How To Get Off Opiates

How do you get off opiates, survive withdrawal, and stay off of opiates for good? Easier said than done. Opiates are notoriously hard to discontinue, but not impossible.

Millions of opiate users have recovered from addiction, and so can you. It's important to remember that recovering from opioid dependence is an ongoing struggle that doesn't end immediately after detoxification. It's a marathon, not a race.

The decision to stop using opiates may be the most important positive decision you make in your life. This is a little simplistic, however, because it's a decision you'll need to make over and over again every single day, that gets easier with time.

I want to share with you the two most important "lessons" I've learned from the cycle of use, abuse, dependence, detoxification, withdrawal, craving and drug use reinstatement.

1 Recovery from addiction is not all-or-nothing

You might've stopped using for a week or for years and slip up. Maybe you ran into an old friend who you shared a habit with, and it triggered you. So now that you've slipped up, you might be tempted to think: it's all over. I fell off the bandwagon and I've ruined my life yet again, I may as well just keep using. If you've been heading in the right direction, away from substance use, and you slip up, you haven't abolished all of your progress in one day. If the fraction of days that you're high verses sober is increasing, you're making progress.

2 You need a community that's struggling with the same thing

I was in medical school once. Could you imagine teaching yourself everything a physician knows, without attending medical school? It's theoretically possible, but insanely difficult. It's so much easier to be submerged in a community of other medical students that share the same goal. As a medical student, you're paying $55,000 per year just for the community of medical students! No one is learning in lecture by osmosis, just from listening to the lecturer. They're going home and hammering the information into their brain, day after day, outside of lecture. Medical students are self-taught. For the same reasons, you need narcotics anonymous (NA). If you were a medical student, you wouldn't skip class for a week. For the same reason, it's necessary to just show up to NA every day.

To get off opiates, you'll need to leverage all of the resources at your disposal. It's important to acknowledge that opioid dependence is an very complex disorder that often requires long-term treatment, care and support. Simple detoxification from opioids is often not enough to maintain abstinence.

  • Talk to a doctor about your intention. For the most part, doctors are nonjudgemental, safe to confide in, and will  respect the doctor-patient relationship.

  • This is an important step, because a physician can prescribe methodone or clonidine plus naloxone which will make it much easier to stop using opiates.

  • Physically remove yourself from any friends or family members who also use opiates. It's about twice as hard to stop using if everyone in your immediate vicinity is.

  • Some people may be reluctant to alienate themselves from their friends, but it's not worth spending the next decade an opiate addict to maintain these relationships.

  • Discontinue using opiates with the right mindset and in the right environment

  • Make sure you don't have any obligations during opiate withdrawal

  • Resist the temptation to use other substances to reduce opiate withdrawal (unless prescribed by a physician)

  • Make it extremely difficult for you to obtain opiates (E.g., give your phone to friend, stay with a family member)

  • Relapse is extremely common; detoxification from opiates alone does not constitute adequate treatment. What's required is a long-term dedication to sobriety.

  • Join Narcotics Anonymous

  • It's an inviting community. If you're reluctant to go, just tell yourself all you need to do is just show up.

  • Among minorities with a longstanding, severe history of crack cocaine and heroin use, over 50% of the individuals with uninterrupted 12-step attendance had over 3 years of sustained abstinence, in contrast to just 13.5% among those with less than continuous attendance.

Medications Used For Opioid Detoxification

Methadone

Methadone is a form of opioid replacement therapy that reduces the use of illic opiates. Methadone relieves narcotic cavings while also diminishing the euphoria associated with opiate use. Some individuals will need methadone maintenance therapy long-term, whereas others will use it to discontinue illicit opiates and gradually reduce methadone until becoming substance-free.

Buprenorphine

Buprenorphine is similar to methadone, but is associated with fewer adverse events and a lower risk of overdose related deaths. The suboxone and Subutex formulations were FDA-approved in October, 2002.

Naltrexone

Naltrexone is an older medication, approved for the treatment of opioid dependence by the FDA in 1984. Naltrexone is regarded as less effective than Buprenorphine or Methadone, due to a high non-compliance rate. Naltrexone blocks the euphoric effects of illicit opioids but is not an opioid substitute in the same way that buprenorphine/methadone are, and therefore has limited usefulness.