Two Things to Know Before Anything Else
First, the supply. CDC states that heroin has largely been replaced by illegally made fentanyl in the illegal drug supply, and that most heroin now available in the United States is combined with it.1 You cannot see it, taste it or smell it.2
Second, the break. MedlinePlus states that most opioid overdose deaths occur in people who have just detoxed, because withdrawal reduces tolerance, so someone who has just gone through it can overdose on a much smaller dose than they used to take.3 A few days in jail, in hospital or in detox is enough.
Naloxone reverses an opioid overdose, including one involving fentanyl, when given in time.2 It is available over the counter without a prescription.1 Keep it where you are, and tell someone where it is. If you would like help finding naloxone, we can point you to a place to get it.
Sol is an outpatient program and does not provide detox. If withdrawal needs medical management, we will help you find that first and pick up your treatment afterwards.
Clinically reviewed by Tania Acevedo, MA, LPCC, Founder and Chief Clinical Officer
What Heroin Is and How It Takes Hold
CDC describes heroin as a highly addictive, illegal opioid drug, made from morphine which comes from the opium poppy, and calls it highly addictive because all the ways of taking it flood the brain very quickly.1 Repeated use leads to tolerance, then to dependence, and someone who is dependent and stops will have withdrawal symptoms.1 Repeated use can lead to an opioid use disorder, which CDC describes as a medical condition that can affect anyone.1 Sol treats it in Riverside through three substance use levels of care: High-Intensity IOP, IOP and OP.
CDC also names the thing that keeps women out of treatment longest: evidence-based treatments exist, but seeking treatment remains stigmatized, and stigma is a major barrier to how well treatment works against the opioid crisis.1
Key Takeaways
- CDC states most heroin now available in the United States is combined with illegally made fentanyl.1
- Methadone, buprenorphine and naltrexone are standard of care for opioid use disorder.4
- Withdrawal usually starts within a few hours to 12 hours, peaks at 24 to 48 hours, and subsides after about a week.53
- Most opioid overdose deaths occur in people who have just detoxed, because tolerance drops.3
- Heroin-involved deaths have fallen sharply. The rate dropped 33.3% from 2023 to 2024.6
Show all 5 takeaways
What You Are Actually Using
This is the single most important change on this topic in the last decade. CDC’s position is unambiguous: heroin has largely been replaced by illegally made fentanyl in the illegal drug supply, and most heroin now available in the United States is combined with it.1
DEA describes the same thing from the supply side. Because of its potency and low cost, dealers have been mixing fentanyl with other drugs including heroin, increasing the likelihood of a fatal interaction.7
Fentanyl is, in NIDA’s words, about 50 to 100 times more potent than morphine, and because a lethal dose can be very small, using a drug that has been contaminated with or replaced by fentanyl can greatly increase the risk of overdose.8
What this means practically is that a bag today is not the same product a bag was five years ago, and the tolerance you built is not tolerance to what is in it. The same amount, from the same person, is not the same dose.
Read more about fentanyl.
What Withdrawal Is Actually Like
SAMHSA’s detoxification guidance draws the comparison directly, placing uncomplicated opioid withdrawal outside the category of alcohol and sedative withdrawal, which can be life-threatening.9 MedlinePlus describes it as painful, but usually not life threatening.3
On timing, NIDA states withdrawal may occur within a few hours after the last dose, with major symptoms peaking between 24 and 48 hours and subsiding after about a week.5 MedlinePlus puts onset at usually within 12 hours of the last heroin use.3
Early symptoms are agitation, anxiety, muscle aches, tearing, insomnia, runny nose, sweating and yawning. Later come abdominal cramping, diarrhea, dilated pupils, goosebumps, nausea and vomiting.3
Not life-threatening is not the same as safe. MedlinePlus notes complications including breathing vomit into the lungs, which can cause lung infection, and dehydration and electrolyte disturbances from vomiting and diarrhea. It also says withdrawal on your own can be very hard and may be dangerous.3
And the real risk sits on the other side of it. MedlinePlus calls returning to use the biggest complication, because tolerance has dropped.3 That is why the plan matters more than the week.
What Else It Carries
CDC notes that people who inject drugs are at risk of serious long-term viral infections including HIV, hepatitis C and hepatitis B, as well as bacterial infections of the skin, bloodstream and heart.1
Polysubstance use raises the risk again. CDC states that people often use heroin along with other drugs or alcohol, and that this is especially dangerous because it increases the risk of overdose.1
A heroin overdose can cause slow and shallow breathing, coma and death.1 The signs are worth knowing whether or not you are the one using.
What Actually Treats This
Heroin use disorder is an opioid use disorder, and it is treated as one. NIDA states that treatment with methadone, buprenorphine or naltrexone is standard of care for opioid use disorder.4
CDC adds that treatments include medicines to treat withdrawal symptoms, medicine to block the effects of opioids, and behavioral treatments, and that a recovery plan which includes medication for opioid use disorder increases the chance of success.1
How that works, how long it continues, and the answer to the “am I just swapping one drug for another” question are all on one page rather than repeated across four.
Sol does not prescribe medication for opioid use disorder; we coordinate with an outside prescriber. Sol provides the therapy and the structure alongside it, and treats whatever the use has been managing, in the same plan. See dual diagnosis, PTSD or childhood trauma.
What Is Different for Women
The research here is limited, and the answer is short.
NIDA’s research report states that research suggests women tend to use smaller amounts of heroin and for less time, and are less likely than men to inject it, and that most women who do inject point to social pressure and sexual partner encouragement as factors.10
NIDA also reports one study indicating women are more at risk than men of overdose death during the first few years of injecting, while adding that it is unclear why, and that women who do not overdose in those first years are more likely than men to survive in the long term.10 That is a single study and NIDA says so. We include it only as a reason not to wait, not as a statistic to lean on.
The part with more behind it is about treatment design rather than pharmacology. NIDA states that women, pregnant or not, have unique needs that should be addressed during substance use disorder treatment, and that effective treatment should recognize sex and gender differences, understand the types of trauma women sometimes face, and provide added support for women with child care needs.11
NIDA’s findings are part of why a women-only program matters.
What Is Actually Happening Nationally
CDC data shows heroin overdose deaths have been falling since 2018.
| Measure | Figure | Period |
|---|---|---|
| Heroin overdose death rate | Down 33.3%, from 1.2 to 0.8 per 100,000 | 2023 to 20246 |
| Heroin’s share of overdose deaths | About 4% of all drug overdose deaths, 5% of opioid overdose deaths | 20231 |
| When the decline started | The heroin overdose death rate has been decreasing since 2018 | 2018 onward1 |
| US drug overdose deaths, provisional | 67,798, a 12.3% decrease on the year before | 12 months ending March 202612 |
CDC notes that factors which may contribute to the decrease include fewer people starting heroin use and a shift from a heroin-based market to a fentanyl-based one.1 A smaller heroin market is not the same as a safer one.
How Much Treatment
Typically suits
What the week holds
Read more
High-Intensity IOPMost intensive substance use level
Typically suits
The first weeks, or straight after detox elsewhere
What the week holds
Sol’s most intensive substance use level, with days structured like PHP: Monday to Friday, 9:00 AM to 1:30 PM
Read more
IOPIntensive outpatient
Typically suits
The common fit: real treatment alongside work or family
What the week holds
Three days a week, you choose which three, counseling plus group
Read more
OPOutpatient
Typically suits
Protecting a recovery that is holding
What the week holds
Ongoing support and relapse prevention
Read more
If home is part of what makes this hard, our supportive housing affiliate has an all-female home about ten minutes from our treatment center. It is run by a separate organization, and admissions can tell you more.
Starting Treatment
1
Call or Send Your Insurance Details
Admissions answers 24 hours a day, seven days a week.
2
Assessment
A clinician looks at what you are using, how much, how long, and whether withdrawal needs medical management first.
3
Verify Your Insurance
We contact your plan confidentially and explain what we learn.
4
Start Date
Set around what your week can hold.
If you have had a break recently, in custody, in hospital or in detox, say so on the first call. It changes the risk picture more than almost anything else you could tell us.
In crisis right now? Call or text 988.
The drug supply has changed in ways nobody could see, and none of that is a failing of yours.
Frequently Asked Questions
Our admissions line is answered 24 hours a day, 7 days a week at (951) 972-5085.
Is Most Heroin Now Fentanyl?
CDC states that heroin has largely been replaced by illegally made fentanyl in the illegal drug supply and that most heroin now available in the United States is combined with it. Fentanyl cannot be seen, tasted or smelled in a drug.
Is Heroin Withdrawal Dangerous?
SAMHSA’s detoxification guidance places uncomplicated opioid withdrawal outside the category of alcohol and sedative withdrawal, which can be life-threatening, and MedlinePlus calls it painful but usually not life threatening. Complications like dehydration and breathing vomit into the lungs are real, and MedlinePlus warns that doing it alone can be dangerous.
How Long Does Heroin Withdrawal Last?
NIDA states withdrawal may occur within a few hours of the last dose, that major symptoms peak between 24 and 48 hours, and that they subside after about a week. MedlinePlus puts onset at usually within 12 hours. Timing varies from woman to woman, so a clinician is the best guide.
Why Is Overdose Risk Highest Right After a Break?
Because tolerance drops. MedlinePlus states that most opioid overdose deaths occur in people who have just detoxed, and that they can overdose on a much smaller dose than they used to take. A few days in custody, in hospital or in detox is enough for this to apply.
What Treats Heroin Addiction?
The same medications that treat any opioid use disorder. NIDA states that treatment with methadone, buprenorphine or naltrexone is standard of care. CDC adds that a recovery plan which includes medication for opioid use disorder increases the chance of success.
Does Naloxone Still Work If There Is Fentanyl in It?
Yes. CDC states naloxone can reverse an overdose from opioids including fentanyl, when given in time. CDC’s guidance is to give one dose, and if she is not breathing normally after 2 to 3 minutes, give another. Stay with her until help arrives. Naloxone is available over the counter.
Are Heroin Deaths Still Rising?
No. CDC reports the heroin overdose death rate has been decreasing since 2018, and it fell 33.3% from 2023 to 2024. Heroin accounted for about 4% of all drug overdose deaths in 2023. CDC attributes part of the shift to the market moving from heroin to fentanyl.
Does Insurance Cover Heroin Treatment?
Every plan is different, so the quickest way to know is to verify your insurance. Sol accepts most major insurance plans, and benefits are confirmed individually before admission. Sol can often work with HMO policies through a single case agreement. Sol does not accept Medi-Cal, Medicaid, Medicare, Molina, IEHP, Kaiser, TRICARE or TriWest.
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It Is Never Too Late to Reach Out
A conversation with admissions is the least dramatic possible first step, and it commits you to nothing.
4175 Brockton Avenue, Riverside, CA 92501
Confidential. We are not going to ask you to promise anything on the phone.
Sources12
- 1.Centers for Disease Control and Prevention. Heroin. https://www.cdc.gov/overdose-prevention/about/heroin.html
- 2.Centers for Disease Control and Prevention. Fentanyl. https://www.cdc.gov/overdose-prevention/about/fentanyl.html
- 3.MedlinePlus, National Library of Medicine. Opiate and opioid withdrawal. https://medlineplus.gov/ency/article/000949.htm
- 4.National Institute on Drug Abuse. Treatment. https://nida.nih.gov/research-topics/treatment
- 5.National Institute on Drug Abuse. Heroin Research Report Series. https://nida.nih.gov/sites/default/files/heroinrrs_11_14.pdf
- 6.Centers for Disease Control and Prevention, National Center for Health Statistics. Drug Overdose Deaths in the United States, 2023-2024, NCHS Data Brief No. 549, January 2026. https://www.cdc.gov/nchs/products/databriefs/db549.htm
- 7.US Drug Enforcement Administration. Facts about Fentanyl. https://www.dea.gov/resources/facts-about-fentanyl
- 8.National Institute on Drug Abuse. Fentanyl. https://nida.nih.gov/research-topics/fentanyl
- 9.Substance Abuse and Mental Health Services Administration. TIP 45: Detoxification and Substance Abuse Treatment, Chapter 4. https://www.ncbi.nlm.nih.gov/books/NBK64116/
- 10.National Institute on Drug Abuse. Substance Use in Women Research Report: Sex and Gender Differences in Substance Use. https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use
- 11.National Institute on Drug Abuse. Substance Use in Women Research Report: Summary. https://nida.nih.gov/publications/research-reports/substance-use-in-women/summary
- 12.Centers for Disease Control and Prevention. CDC Launches New Overdose Prevention Data Channel, August 31, 2026. https://www.cdc.gov/media/releases/2026/cdc-launches-new-overdose-prevention-data-channel.html
Medical Disclaimer
This page is educational and is not medical advice. Opioid use disorder can only be diagnosed by a qualified clinician, and decisions about medication, dose and withdrawal belong to a prescriber. Sol Women’s Treatment is certified by DHCS for outpatient and intensive outpatient services (330246AP) and licensed by CDSS (facility 331881576), and does not provide detox, inpatient or residential care. No two women respond identically and nothing here promises a result. In a medical emergency call 911. If you are in crisis, call or text 988.