What Is Heroin?

Heroin is a semi-synthetic opioid derived from morphine. It is illegal in the United States and has no accepted medical use. Users typically inject, smoke, or snort it. Heroin produces a rapid, intense euphoria followed by a deep sedation, and regular use quickly leads to physical dependence.

The heroin supply in the United States is now profoundly different than it was a decade ago. Since the mid-2010s, illicitly manufactured fentanyl has contaminated most of the heroin supply. Many people who believe they are using heroin are actually using a fentanyl-heroin mixture, or pure fentanyl sold as heroin. This shift is responsible for the dramatic rise in opioid overdose deaths nationwide and makes modern heroin use significantly more dangerous than it was even five years ago.

Southeast Tennessee and North Georgia have not been spared. Hamilton County and surrounding counties have seen rising rates of heroin-related overdoses, almost all now driven by fentanyl contamination. Effective treatment today has to account for this reality — patients presenting for heroin use disorder are often physiologically dependent on fentanyl without having known it.

The Tennessee Picture

The scale of the opioid overdose crisis in Tennessee is significant, and the latest data is worth seeing clearly.

  • 2,720 of Tennessee’s 3,616 overdose deaths involved fentanyl in 2023 — roughly three-quarters of every fatal overdose in the state. Illicit opioids overall were involved in 78% of deaths.
  • Tennessee’s overdose death rate in 2023 was 57% higher than the national rate, the fourth-highest in the United States.
  • 3,648 Tennesseans died from drug overdose in 2023 per statewide tracking — the first year-over-year decrease since 2019, though the total remains 82% above 2019 levels.
  • Polysubstance overdoses involving both opioids and stimulants rose 200% between 2019 and 2023, largely driven by fentanyl contamination of the cocaine and methamphetamine supplies.
  • In Hamilton County, fentanyl contributed to 82% of overdose deaths in 2023 (and 83% in 2022). Fatal overdoses in the county have since dropped from 105 (first half of 2023) to 66 (first half of 2025) — a 38% decrease over two years — driven by expanded naloxone access, better treatment availability, and coordinated public health response.

The data tells two stories at once: overdose remains a serious public health emergency in Tennessee, and treatment access is starting to move the numbers in the right direction. If you or someone you love is using opioids today, the decline in overdose deaths isn’t a reason to wait — it’s a reason to believe treatment works.

Sources: Tennessee Overdose Response Coordination Office Annual Report 2023/24 (Tennessee Department of Health, May 2025); Tennessee SUDORS Report 2025 (TDH, June 2025); Hamilton Counted 2025 Mid-Year Report (Hamilton County, TN); Hamilton County Public Health community overdose surveillance assessment.

Signs of Heroin Use Disorder

Heroin use disorder is a medical condition, not a moral failing. Physical dependence can develop within weeks of regular use. Common signs include:

  • Physical tolerance. Needing more of the drug to achieve the same effect, or finding that the previous amount no longer prevents withdrawal.
  • Withdrawal symptoms. Experiencing muscle aches, sweating, nausea, diarrhea, anxiety, or insomnia within hours of the last dose.
  • Preoccupation. Spending significant time thinking about, obtaining, or recovering from heroin use.
  • Loss of control. Using more than intended, or being unable to stop despite repeated attempts.
  • Track marks or injection-related health issues (for intravenous users), including abscesses, collapsed veins, and elevated risk of hepatitis C and HIV.
  • Continued use despite consequences. Maintaining use even when it damages health, relationships, work, or finances.
  • Isolation. Withdrawing from family, friends, or activities that used to matter.

If several of these apply to you or someone you care about, a professional evaluation can help clarify what is happening and what options exist.

Heroin Withdrawal: Timeline and Symptoms

Heroin withdrawal is medically uncomfortable but not typically life-threatening in otherwise healthy adults. It is, however, severe enough that many people relapse to stop the symptoms. This is one of the main reasons medication-assisted treatment is so important — it prevents withdrawal rather than forcing patients to endure it.

A general timeline for heroin withdrawal looks like this:

  • First 6 to 12 hours. Onset of early symptoms: anxiety, restlessness, muscle aches, yawning, watery eyes, and runny nose.
  • Day 1 to day 3. Peak physical symptoms: nausea, vomiting, diarrhea, abdominal cramping, sweating, chills, dilated pupils, insomnia, and intense cravings.
  • Day 3 to day 7. Acute symptoms gradually subside. Sleep remains disrupted. Cravings are still strong.
  • Week 2 and beyond. Post-acute symptoms may continue: low energy, difficulty concentrating, mood changes, and intermittent cravings. These can last weeks to months if unmanaged.

If the heroin supply has been contaminated with fentanyl — as most of it now is — the withdrawal timeline can be longer and the window before buprenorphine can be safely started may shift. Your provider will assess your specific situation to determine the right timing and avoid precipitated withdrawal.

How We Treat Heroin Addiction

At Restoration Recovery, heroin use disorder is treated with a combination of medication and psychosocial support. The medication options available are:

  • Suboxone (daily film or tablet). A combination of buprenorphine and naloxone taken sublingually — available as a dissolving film or tablet placed under the tongue. Buprenorphine reduces cravings and prevents withdrawal by partially activating opioid receptors without producing euphoria. Naloxone is included to discourage misuse.
  • Sublocade (monthly injection). A long-acting form of buprenorphine administered once per month at our clinics. Many patients prefer Sublocade because it removes the daily decision-making around taking medication and provides steady blood levels throughout the month.
  • Brixadi (weekly, bi-weekly, or monthly injection). Another extended-release buprenorphine injection, with flexible dosing intervals. Patients who prefer a longer or shorter schedule than Sublocade’s monthly cadence — or who are still finding the right maintenance dose — often start with Brixadi’s weekly or bi-weekly options before transitioning to monthly if that fits their treatment plan.

Medication is paired with:

  • Individual counseling with licensed therapists experienced in substance use disorder.
  • Certified peer support from specialists who have lived experience with recovery themselves.
  • Intensive outpatient programming (IOP) for patients who benefit from a more structured treatment schedule — delivered in a group format by design.
  • Integrated care for co-occurring conditions, including anxiety, depression, trauma, and hepatitis C.

Restoration Recovery is an outpatient clinic. We do not provide medical detox or residential care. For most patients with heroin use disorder, a formal detox is not required — medication-assisted treatment can begin at the appropriate point after last use, under clinical supervision. For patients who need a higher level of care before starting outpatient MAT, we coordinate with regional referral partners.

What to Expect at Your First Appointment

Your first visit typically lasts 60 to 120 minutes and follows a four-step clinical flow:

  1. Intake. You’ll complete paperwork and a clinical intake. For opioid use disorder, this includes a DSM-5 assessment to confirm the diagnosis and its severity, and a COWS (Clinical Opiate Withdrawal Scale) score to measure your current withdrawal state. The COWS score guides whether you’re clinically ready to begin buprenorphine the same day without risking precipitated withdrawal.
  2. Counseling. You’ll meet with a counselor to discuss your substance use history, any previous treatment, and your personal recovery goals.
  3. Doctor evaluation. A medical provider reviews your intake, COWS score, and counselor notes. They walk you through medication options (Suboxone, Sublocade, Brixadi), explain side effects and timing, and answer your questions.
  4. Prescription (and injection ordering, if chosen). If clinically appropriate, you leave the same day with a Suboxone prescription. If you prefer the extended-release route, your provider will order Sublocade or Brixadi during this visit — we don’t stock injections on-site — and you’ll continue on Suboxone as a bridge. Your injection appointment is scheduled for a follow-up once the medication arrives, typically after a short stabilization period on Suboxone (Sublocade’s FDA label requires at least 7 days of transmucosal buprenorphine before the first injection).

Bring a valid photo ID, your insurance card if applicable, and a list of any medications you currently take. If you’d like to see the full process walked through step by step before your visit, our guide on what to expect at your first Suboxone appointment covers it in more detail.

Why Medication-Assisted Treatment Works for Heroin

For many patients, the fear of withdrawal is what keeps them stuck. MAT removes that barrier — the medication prevents withdrawal rather than forcing patients to endure it — which is why it works when willpower alone doesn’t.

Medication-assisted treatment (MAT) is endorsed as the standard of care for opioid use disorder by the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM), and the World Health Organization.

Large-scale evidence shows that patients with opioid use disorder who receive buprenorphine-based MAT:

  • Experience more than a 50 percent reduction in the risk of fatal opioid overdose
  • Stay in treatment significantly longer than those receiving counseling alone
  • Report fewer cravings and lower rates of illicit opioid use
  • Are more likely to maintain employment and stable housing during recovery
  • Have lower rates of infectious disease transmission associated with injection use

For heroin in particular, the fentanyl-contaminated supply has made relapse overdoses far more common and more lethal. MAT dramatically reduces both cravings and overdose risk, giving patients a realistic path to stability. MAT is not a replacement of one drug with another; it is evidence-based medical care for a medical condition. Medication stabilizes brain chemistry enough that patients can engage in counseling, rebuild relationships, and return to work without the daily cycle of cravings and withdrawal.

Why Restoration Recovery

Choosing where to start treatment matters. Restoration Recovery brings together the clinical depth, the practical access, and the kind of care that keeps patients in treatment long enough to get well.

  • Chattanooga’s longest-running outpatient addiction treatment clinic. Our providers have decades of clinical experience treating opioid and substance use disorders in Southeast Tennessee.
  • CARF accredited. The Commission on Accreditation of Rehabilitation Facilities is the gold standard for outpatient addiction care — our accreditation is reviewed on an ongoing basis, not a one-time stamp.
  • Four clinic locations across Southeast Tennessee and North Georgia, with telehealth follow-up available for established patients.
  • Most major insurance accepted — TennCare, Georgia Medicaid, commercial plans, Medicare, and supplemental Medicare. Our patient services team verifies your benefits before your first visit so there are no surprises.
  • Same-day Suboxone appointments in most cases. You don’t have to wait weeks to start.
  • One integrated team. Medical providers, counselors, certified peer support specialists, and psychiatric care under one roof — not parallel referral tracks that leave you coordinating your own care.
  • Licensed in both states. Licensed in Tennessee and Georgia, HIPAA compliant, 42 CFR Part 2 compliant — your treatment is confidential from the first phone call.

Insurance and Access

Restoration Recovery accepts most major insurance plans, including TennCare, Georgia Medicaid, a broad range of commercial plans, and Medicare (plus supplemental Medicare plans). Our patient services team can verify your benefits before your first appointment so you know exactly what to expect in terms of cost.

If you do not have insurance, contact us anyway. We can help you explore options and will walk you through self-pay pricing. For a full list of accepted carriers and details on the verification process, visit our insurance page.

Four Clinic Locations

We operate four outpatient clinics across Southeast Tennessee and North Georgia. All locations offer heroin addiction treatment with same-day appointments in most cases:

  • Chattanooga, TN — 6141 Shallowford Rd, Suite 100, Chattanooga, TN 37421
  • Cleveland, TN — Serving Bradley County and surrounding areas
  • Soddy-Daisy, TN — Serving Hamilton County north and the Sequatchie Valley
  • Ringgold, GA — Serving Catoosa County and Northwest Georgia

Telehealth follow-up visits are available for established patients who have completed their initial in-person evaluation. For directions, hours, and contact information, visit our locations page.

Take the Next Step

Heroin addiction is survivable, and treatment works. You don’t have to figure this out alone — and you don’t need to have all the answers before you call. You don’t need to be clean before your first appointment. Our team will walk you through the process from your first phone call to your first visit and every follow-up after that.

Same-day appointments are available in most cases. Contact us today to schedule your evaluation, or call 423-498-2000 to speak with our team directly.