by Keri Blakinger
John Lennon described it as “rolling in pain” – and he wasn’t wrong. No matter how you cut it, detoxing from heroin – which Lennon describes in his 1969 song “Cold Turkey” – is no walk in the park.
In the nine years I used drugs, I went on and off heroin repeatedly and ended up trying all of the most common detox methods: cold turkey, suboxone, and methadone. None of them are easy, but they each have their pros and cons. Here’s a quick overview:
Physically, cold turkey is unquestionably the most grueling detox option. The symptoms vary, but can include everything from fever to vomiting to diarrhea to insomnia to restless leg syndrome and much more.
Krista Cherry is a drug user who’s been addicted to a variety of opiates but said that right now heroin is her drug of choice. She’s detoxed six times and said that, for her, that entails “excruciating body aches” where “even the slightest touch from someone hurts so bad.” She can’t sleep and gets hot and cold sweats.
“Detoxing cold turkey always leaves me writhing in pain, hysterical, crying on the bed,” she said.
How long those symptoms last varies a lot from one person to the next. For some heroin users it’s three days and for some it’s more like eight or nine. For other opiates, the withdrawal period is as long or sometimes considerably longer.
The FDA approved suboxone as a treatment for opiate addiction back in 2002. At first, it came in the form of orange octagonal pills, but now it’s primarily available in water-soluble strips.
Suboxone – colloquially known as “subs” or “strips” – is made up of two drugs. One is buprenorphine, a semisynthetic opioid that mitigates withdrawal. The other is naloxone, an opioid antagonist that prevents users from getting high.
When I finally got sober in 2010, I was given suboxone in the county jail. I used it short-term, just to detox. Being on suboxone meant that instead of spending the first few days off heroin in a constant state of wanting to find more heroin to ease the pain, I was able to spend that time thinking about changes I needed to make in my life. Because of the suboxone, I started off the crucial early days of sobriety in a clearer, slightly less horrible place mentally. For me, that made a huge difference in the end – I haven’t gone back to drugs since then.
Of course, suboxone isn’t the answer for everyone and some people see a lot of drawbacks to it. For instance, sometimes finding it legally can be challenging. There are a limited number of doctors who prescribe suboxone – 3% by one estimate – and federal regulations prevent them from prescribing it to more than 100 patients at any given time.
Also, if it’s taken as a long-term opioid replacement therapy – as opposed to short-term use for detox – then users become addicted to suboxone. As Cherry said, “It’s just replacing heroin. Substituting one drug for another.”
That’s an argument that some treatment centers subscribe to, as detailed in a 2014 piece by Huffington Post.
However, there are also some significant benefits to long-term suboxone use. For one, you can’t really get high on suboxone. (I know, I’ve tried.) Also, being on suboxone eliminates the highs and lows of heroin use, meaning that suboxone patients can maintain normal lives in a way that many heroin users can’t.
For two, some believe that suboxone saves lives. The fact that suboxone makes it nearly impossible to get high and the fact that it helps with cravings can make a huge difference when it comes to relapse. People who relapse after a period of sobriety – like in rehab or jail – are prone to overdose because their tolerance has gone down and the same amount that once got them well could now kill them.
Speaking of opioid replacement therapies like suboxone and methadone, Dr. Bankole Johnson told Huffington Post, “It’s just a fact that this is the best way to wean people off an opioid addiction. It’s the standard of care.”
Methadone was invented by the Germans before World War II when morphine shortages made it difficult to find enough painkillers for the troops.
After the war, doctors realized that it could be used for heroin detox and since the 1960’s, it has been available for maintenance treatment offered at specialized clinics. That’s one key difference between suboxone and methadone: While patients can get monthly suboxone prescriptions, for methadone they have to travel to clinic every day to get their medication.
Like suboxone, methadone can also be used for short-term detox, but most people commonly associate it with maintenance therapy. As with suboxone, the long-term use of methadone as an opiate replacement therapy means that the patient develops a methadone habit instead. Unlike with suboxone, it’s still possible to get high on heroin while taking methadone.
In fact, with enough of the drug, it’s possible to get high on methadone. Suboxone, on the other hand, only works well for getting high with people who no longer have an opiate habit. (As a result, suboxone is a popular smuggling item in jails, where users have typically kicked their habits.)
Mike, who’s been on methadone for seven years and asked to be identified by only his first name, said that the drug has helped him immensely. “Since I am on a therapeutic dose, it doesn’t make me feel ‘high,’ however it fills my opiate receptors enough to fool my body into thinking that it’s high on an opiate drug,” he said.
“It may be a controversial treatment to some, but to me and many other patients it’s a life saver. As far as alternative treatments, the only other one that I am aware of would be suboxone, which I have tried in the past, and like many other people, had no success with.”