Here’s the thing about opiates… most people can’t stop taking the drug because of withdrawal symptoms. Imagine this scenario. You come down with a really bad case of the flu, some new wave Asian strain. Writhing in pain with fever and stomach issues, someone tells you it can all end if you take a pill or receive a shot.
What would you say? No? In that circumstance, any logical person would jump at the chance to be rid of nightmarish symptoms. The same rule applies to an opiate or heroin addict.
During acute withdrawal, an opiate or heroin addict feels like the flu on steroids. Body aches, restless legs, chills, sweats, insomnia, vomiting and diarrhea, all neatly packaged together for days on end. Time seems to slow to a standstill. And if you’re in the thick of it, the sickness feels like it will never end.
That’s why virtually every at-home opiate detox and heroin detox fails. All the addict has to do is make one phone call, viola, the discomfort disappears. For a time. It is important to remember that in the midst of acute opiate withdrawal, most abusers will do just about anything to get another fix.
Remember, too, that substance abusers become accustomed to feeling no pain. So when the opiate detox begins, they’re ill-suited to endure the torment. They have no tolerance for suffering. Heck, some movies depict bad guys torturing people by hooking them on heroin and abruptly cutting off supply, thus initiating withdrawal.
Now I’m not trying to scare those about to enter this difficult phase of recovery. But I think it’s important to know what we’re up against. The good news: opiate detox is not life-threatening. The bad news: in the absence of a controlled environment (hospital, treatment center, etc), most addicts don’t succeed.
1. Hospital/Detox Facility/Treatment Center
This is the method I suggest, though I am not a medical professional. It has resulted in almost 2 years of continuous sobriety. An inpatient medical opiate detox, however, should be complemented by a residential recovery program or treatment center. Completion of an opiate detox in a hospital is a good start, but it’s unlikely to produce sustained sobriety without a vigorous program of recovery.
All of these facilities, couple with a strong willingness in the heart of individual, have the potential to bring about a lifetime of quality sobriety. For that reason, I believe it is the best approach.
Pros: This approach provides a controlled setting and medication to ease opiate withdrawal symptoms. Professionals are able to monitor vital signs to ensure no complications occur, though opiate withdrawals are not life-threatening. Opiate detox in a treatment center ensures the best chance for success since the individual receives both detoxification and treatment.
Cons: The only drawback here is cost. Medical services can be very expensive, especially without health insurance. Treatment centers are no exception either, but there are affordable facilities with quality programs.
Patients taking maintenance medications like buprenorphine must refrain from using alcohol or benzodiazepines to prevent the potential for overdose.
2. At-Home Opiate Detox/Cold Turkey
I knew a lot of active opiate addicts who made repeated attempts at home to stop opiate abuse. Their methods, including those of my own design, usually consist of some other drug to deal with withdrawal. I tried benzodiazepines (Xanax), weaker opiates (Lortab) and marijuana to stop using heroin and stronger opiates like oxycodone.
All my efforts failed. I heard of people who got through the opiate detoxification process using these methods, but even these stories ended in the addict, at some time or another, returning to opiate or heroin abuse.
As I stated earlier, when the withdrawals begin, it’s too easy to make a phone call. That’s why virtually all at-home opiate detox attempts fall short. The ones that do succeed rarely result in sustained sobriety. But for some people, especially those without health insurance, it’s the only viable alternative.
Pros: The at-home or cold-turkey method costs substantially less than an inpatient facility or treatment center. With a cold-turkey approach, withdrawals will be more acute but shorter in duration. You will feel better quicker as opposed to medication-assisted detoxification.
Cons: There is virtually no success for the at-home approach, though the cold-turkey method can be successful in a controlled environment (hospital or treatment center). The at-home method can also be problematic if the opiate addict introduces additional substances, like benzodiazepines, to ease withdrawal.
3. Medication Maintenance
Suboxone
Without question, Suboxone is the most popular opiate maintenance medication today. Also known as buprenorphine, it contains a substance called naloxone that prevents patients from using the drug intravenously.
In the sober community, Suboxone opinions vary. Many feel those who take this medication are not genuinely sober, while others maintain that, if taken as directed, buprenorphine can complement a program of recovery. This belief, however, definitely represents the minority opinion.
I used Suboxone during my detoxification period and found it marginally effective. It did provide periods of comfort, but in the end, I felt my withdrawal period was protracted as a result of taking buprenorphine. But I do feel it is a valuable detox medication for opiate and heroin addicts.
Suboxone carries all the side effects of traditional opiate-based narcotics. Caution is necessary when administering the first dose, as buprenorphine can initiate extremely acute withdrawals if taken within 24 hours of opiate-based narcotics.
Methadone
Research shows conflicting evidence in the buprenorphine versus methadone question. In Medications Used in Opioid Maintenance Treatment, Dr. Christie Choo notes that, “It is well established that both methadone and buprenorphine are effective for decreasing illicit drug use… Overall, it is accepted that buprenorphine and methadone have comparable efficacy and that treatment should be individualized.”
Methadone has two primary drawbacks. First, it is very difficult to stop taking methadone. It has an incredibly long withdrawal period (14-21 days). Second, doctor visits on a daily or weekly basis are required to maintain a methadone regimen.
As with buprenorphine, methadone carries all of the side effects of traditional opiate-based narcotics.
Zubsolv
The new kid on the block, Zubsolv offers a menthol flavor (Suboxone has an orange flavor), faster dissolve time and better bioavailability. It’s essentially the same buprenorphine with a different recipe. According to the manufacturer, Zubsolv has a better taste, dissolves quicker and is absorbed by the body better than the traditional Suboxone formulation. As a result of better bioavailability, Zubsolv comes in a lower dosage with the same effectiveness.
It has not been determined whether Zubsolv will overtake Suboxone as the medication of choice for those using prescription maintenance programs for opiate addiction.
Pros: Studies clearly demonstrate the efficacy of maintenance medications in preventing illegal drug use, and some people who previously suffered from active opiate addiction claim prescriptions like Suboxone “saved their life.”
Buprenorphine can be extremely beneficial in the facilitation of a more comfortable opiate detoxification process, even from maintenance medications like methadone. And depending on which particular study you believe (as the numbers vary), maintenance medication enjoys a stronger success rate than a cold-turkey sobriety program. Many medical professionals, however, suggest a whole-hearted attempt at cold-turkey sobriety prior to consideration of maintenance medication.
Cons: Maintenance medications like Suboxone are not cheap. Most people will need health insurance to afford it, and even then, the prescription cost can be expensive. The medications bring all the side effects of opiate-based drugs. They are just as difficult (in some cases more difficult) than traditional opiate-based narcotics to stop using.
Methadone and Suboxone also have a high risk of dependency. I have personally seen men enter treatment programs specifically to stop taking maintenance medication. In many cases, the detoxification process is more severe than your run-of-the-mill opiates.
- For those with no financial resources whatsoever, the SAMHSA website is a good outlet for state-funded facilities. They can also be reached at 877-SAMHSA-7 (877-726-4727).
- For those with access to some financial resources, Discovery Place offers excellent residential recovery programs for opiate addiction. We also have a strong network of qualified medical professional to assist in the detoxification process. You can call us 24 hours a day, 7 days a week on our confidential admissions line 800.725.0922
- For those attempting an at-home detox, it is advisable to inform at least one trusted individual of your plans. Morbid thoughts are fairly common during acute opiate withdrawals, so it is best to have someone check up on you during active withdrawals.
- For those who are entering the post-opiate detoxification phase of recovery, I strongly recommend educating yourself on post-acute withdrawal syndrome.
