Heroin detox in Los Angeles, from the first hours to the months after.

Symptoms

What are heroin withdrawal symptoms at each phase?

Heroin withdrawal symptoms move from restlessness and aching in the first hours to vomiting, diarrhea and cold flashes at the peak, and then to a long, quieter phase of poor sleep and low mood.

The first hours

MedlinePlus lists agitation, anxiety, muscle aches, watering eyes, a running nose, sweating, frequent yawning and trouble sleeping as the early signs.

The peak

NIDA describes restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements. MedlinePlus adds stomach cramps, nausea and widened pupils. The medical risk in this phase is mostly about fluids: repeated vomiting and diarrhea can dehydrate a person, and vomit can be inhaled into the lungs.

The weeks and months after

As the physical symptoms fade, a different set can linger: broken sleep, low mood, craving and greater sensitivity to pain. MedlinePlus advises that people in detox be screened for depression and other mental illness.

Withdrawal from heroin is very unpleasant but, according to MedlinePlus, is not usually life threatening in itself. MedlinePlus is just as direct about what is: the biggest danger in opioid detox is going back to using, covered further down this page.

The supply

Is heroin today mixed with fentanyl?

It can be, and there is no way to tell by looking. MedlinePlus says illegal heroin has no quality control and is sometimes mixed with fentanyl, and the CDC says illegally made fentanyl is added to heroin, often without the buyer knowing.

That changes three things for a family. First, an overdose may be harder to reverse: the CDC notes that stronger opioids such as fentanyl can need more than one dose of naloxone. Second, someone who believes they use only heroin may have built up a dependence on fentanyl too, which is worth telling the assessing clinician even as a guess. Third, MedlinePlus warns that heroin taken with prescription painkillers, other drugs or alcohol is very dangerous, and mixed supply makes those combinations harder to predict.

Street fentanyl can carry its own additives, including veterinary sedatives that naloxone does not reverse. Our fentanyl page explains xylazine, medetomidine and the other additives in street fentanyl.

A common belief

Is smoking or snorting heroin safer than injecting?

Only in avoiding needle-borne infections. Heroin that is smoked or snorted still builds tolerance and dependence, still brings withdrawal when it stops, and still carries whatever was mixed into it, fentanyl included.

NIDA names this belief directly. Its research report on heroin says a misperception that purer heroin is safer, because it does not have to be injected, may be part of why people start. The tolerance and dependence NIDA describes come from repeated use, whatever the route.

The route also carries harms of its own. NIDA notes that snorting heroin can damage the tissue inside the nose and can perforate the nasal septum, the wall between the nostrils. Long-term heroin use, however it is taken, is linked to lung problems including pneumonia and tuberculosis, along with constipation, insomnia and changes to sexual function and menstrual cycles.

For detox, the route matters mainly for what the assessment looks for. Someone who has never injected avoids most of the infections in the table above. They do not avoid withdrawal, or the overdose risk that follows it.

Licensing and setting

Heroin detox in Los Angeles: a license on the public record, and how the setting is chosen

Lumora’s license is not something you have to take on our word. It sits in California’s public dataset of treatment facilities, kept by the Department of Health Care Services. The entry under 191642AP shows Lumora Recovery at 6130 Wilbur Avenue, licensed as a residential program that includes detoxification (RES-DETOX), with capacity for six residents and incidental medical services marked as approved. That approval, available to licensed residences since 2016, allows set medical services under a licensed practitioner, among them medical histories, health monitoring and the treatment of substance use disorders, detox included. It does not reach general primary care or anything that must be done in a licensed health facility. Find Lumora’s entry in the state’s facility data.

For heroin, the assessment looks hardest at three things: how the drug is taken, any sign of infection, and what else is used alongside it. Together they settle whether withdrawal begins in the house in Tarzana or in a hospital, with Lumora afterward if that fits. When a hospital should come first, admissions tells you on the call. For the wider picture, see how Lumora approaches detox across substances.

We work with many PPO plans, and admissions checks detox and residential benefits by phone. For the rules behind coverage, read the way PPO benefits for detox and rehab are decided.

Plain definitions

What do the medical words around heroin detox mean?

Three terms a family is likely to hear during heroin detox, each defined in a sentence or two from the federal sources on this page.

Black tar heroin. A sticky, dark form of heroin, as opposed to the white or brown powder, according to NIDA. The form does not change the withdrawal.

Opioid use disorder. The clinical name for opioid addiction. NIDA describes medicines and behavioral therapy as treatments that are most effective in combination.

Protracted withdrawal. The long tail after the acute days: low mood, craving, poor sleep and heightened pain that SAMHSA says can last weeks or months.