suggests anyone considering quitting heroin seek medical treatment by entering an addiction treatment program. 

         The question,“Can you die from heroin withdrawals?” is often posed to me by clients. The short answer is no; an addict will not die due to a lack of heroin in their system. However, an addict can die, or at the very least, put themselves in a great deal of danger due to the paralyzing symptoms of heroin withdrawal. Specifically folks can potentially die from the withdrawal symptom of dehydration or electrolyte imbalances caused by diarrhea and vomiting. The other major risk of death in heroin withdrawals is suicide; many will experience extreme anxiety and depression during withdrawals and because addicts often have impaired (or a complete lack of) impulse control, these symptoms can lead to fatal decisions.  

The symptoms of heroin withdrawal vary wildly in severity. The factors that impact the intensity of one’s symptoms depends largely on the duration of use, potency, average amount used, and method of ingestion. Regardless of these factors most who detox from heroin experience, anxiety, depression, sweating, dilated pupils, insomnia, vomiting abdominal aches, bone pain, muscle soreness, and diarrhea.  

I write all this to say: heroin withdrawal, like war, is Hell. However, also like war, this battle cannot be fought alone. An easy way to understand the heroin withdrawal is to say that it is the opposite of heroin use; because of this, the relapse potential for someone trying to detox from heroin on their own is extremely high. Coupled with the very real mortal threat the symptoms of withdrawal pose, the need for medication assisted treatment (MAT) is paramount. MAT is the short prescription of medication that a former heroin users is tapered off of throughout their detox in order to make the withdrawal symptoms possible to cope with. However, like most hard things, heroin detox cannot be solved simply by taking a series of pills. Anyone wishing to detox from heroin should seek a treatment center to ensure that they are detox in a safe and therapeutic manner in order to avoid the pitfall of trading one addiction for another.

As quoted at the beginning of this piece, someone who is caught in the grip of a heroin addiction is a feels s/he is a, “Prophet of evil I ever am to myself”. On their own, heroin addicts will constantly find themselves struggling against their own mind that is trying to continue down the path of substance abuse so it may maintain the homeostasis it has become accustom to. The only way to overcome the darkness of one’s own mind is to offer themselves up to the higher power of recovery. Addiction is the brain desperately fighting against the prospect of change, hiding from the consequences, and wishing to avoid the pain of being reborn. As Prime Minister Winston Churchill once said, “If you’re going through Hell, keep going” and we will gladly walk by your side