Heroin Dope Sickness
What does it mean to be dope sick?
“Dope sick” is a colloquial term used to refer to the uncomfortable feelings of heroin or other opioid withdrawal. Physical dependence on opioids like heroin precedes dope sickness; someone who is not yet dependent will not experience this phenomenon.
Dependence is the natural way the brain and body respond to repeated exposure of the drug over time. The body begins to adapt to opioids and, at a certain point, begins needing them to maintain a sense of stability. During withdrawal, the body has to recalibrate to their absence, and this can be acutely uncomfortable. Several physiologic reactions can occur during withdrawal.1 Depending on your level of dependence (which is influenced by how much of the drug you were using, and for how long you were using it), these reactions can be relatively mild or very severe. For most opioid-dependent individuals, withdrawal is incredibly intense—so intense, in fact, that many people relapse when they are going through withdrawal.2
If you don’t know what to expect, the prospect of withdrawal can be frightening and leave you with questions about how to manage the symptoms. If you are thinking about quitting heroin or currently in the process, continue reading to learn what you need to know about making it through dope sickness.
Do Painkillers Make You Dope Sick?
Like heroin, prescription painkillers have the potential to cause physical dependence. Like heroin, painkillers themselves won’t make you dope sick, but not having them once you’re dependent on them will result in some form of dope sickness (withdrawal).
Opioid painkillers are chemically similar to heroin (both are opioids). Both attach to and activate opioid receptors and are associated with an increase in dopamine activity in key brain regions, specifically areas involved with pleasure and reward. Used therapeutically and as prescribed, opioid painkillers are very effective for pain management but when used recreationally and/or in high doses, they can bring about the same kind of addictive euphoria, or “high,” of heroin.1 As such, opioid painkillers have a significant potential for abuse, addiction, and physical dependence.3 Fentanyl, for example, is an extremely potent opioid—on average, 30-50x that of heroin—and may drive the development of significant opioid dependence even more surely and swiftly than heroin itself.4
When Does It Start and End?
Heroin is a short-acting opioid, which means that its effects diminish rapidly, leaving the individual subject to feeling dope sick within a matter of hours. After the last dose of heroin, a person may experience the onset of withdrawal symptoms within 6-12 hours and continue to experience these symptoms for 5-7 days.5 Symptoms may include5,6
- Low mood.
- Trouble sleeping.
- Excessive sweating.
- Runny nose.
- Watery eyes.
- Cramping and muscle tension.
The acute phase of opioid withdrawal is sometimes followed by a protracted withdrawal phase that may last for weeks or months beyond the resolution of acute symptoms.7 Protracted, or post-acute, symptoms common to recovering heroin addicts include fatigue, emotional numbness, irritability, and cravings for heroin.7
Going back to heroin may seem appealing when consistently low mood and strong cravings make living in sobriety especially difficult. Relapse is also a risk. During any significant period of sobriety, you will begin to lose your tolerance, and a return to your usual dose of heroin could be fatal.6 This is one reason establishing care with a therapist or entering addiction treatment during and after detox can be so beneficial.
Anyone attempting to overcome a heroin dependence—especially those who have tried unsuccessfully in the past—can benefit from a structured course of detox in a professional setting, followed by inpatient or outpatient rehab. The medications and therapeutic approaches utilized by staff in detox and addiction treatment programs help you to stay on track, ward off relapse, and remain sober in the long-term.6
How Can I Detox Comfortably?
You can find a certain level of comfort during withdrawal but it will be very difficult if you’re detoxing without help.
A medical detox can ensure you stay hydrated, safe, and comfortable. When you are under supervision, any adverse medical events such as dehydration or irregular heart rhythms can be immediately addressed. The absolute safest option is an inpatient setting, such as a hospital or inpatient detox center, although doctors can also monitor your withdrawal on an outpatient basis. If you are opposed to the use of medications, and your withdrawal symptoms are likely to be relatively less severe, you can also seek out a social detox, a nonmedical yet supportive inpatient detox environment.
If you are detoxing under medical supervision, you may be prescribed medication to help reduce your cravings and manage opioid withdrawal symptoms.
- Methadone: This long-acting opioid agonist helps to lessen the severity of withdrawal symptoms as well as cravings.8
- Buprenorphine: Like methadone, this partial opioid agonist helps to lower cravings and alleviates symptoms; however, unlike methadone, there is a ceiling to the opioid effects it produces. This ceiling helps to prevent abuse.6
Medication use is not limited to the acute withdrawal phase. Some medications are also prescribed to manage cravings and prevent relapse beyond detox on a more long-term basis. Best used as part of an approach that incorporates therapy, these medications include methadone and buprenorphine as discussed above, as well as naltrexone. An opioid antagonist, naltrexone blocks the pleasurable effects of heroin and other opioids and has no potential for physical dependence itself.8 Vivitrol (a once-monthly version) eliminates the need for daily compliance to a treatment regimen.
Buprenorphine, like naltrexone, also has a version that does not involve daily medication intake. Probuphine is an arm implant that delivers a continuous dose of buprenorphine for 6 months.
Your treatment team can discuss the best options for you based on certain considerations such as your history of substance use and previous treatment approaches.
Why Quit Heroin?
Living with an opioid addiction can make you feel helpless and hopeless, but a new life is possible.
If you are addicted to heroin, making the decision to quit is not an easy one. Heroin and other opioids are extremely addictive, and you may be caught in a scary cycle of abuse and withdrawal avoidance. But, taking a moment to consider just how devastating the consequences can be may help you make the decision to get clean and move on.
People who use heroin are at risk for a long list of acute and chronic health consequences that includes:5,9
- Severe constipation.
- IV drug use-related issues such as abscesses, infection of the heart lining and valves, local vascular inflammation, collapsed veins, and tissue necrosis at injection sites.
- Health problems related to snorting heroin, including perforation of the nasal septum.
- Impaired mental functioning.
- Mental health disorders (e.g., chronic depression).
- Sexual dysfunction (in men).
- Irregular periods for women.
- Lung complications, including pneumonia.
In addition, people who inject heroin are at a significant risk for contracting HIV, hepatitis C (HCV), and other communicable diseases from sharing needles and related paraphernalia.9
In addition to the above risks, heroin users are 14x more likely to die from suicide compared to their peers.10
Living with opioid addiction can make you feel helpless and hopeless, but a new life is possible. If you are currently using heroin and are looking for help, resources are out there and they are only a phone call away.
- Kosten, T. R., & George, T. P. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives, 1(1), 13–20.
- National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction.
- National Institute on Drug Abuse. (2018). Prescription Opioids.
- Drug Enforcement Administration. (n.d.). FAQ’s-Fentanyl and Fentanyl-Related Substances.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Dolan, K. (2010). Clinical Guidelines For Withdrawal Management And Treatment Of Drug Dependence In Closed Settings. Addiction, 105(7), 1318.
- Substance Abuse And Mental Health Services Administration. (2010). Protracted Withdrawal.
- National Institute on Drug Abuse. (2018). What are the treatments for heroin use disorder?
- National Institute on Drug Abuse. (2018). Heroin.
- Darke, S., & Ross, J. (2002). Suicide among heroin users: rates, risk factors and methods. Addiction, 97(11), 1383-1394.