Getting Sober From Heroin: Treatment and Safer Next Steps

Getting sober from heroin is different from quitting many other drugs in two ways: there are FDA-approved medications that treat opioid use disorder, and overdose risk needs attention at every stage. This guide is for someone who wants to stop, and for the people who love them. It starts with emergency information because that part cannot wait.

If someone may be overdosing right now

If a person who has used heroin is unresponsive, breathing slowly or not at all, or has blue or gray lips, call 911 immediately. Give naloxone if you have it; naloxone and nalmefene are FDA-approved medications that reverse opioid overdose (SAMHSA). Stay with the person and tell responders exactly what was taken. Our page on signs of overdose lists what to watch for.

If you use heroin and do not have naloxone, getting some is a practical first step, before any appointment. Pharmacies, health departments, and harm-reduction programs carry it.

Where to start when you want to stop

A primary care doctor, an addiction medicine clinician, an emergency department, or a treatment program can assess you and discuss medication. SAMHSA notes that buprenorphine can be prescribed in ordinary physician offices, which has expanded access (source). The federal locator at findtreatment.gov lists programs by location.

If you are unsure how serious your situation is, the short quiz below is an optional educational tool. It is not a diagnosis, and it cannot tell you whether it is safe to stop on your own; only a clinician can assess that.

Why detox alone usually isn't enough

Many people picture recovery as getting through withdrawal and then holding on. Withdrawal management, or detox, addresses the first days; it does not treat the disorder that brought you there. SAMHSA describes medications for opioid use disorder as evidence-based treatment that relieves withdrawal symptoms and cravings, and describes counseling and behavioral therapy as part of a whole-patient approach that can support it (source). A clinician can often make the first days more bearable than doing it alone.

One thing to be clear about: heroin is not a prescription you taper down. There is no controlled dose of street heroin, and you cannot know what a given batch contains. Learn more about fentanyl.

Medications a clinician can manage

Three FDA-approved medications treat opioid use disorder: buprenorphine, methadone, and naltrexone. SAMHSA describes them as helping to normalize brain chemistry, relieve cravings, block the euphoric effects of opioids, and restore normal body function, and states that they do not just substitute one drug for another (source).

• Buprenorphine can be prescribed in office settings and taken at home.
• Methadone is a long-acting full opioid agonist dispensed through specialized programs.
• Naltrexone blocks opioid effects and is available as an extended-release injection.

Which one, and when to start, are clinical decisions that depend on what you have been using and when, so this guide deliberately gives no timing instructions. SAMHSA reports these medications are safe for long-term use, from months to a lifetime, and that people should consult their doctor before discontinuing them (source). Taking one is an evidence-based medical treatment. How people and communities use words like sobriety and recovery varies; see what sobriety means and myths about medication-assisted treatment.

If you also take benzodiazepines such as Xanax, tell the clinician. Combining benzodiazepines with opioids can cause severe breathing suppression and death, but the FDA has also cautioned clinicians against withholding opioid use disorder medication for that reason; the answer is careful management, not refusal (source).

Overdose risk after any break from use

This is a part families need to hear. After a period without heroin, whether because of jail, a hospital stay, detox, or an attempt to quit, tolerance can fall, and an amount a person previously used may cause an overdose. SAMHSA lists improved survival among the documented benefits of medication-based treatment (source).

Practical steps: keep naloxone where you and the people around you can find it, avoid using alone so that someone can call 911 and give naloxone if needed, and tell someone if you have returned to use rather than hiding it. Another person's presence makes a response possible; it does not guarantee an outcome, which is why 911 still needs to be called.

Counseling, support, and levels of care

Counseling and behavioral therapy can support medication treatment. SAMHSA describes medication combined with behavioral therapy as a whole-patient approach, with benefits that include better retention in treatment and improved ability to hold a job (source). Counseling is not a requirement for accessing medication, and it is not a substitute for it. Options range from outpatient visits to intensive outpatient, residential programs, and sober living afterward; the right level of care is an individual decision made with a clinician. Many people also use peer groups; some are more welcoming to people on medication than others, so ask before assuming.

Co-occurring depression, anxiety, and trauma are common and should be raised with your clinician so they can be treated at the same time. If you are thinking about suicide, call or text 988, the Suicide and Crisis Lifeline. Browse treatment programs and ask each one which medications it offers.

For family members

You cannot make someone stop, but you can reduce risk: carry naloxone, learn the overdose signs, keep the door open, and support the things that make treatment easier. Get support for yourself too; see how to support a loved one.

Checklist and next steps

• Get naloxone this week and tell people where it is
• Book one appointment with a prescriber or program that offers medication
• Write down every substance you use, including alcohol and benzodiazepines, to share with the clinician
• Choose one person who will know your plan
• Avoid using alone, especially after any break

While you wait for the appointment, our overview of getting sober explains what the first weeks tend to involve.

Sources

• SAMHSA: Treatment Options for Substance Use Disorder
• SAMHSA: Opioid overdose reversal medications
• FDA Drug Safety Communication on benzodiazepines
• SAMHSA Behavioral Health Treatment Services Locator
• 988 Suicide and Crisis Lifeline