Can withdrawal from heroin kill you?

The intern’s face was pale white, and her eyes were panicky.

“Ryan, I need help.”

She led me into her office.

Harold was lying on the concrete floor of her office.

“He says he is withdrawing from heroin,” the intern said.

I tried to talk to Harold but didn’t get very far. He was far more concerned with his own pain than communicating it to me.

We called 911 and waited 30 minutes for the paramedics to arrive.

I’m not sure I have ever seen someone in more misery than Harold:

  • He writhed around on a concrete floor in pain greater than I could comprehend.
  • His arms were bloody from scratching at imaginary bugs that had burrowed under his skin.
  • His eyes rolled around in his head. Snot from his nose mixed with spit from his mouth.

A few times in my career I have watched someone in absolute hell.

Harold’s heroin withdrawal was the most obvious and acute case of hell I have ever witnessed.

I wouldn’t wish it on ANYONE.

Withdrawal Risks

If you work with the public, here’s what you need to know about the risks from withdrawal:

ALCOHOL withdrawal is the most lethal withdrawal. People die from alcohol withdrawal every day. 

When someone is deep into alcoholism, they need medical treatment to stop drinking. If they try to go “cold turkey” they can die.

Remember this fact when someone asks, “Why doesn’t he just stop drinking?”

BENZODIAZEPINE withdrawal is the second most dangerous.

OPIOID (PAIN PILLS, HEROIN, FENTANYL) withdrawal, while miserable, is unlikely to kill a person.

The risk of opioid withdrawal is from extreme vomiting and diarrhea. A person can die from dehydration or hypernatremia (elevated blood sodium levels). 

The greatest risk is for people with pre-existing medical conditions.

CRACK/COCAINE withdrawal is unlikely to be lethal.

The greatest risk to a person withdrawing from crack or cocaine is suicide caused by extreme depression.

METH withdrawal is unlikely to be lethal.

Like crack/cocaine, the greatest risk is suicide.

I apologize that this week’s email is so dark.

If you work in a job where you need to know this, then you serve the most vulnerable members of your community. THANK YOU THANK YOU THANK YOU THANK YOU THANK YOU!



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