Treatment for Heroin Use Disorder

You are treating the kick as if getting through it were the treatment, or you are planning to use the old amount once the sweats stop. Ask for methadone, buprenorphine, or naltrexone, and for a plan that continues after the acute days. Do not detox at home. Do not take a friend's leftover buprenorphine.

If someone will not wake, is breathing slowly, or has stopped breathing, call 911 and give naloxone if you have it. Stay until help arrives. For a mental health crisis, call or text 988.

What may be in the bag

Heroin is an illegal opioid processed from morphine. It may be a white or brownish powder, or a dark sticky form called black tar. It may be snorted, smoked, or injected. Routes that reach the brain fastest, injection and smoking, raise the chance of heroin use disorder.

The name on the bag is not a safety category. Illegally made fentanyl is commonly mixed with heroin, cocaine, and methamphetamine, and you would not see it, taste it, or smell it. Test strips can help and usually answer in about five minutes. A negative strip does not prove the rest of the bag is safe, and strips can miss a more potent drug such as carfentanil. Potency and naloxone are in fentanyl treatment. Slowed breathing is in opioid overdose signs. Naloxone wears off. The emergency call still matters after someone wakes.

Ask for medication

For addiction to opioids, including heroin and fentanyl, medication should be the first line of treatment, usually combined with counseling. Fewer than 1 in 5 people with opioid use disorder receive those medicines. People treated with methadone or buprenorphine are less likely to die of an overdose than people who do not receive those treatments. They are also less likely to inject, share equipment, or take other risks that spread HIV and hepatitis C. That is a finding about groups. It is still a reason to ask.

The three medicines are not the same, and a clinician chooses.

Methadone for this disorder comes only from an opioid treatment program. People often start by going daily or almost daily. Since 2020, many people who have already been in treatment may receive up to 28 take-home doses. The program decides who qualifies. Do not stop methadone in order to start fresh. How the clinic works is in how methadone treatment works.

Buprenorphine can be prescribed by many physicians, nurse practitioners, and physician assistants, including by telehealth. It does not require an opioid treatment program. The film and tablet forms are in Suboxone treatment.

Naltrexone blocks opioid receptors and is not addictive. It is usually started only after other opioids have stopped, often after 7 to 10 days off a short-acting opioid, because an early dose can cause withdrawal. A clinician manages that gap. Do not test a tablet on your own.

Lofexidine is approved for acute symptoms such as feeling sick, stomach cramps, muscle spasms, a pounding heart, aches, and sleep problems. It is not long-term treatment of the disorder.

Myths, pregnancy, and how the three medicines differ are in medication for opioid use disorder. When the opioid started as a pain prescription, the history is in prescription opioid addiction. The same medicine list applies. The drug class is on opioids.

Counseling beside the medicine

Medication for opioid use disorder increases retention in care and decreases drug use, infectious-disease transmission, and criminal activity. Behavioral treatment and medication are often most effective together. Contingency management uses rewards tied to drug-free tests or to showing up. Cognitive behavioral therapy works on the situations that lead back to use, and on coping skills. Both can happen in outpatient or residential care. A program that refuses to discuss methadone or buprenorphine, for a person with heroin use disorder, is describing a philosophy. It is not the first-line standard.

The kick creates its own risk

Withdrawal can start within a few hours of the last dose. Symptoms can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and leg movements. Major symptoms peak between 24 and 48 hours and ease after about a week for many people. Some signs can last for months. That is a research description. It is not a calendar for a bedroom. The hour-by-hour clinical ranges are in opioid withdrawal basics.

Medicines can ease craving and the physical symptoms that otherwise push people back to use. Detoxification is not itself treatment. It is useful only when evidence-based care follows. A complete process has three parts: evaluation, stabilization, and a way into ongoing treatment. Uncomplicated opioid withdrawal is not life-threatening, unlike alcohol or sedative withdrawal, and significant opioid withdrawal should not be managed without medication. Why discharge from withdrawal care is not graduation is in detox versus rehab.

People lose tolerance during abstinence without realizing it, so an amount they used to survive can stop breathing. Using as much as before a period of abstinence can cause an overdose, because the body is no longer adapted to that exposure. Fentanyl in the supply makes the old amount a guess. A return after detox, jail, or a short stay is a medical risk. The first hours are in what to do after a relapse.

Do not follow a forum schedule, a friend's leftover buprenorphine, or a plan to tough it out so a bed feels earned. If alcohol or a benzodiazepine is also in use, say so before any taper. Stopping a benzodiazepine abruptly, or cutting it too fast, can cause seizures. Alcohol and sedative withdrawal can be life-threatening. Who needs a medical setting is in detox at home versus medical care.

Search FindTreatment.gov for programs, including opioid treatment programs that provide methadone. How the filters work is in finding treatment near you. Call or text (800) 653-9376 if you want help sorting medication and the care that comes after the acute days.

Additional Resources

Sources cited on this page:

• NIDA Heroin Research Report: What is heroin and how is it used?
• NIDA Heroin Research Report: What are the long-term effects of heroin use?
• NIDA Heroin Research Report: What are the treatments for heroin use disorder?
• NIDA: Medications for Opioid Use Disorder
• NIDA: Misconceptions about maintenance treatment (tolerance after abstinence)
• NIDA: Treatment and Recovery
• CDC: Fentanyl Facts
• SAMHSA TIP 45 quick guide: Detoxification and Substance Abuse Treatment
• FDA: Boxed warning on benzodiazepines
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions