Heroin carries a weight of stigma that few other substances do, and many people walk into the first call carrying that weight in addition to the addiction itself. Heroin is an illicit opioid derived from morphine that produces one of the fastest and most intense dopamine surges of any substance of abuse, and one of the most rapid and profound physical dependencies. For many people who develop heroin use disorder, the path began with prescription opioids: a legitimate pain prescription, escalating tolerance, the prescription stopped, and a turn to heroin as a cheaper and more available alternative. That trajectory is not a moral failure. It is the documented pharmacological and social pattern of the prescription opioid epidemic, and it accounts for a meaningful share of the heroin use disorder we see in admissions across the Roanoke Valley.
Heroin use disorder is treatable. Genuinely treatable, with the right combination of medical support, behavioral therapy, peer community, and sustained clinical engagement. Roanoke Refuge provides outpatient PHP and IOP for adults with heroin use disorder, anchored to on-site MATto the treatment approach we apply across the program.
The Physical Reality of Heroin Dependence
This is the part that scares people most about asking for help, and we want to talk about it honestly. Physical dependence on heroin develops rapidly because of the drug’s high opioid receptor affinity and short duration of action. Withdrawal begins within six to 12 hours of the last use and peaks at 36 to 72 hours. Here is what most clients describe.
Intense craving
The dominant feature of withdrawal and the primary driver of return to use.
Severe muscle aches and cramping
Particularly in the lower back and legs.
Profuse sweating and alternating chills
Often described as the worst flu the client has ever experienced.
Nausea, vomiting, and diarrhea
Severe enough to cause dehydration if untreated.
Insomnia and extreme restlessness
Often persisting beyond the acute withdrawal window into post-acute withdrawal.
Anxiety, agitation, and irritability
The emotional dimension of withdrawal that is rarely captured in physical-symptom lists. Learn more
Elevated heart rate and blood pressure
Cardiovascular effects that need clinical monitoring during detox.
While heroin withdrawal is rarely life-threatening in otherwise healthy adults, the severity is the primary driver of return to use. We will not pretend otherwise. Medically supervised detox with buprenorphine substantially reduces withdrawal severity and is strongly recommended before beginning outpatient treatment. You do not have to white-knuckle this. Detox happens with our partner providers in the Roanoke Valley, coordinated by our admissions team.
From Detox to Outpatient Treatment
Detox is not treatment for heroin use disorder. It is the first step that makes treatment possible, and the days right after it are the days we worry about most. The gap between detox discharge and the start of outpatient treatment is one of the highest-risk periods in opioid recovery because tolerance drops rapidly during withdrawal while cravings persist. Closing that gap is part of our standard intake model. The conversation with our admissions team ideally happens before the detox discharge date so that the PHP placement is ready the moment detox is complete.
MAT for Heroin Use Disorder
Buprenorphine-based MAT is the clinical standard of care for heroin use disorder and is supported by overwhelming evidence. Roanoke Refuge prescribes FDA-approved MAT medications on-site, including buprenorphine (Suboxone, Subutex, Sublocade, Brixadi) and naltrexone (oral and Vivitrol), so the medication and the therapy are one integrated plan rather than two parallel tracks.
Clients arriving with an existing buprenorphine or naltrexone prescription from another provider can continue with that provider or transfer their prescription to our medical team, depending on what fits the situation. Clients not yet on MAT but who are candidates begin induction on-site with our medical team.
Naloxone and the Fentanyl Reality
If you take one piece of information from this entire page, please make it this one. Heroin in the current drug supply is frequently contaminated with fentanyl, often without the user’s knowledge. The risk of accidental overdose is higher than at any previous point in the history of the opioid epidemic. We provide naloxone (sold as Narcan) education to every client with heroin use disorder and to family members willing to receive it. Naloxone is available without a prescription at most Virginia pharmacies, and a family with a member in active heroin use disorder should keep naloxone in the home as a baseline safety measure. We treat this as a lifesaving conversation, not an optional one.
Our Clinical Approach to Heroin Use Disorder
Here is what the work looks like once stabilization is behind you. Clients with heroin use disorder typically enter our PHP program following detox or MAT stabilization, with a step-down to IOP after two to six weeks of clinical stability. A treatment plan typically pulls from the following.
- Cognitive Behavioral Therapy — Identifying and modifying the thought patterns, environmental triggers, and behavioral patterns that drive heroin use.
- Motivational Interviewing — Strengthening the client’s own motivation for change during the early ambivalent phase of treatment.
- Trauma-informed care — Trauma is nearly universal in this population, including childhood adverse experiences and trauma from witnessing peer overdose deaths. The treatment environment is built to hold the trauma rather than ask the client to carry it alone.
- Recurrence-prevention planning — Specific to heroin triggers, the high overdose risk in early recovery, and the social patterns that surrounded active use.
- Peer recovery support — Certified peer specialists with lived experience of opioid recovery provide mentorship and community connection across the Roanoke region.
- Family therapy: The relational impact of heroin use disorder is severe, and the Family Program structures the work alongside the family.
Dual Diagnosis and Heroin Use Disorder
What was happening in your life before the heroin matters. Co-occurring post-traumatic stress disorder, depression, and anxiety are extremely common in clients with heroin use disorder. The trauma history that precedes heroin use is often the central clinical reality, and addressing the heroin use without addressing the trauma is like treating the smoke while leaving the fire burning. Our integrated dual diagnosis program treats both at the same time, in the same setting, and by the same clinical team.
Local, regional, and accessible.
Treatment for this substance is delivered from our Salem facility at 1630 Braeburn Drive — just off I-81 exit 137. The Roanoke Valley service area covers Roanoke City, Salem, Vinton, and the surrounding counties of Roanoke, Botetourt, and Bedford. The Salem VA Medical Center sits roughly two miles away and serves as a referral partner for veterans transitioning to civilian outpatient care.
The path in is a single phone call. The admissions team walks through fit, level of care, insurance, and what the first week of treatment will actually look like — at no cost and with no clinical commitment until you are ready. Insurance benefits get verified during the same call. Call (540) 900-0353 to start the conversation.