Why is it so hard to quit taking heroin?
Many people do not understand the typical heroin user. Heroin use does not only happen under bridges and in back alleys. Heroin is a street drug, but that does not mean that heroin users are people who live on the streets.
A heroin user might be a business man or woman getting ready to go to work. They might even be a successful entrepreneur, building a highly successful startup.
Substance abuse is not always obvious. Look around at the people you encounter during a typical weekday.
There is no way to be certain if they are using heroin or not. Many users are able to effectively hide their drug abuse.
Heroin, usually combined with the synthetic opioid, fentanyl, is sold on street corners and in front of gas stations and convenience stores by shady characters who disappear at any sign of police in the area. However, it is also shipped direct by US mail. Heroin is even delivered by Lyft and Uber drivers.
You might be surprised how pervasive this drug is in our society. Next time you see a mail truck drive by, think about the possibility that there could be heroin in one of the packages out for delivery.
Does heroin cause addiction?
Heroin, a potent opioid drug, is considered to be highly addictive. In fact, the US government classifies it as a schedule I drug, meaning that it has no accepted medical use. Yet, medical cannabis is also a schedule I drug and, as of this writing, 36 states consider it to be medically useful.
Morphine and heroin are chemically related opioid drugs. Morphine is legal and it is used frequently in the medical field. Heroin is illegal and only sold on the streets.
While heroin, along with other opioids, is considered to be highly addictive, the fact is that not everyone who tries heroin becomes addicted. Heroin itself cannot turn just anyone into a heroin addict.
There are people who have a predisposition to becoming addicted to heroin. There is a genetic component as well as environmental factors, such as childhood emotional or physical abuse.
Heroin is an analgesic, meaning it covers up pain. The pain covered up by heroin can be physical or emotional. Some people who are in pain and try heroin enjoy the feeling of euphoria and temporary freedom from pain. This can lead to a malignant habit that is called addiction.
What does it feel like to be addicted to heroin?
How long can you hold your breath? 30 seconds? 45 seconds? A minute? If you hold your breath as long as possible, what do you start to think about?
Your only thought after a short time is when are you going to take your next breath. The same goes for food, water, and any other necessity of life. When something important is missing, it’s all you can think about.
When a person becomes addicted to heroin, their brain changes. The brain is adaptable and can adjust to learn at a deep level what is vitally important for survival. Heroin hijacks the reward system of the brain that is intended to help us learn to survive in our environment.
When a person is addicted to heroin, the entire focus of all of their thoughts are on how to get more heroin. It becomes an all encompassing, consuming obsession. Scoring more heroin feels like coming up for a breath after diving to the bottom of a deep pool.
As you can imagine, heroin addiction is not a pleasant experience. While heroin itself provides a euphoric experience, the life of a person addicted to heroin quickly becomes a nightmare.
Leaving the house to go to work without any more heroin supply can feel like jumping out of an airplane without a parachute. You have to figure out how to get a parachute from someone else on the way down before you hit the ground.
What happens when you can’t get more heroin?
If you use heroin, you very likely already know the answer to this question. The first time you tried heroin, you probably experienced the most powerful high of your life, which can rarely ever be repeated.
After using heroin the first time, you will still be able to get high from using it. Yet, most heroin users describe the experience going forward as always chasing after that first high.
After a while, most heroin users say that the high goes away. The only reason they continue to use heroin is to not get sick and to feel “normal.”
What does it mean to get sick if you stop using heroin suddenly? One of the features of opioid dependence is the issue of physical dependence and severe withdrawal symptoms. When a person stops taking heroin, not only do they have to deal with the psychological addiction, they also face severe physical symptoms as well.
The symptoms of physical opioid withdrawal start out with acute withdrawal symptoms, such as runny nose, watery eyes, and sneezing. As it progresses over the heroin withdrawal timeline, there are chills, aches, cold sweats. Further in, there are severe muscle cramps and muscle twitching, including restless leg syndrome. Upset stomach, nausea, vomiting, and diarrhea are also common.
What are the worst heroin withdrawal symptoms?
Many opioid users describe the restless leg syndrome symptoms, such as uncontrollable leg movements and kicking at night while they try to sleep as being the worst of their symptoms. As the opioid withdrawal symptoms reach their peak by about the third day, intense cravings, set in.
There is the overwhelming obsession with getting more heroin or another opioid to relieve the withdrawal syndrome. Just one more time will make it all go away for a while longer. This is what makes heroin abuse so difficult to quit.
These physical withdrawal symptoms occur over a backdrop of depression, anxiety, insomnia, and other psychological symptoms. Imagine how difficult it must be to quit heroin cold turkey. If heroin or other opioids are available, most people would give in at some point and take more opioids to stop the suffering of withdrawal.
Yet, often the reason for stopping heroin use is due to a lack of availability. You might be out of money and have no way to get money for more heroin. Or, maybe your dealer ran out or was arrested. When the supply runs out, you really start to ask yourself, “how long to detox from heroin?”
Are there people who are opioid-dependent who have never experienced opioid withdrawal?
I have met people who are heavy opioid users, yet they have never, yet, experienced opioid withdrawal or any part of the detox process. These rare individuals had the resources and access to continually feed their opioid addiction or opioid physical dependence.
So, it’s not that they would not have opiate withdrawal symptoms if they stopped opiate use, they have just not had to stop yet. I have met successful business owners who have reliable heroin dealers who show up at their door at a moment’s notice. A quick text message in the night to the dealer is followed by a discrete knock at the door just a few minutes later.
I have also known people who are independently wealthy and have mastered the art of accessing the dark web without leaving a trace of their identity. Orders placed with cryptocurrency are followed up by a plain package, filled with opioid pills or powders, showing up at the door, faithfully delivered by the United States Postal Service.
Other than the wealthy patron with a reliable opioid supplier, there are also chronic pain management patients who are prescribed opioids for pain by their doctors. Prescription opioids, such as morphine, hydrocodone, hydromorphone, and oxycodone are very similar to heroin, but they are approved by the FDA to be prescribed by doctors to treat pain.
While these patients are not necessarily addicted to opioids, they still develop the physical dependence over time. If they are unable to obtain their prescription, in addition to being in pain, they will go through the same physical opioid withdrawal syndrome as someone addicted to heroin would.
Are prescription pain pills always addicting?
The fact is that most patients who are prescribed opioids for chronic pain are not addicted to their medication. Only a small percentage of pain patients develop an opioid addiction. Because of media focus on the opioid addiction crisis and government response to attempt to address the problem, many patients in pain who are not addicted have lost access to effective medical treatment. Of course, shutting down doctors and pharmaceutical companies is easier and more satisfying to lawmakers and the media than providing addiction treatment.
Another issue that comes up in addiction recovery groups, such as Narcotics Anonymous (NA), is addressing medical treatment that involves drugs such as opioids. NA has rightly opted to not get involved in the medical care of its members for nearly all health conditions.
Yet, strangely, NA has decided to take a stand and get very involved in medical treatment when it comes to medication assisted treatment of opioid addiction. NA has an official stand on drugs such as buprenorphine/naloxone (Suboxone) and methadone.
If these life-saving drugs are prescribed to treat opioid use disorder, a real mental illness and health condition, they are frowned upon by NA. However, this official stigma does not apply if the same drugs are prescribed for off-label uses, including the treatment of chronic pain.
This confusing policy of the Narcotics Anonymous World Service organization has led to some interesting situations in NA groups. There are members who take buprenorphine or methadone for opiate addiction who are not considered to have any clean time, and other members who take the exact same prescribed drugs for chronic pain who may have decades of clean time.
In both situations, the person in question is taking a medication prescribed by a doctor for a legitimate medical use. Yet, NA has decided to take a stand on which of these people get to say they are clean depending on their diagnosis.
Imagine an NA newcomer on Suboxone being told by an old timer on methadone that because they take Suboxone, they cannot claim clean time. Meanwhile, that same old timer can celebrate years of clean time in recovery, simply because the drug is prescribed for a different medical diagnosis.
Something feels unfair about an addiction recovery program where a person on high levels of opioids who may have never experienced opioid withdrawal can talk down to a newcomer on Suboxone or Methadone. The “rules” start to seem very arbitrary and not conducive to harm reduction and healing.
The difficult detox from opioids is the same, no matter what the reason the opioids are taken for. Whether an opioid is prescribed for pain or addiction, or bought from a dealer on the streets, the withdrawal symptoms are the same.
It is critical that leaders in the field of addiction treatment and recovery get on the same page with evidence-based, medical treatment that has been proven to work for decades. Detox from heroin can be long, difficult, and dangerous because of the risk of relapse and overdose. But, it doesn’t have to be.
How long does it take to get off heroin with medication-assisted treatment?
This is the real question we should be talking about. Quitting opioids cold-turkey has a high risk of relapse and it is a long and difficult process with a low success rate. With medication-assisted treatment (MAT), the success rates are far better and the withdrawal period is very short.
For example, in most cases, a patient can start Suboxone, Subutex, ZubSolv, or a similar buprenorphine-based medication within about 24-hours after quitting heroin. While there is a period of some hours of withdrawal discomfort, it is far easier than days or weeks of opioid withdrawal.
With methadone, treatment can be started right away. On the same day that the patient quits heroin, they can start taking methadone. Of course, the downside of methadone is that you have to go to the clinic every morning to get your dose. With Suboxone, on the other hand, you can go monthly after your doctor stabilizes your treatment.
Is MAT just a way of postponing the inevitable?
Some people worry that they are just putting off their opioid withdrawal for a later date. As they shoot up or snort heroin, they think to themselves that it would be better to suffer through heroin withdrawal now rather than deal with Suboxone withdrawal in a year or two.
It is true that Suboxone, ZubSolv, and similar meds also have an opioid withdrawal syndrome after stopping the medication. The process of completing treatment is referred to as “tapering.” When a patient is tapered, they take a lower dosage over time as prescribed by their doctor.
At some point, there is a “drop off,” when the patient takes the final dose, and they are done. Afterwards, there will likely be withdrawal symptoms. These symptoms are physical withdrawal and are most often not accompanied by opioid cravings.
So, taking Suboxone as MAT for heroin addiction is not simply postponing the inevitable withdrawal sickness. It gives the patient, their body and brain, a chance to heal. Addiction is not eliminated, but it goes into remission.
The healing process is slow and takes place over a period of a year or two, sometimes longer for some patients. Suboxone healing does take place while the patient is taking their medication on a daily basis during that time.
Meanwhile, if you take Suboxone for opioid addiction, you will likely be able to function optimally during your treatment. Many Suboxone patients report that, while they take Suboxone, they feel as if they had never been addicted to opioids.
They are able to function at work and at home without brain fog, sickness, thoughts of drugs, drug obsessions or compulsions. In fact, I have seen patients on Suboxone accomplish great things in their lives during their treatment. Is Suboxone MAT just trading one drug for another, or trading one addiction for another?
The Narcotics Anonymous literature would like for us to see it this way. They refer to MAT medications as “replacement drugs.” While the NA program does provide a great service, and there are many incredible people in local groups, the language used in the world service literature might be seen as offensive by the many people receiving successful medication-assisted treatment.
We must be clear on this point. Medication-assisted treatment for opioid use disorder, using buprenorphine-based medications, such as Suboxone, Subutex, ZubSolv, Bunavail, Sublocade, or Brixadi is not at all trading one drug for another or trading one addiction for another.
These are not “replacement drugs.” They are an important component of a proven, evidence-based, effective form of addiction treatment.
How long heroin detox take, getting started with MAT to bypass the long withdrawal syndrome?
While it may depend on availability of treatment in your area, you may be able to get started right away. Many regions of the US have same-day outpatient treatment available.
You can either make a same-day appointment for heroin addiction treatment, or some clinics also accept walk-ins. Your options for MAT range from heroin rehab to outpatient detox programs to concierge clinics.
If you are postponing your Suboxone appointment for opiate detox because you know that you have to be in moderate withdrawal to start the medication, don’t let that hold you back from going to see the doctor. Most doctors are happy to see you to start with the evaluation, even if you are not in withdrawal yet.
In fact, many Suboxone doctors are willing to do at-home induction to initiate opioid detox with buprenorphine. This means that you will take your first Suboxone dosage at home rather than in the clinic. As reported in past episodes of our heroin addiction podcast, MAT has evolved and improved significantly over the past two decades.
This is often possible with concierge Suboxone doctors who are willing and able to be available by voice or video call at a moments notice. Your doctor can be on video with you as you take your first Suboxone, or the doctor can be available immediately if needed.
Most importantly, you should not postpone getting started with medication-assisted treatment if you are misusing opioids, such as heroin. Now is the time to get started with a medical detox program, so you can feel better, get back to normal functioning with improved mental health and work towards overcoming your opioid dependence.