Heroin & Opioid Addiction: Symptoms, Effects and Treatment

Written by the medical team at Day One Rehabilitation Center, Nakhon Nayok, Thailand · Medically reviewed by Dr. Pichayut Kasemphakdeephong (Psychiatrist)

Heroin is an opioid, a class of drugs derived from the opium poppy that act on the brain and nervous system. This class includes medications used in medicine, such as morphine, as well as substances with a high risk of misuse, such as heroin. Heroin can cause drowsiness, reduce pain, and produce a feeling of relaxation, but at the same time it can lead to dependence, cravings, withdrawal symptoms, and overdose severe enough to suppress breathing.

With continued use, some people don’t keep using purely for the feeling the drug produces — they use it to avoid withdrawal symptoms such as aches, restlessness, insomnia, nausea, diarrhea, and intense cravings. This makes forcing someone to stop without a treatment plan difficult.

Treatment for heroin and opioid addiction today includes medications that help relieve withdrawal symptoms, medications that help reduce cravings and relapse, and psychological therapy and rehabilitation. Treatment therefore should not end simply with getting through withdrawal — there must be an ongoing plan to help patients avoid returning to heroin to manage cravings or discomfort.

What Are the Signs of Heroin and Opioid Addiction?

With repeated heroin use, the brain and body gradually adjust. Some people need to use more to get the same effect, while as the substance level drops, withdrawal symptoms appear, until life starts to revolve around finding the substance, using it, and avoiding withdrawal.

Signs that may be seen include:

Drowsiness or unusual sluggishness
Small pupils while the substance is active
Slowed speech or slower responses
Using heroin or opioids more heavily or more often
Frequent cravings and thoughts about using
Trying to cut down or stop, but finding it difficult
Spending a lot of time finding, using, or recovering from the substance
Problems beginning to appear at work, school, with finances, or in relationships
When not using: aches, restlessness, insomnia, nausea, or diarrhea
Having to use again to relieve withdrawal symptoms

The key thing to look for isn’t just whether someone uses every day, but whether use has started to become hard to control, and how much heroin has come to govern the person’s routines and decisions.

The Dangers of Heroin and Opioid Overdose

The most significant acute danger of heroin and opioids is respiratory suppression. If someone takes too much, they may become extremely drowsy, unresponsive, breathe slowly or abnormally, and lose consciousness.

Warning signs that require urgent help include:

Unconsciousness or being unable to wake
Very slow or abnormal breathing
Extremely small pupils
Abnormal skin or lip color
No response to being called or stimulated

Medically, naloxone is a medication used to reverse the effects of opioids in an overdose. However, the patient still needs medical evaluation and monitoring, because some opioids can act longer than naloxone, and symptoms can return.

The risk increases further when heroin is combined with alcohol, sleeping pills, anti-anxiety medication, or other central nervous system depressants.

Another period requiring caution is after stopping heroin for a while, because the body’s tolerance decreases. If someone returns to the same dose they previously used, the risk of overdose can be higher. Preventing relapse is therefore a matter of safety, not simply behavior control.

Heroin Withdrawal: What Are the Symptoms, and How Can Medication Help?

When someone who has become physically dependent stops heroin, withdrawal symptoms can appear within several hours of the last use. Symptoms can include restlessness, aches, insomnia, runny nose or watery eyes, sweating, nausea, vomiting, stomach pain, diarrhea, anxiety, and intense cravings to use again.

Although opioid withdrawal generally isn’t like alcohol withdrawal, which carries the risk of certain severe withdrawal complications, the symptoms can be agonizing enough that patients return to heroin just to make them stop — and after stopping for a period, relapsing further increases the risk of overdose.

Medications to Relieve Heroin Withdrawal Symptoms

Doctors can use several categories of medication to help patients get through withdrawal more easily, selected according to each person’s symptoms, such as:

Pain relievers (Analgesics) such as paracetamol or ibuprofen, to help reduce muscle aches and pain
Anti-nausea medication (Antiemetics) such as ondansetron or metoclopramide, used for nausea or vomiting
Anti-diarrheal medication (Antidiarrheals) such as loperamide, to help control diarrhea during withdrawal
Sleep aids or anti-anxiety medication (Anxiolytics) such as melatonin, or other medications a doctor may consider appropriate, which may be used in some cases under medical supervision

This doesn’t mean every patient needs every type of medication. A doctor selects treatment based on symptoms, health, existing conditions, and other substances being used. Buying multiple medications to self-manage heroin withdrawal can be dangerous due to side effects or drug interactions.

Methadone and Buprenorphine: Opioid Agonist Treatment

Besides symptomatic treatment, there is also Opioid Agonist Treatment (OAT), which uses medications that act directly on the opioid system, such as methadone and buprenorphine, to help control withdrawal symptoms, reduce cravings, and reduce a return to heroin or unregulated opioid use.

The principle of opioid agonist treatment is to use a medication that acts on the same system as heroin, but given in a dose and form controlled by a doctor, so the level of opioid activity in the body stays more stable rather than spiking and dropping rapidly as with heroin use. This helps reduce withdrawal symptoms and cravings, so patients don’t need to return to heroin to feel better, and have the opportunity to take care of their health, work, relationships, and psychological treatment.

Methadone is a long-acting opioid that continuously stimulates opioid receptors, while buprenorphine acts on opioid receptors partially and has a ceiling effect, so it helps reduce withdrawal symptoms and cravings with a different mechanism of action from methadone. Both medications aim to keep patients stable and reduce the harm from returning to heroin use — not to produce intoxication or the rush associated with heroin use.

Opioid agonist treatment doesn’t mean simply switching from heroin to an unregulated medication. It is medical treatment involving assessment, monitoring, and plan adjustment based on each person’s symptoms and needs. The medication may be used continuously for a period, or longer, depending on treatment goals, and should not be stopped, reduced, or adjusted without medical guidance.

The choice of methadone, buprenorphine, symptomatic treatment, or another approach must be assessed individually, considering the level of dependence, withdrawal symptoms, pattern of substance use, physical health, mental health, use of other substances, and readiness to follow up with treatment.

After Heroin Withdrawal: Are There Medications to Reduce Cravings and Prevent Relapse?

Yes, and this is a key part of what makes heroin treatment different from simply “enduring withdrawal” alone.

For some patients, a doctor may consider continued treatment with methadone or buprenorphine to control cravings, reduce a return to opioid use, and help the patient become stable enough to rebuild other areas of life.

Another option is naltrexone, a medication that blocks the effects of opioids. It can be used in certain patients after they have stopped opioids and completed an appropriate waiting period, to help prevent relapse. This medication should not be started while opioids are still present in the body, as it can trigger severe withdrawal symptoms.

So the term “medication to reduce heroin cravings” doesn’t refer to a single drug — there are several approaches, from methadone and buprenorphine, which help control cravings and dependence, to naltrexone, which blocks the effects of opioids after a person has completed a period off the substance. The choice of method depends on the pattern of use, treatment goals, health, and what’s appropriate for each individual.

Therapy and Relapse Prevention for Heroin

Medication is an important part of treatment, but rehabilitation must also address the factors that lead someone back to using, because cravings can be linked to people, places, emotions, and situations that the brain has learned to associate with heroin use.

Common triggers include friend groups or places where the person used to use, contact with sources of the drug, stress, conflict, loneliness, sleep problems, use of alcohol or other substances, and the thought that “it’s been so long — just once won’t hurt.”

Ongoing treatment should therefore include medication to reduce cravings or prevent relapse as appropriate, individual therapy, group therapy, trigger management, restoring sleep and routine, and treatment of co-occurring psychiatric conditions.

If relapse occurs, it shouldn’t be taken to mean treatment doesn’t work — instead, the person should quickly return to treatment, because after a period of not using, tolerance may have decreased and returning to use can increase the risk of overdose. From there, an assessment of what happened before the relapse can guide adjustments to medication, therapy, or the prevention plan.

What to Do When a Family Member Is Addicted to Heroin but Won’t Admit There’s a Problem

Blaming, threatening, or trying to force the other person to admit they are “addicted” can lead to defensiveness and unwillingness to keep talking.

Families can start from what has actually happened — for example, “Lately I’ve noticed that when you don’t use, you feel very unwell and have to use again, so I’m worried the situation is becoming harder to control.”

You might follow up by asking what happened during past attempts to stop, how substance use is affecting their health, work, money, or relationships, and what life will look like if things continue as they are.

The first step doesn’t have to be a lifelong decision to never use again — it can simply be agreeing to an evaluation and hearing about the options available today to reduce withdrawal symptoms and cravings. If the person isn’t ready, the family can consult a treatment team first to plan how to communicate and bring the person into treatment.

Heroin and Opioid Treatment at Day One Rehabilitation Center

Day One Rehabilitation Center provides residential treatment, beginning with an assessment of the type of substance used, duration and frequency of use, withdrawal symptoms, history of overdose, use of other substances, physical health, mental health, sleep, and co-occurring psychiatric conditions.

During withdrawal, the treatment team monitors symptoms and vital signs. A psychiatrist may consider medications to relieve withdrawal symptoms as needed, such as medication for pain, nausea, diarrhea, insomnia, or autonomic nervous system symptoms, tailored to each individual.

For those with severe withdrawal symptoms or strong cravings, medication specifically for opioid addiction treatment may be considered based on clinical indication.

Day One is a licensed facility authorized to provide methadone under the relevant regulatory system, but this doesn’t mean every person addicted to heroin needs methadone. The center’s approach has a psychiatrist first assess whether the patient can be managed with symptomatic withdrawal medication; methadone is considered only if withdrawal is severe or clinically indicated.

After withdrawal, treatment doesn’t stop simply because aches or diarrhea have resolved. The team continues to assess whether medication to reduce cravings or prevent relapse to opioids is needed, alongside individual therapy, group therapy, treatment of co-occurring psychiatric conditions, exercise, and adjusting sleep and daily routines.

Residential care also helps separate the person in treatment from sources of the drug, social groups, and situations that trigger cravings during the early period, giving them time to practice managing cravings and build new routines before returning to life outside the center.

The goal, then, is not simply “getting through heroin withdrawal,” but ongoing care — from reducing the suffering of withdrawal, managing cravings, and treating the factors that led to substance use, through to preventing relapse and reducing the risk of overdose.

Frequently Asked Questions About Heroin Treatment

What medications are used for heroin withdrawal?

It depends on the symptoms and the level of dependence. A doctor may use medications to relieve symptoms, such as medication for restlessness and sweating, pain relievers, anti-nausea medication, or anti-diarrheal medication. Some patients may be suited to methadone or buprenorphine to control withdrawal symptoms and cravings.

How does methadone help treat heroin addiction?

Methadone acts on the opioid system and can help control withdrawal symptoms and cravings, so patients don’t need to return to heroin use to relieve withdrawal. It must be used under a medical treatment and monitoring system.

Is there medication to reduce heroin cravings?

Yes. Treatment approaches may use methadone or buprenorphine to help control cravings and reduce a return to opioid use. Some patients may be suited to naltrexone after completing a period off opioids. A doctor will choose the approach best suited to the individual.

Does completing heroin withdrawal mean someone has recovered from addiction?

No, treatment isn’t considered complete at that point. Even though physical withdrawal symptoms improve, cravings, triggers, and behaviors related to substance use can still persist. Continued treatment and relapse prevention are needed.

Why is relapsing after quitting heroin dangerous?

After stopping opioids for a period, the body’s tolerance to the substance may decrease. If someone returns to the same dose they previously used, their body may not be able to handle it, and an overdose can result.

Can someone really quit heroin?

Recovery is possible, and today there are medications that help manage withdrawal symptoms, medications that help control cravings and reduce relapse, as well as psychological therapy and rehabilitation. Ongoing treatment is therefore more important than trying to get through withdrawal alone.

Quitting heroin isn’t just about getting through withdrawal — cravings need ongoing treatment too.

Families don’t need to wait for an overdose or the loss of daily functioning before starting treatment. If you begin to see that the person experiences withdrawal symptoms when not using, has to use again to feel better, has tried to quit multiple times and relapsed, or has a life that increasingly revolves around finding and using the substance, an evaluation by a specialist should be the starting point.

Heroin treatment today isn’t just about enduring withdrawal — medication can be used to ease withdrawal discomfort, medication for opioid addiction can reduce cravings and relapse, and therapy can address triggers, mental health, and old behavior patterns. The goal, then, isn’t simply having no heroin in the body, but helping the person in treatment sustain that change and return to life without depending on the substance again.