Heroin withdrawal

Heroin withdrawal starts fast, peaks in two to three days and mostly passes in about a week. Here is what to expect and what helps.

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Updated October 2026. Sources are linked on this page.

Illustration of a person resting on a sofa under a green blanket, with a friend sitting nearby

The short answer

When it starts: Often within a few hours, and usually within 8 to 24 hours of the last dose.
When it peaks: Major symptoms peak 24 to 48 hours after the last dose.
When it eases: Most physical symptoms subside after about a week, though sleep and mood take longer.

What to expect in the first week without heroin

Heroin is a short-acting opioid. It leaves the body quickly, so withdrawal arrives quickly too.

The National Institute on Drug Abuse (NIDA) says withdrawal may begin within a few hours of the last dose. Major symptoms peak between 24 and 48 hours and subside after about a week. World Health Organization guidelines give a total length of 4 to 10 days.

The first day

It starts like a cold with nerves: yawning, a runny nose, watery eyes, sweating, aching and a restless feeling you cannot shake.

Days two and three

This is the worst of it. NIDA lists muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goosebumps, and leg movements. The goosebumps are where the phrase “cold turkey” comes from.

Days four to seven

The vomiting and cramps ease first. You will likely still be tired, sleeping badly and feeling low. Appetite comes back slowly.

How this compares with methadone and pain pills is laid out in the withdrawal timeline.

Why heroin today may really be fentanyl

What is sold as heroin often is not only heroin. NIDA notes that fentanyl is commonly mixed with heroin, and that people often do not know it is there.

This matters for withdrawal in two ways.

First, your withdrawal may not follow the heroin pattern above. It may come on faster or last longer than you expect.

Second, it affects treatment. Buprenorphine has to be started with more care when fentanyl is involved, because of a reaction called precipitated withdrawal. This is explained on the fentanyl withdrawal page.

When you talk to a clinician, say what you buy and how you take it, and mention if your supply has changed lately. They are not there to judge. They need the information to choose the right plan.

What a clinician can do for heroin withdrawal

You do not have to lie on a bathroom floor for a week. Heroin withdrawal responds well to treatment.

Buprenorphine relieves withdrawal and cravings. It is usually started once early withdrawal has begun, and it can be prescribed in an office or by telehealth.
Methadone does the same job and can be started without waiting for withdrawal. It is given through opioid treatment programs.
Lofexidine or clonidine are non-opioid medicines a prescriber can use to ease symptoms.
Other medicines can settle vomiting and diarrhea and help with sleep.

If you inject, a clinic visit is also a chance to get checked for infections and to have any sore or swollen injection sites looked at.

The details are on the easing withdrawal symptoms page, and medication treatment covers what staying on these medicines looks like.

The risk that comes after the first week

Many people have been through heroin withdrawal more than once. If that is you, you already know that the week itself is not the hardest part. Staying off afterwards is.

NIDA notes that some people show withdrawal signs for many months. Sleep, mood and cravings take time to settle, as covered on the post-acute withdrawal page.

During that time your tolerance is much lower than it was. MedlinePlus states that most opioid overdose deaths occur in people who have just detoxed.

If you do use again, the amount you were used to can now be far too much, and more so if there is fentanyl in it. Do not use alone, and keep naloxone within reach. The CDC notes that naloxone reverses overdose from heroin and fentanyl when given in time.

Call 911 if someone is not breathing or cannot be woken.

Where to turn when you want to stop

You do not need to wait until things get worse. Help works at any stage, and earlier is safer.

A good first step is one phone call or one appointment. A prescriber can often start treatment the same day or within a few days.

The treatment directory lists providers in every state. If money is the obstacle, read what Medicaid covers. There are options for people without insurance too.

SAMHSA’s National Helpline, 1-800-662-4357, is free and open 24 hours a day. For a crisis or thoughts of suicide, call or text 988.

For the wider picture of how withdrawal works, see the main guide to opiate withdrawal.

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Questions people ask us

How long does heroin withdrawal last?

Major symptoms peak 24 to 48 hours after the last dose and subside after about a week, according to NIDA. WHO guidelines give a range of 4 to 10 days. Tiredness, poor sleep, low mood and cravings often continue for weeks or months after the physical symptoms have gone.

How soon after the last dose does heroin withdrawal start?

It can begin within a few hours. Most people notice the first signs, such as yawning, a runny nose, sweating and restlessness, somewhere between 8 and 24 hours after the last dose. If your supply contains fentanyl, the timing may be different from what you are used to.

Is heroin withdrawal dangerous?

For healthy adults it is rarely life-threatening, though it is very unpleasant. Dehydration from vomiting and diarrhea is the main physical risk. It is more dangerous in pregnancy or with other health conditions. The greatest danger is overdose afterwards, once your tolerance has dropped.

Does it matter whether I inject, smoke or snort heroin?

Withdrawal symptoms are the same whichever way you take it. What matters more is how much you use, how often, for how long, and whether fentanyl is in your supply. Tell your clinician how you take it anyway, because it helps them check for other health problems.

Sources

This page is general information, not medical advice. Talk with a clinician about your own situation.

Need help right now?

Someone is not breathing: call 911 Crisis or thoughts of suicide: call or text 988 Free treatment referral, 24/7: 1-800-662-4357 (SAMHSA National Helpline)