How bad is heroin withdrawal?

Opioids have specific withdrawal and dependence characteristics common to all opioids, varying according to the specific drug. All opioids cause both physical and psychological dependence with prolonged use. Depending on the opioid in question withdrawal can become evident after continued use in as little time as 2 weeks or as long as 2 months.

Withdrawal is commonly overstated by media and tends to be similar to bad case of flu. This is due to the fact that most opioid users don't tend to be able to acquire enough drug to result in severe withdrawal. It must be noted that physical symptoms may be similar to flu, psychological symptoms can be quite painful. Depression, mood swings, hypersensitivity to pain are some common symptoms. 

Opioid withdrawal DOES NOT endanger life as does alcohol and other depressant withdrawal.

I have had information online about the severity of opiate withdrawal for many years. See for example How bad is Heroin Withdrawal? Occasionally, I get angry letters from addicts claiming that such articles vastly understate the torture of heroin withdrawal.

In response, first let me point out that pain and suffering is a very subjective thing. Something that will cause one person to writhe in pain and beg for pain killers will barely disturb another person at all. In order to try to get some reasonable handle on how much pain and suffering someone is actually enduring, doctors will usually ask their patients to rate their pain on a scale of 1 to 10. Of course, all patients quickly learn that, if they want medication, then their chances are far better if they tell the doctor the pain is a 10. While pain is purely a personal thing, we cannot discount the motives that one might have when describing their pain.

I don't seek to judge others on this point. If they want to claim their pain or suffering from a hangnail, drug addiction, or whatever is a 10, then I am not really in a position to dispute that. That's how they feel about it, and I have long argued that the only sensible thing to do is to take people at their word on these issues, at least until you have firm indications that they are not telling the truth.

However, having said that, I have observed a number of addicts and medical patients in withdrawal and their appearances and actions varied quite a bit. Some looked and acted like they were about to die. With others, a casual observer might have judged them to be suffering from something no worse than a mild case of the flu. Some regular opiate users have described it as no big deal to them. "So you feel like you have mild case of the flu for a few days," one told me. "You just look at the long-term picture and realize that this will be over in a couple of days and you go on with your life."

My own mother was a chronic pain patient who used morphine on a regular basis for pain control. She reported that she experienced physical withdrawal symptoms on a number of occasions. She described it as comparable to a case of the flu. It was uncomfortable, she said, but not so uncomfortable that it would cause her to do anything extreme to get more drugs. Moreover, she said that, compared to her chronic pain, the withdrawal symptoms were "nothing" by comparison.

One thing that is certain is that people with a drug habit tend to become very manipulative. They learn to get what they want by persuading or cajoling others to do what they want, rather than by what might be called "honest labor." One prominent addiction specialist placed secret cameras in his waiting room. He noted that the heroin addicts often acted quite normally in the waiting room, even discussing their addiction and the best kinds of drugs in a quite animated fashion with others. However, when they came in to see him, their appearance changed dramatically and they claimed great suffering. He concluded that much of their suffering was for the purpose of manipulating him.

But that really doesn't settle the issue, either. Pain and suffering is a personal issue and we have no good way to measure the pain and suffering of others.