Surviving Heroin and Other Dangerous Drugs: Notes from a Former User

Introduction

Nearly sixty years ago, William S. Burroughs penned a “Letter from a Master Addict to Dangerous Drugs” for the British Journal of Addiction, which has since been included as an appendix to his magnum opus Naked Lunch. While I found some of the notes still relevant and useful while in the throes of my own addiction, quite a lot has changed about drugs and drug culture since the 1950’s. While the means of procuring and ingesting drugs remain mostly unchanged, we know quite a bit more about why people become physically and psychologically addicted to certain drugs and there are dozens of new methods and medications directed at helping people to stop using drugs, or at least make it safer for them if they’re going to do it anyway.

With that in mind, and in the spirit of harm reduction, having gathered a wealth of information about modern drugs and methods to stop using them over a course of many years, I present my own collection of notes on using and quitting certain drugs, especially heroin and other opiates. This is not intended to be a comprehensive list and what worked for me might not work for others. Notes on the safety of certain methods are indicated, but everyone is different and some of these methods may prove harmful for some people. Regardless, this sort of comprehensive information difficult to find, especially all in one place. When it is available it often contains inaccuracies or perpetuates social myths around drugs and drug users. It is my hope that with this sort of information modern drug users might avoid some of the mistakes and pitfalls that ensnared my friends and I during our countless efforts at survival and recovery. At the very least I hope it might help some habitual drug users survive until they’re able to finally make the break and pursue a life that doesn’t place them at the mercy of dangerous drugs. Lacking that, perhaps something in here will make using safer for those who aren’t ready or don’t want to stop.

Table of Contents:

Heroin and Opiates in General
Since my first taste, heroin has been my drug of choice. It completely satisfied the purposes for which I chose to consume it. Contrary to popular (and not entirely accurate) stereotypes, heroin was the first illegal drug I ingested. I began sniffing it, but within a few short weeks I was mainlining it nearly every day to maximize the effects. Figures suggest that less than 1 in 4 people who try heroin will ever become addicted. I don’t have any reason to doubt those numbers, but this was not the case for me. I was facing an insurmountable mountain of accumulated stress, anxiety, and mental instability built over two decades when I began using. I was hooked from the start, grateful for some relief and thinking I could stop whenever I decided. If I’d chosen any drug but heroin, perhaps that would have been the case; but I doubt anything but a potent narcotic would have filled that void that heroin seemed to fill so completely. The physical dependence, even when I sincerely desired to stop using, proved too large an obstacle to overcome.

Heroin withdrawal is extremely uncomfortable. Whoever has compared to having a bad case of the flu has obviously never had to endure the seemingly unending array of days and nights where the entire body aches and the brain cries out for any sort of relief, no matter the cost

Heroin withdrawal is extremely uncomfortable. Whoever has compared to having a bad case of the flu has obviously never had to endure the seemingly unending array of days and nights where the entire body aches and the brain cries out for any sort of relief, no matter the cost

Withdrawal from heroin (commonly called dope sickness) and other opiates is an experience so insufferably painful, mere words would fail to capture its horror. It is very likely the most awful experience most users of these drugs will ever endure. Nonetheless, it is not uncommon to find a user in one of the various stages of sickness, either self-imposed or involuntarily, during the course of their dependence. The sickness caused by withdrawal is so dreadful not due to the severity of the individual symptoms, which can often be extreme in their own right, but because of the combination of symptoms and their unending attack on the user’s mind and body. The body and muscles ache uncontrollably. The hair on the arms and head, which I’d previously imagined to be incapable of registering pain, scream out in agony. The sensation extends to the core of the bones, reaching even the teeth and fingernails. Even a soothing touch is unendurable. Neurons in the brain have short-circuited and fire rapidly in all directions. The mind races interminably, unable to settle on a single thought aside from the need for immediate relief. It is not uncommon for users find themselves unable to muster the mental and physical energy to find ways to obtain more drugs that could immediately improve their condition.

I have suffered this sickness on more occasions than I care to remember. In some instances the withdrawal was self-imposed, an ill-conceived effort to stop using of my own volition. More often it was involuntary, due to incarceration or institutionalization. Correctional facilities in the European Union and a handful of jails and prisons in New York City, Baltimore, Philadelphia and Rhode Island provide methadone treatment, a medically-accepted standard, for opioid-dependent inmates. Many jails and hospitals provide either no treatment or the least care necessary for a patient to withstand the ordeal. They sometimes refuse to provide even over-the-counter pain relief like ibuprofen or diarrhea pills, and on their own arbitrary schedule.11156126_646273108839916_6515454832644953674_n

The experience has been likened to the flu, but I fail to see any but the faintest correlation. In Trainspotting, the heroin high is likened to taking “the best orgasm you’ve ever had… multiply it by a thousand, and you’re still nowhere near it.” The reverse, unfortunately, is true for withdrawal from heroin. It is nothing at all like the flu; at least none I’ve ever experienced, or even imagined. It is, without a doubt in my mind, the sort of pain to which one must to have any sort of comprehension as to its nature — and that is a fate I would wish on no one.

In Atlanta and the surrounding area, where most of my drug using took place, the Bluff is a world-famous open drug area, and one of the few places to easily obtain heroin (and just about any other drug you can imagine). Most long-time users avoid the Bluff in favor of connections they’ve met along the way or through other people, both because the quality of drugs tends to be higher and the risk of police interference and harassment is lower. It is also generally safer, if you are going to continue using, to purchase from a consistent seller you know. This will help ensure a more (though not always) consistent quality and help reduce the likelihood of overdose.  If you use heroin and plan to continue, I’d strongly encourage stocking up on naloxone (click here to get a kit in Georgia) and always use with someone who can call for help and administer first-aid in case of an overdose. Naloxone can almost always reverse any opiate overdose if given in time. In many states it is now legal to carry and distribute (click here for a recent map of naloxone and 911 Good Samaritan laws).

The Chemistry of Opiate Dependence
Heroin and other opiates are unique among most drugs in that they cause physical as well as psychological dependence. Only a few other drugs, notably alcohol, benzodiazapenes, and barbiturates, also cause physical dependence, although not in the same manner as the opiates. One of the most common pursuits of the habitual heroin user, other than finding drugs, is trying to short circuit the brain’s chemistry to find a painless method of withdrawal from opiates. This is something I researched in great detail right after I started using, scouring the Internet for advice and even checking books on addiction and physiology. As such, I learned a great deal about why we become dependent on opiates, but I never succeeded at finding a miracle cure. Needless to say, I’m not a doctor or a chemist, but I have acquired a fairly decent understanding of how opiates work in the brain and why we become sick when we don’t have them.

The brain (and other parts of the body) contain several different types of opiate receptors. The most important for heroin users is the mu-opioid receptor, but other receptors like the kappa-opiod receptors and the delta-opioid receptors also play a role (these are all broken down further into subtypes which play varying roles). These receptors are primarily located in the brain, some are also located in the intestinal tract and the spinal cord. Our body produces chemicals called endorphins, enkephalins, dynorphins, endomorphins, and nociceptin that bind to and activate these receptors. When the receptors are activated they help relieve pain, reduce anxiety, and generally make us feel good.

Morphine and other opiates closely mimic the natural endorphins in our body and bind to the opioid receptors in much the same way. Some bind more strongly than others (binding affinity) and some can either activate (agonist), bind but not activate (antagonist), or partially activate (agonist-antagonist) the brain’s opioid receptors. This is why we feel such an intense pleasure from heroin or morphine, but only feel “not sick” or get a very slight euphoria from suboxone. Naloxone has a very strong binding affinity — so strong it can rip most other opiates off the receptors — but doesn’t activate them, which is why it can reverse heroin overdoses and cause instant withdrawal.

Over time, if we continue putting opiates like morphine and heroin into our bodies, we develop a tolerance (scientists still aren’t exactly sure how this happens) and our body stops making its own opiates, like endorphins. So when we stop using opiates, our brain isn’t producing as many of its own opioids as it normally would, while still expecting plenty of the opiates we’ve been using to be around. As such, withdrawal is essentially the opposite of the effects we receive from using opiates. It can take several days, or even weeks, for our brains to adjust and restore some sense of balance to the internal opioid system.

These is also some recent evidence that opiates have an effect on the brain’s dopamine receptors (for more information on this, check out this article from The Fix). Drugs like nicotine, cocaine and methamphetamine have long been known to work on the dopamine receptors. They generally act as dopamine-reuptake inhibitors, which means they cause an overabundance of dopamine by preventing the brain from removing it. The result is vasodilation, and increased heartbeat, numbness, and sometimes euphoria. When the effects of these drugs wear off our brain have reduced its production of dopamine (downregulation), causing severe depression and agitation. Over time, users of these drugs become psychologically dependent on the drugs because they have essentially “re-wired” the brains reward system. The brain’s desire for these drugs can easily become stronger than our desire to eat, drink, or motivate ourselves to work, or even get out of bed in the morning. Recent studies suggest that heroin can increase dopamine levels in the body more than nicotine and marijuana, and nearly as much as methamphetamine. This effect is most likely the reason, in addition to the fear of withdrawal symptoms, that habitual heroin users (and frequent users of stimulants) essentially go into “survival mode,” risking their personal safety or going to jail, and even forgoing food and drink when they run out of drugs. It is also a likely reason why opiate users, even after they’ve endured physical withdrawal, still strongly crave their drug of choice for months, or even years, after they’ve stopped using.

Substituting Other Opiates for Heroin
In general, most of the opiates and opioids (synthetic opiates — I’ll use “opiates” for simplicity) are interchangeable, in different degrees and doses, with other opiates. This includes drugs like hydrocodone (lortab, vicodin, etc.), oxycodone (percocet, oxycontin, etc.), dilaudid (hydromorphone, K4s, K8s, etc.), morphine, codeine, opium, fentanyl, and methadone, many of which are available by prescription. In recent years many of the prescription opiates have become more difficult to obtain in the United States, due mostly to tightened restrictions by the federal government on doctors who prescribe them (whether the patients require them or not). Many people who suffer from chronic pain become physically dependent on prescription opiates, even when using them at prescribed doses. Their inability to find relief for their pain has resulted in a dramatic increase in the number of people using (and overdosing from) illegal opiates like heroin.

Drug users jumping from prescription painkillers to heroin has been an issue for some time, but it was more common to see users taking prescription pain medications to stop using heroin when I was using. I’ve tried to alter my habit using all the drugs listed above with only marginal success. While most control withdrawal symptoms to some degree, their vary greatly in duration and intensity. Many control withdrawal for only a short time or barely at all.

In my experience, oxycodone and hydromorphone, while effective, have an extremely short half-life. Trying to kick a heroin habit with oxycodone is a recipe for disaster. I once tried to wean myself off opiates using Oxycontin and gradually reducing the dose. This yielded more severe withdrawal symptoms when I ran out of pills. I crapped my pants and barfed into a McDonald’s cup all the way back to the dope man’s house for relief.

Hydrocodone lasts somewhat longer, and I’ve known people who claim they kicked a habit using it, but I doubt their sobriety lasted for long. Hydrocodone causes a euphoria similar to heroin and this is the route many users end up taking to get to heroin. Most hydrocodone preparations contain acetaminophen, which can cause liver damage in high doses.

Ultram (tramadol) can relieve withdrawal in sufficiently high doses. I can’t confirm the safety of this method and have only used it once, but a handful of pills helped me sleep through the night and feel mostly normal the next morning. Ultram was originally marketed as a non-addictive pain reliever, but that claim seems to have been disproven given the numerous accounts of patients becoming dependent.

Codeine seems to relieve symptoms and lasts an incredibly long time. I once took a couple codeine pills, not expecting them to do much. I ended up sleeping for nearly twenty-four hours and still felt the effects after I woke up. I’ve never tried codeine to kick a habit, but if I had to do it again and was able to get my hands one some, I imagine it would make a fairly safe and effective option.

Fentanyl and its analog 3-methylfentanyl (sometimes called “China white“) are extremely potent synthetic opioids. Fentanyl is used in the medical field as a general anesthesia or as pain relief for cancer patients, etc. It is estimated to be 80-100 times stronger than morphine and 15-20 times strong than heroin. 3-methylfentanyl is estimated to be 400 to 6000 times stronger than morphine. For reference, heroin is about 10 times stronger than morphine. It’s sometimes used by sellers to cut heroin and make it stronger. This often results in unsuspecting drug dealers (who often don’t know what they’re selling) delivering lethal products to unsuspecting drug users.

Fentanyl is an extremely strong synthetic opiate. Heroin is often laced with fentanyl to create a stronger product. Sometimes fentanyl is sold as heroin. In both cases it can yield deadly results.

Fentanyl is an extremely strong synthetic opiate. Heroin is often laced with fentanyl to create a stronger product. Sometimes fentanyl is sold as heroin. In both cases it can yield deadly results.

My primary supplier ran into a stash of fentanyl that lasted for three wonderful months. My using partner and I fortunately never overdosed on it, but the experience was clearly different and more potent than we got from heroin. It was generally white and had a clear-to-yellowish tint when mixed with water (whereas heroin almost always mixed up some shade of brown). We could always tell that it was something different and we both came to prefer the fentanyl over regular dope. Immediately after injecting, a distinctive chemical taste wafts from the back of the throat and enters the mouth, almost like breathing out chemically-laced cigarette smoke. A heroin high almost always starts in the gut and slowly creeps up the spine and into the brain, sometimes causing a burning sensation in the limbs. A fentanyl high immediately starts in the brain and quickly makes its way to the extremities, causing a warm, numb sensation all over the body. A fentanyl high is more intense, but doesn’t last as long as heroin (generally 4 to 6 hours versus 6 to 8). Fentanyl seemed to yield almost no withdrawal symptoms, which was one of the reasons we preferred it. Of course, this could be because we never went more than a day or two without it.

We would seek out and wait hours to get our hands on fentanyl, even at the expense of getting heroin much more quickly and easily from somewhere else. I once waited three hours outside the dope man’s spot as he slowly and deliberately strung me along, promising he’d be pulling up any minute. Finally, he had me drive an hour to his house, to which he couldn’t even supply accurate directions. When I finally made it there he left me waiting another thirty minutes. He casually apologized for the inconvenience in his big, goofy voice. With the drugs in hand, all was forgotten and forgiven. He was so lovably mindless and clumsy it was difficult to hold a grudge. I sometimes think I kept using just because I enjoyed his antics and he felt like one of my only friends. Not much has changed since the Velvet Underground’s ode to waiting for the drug dealer I’m Waiting for the Man. The heroin user quickly becomes an expert at waiting, or drives themselves mad in the process. Eventually my guy’s connection was busted and we lost our access to fentanyl. Disappointed, we went back to using heroin and the next time we went to visit, he asked me where to locate a new supplier. That was the last we saw of him for a while.

I can not emphasize enough the dangers of fentanyl. Many overdose deaths during the past several years are the result of heroin laced with fentanyl. Several people I’ve known and used with have died from overdose because of this. If you use heroin, especially if you inject, always use with someone else, and always carry naloxone. These harm reduction methods have saved tens of thousands of lives that would have been otherwise lost.

In general, using a lesser opiate to quit using heroin (or another strong opiate) ends in failure and frequently results in the user having a worse habit in the end. In my experience, this is one of the least effective methods for quitting heroin and can sometimes be dangerous or deadly. I do not advise this method if you’re trying to quit using or reduce how much you’re using.

Long-term Effectiveness: 3/10
Relief from withdrawal: 7-10/10
Danger: 5/10

Dose Reduction/Tapering
Dose reduction was once the standard medical approach to quitting opiates. Doctors and the recovery industry have since moved away from this method, sometimes preferring complete abstinence or requiring user to detox at facilities that use non-narcotic drugs, before treating patients. Such a rigid approach can cause drug users to feel pressured into relapse or die from a drug overdose when their tolerance for opiates diminishes.

The general idea behind a dose reduction cure is essentially the reverse of building up a tolerance for opiates. The user gradually reduces their tolerance by slowly decreasing the amount of drugs used. For example. 1 gram the first and second day, 1/2 gram the third and fourth day, 1/4 gram the fifth and sixth day, and after a week to 10 days, the dose is small enough that stopping won’t be nearly as difficult (although the user will likely still experience some level of withdrawal). This method can be especially difficult for heroin users, not only because it requires a nearly inachievable level of self-control, but because the potency of street drugs varies so greatly. One might cut down the dosage and receive a fresh supply of drugs that is much stronger than the last, which even at a reduced dose could result in a stronger effect and a corresponding increase in tolerance. One might avoid this situation by purchasing a large amount of drugs all at once to ensure a consistent potency, but it’s unlikely many habitual users can muster the level of discipline requires to adhere to the protocol with such a ready supply on hand.

I have attempted a reduction cure both by using smaller and smaller quantities of heroin and by switching and using lower and lower doses of prescription painkillers. This method has almost always resulted in disaster. On the few occasions when it did seem to work, I was quickly back to using heroin, convinced that if I managed to control my intake I might avoid dependence and full relapse. This had predictably awful results.

Long-term Effectiveness: 3/10
Relief from withdrawal: 2-3/10
Danger: 7/10 (increased risk of overdose when using after a period of abstinence)

Methadone Assisted Treatment
Methadone is a synthetic opiate developed by the Germans during World War II amid a morphine shortage. It’s been used since at least the 1960’s to replace heroin addiction with legally-administered medication and has consistently proven to be one of the most effective methods of getting heroin users to stop using illegal drugs for an extended period. During methadone-assisted treatment (MAT, formerly known as methadone maintenance treatment or MMT), patients are often able to go to school, get jobs, seek medical and mental health treatment, and lead normal lives in ways they were unable to do while using. With proper medical attention and counseling, many methadone users are able to stop using completely.

Methadone completely satisfies the desire for opiates and prevents withdrawal for 24 to 36 hours in most people, depending of how quickly they metabolize the drug. Some people have to dose twice a day, while most methadone patients can miss a day with few ill effects. Access to methadone is not always easy and sometimes the cost to enter treatment can prove prohibitive. I once attempted to enter a methadone program but found the initial costs would equal to 3 or 4 days worth of heroin use, during which I would have to be sick for at least 2 days before I could get into the program. I decided to stick with the heroin until I had more money which, of course, never happened.

Despite its record of success, methadone still suffers from a latent stigma that leads many user to avoid it. Many methadone clinics are located in impoverished communities where illegal drugs are readily available. They are frequently areas of conflict when these neighborhoods are swept aside in the latest wave of gentrification and redevelopment. Rare cases of overdose from methadone (usually in combination with other drugs) result in an inordinate amount of negative media attention. It is also not accepted as a valid treatment option by most twelve step (NA/AA) groups or inpatient recovery programs, which usually promote an “abstinence only” approach to addiction recovery.

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A dose of methadone liquid

My exposure to methadone and entry into a structured program marked a definitive turning point in my drug use. While it didn’t result in my immediate abstinence from heroin, it did lead to an immediate and dramatic reduction in the number of times I used illegal drugs. I went from injecting heroin 3-4 times a day to using only 3-4 times a month. The added incentive of having to adjust my using to certain times of the month to pass a drug test and receive additional take-home doses, along with my now receiving drugs in a clinical setting, rather than copping from the dope man, changed my thinking about how I used. It transformed the process into a medical procedure rather than a familiar ritual I found both dangerous and intriguing. This is not the case for everyone. Some people have awful experience with methadone treatment, which could be due to the variation in quality and care between methadone clinics. It is my feeling that most methadone patients find some success, even if not complete abstinence from illegal drugs, and that much of the negative attention these clinics receive is from a handful of problem patients. I advise methadone treatment for longtime heroin users, especially when other methods have failed, and for those addicted to prescription pain pills wishing to quickly taper their addiction using methadone rather than suboxone or another method.

Methadone softens the intensity of a heroin high, but doesn’t completely eliminate it. At one time I was using with a friend who was in a methadone program (she’s since suffered a fatal overdosed). She insisted on a trip to the clinic immediately before we went to buy our drugs. I wasn’t pleased about having to wait, but she insisted if she didn’t make to the clinic in time they would kick her out of the program. So I waited for her to dose, which felt like an eternity. When she returned to the car she immediately swallowed four Xanax bars (2mg each) and offered me one. We then made the short trip to the dope man and fixed up. She couldn’t grasp why she felt nothing and I was comfortably nodding and bragging about how great I felt. “It must be bad dope,” she insisted, but considering she’d been using twice as long as me I expected her to know that methadone would put the diminish her high. I’ve been able to feel heroin within a few hours of taking methadone. I never tried using immediately after a dose, although I managed to sneak a hit in before the methadone took effect (generally 45 to 60 minutes, with varying results.

Coming off methadone was a long and difficult process. Even reducing my dose by 5mg every two weeks proved too grueling to tolerate. I paused the taper at the halfway point and and stayed at 40mg for a year. Picking back up was still difficult, but I was determined and reduced by 5mg every 3 weeks the second time around. Near the end I turned to kratom (discussed later) to ease my symptoms. This yielded disastrous consequences and completely ruined all the pain and work I’d invested in my methadone taper. Without the kratom I feel like I would have been uncomfortable for the last month or two, but would have survived it and likely not reverted to using other opiates.

Many countries, including Switzerland, Germany, the Netherlands, Denmark, the United Kingdom, and parts of Canada and Belgium, also use heroin-assisted treatment. The general idea is the same as methadone-assisted treatment, only heroin is used instead. This approach has proven successful at helping those for whom other methods, like methadone, have failed to lead healthy and productive lives. It provides an affordable (or even government-subsidized) and consistent dose of heroin in a clean, safe environment, making drug use much less dangerous for the community and drug users. It also reduces the need for users to resort to property crime or robbery to obtain drugs and diverts users from the correctional system, which can dump users into an endless cycle of unemployment, further drug use, and repeated incarceration. Given the current  environment and the rehtoric surrounding the “War on Drugs” in the United States, it is unlikely heroin-assisted treatment will be available here in the foreseeable future.

Long-term Effectiveness: 8/10
Relief from withdrawal: 9-10/10
Danger: 2/10 (danger increases when mixed with other drug, esp. benzos)

Suboxone/Buprenorphine Assisted Treatment
Suboxone is a synthetic opiate that partially activates the brain’s receptors (called an opioid agonist-antagonist) that cause an intense high and severe withdrawal from heroin and the other natural and synthetic opiates. It can be substituted for any opioid and is almost always completely effective at removing and preventing withdrawal symptoms at the correct dosage. Some users indicate it is also effective at controlling cravings for opiates. It is an extremely potent blocker of most opiates.

One problem many opiate users have with suboxone is that they must be in withdrawal prior to taking it. This might sound like an easy task, but for a heroin user with a crippling fear at even the slightest sniffle that the sickness is looming, this is easier said than done. Because of the way suboxone works in the brain, and that it only partially activates the receptors that were fully activated moments before, taking the first dose of suboxone too soon can cause precipitated withdrawal, resulting in immediate and severe dope sickness.

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8mg suboxone film

The first time I tried suboxone was from a friend, and former heroin user, who had stopped using it and still had a large supply on hand. Me and my using partner at the time intended to use the suboxone to get off drugs completely. Within an hour of taking them, however, we decided we’d rather not stop just yet. An hour later I injected a sizeable amount of heroin and felt not the slightest twinge of euphoria. My partner, who had secretly failed to take her dose of suboxone, (one of many times we each sabotaged the other’s plans to stop using) was slithering and sliding down in the seat next to me in a fit of pleasure. She later explained to me that suboxone is a powerful opiate blocker, something I re-learned when I was in a suboxone program myself. Every time I promised myself the risk of getting drugs was worth the reward I’d get from using them, and every time I failed to feel much, if anything, at all. Generally it can take 1 to 3 days, depending on one’s metabolism, after taking suboxone before it’s possible to notice any substantial pleasure from heroin.

Suboxone is a medication that contains both buprenorphine and naloxone (subutex contains only buprenorphine). Naloxone is a drug used to reverse the effect of opiates. The thinking goes that if a user tries to inject the suboxone, the naloxone will prevent the user high and can result in immediate and uncomfortable withdrawal. I’ve never tried this, so I can’t confirm that theory, but I’ve heard mixed accounts. Many users believe it’s the naloxone that prevents them from getting high on heroin or other opiates after taking suboxone, but the naloxone isn’t absorbed by the body if the medication is taken correctly. Buprenorphine, the active ingredient, is a binds strongly to the opiate receptors on its own, which leaves other opiates with nowhere to go, rendering them effectively useless until the buprenorphine goes away. Buprenorhine has a ceiling effect which means that once a user goes over 24-32mg they get no further effect. This also means that respiratory depression, the cause of most opiate overdoses, is not as pronounced. It is nearly impossible to overdose on buprenorphine, with only one death ever reported in adults.

One common criticism of suboxone-assisted treatment is that it is “just replacing one drug with another.” This claim is easily refuted by statistics that show the success of suboxone programs.  Patients in a suboxone program don’t get a high or euphoria from their medication — not that it should matter, but of course the abstinence-only crowd frowns on medication that might induce any sort of pleasure.

One of the main reasons users don’t enter into suboxone programs is that the cost poses an enormous barrier to entry. Patients generally have to visit a doctor who is licensed to prescribe suboxone, which can be extremely expensive without insurance (usually $200-300 per visit). The suboxone itself is also expensive, although now that generic versions of suboxone tablets are available the medication itself is now within reach for many patients. Many methadone clinics now also operate suboxone programs. One thing to keep in mind, and this can be difficult for active opiate users, is that the cost of entering a methadone or suboxone program is likely much lower than maintaining a daily heroin habit. It also removes many of the health and legal risks associated with illegal drug use.

Suboxone is an excellent choice for those dependent on low doses of prescription pain pills, to those who have been using heroin only a short time, or to those looking to jump off methadone at an appropriate dose (usually 30-35mg/day). It should be noted that, very often, less is more with suboxone. I was started on a standard dose of 8mg/day, which I found too strong, resulting in some undesirable side effects. I cut my dose to 4mg/day and eventually tapered down, under a doctor’s guidance, to .25mg (an extremely low dose). I was using the sublingual suboxone film, which is much easier to cut into small doses using a razor blade or X-acto knife. After a few days at .25mg I stopped taking suboxone entirely. I still had to endure the usual withdrawal symptoms, though not as severe, and I had trouble sleeping for over three weeks. If given the option, I likely would have stayed on suboxone indefinitely, enduring its minor side effects in favor of never have to suffer such a painful withdrawal and the eventual risk ofa slip or relapse.

For anyone curious, and some folks might find this important, here’s how my suboxone taper progressed: I was sick when I started on 8mg, coming off a methadone taper and bad experience with kratom and some dabbling again in heroin. I took two percocet the night before to help me through the worst of it, and that mostly held off the withdrawal. By the time I got my prescription at a methadone clinic (which took much less time than I expected) and filled it at the local CVS (the one near the clinic didn’t have it, for some reason) I was amazed that it completely wiped the sickness within 30 minutes. The first few days I felt a little bit of euphoria, but nothing compared to heroin or methadone. It was more a sense of  warm, fuzzy comfort than anything. Within a few days that effect wore off and I only felt “normal” when I took my suboxone. It did give me trouble sleeping for several weeks. I used melatonin to combat that, which helped somewhat but left me feeling groggy and empty-headed during the day.

After a while I realized it was the suboxone that made my head feel like it was stuck in a cloud, leaving me lethargic and groggy most days. I decided to cut down my dose to 4mg without consulting the doctor (which also extended the time before I had to go back for a refill). It was much easier than I imagined. In fact, I actually felt better on a lower dose. This may not be the case for everyone, but this is one of the reasons I say less is more with suboxone. During this time I moved from Atlanta to the very rural North Georgia mountains. Rather than drive 90-minutes to the clinic each time I needed a refill, I found a doctor in a nearby town (after an exhaustive search) who treated pain and could prescribe suboxone (note: many of the doctors who are best qualified, like psychiatrists and addiction specialists can’t prescribe suboxone because they haven’t obtained a license, which makes getting quality treatment for long-time drug users difficult). The doctor was great and spent plenty of time with me each visit. He was a little more optimistic about me coming off the suboxone than I was. Up o that point I was comfortable with the idea of staying on suboxone as long as I needed, maybe forever. I reluctantly followed his plan, thinking maybe it was for the best since I hadn’t been on the suboxone for even a year. The first month I cut down to 2mg, which was a breeze. In fact, it was the most functional I’d felt, mentally and physically, is as long as I could remember. The 2mg/day dose felt ideal. It controlled my psychological issues almost completely without making me feel too awful.

Suboxone sublingual pills are generally less expensive than the film, but is much more difficult to cut into smaller doses, even with a pill cutter.

Suboxone sublingual pills are generally less expensive than the film, but is much more difficult to cut into smaller doses, even with a pill cutter.

A month later I cut down to 1mg. It wasn’t as easy as my previous dose reductions, but it wasn’t particularly uncomfortable. A few weeks later I cut down to .75mg. I imagined it would be easy since it was only a minor decrease, but I was miserable for the next several days. I stabilized on that dose after a week, but wasn’t feeling anywhere near as well as I did at 2mg. Two weeks later I dropped to .5mg. It was essentially the same experience as the previous decrease, but I survived it without too much trouble. I was dealing with some especially stressful issues at this time, and it was near Christmas time. This caused me a good amount of anxiety and led to sleep problems. A couple of nights I took an extra .5mg to help me sleep and soothe my nerves. I never felt an urge to use heroin or other opiates, but I probably didn’t do myself any favors taking an extra dose because it likely increased my tolerance at at time I was trying to decrease it.

Two weeks later I cut down to .25mg. This was my jump-off dose. I had a backup appointment with the doctor, but committed to breaking the hold opiates had on me. I stayed at .25mg/day for several days and then stopped taking it altogether. I felt awful, from waking up that morning and even after I took the final dose. I told myself it would be alright and that I’d feel better in a matter of days, just like I’d done countless times with heroin. That’s not how it worked out. The sickness wasn’t severe, but it was anything but pleasant, especially after not having dealt with it in nearly a year. The awfulness lasted for about three weeks, during which I tried to ease some of the symptoms with moderate doses of loperamide and NyQuil. Once my symptoms had mostly disappeared I sought psychiatric care from a doctor who was open to alternative treatments (e.g., not stuck on the archaic twelve-step method) and specialized in addiction issues. They started me on Seroquel (an anti-psychotic), which caused a terrible manic reaction that left me unable to sleep (just when I’d regained my talent for it) and sent me into a horrible week-long manic episode. Within a few weeks they had me on medications I was able to tolerate (Lamictal, a mood stabilizer, and Remeron, a noradernergic and specific seretonergic antidepressant (vs. SSRI’s), along with a steady stream of supplements) and which helped me to feel stable for the first time in over a decade.

If I had it to do over again, I would started taking my dose at the 1mg point and continue reducing the dose from there by half every two weeks until I no longer needed it. Unfortunately, even after all I’d been through, I couldn’t muster the self-restraint to do something of that magnitude. I tried dosing every 36 hours during my taper, but that became confusing and caused me to accidentally dose more frequently. Regardless, I highly recommend suboxone as an extremely safe and solid choice for coming off opiates, especially for those looking to break their dependence completely or stabilize their opioid dependence.

Long-term Effectiveness: 9/10
Relief from withdrawal: 8-10/10 (danger of precipitated withdrawal when taken too soon)
Danger: 0/10

Kratom (Mitragyna speciosa)
Kratom is one of the most vile and useless drugs I’ve ever encountered. It comes from the leaves of a tree that grows in southeast Asia and shares some similarities to drugs derived from opium, like heroin and morphine. It partially binds to some of the same receptors as other opiates, but doesn’t activate them as strongly. As such, it’s usually marketed as a legal (though not in all areas) and “non-addictive” form of heroin. My experience is that it can be addicted, especially for those who have ever built up a tolerance for strong opiates.

I first encountered kratom during my second taper from methadone. I bought into the hype surrounding this legal, herbal drug, with some reservations, that it could truly be “non-addictive.” Several opiate users claim to have kicked their habit entirely by using kratom. While their accounts might have been true, that was not my experience and it doesn’t seem worth the risk of finding out for yourself.

Kratom generally comes as a finely ground ready for oral consumption, although it sometimes comes as a weak, horrible tasting liquid, pills, or a concentrated liquid extract. To feel any effect one must consume a very large quantity of the powder, which is difficult to cram into the body. It remains one of the most stomach-churning concoctions I’ve ever had the displeasure of consuming. At first I tried it as a hot tea, which provided a mild buzz that mostly got rid of my anxiety (which had disappeared entirely on heroin and slowly crept back when the methadone wore off). After a few days, the warm, putrid green tea became too much to handle. I next tried mixing the powder with water or juice and gulping it  all down at once, which didn’t work as well as I’d hoped. The powder didn’t dissolve in liquid and still tasted awful.

mbss-3

Kratom powder tastes awful

On one week-long trip to Washington, DC, I stumbled on some gelatin capsules at a natural foods store. This seemed like the perfect route of ingestion for something that tastes so awful. When we got back to our temporary apartment I meticulously poured my stash of kratom into capsule after capsule until I had what looked to be several days worth of pre-packaged kratom on hand. It took 14 or 15 capsules each time to get the job done. This seemed to work well for a while. Several days later, however, I found myself constipated and finally having to go to the bathroom. By this time I was acclimated to frequent constipation from heroin and, especially, methadone. It wasn’t unusual to have only one bowel movement (or less) per week. This was a different sort of constipation, though. Not long after the urge hit me, it felt like a little human was inside my guts, trying to push and kick their way out. I went to the toilet, but nothing happened. Everything was ready, but the package just couldn’t be delivered. It felt like trying to push a basketball through a drinking straw. After several trips back and forth to the toilet the gravity of my situation started to set in. There was no way this thing was coming out of its own accord. Between repeated fits of crashing onto the floor, curling into a ball and writhing around in pain, with several frantic searches for laxatives or enemas and more trips to the bathroom, I persuaded my wife to walk to the drugstore to get me an enema — or some sort of relief. Such an experience might have been tolerable on heroin, or even methadone, but the kratom provided no pain relief for such a condition.

The trip took longer than I expected. Of course, even if she’d returned in two minutes if would have been too long. After waiting a few minutes I got the brilliant idea to force the blockage out by whatever means I could manage. The most promising tool I could locate was a wooden #2 pencil. In retrospect I realize how dangerous this was and I absolutely do not recommend it for anyone who finds themselves in this situation. I jammed the pencil in there and dug it around, hoping perhaps I might chop the behemoth down into more manageable chunks. That was a total failure — the pencil wouldn’t even penetrate the surface. Eventually I tossed all dignity aside and dug in with my fingers to pull the little fellow out. I’d heard of this being done before, most famously in William S. Burroughs’ telling of his own drug experiences in Junkie, but I had no idea how effective it could be. Within moments the blockage was cleared and I found some relief, despite now having my fingers covered in shit. I must have lost 20 pounds in a matter of seconds. After that experience I settled on shoveling a large spoonful of kratom into my mouth and washing it down with a glass of juice. That seemed to get the job done as well, and as safely, as anything else I’d attempted.

Kratom alone might not cause constipation, but combination with gelatin capsules is a recipe for disaster

Kratom alone might not cause constipation, but combination with gelatin capsules is a recipe for disaster

My methadone taper had seemed like a breeze using the kratom method. When I made it down to 5mg I simply quit taking the methadone because I felt fine and it wasn’t doing anything for me. It all seemed too good to be true and, alas, turns out it was. I was now strung out on this useless powder that I could barely stomach. Within a matter of days I was back onto heroin just to ease myself off the kratom. My thinking, and this probably indicates I wasn’t all the way ready to make a break yet, was that I’d be able to quickly taper off the heroin if only I could control my use to every other day. You can probably guess how that turned out. I entered a suboxone program at another methadone clinic within a few weeks and had a much better experience with that.

Stay away from kratom if you can. Kratom is awful stuff.

Long-term Effectiveness: 2/10
Relief from withdrawal: 4-5/10
Danger: 4/10

Cocaine & Crack
A solid cocaine high is pure, unadulterated bliss. It might just be the greatest feeling you’ll ever experience if you try it — better even than heroin. The rush from intravenous cocaine is better than that of any drug I’ve ever tried (and I’ve tried most of them). The downside is that it doesn’t last long (maybe 5 or 10 minutes) and when the ride is over, boy is it over. The most severe sort of depression sets in and not even more cocaine can push it aside. Heavy doses of heroin or benzos can make it more tolerable, but time is really the only effective cure coming down from cocaine

My first dabble into the world of cocaine was by injection. That likely ruined any other route of administration for me. I found snorting cocaine to be a colossal waste of good drugs and money that did nothing for me. Smoking cocaine (crack) provides a “dirtier” version of intravenous cocaine that I generally tried to avoid because of the even nastier compulsion for more and an even worse post-binge comedown. When I was with fellow users who bought a batch of crack, more often than not, I would stop at a fish fry joint to pick up a packet of lemon juice or malt vinegar to break it down into something I could stick in my arm (I would not recommend this, as the safety of injecting lemon juice or malt vinegar is dubious at best).

I once used cocaine to successfully kick a heroin habit. This was only months after I’d first started using, so that probably helped.  The fact that dope sickness never lasted more than 3 to 5 days for me certainly contributed. One afternoon I purchased a handful of eight-balls (actually, the dope man delivered them to me in a white paper bag) and consumed the whole thing over the course of three days. Looking back, and having had several unpleasant experiences with cocaine, I’m not sure how I managed to survive the whole ordeal. Much of that time period is a blur, but I do remember that I managed to sleep at some point during my 3-day mega-binge. The cocaine completely removed my withdrawal symptoms, even for hours after I’d used it. To this day I feel like it was some sort of magical cocaine powder that didn’t carry the heavy downside of regular cocaine. I suffered a very mild depression when it was all gone, which eventually led me back to heroin in an attempt to lift myself back up. As was usually the case in these situations, I convinced myself that if I used 2 days on, 1 day off, I could hold off a return of the dope sickness. Of course, as I’m sure you know, that’s not how it worked out.

The depression caused by a coke binge, as I mentioned, can be extremely debilitating. I’m diagnosed with bipolar disorder, so perhaps I’m predisposed to this sort of thing, but I’ve heard similar accounts from many other people. On one occasion, my partner and I purchased 2 eight balls (7 grams), with which our dealer at the time threw in a free supply of heroin. We were delighted and quickly went home to indulge in our goodies. We consumed the small mountain of cocaine within a few hours, each of us nearly giving ourselves a heart attack in the process, after which we turned to the free heroin for relief. After taking a couple shots and feeling nothing, we discovered why the heroin had been free. It likely wasn’t heroin. Whatever it was had no effect. We settled in for an excruciating night of depression and the first signs of acute heroin withdrawal. We called our supplier’s phone from 6 in the morning until he finally picked up around 10 and gladly handed over what money we had left for some real drugs.

Cocaine is generally a bad idea. Even if it starts out feeling enjoyable, one quickly finds themselves in a painful cycle of needing more just to achieve a fraction of its previous effects, until it finally wears off and leaves everyone involved that much the worse for wear.

Long-term Effectiveness: 0/10
Relief from withdrawal: 7/10 (withdrawal effects compounded by cocaine withdrawal)
Danger: 8/10

Methamphetamine
Methamphetamine is cocaine’s dirty little step-brother that just doesn’t know how to let go. Injecting methamphetamine results in a mild quick rush of euphoria, similar to a cocaine high, after which it’s off to the races. Your heard will be exploding out of your chest and you won’t sleep the first night after, and probably not the second or third night either. When sleep does take hold, it is both overwhelming and unavoidable. The sleep after a methamphetamine binge can sometimes last for several days.

I generally avoided methamphetamine because I really enjoy sleeping. Meth is extremely easy to find, especially in rural areas, and is currently one of the most popular dangerous drugs. The few times I indulged I would almost immediately regret it and try everything imaginable to come down. Nothing ever seemed to work. With cocaine, I could take a couple shots of heroin or a few milligrams of xanax (I don’t recommend either of these as they can result in a deadly combination of drugs in the body) and find a good night’s sleep shortly after. Not so with methamphetamine. I have tried every combination of downers to combat the tweak of a speed high and the most I could manage was to cut the length of its effects by a few hours. Some users take Seroquel, an anti-psychotic that can cause a deep sleep. I’ve had extremely negative reactions to Seroqeul (it induced mania and had the opposite effect on my sleep).

I once tried using methamphetamine to kick a heroin habit. This led to a dangerous cycle of using heroin to recover when I came down from the methamphetamine and then using methamphetamine to pick myself back up when I needed to go to work and couldn’t gather the energy. I’ve heard similar accounts from others who thought this might be an effective method for stopping heroin. It’s not uncommon for users of both to take meth to get through the week and enjoy some heroin over the weekend, repeating the cycle over and over. I’ve never heard any stories of success this way.

Snorting methamphetamine is both wasteful and unnecessarily painful, causing a burning sensation unequalled by anything I’ve encountered. It can also result in a deviated septum after extended use. Many people have burned holes in their noses and sinus cavities snorting meth (and cocaine).  Injection is more rewarding, but incredibly dangerous and not without its own risks. Overdoses from meth are rare, but it can be especially dangerous for people with heart conditions or who are in poor health. In general, methamphetamine is one of the few drugs I suggest avoiding at all costs.

Long-term Effectiveness: 0/10
Relief from withdrawal: 8/10
Danger: 7/10

Marijuana
Marijuana is a drug people seem to either love or hate. I find myself in the second group. That many people don’t even consider marijuana a “real” drug should give some indication as to its potential benefits for recreational use. I’ve never enjoyed marijuana. Perhaps that’s because I’d already tried most of the harder drugs before smoking it (the “gateway drug” theory is pure propaganda by the way), but I never found marijuana pleasurable or particularly useful for much of anything. Every time it caused me to feel slow and think everything was hilarious, even when it obviously wasn’t. Perhaps this is why some people favor it. On the few occasions I have used marijuana, it’s almost always resulted in me doing something senseless and regrettable.

In one instance, after using heroin and then smoking a marijuana cigarette, me and a friend who knew a dealer in exotic pets, developed a plan to go into a pet shop, slip some birds and snakes into our jackets, and trade them to his contact for a large pile of cash. Our attempt to execute this plan, especially under the influence of the marijuana, had predictably disastrous results. We were chased out of the store and were lucky not to have ended up in jail. After coming back to our senses several hours later, we settled on one of our usual scams to obtain cash (boosting baby formula in this case). That plan was significantly more successful.

I’ve never understood the fixation many people have with marijuana, but if they enjoy it I suppose it’s not my place to discourage anyone using it or judge their taste in recreational drugs. Besides that, if you use heroin or other opiates regularly, you’ve most likely been exposed to marijuana and have already formed your own opinion. I would advise against using marijuana to help with heroin withdrawal. It can increase paranoia and intensify the feeling of general discomfort. It also seems to have no beneficial effect on withdrawal symptoms.

Long-term Effectiveness: 0/10
Relief from withdrawal: 0/10
Danger: 1/10

Alcohol
Alcohol is useless when trying to stop opiates. I enjoyed drinking, even the partaking the occasional all-night binge, before being introduced to heroin. After being exposed to heroin I lost my taste for alcohol completely.

Trying to get drunk to fight heroin withdrawal will not be a pretty sight. likely make you puke your guts out well before it numbs any discomfort from the sickness. In fact, it will likely make you feel even worse. In one of my more desperate moments, I had no access to heroin or other opiates, but I did have a fifth of vodka nearby. I drew a few cc’s into a syringe, fancying myself some sort of modern-day GG Allin. As soon as the needle punctured my skin, well before I pressed on the plunger, a burning sensation shot all the way up my arm. I didn’t even manage to push all of it in. I was screaming and writhing in a fit of pain, all alone in a dank, dark basement. It was one of my worst moments. I felt no rush from the alcohol, but did sense a drunk feeling almost immediately (after which I throughly barfed my guts out into a mop bucket).

It is my firm belief that alcohol and heroin do not mix, either when using or in withdrawal. Some people enjoy mixing the two, but I cannot understand why. I have been able to use alcohol on occasion after stopping heroin, and have even brewed batches of beer and mead at home, without becoming dependent. I doubt everyone can sbe successful at this, but I’ve never had a particular fondness for feeling drunk. It is my opinion that a predisposition to alcoholism and opiate addiction are not necessarily linked, although some users definitely experience both. The old Narcotics Anonymous adage that “a drug is a drug is a drug” seems incredibly naive. Just because a person is dependent on one drug doesn’t mean they’ll magically become dependent on another. Obviously care should be taken when those in recovery drink alcohol or smoke marijuana, etc., but the dangers (as opposed to use by those who have never been dependent on other drugs) seem highly exaggerated.

Long-term Effectiveness: 0/10
Relief from withdrawal: 0/10
Danger: 7/10 (effects of opiates after returning to use are compounded by alcohol)

DrugItem_3451

Librium won’t do much on its own, but combined with clonidine it can work wonders for opiate withdrawal

Benzodiazepenes: Xanax, Valium, Klonopin, Ativan, Librium
I’ve tried almost all the benzodiazepines available in the US to combat heroin withdrawal. While all of them yield different results, they are usually effective at easing the anxiety and psychological symptoms of dope sickness. That’s not to say they’re perfect or that you’ll feel wonderful on them while experiencing withdrawal, but they can help.

When taking Xanax (alprazolam) for withdrawal, I felt more at ease, but grew extremely irritable, to the point that I cursed out one of my co-workers for some insignificant transgression and was sent home from work. I was lucky not to have been fired. While I was generally irritable during regular bouts of dope sickness, I could always control my temper.

Klonopin (clonazepam) will help with sleep during opiate withdrawal, or at least make you wish you could sleep. It is moderately effective at relieving other symptoms in higher doses. Ativan (lorazepam) is extremely effective for withdrawal if you can get your hands on it. It’s probably the best of the benzodiazepines, for anxiety, sleep, and general withdrawal symptoms. One time, when I went to the hospital for help with detox (which I didn’t know was an option until well into my heroin use), I become extremely uncooperative when nurses and security personnel refused to let me leave. They offered me an injection of Ativan, which immediately relieved all of my symptoms. After two more injections I was out like a light. During that time they had me transported to a detox facility. I was there for a week and received Ativan (pill form) and clonidine several times a day. Most of that week is a blur. Weeks later I bumped into someone I’d met at the detox facility and had no recollection of he she was or how I knew here until she told me (I still had no memory of anything I spoke with her about). Upon leaving the detox I met with a doctor who diagnosed me with “drug-induced depression” and gave me a prescription for Prozac, which ended up being useless.

While Librium (chlordiazepoxide) has almost no noticeable effects on its own, aside from drowsiness, when coupled with clonidine it is one of the most effective combinations I’ve found for alleviating the symptoms of dope sickness. This is the preferred method in many jails and detox facilities, which generally don’t use methadone or suboxone, and if you can use this method to get off opiates, I strongly encourage it (more on this method below).

Benzodiazepines are one of the most lethal prescription drugs and are a frequent cause of overdose deaths. They are especially lethal when mixed with opiates. I’ve known many people to die by a combination of heroin and Xanax who would very likely still be alive if they’d never mixed the two. The only times I’ve blacked out or “browned” out when using drugs (and come close to overdose myself) was while using Xanax or Klonipin with heroin. On one occasion I consumed about 2mg of Xanax (a small dose) prior to fixing up and then blacked out for a half hour. I woke up in a smily puddle of drool not knowing what happened or where I was (fortunately I hadn’t been driving). When I came to, I had a syringe poking from my neck, which I promptly removed and used to mix up another dose. I asked my using partners, who had used only heroin, what happened. They informed me that they were on the way to another dealer because the stuff we got was garbage. Not from where I was sitting it wasn’t! Many users take benzos to make their heroin last longer or get by with less. They have an extremely strong potentiating effect (perhaps 2 to 1, or greater) on opiates, which is particularly noticeable with intravenous heroin. Keep this in mind when using benzos for withdrawal. If you think you might revert to using opiates, abstain from them at all costs. The consequences of mixing benzos and opiates with a reduced tolerance can be grave.

Long-term Effectiveness: 4/10
Relief from withdrawal: 5-8/10
Danger: 6/10 (overdose danger is increased after returning to use with benzos in your system)

Clonidine is available as a patch or pill. The patch provides a more steady dose and can reduce possible problems caused by low blood pressure

Clonidine is available as a patch or pill. The patch provides a more steady dose and can reduce possible problems caused by low blood pressure

Clonidine and Librium
Clonidine is a blood pressure medication, but it’s frequently used to treat heroin withdrawal. It is frequently used in correctional facilities or detox facilities that don’t provide access to (medically-accepted) controlled substances, like methadone or Ativan (lorazepam), for relief from withdrawal. I’ve been forced to endure this treatment on multiple occasions during my many trips to jail. I’ve found it surprisingly effective at relieving dope sickness. While not painless, a combination of clonidine and librium can make the withdrawal experience much more bearable. It was especially effective at controlling anxiety, helping me to sleep, and allowing me to eat more than I would have otherwise.

Be advised when taking clonidine without medical supervision that it can cause a dangerous decrease in blood pressure. I once fainted in the bathroom stall of the Atlanta city jail under the effects of clonidine. It was as disgusting as one might expect, and potentially dangerous (although I was fortunate to have some friendly fellow inmates help me out in that situation).

Long-term Effectiveness: 5/10 (usually applied during involuntary abstinence in jail, so long-term effects vary)
Relief from withdrawal: 7/10
Danger: 2/10 (clonidine can drastically reduce blood pressure)

Barbiturates and Sleeping Pills
Barbiturate can help with sleep during withdrawal, but they likely won’t relieve symptoms aside from that. Taking barbiturates during withdrawal might extend the sickness and make the ordeal feel much more interminable, especially if you find yourself still unable to sleep after taking them. On their own they cause excessive sleep and are mostly useless if you want any meaningful sort of pleasure from your drugs. I once slept for about 16 hours straight in jail (not during withdrawal) after a guy gave me 3mg of the phenobarbitol he was on to prevent seizures. I could see some benefit from using it in jail or prison to pass the time, but that idea is accompanied by its own set of risks.

Most modern sleeping pills, such as Lunesta, Rozerem, etc., are mostly useless for anything but the mildest withdrawal. It is not unusual for them to cause or aggravate the cramping and muscle aches that give rise to the term “kicking” heroin. If they do help a user to fall asleep, it will likely be for a matter of minutes, after which the withdrawal will feel even more intense. This might result in an endless cycle of sleeping and waking to feel even worse over the course of the night.

Taking too much barbiturate or any other sleeping pill can result in extreme intoxication and sluggishness if you can manage to stay awake. Staying awake for hours after taking Lunesta one night caused me to have some strange and decidedly unenjoyable hallucinations. Most sleeping pills can also cause death from overdose at higher doses.  .

Long-term Effectiveness: 3/10
Relief from withdrawal: 4/10
Danger: 6/10

Immodium (loperamide)
Loperamide, the active ingredient in Immodium, is derived from opium, the same plant that gives us morphine (and thus heroin) and other opiates. It is chemically altered in such a way that it can not cross from our bloodstream into our brains (the blood-brain barrier). As such, its only general use is as an anti-diarrheal medicine, since it can reach the opioid receptors in our intestinal tracts (which can cause severe constipation when activated) .

I once tried loperamide to ease my 3-week long withdrawal from suboxone. I found that in high doses it was unexpectedly useful for treating the sickness. There are countless resources that attempt to explain this effect and go into great detail as to the different different methods available to “hack” the brain’s natural defenses so that some of the drug can make its way through. I won’t go into any of those here, since there are plenty of places to find that information on the Internet, but there is some medical evidence that some of the loperamide can make its way into the brain, even without these hacks.

imodium-a-d-loperamide

Be sure to use Immodium (or generics) that contain only loperamide hcl

In sufficient quantity, loperamide eased most of my withdrawal symptoms. It calmed my body, but didn’t make me feel high or cause any noticeable euphoria. I have a strong suspicion that it extended my withdrawal from suboxone by several days, if not more, and have since read more than one account of people becoming addicted to loperamide and suffering months of withdrawal from it. Not only is such a situation unfortunate, becoming addicted to diarrhea medication is probably very embarrassing. No one wants to be that person who plops five boxes of Immodium down at the drugstore checkout (or worse, gets busted shoplifting them).

I advise using loperamide only as directed to control stomach symptoms, or as a last line of defense against withdrawal symptoms if you get desperate. If you intend to take large quantities of loperamide to control other symptoms of sickness, be sure to get the tablets that contain only loperamide hydrochloride. Other ingredients may cause undesirable side effects.

Long-term Effectiveness: 2/10 (increases when combined with other treatments)
Relief from withdrawal: 5/10
Danger: 3/10 (can increase constipation, also potential for dependence)

Over-the-counter Pain Relief Ibuprofen, Acetaminophen, Naproxen
For an over-the-counter medication, I found ibuprofen (Advil, Motrin) to be remarkably useful at controlling muscle aches and pain during withdrawal. It won’t touch most of the other symptoms, but it will most likely make the process more bearable. Huge doses are not required. Ibuprofen reaches peak concentration in the body around 800-1000mg, so any more than that will likely be wasted and may cause harm to other parts of the body. The effects of ibuprofen last for several hours.

Acetaminophen is practically useless as a pain-killer except perhaps for the mildest headache. I’ve found it useless during withdrawal. It leaves an awful taste in the mouth, which is only exacerbated by dope sickness, and can cause stomach problems in some people.

Naproxen (Aleve) is generally effective, but the dose required can often result in discomfort or stomach problems. On one occasion, I consumed a massive amount of naproxen during withdrawal, which resulted in severe stomach cramping, vomiting up the little food I could manage to get down (a bowl of chili, no less), and an endless night of wretching and squirming around the bed in pain.

Long-term Effectiveness: 2/10 (increases when combined with other treatments)
Relief from withdrawal: 3-4/10
Danger: 1/10 (potential liver damage from acetaminophen)

Anti-histamines (Benadryl, etc.)
It’s impossible to forget the faint glimmer of hope I experienced upon reading Burroughs’ description of anti-histamines as a possibly effective cure for opiate addiction. The thinking at his time was that opiates somehow affected histamine levels in the body or caused some sort of allergy and that anti-histamines drugs might bring the body and mind back into balance. This idea was further confirmed, at the time, by the apparent fact that rabbits, who have high histamine levels in their blood, are immune to the effects of opiates.

Modern medical research has disproved this theory, but anti-histamines can be somewhat effective at treating withdrawal in sufficient doses. This is likely due more to the effect they have on histamine receptors in the brain, which can cause a deep sleep, than anything else. Still, the theory is intriguing and, given that most medicines affect various types of receptors in the body, this might prove a good method for getting over a light habit. It is seriously doubtful that anti-histamines alone, while relatively safe, could treat a strong habit in any quantity.

Long-term Effectiveness: 2/10
Relief from withdrawal: 2/10 (mostly ability to sleep, relieve watery eyes and sneezing)
Danger: 1/10

Nyquil and Dextromethorphan
Nyquil generally contains acetaminophen. dextromethorphan (DXM), and a decongestant or anti-histamine. While the acetaminophen and anti-histamines may provide marginal relief, the greatest benefit comes from DXM. DXM is distantly related to opiates like heroin and morphine and binds to the opioid receptors in the brain. As such, it can provide some minor relief from withdrawal. It can also cause a false-positive on drug screens for opiates, which I discovered the hard way when taking it for a head cold during methadone maintenance.

DXM is abused as a recreational drug by some people for its dissociative and and hallucinogenic properties at high doses. I have never experienced this effect, even in quantities well above the recommended dose. I would recommend using Nyquil with caution when using it for withdrawal or recreational enjoyment.

Long-term Effectiveness: 2/10 (increased when combined with other treatments)
Relief from withdrawal: 3-4/10
Danger: 3/10 (DMX carries risks of dependence, can cause positive drug screen results for opiates)

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Sudafed PE, which contains only pseudoephedrine HCl

Sudafed and Ephedrine
Sudafed (pseudoephedrine) and ephedrine are both surprisingly effective at controlling or minimizing withdrawal symptoms. I wouldn’t believe something over the counter could be so effective (both are more difficult to obtain than when I used them) had I not experience these effects myself. Pseudoephedrine is a precursor, and the primary ingredient, of methamphetamine. I suspect its effects on withdrawal are similar, though markedly reduced, to those created by methamphetamine and other stimulants.

Sudafed and ephedrine provide relief only at very high doses, which can cause serious problems for people with heart issues or other health conditions. As such, I would not recommend this method, even if you can get your hands on them, and if you do use only the tablets containing pseudoephedrine hydrochloride. Other varieties contain acetaminophen or other medications that can be harmful in high doses.

Long-term Effectiveness: 1-2/10
Relief from withdrawal: 5-6/10
Danger: 2/10

Naltrexone and Rapid Detox
Some doctors who specialize in addiction and drug detox offer an extremely expensive and not-entirely trusted method of rapid detoxification using naltrexone. Naltrexone is a powerful opiate blocker that causes immediate and severe withdrawal. During a rapid detox using naltrexone the patient is put to sleep under general anesthesia, as the symptoms would be too severe for  even the most hardened junkie to endure.

There are numerous accounts of people attempting this sort of rapid detox on their own at home using a combination of naltrexone and sleeping pills, tranquilizers, benzodiazepenes, and so on. Mixing these drugs it not only extremely dangerous, but will also cause an incredible amount of discomfort and  regret. This is one of the most painful methods for stopping opiates I could imagine. It is good only as an effective method of torture or masochism.

There are mixed accounts as to the long-term success of rapid naltrexone detox and questions as to whether it truly is painless or if some of the pain isn’t “remembered” by the subconscious. There are also concerns in the medical community as to the overall safety of the procedure. I have no strong opinion against or in favor of rapid-detox with naltrexone, although I can say I would unequivocally never consider this approach for myself.

Naltrexone is most frequently used after an opiate user has detoxed to help prevent them from using opiates and, ostensibly, to control cravings. It is available either by daily pill, an injection that lasts up to 30 days, or by a pump implanted under the skin that administers a regular dose. Some opiate users are coerced into having these implants or injections by drug courts or other authorities. I have been voluntarily offered this method but refused, insisting that if I wish to abstain it should be of my own volition, not because a pill or injection prevents me from deciding. There are also doubts as to the long-term safety of such a high dose of naltrexone and how one might respond to general anesthesia or pain medication when they are needed for legitimate purposes.

Long-term Effectiveness: inconclusive/10
Relief from withdrawal: inconclusive/10
Danger: unkown/10

Ibogaine Cure
Ibogaine is another controversial treatment for the treatment of opioid dependence (it’s also used to treat dependence on alcohol, cocaine, methampehtamine, and other drugs). Its administration is illegal in the United States and many other countries. As such, doctors generally take patients into international waters or they must travel to Mexico or Europe, where ibogaine is not as tightly controlled, to administer the treatment. This should be a red flag that it might not be entirely safe. While it’s estimates that 1 in 300 patients die from ibogaine treatment, there remains a mystical belief that ibogaine can provide a painless opiate detoxification method.

Ibogaine is a powerful hallucinogen. One can’t help but be reminded of Burroughs’ long-time obsession with ibogayage/ayahuasca, a South American hallucinogenic vine that was at one time, and still occasionally is, thought to be a heroin cure. The drug reportedly helps patients resolve the mental and emotional issues that caused them to begin using drugs in the first place. Some patients have reported having no desire to use again after an ibogaine cure, but there aren’t enough statistics enough statistics to prove any conclusive benefit.

Due to the difficulty of obtaining ibogaine and that it must be administered over several days by a dedicated medical professional, this method is out of reach to all but the wealthiest addicts. Even if one has the money, this route should only be pursued as a last resort and after much independent investigation.

Long-term Effectiveness: inconclusive/10
Relief from withdrawal: inconclusive/10
Danger: 9/10 (reported to carry 1 in 300 chance of death, often administered by quack doctors)

Exercise — No, Really!
Believe it or not, exercise is actually one of the best cures for opiate withdrawals. Putting this into action, though, is easier said than done. During withdrawal, users generally don’t have much reserve energy, if any at all. It seems counter-intuitive, but taking just 10 or 15 minutes to do some moderate anaerobic exercise (like running, jumping rope, push-ups, etc.) can result in a substantial improvement.It’s thought that exercise either releases endorphins or helps the body to regenerate them more quickly (endorphins are chemicals inside our bodies that act much like heroin, and an acute lack of them during withdrawal is the reason we suffer dope sickness).

Exercise is perhaps one of the best, and certainly the safest, cures for dope sickness. It might be impossible during the first several days of acute withdrawal, when even moving out of the bed seems too monumental a task to complete, but during the following weeks and months of post-acute withdrawal it can result in dramatic improvements in mood and energy levels. Exercise is also one of the best defenses against relapse. Keep all that in mind when you’re feeling awful and don’t think you can bring yourself to make that first step. You won’t regret it.

Long-term Effectiveness: 8/10
Relief from withdrawal: 5/10
Danger: 0/10 (aside from physical injury)

Recovery Programs: Twelve Step vs. SMART Recovery
For many decades twelve step programs like Alcoholics Anonymous and Narcotics Anonymous have been the gold standard for long-term recovery from addiction. I find their reputation for success misplaced, especially when one considers the success rate of these programs is consistently around 5-10%. Nonetheless, with no alternative, most rehab facilities and addiction specialists have preferred this method, thinking that former drug users are the people most able to help active drug users address the “spiritual defects” that led them to use in the first place.

The belief that defects of the spirit or character have caused people to turn to drugs is both misplaced and dangerous. Recent research has shown that people start using drugs for a variety of reasons. Defects in their personalities are rarely to blame. Habitual drug users often suffer from mental illness, such as depression, anxiety, bipolar disorder, schizophrenia, etc., or emotional trauma, or they find themselves victims of life circumstances, like poverty, homelessness, and stress, that lead them to seek some relief in drugs.

Anyone can become physically dependent on drugs like heroin or benzodiazepenes and alcohol. The fact that most illegal drugs are extremely effective in treating the situations users are initially attempting to escape causes a psychological dependence that many find impossible to break. They’re no more spiritually defective than the next person. In fact, many drug users have a strong sense of morality and have had to build up a number of survival skills they find useful even after their addictions.

This is not to say users don’t need help recovering from dangerous drugs; however, research suggests that most users of dangerous drugs who quit generally do so of their own accord, only after having failed to find success through twelve step programs and rehabs that insist on an abstinence-only approach. Having been exposed to these sorts of programs, as well as medication assisted treatments like as methadone or suboxone maintenance, I tend to agree with the research that suggests the effectiveness of methadone and suboxone at helping users avoid long-term continued use of heroin and eventually become abstinent.

One of the most effective recovery programs I have found, and which marked a dramatic shift in how I looked at drugs and recovery, is SMART Recovery. SMART is based on scientifically proven cognitive-behavioral therapy (CBT) that teaches users to change their thinking around drugs rather than blame their addiction on their own shortcomings. It is most often led my a medical expert in addition or a trained facilitator and accepts medication assisted recovery under the care of a qualified doctor, which most twelve step programs do not. In fact, most twelve step programs insist on complete abstinence, which for heroin and opiate users can prove dangerous and deadly. Many heroin users leave twelve step rehab programs only to return to using and, having lost their tolerance, die from overdose. I have seen several friends and former using partners die this way and I hold the negligence and intolerance of the twelve step approach, and their fundamentalist insistence on complete abstinence at all costs, at least partially responsible for their deaths.

For me, the most important aspect of the SMART and CBT approach was that I wasn’t made to feel that if I did slip up and use once or twice that I’d be a complete failure who must start over from scratch. In fact, SMART distinguishes between different types of using in such a way that it entirely shifts the thinking about using and recovery. If a SMART patient uses once or twice, it’s considered a slip, and it’s not a big deal provided they get themselves back on track. A short period of regular use is called a lapse, which is more serious, but not cause for alarm, provided the user still applies the tools they’ve learned to stop using again. A prolonged period of regular use is known as a relapse, which is cause for concern and which places the user at considerable risk. Even after a relapse, a user in the SMART program is accepted back without shame or being forced to start over at the beginning. There is a belief that even after falling off the wagon, users with a desire to recover can make progress and learn from their mistakes. Contrast this with the twelve step approach that requires users who slip up even once to start over, accept a white chip of surrender, and become the subject of gossip and rumours within their recovery community and social circle. I’ve seen many twelve step members slip once, even when taking a substance other than their preferred drug of choice, and use this supposed failure as an excuse to descend into a full relapse, since they have to start over at the beginning (or that they haven’t yet “hit bottom”) and think they have nothing to lose.

I continued to dabble in heroin on occasion during my time in SMART Recovery, even when taking methadone. Knowing these were merely slips or lapses and that I could bring myself back toward long-term recovery helped prevent me from veering toward daily heroin use and full relapse. I credit a combination of SMART Recovery, methadone maintenance, suboxone treatment, and a strong and caring support network with helping me achieve long-term recovery. Likewise, I have seen several friends die or revert to long-term addiction during twelve step programs. There is a growing acceptance of SMART Recovery, suboxone treatment, and cognitive behavioral therapy in the medical community. Recovery programs with a financial stake in the twelve step model have been dangerously slow to adapt.

Long-term Effectiveness: Twelve Step – 2/10, SMART – 5/10
Relief from withdrawal: Twelve Step – 0/10, SMART – depends on treatment
Danger: Twelve Step – 5/10, SMART – 1/10 (some AA/NA concepts often result in relapse or overdose)

Overdose Stories and Losing Friends
(coming soon)

Naloxone and Harm Reduction
At some point during my drug use I was exposed to hepatitis C, which can be a debilitating and life threatening disease. I was fortunate to receive wonderful medical treatment that eliminated the disease and was equally lucky not to have been exposed to something more dangerous. Many intravenous drug users share needles because they are often difficult or inconvenient to obtain. Some buy needles on the street that might have been previously used.

In many states it is illegal to possess or distribute needles without a license. Fortunately, there are underground harm reduction programs, many born during the AIDS crisis of the 1980’s, that operate needles exchanges using extralegal methods. While otherwise hard on drug users and sellers, police often turn a blind eye to such programs due to the extraordinary benefit to the community, or at the very least the fact that they themselves are thus less likely to be exposed to hepatitis C or HIV.

In recent years, harm reduction programs have also focused on teaching drug users to use drugs more safely and provide naloxone, a drug that can almost always reverse opiate overdoses, to users. Such methods have resulted in the saving of countless lives that would otherwise have been lost to addiction and overdose. I was exposed to a harm reduction coalition in my city following the overdose death of a close friend. Within a period of less than two years, a small group of harm reduction advocates, former users, and people who lost loved ones to overdose, were able to pass one of the most comprehensive laws providing naloxone access to the public and protecting those who call for emergency assistance from arrest when calling for help with an overdose. Such protections and access to life-saving naloxone saved (at least) over 200 lives in the first years alone. Similar measure have been adopted in many other states.

If you must use heroin or other opiates, I strongly encourage you to get a supply of naloxone and get yourself and your using partners trained in its administration and other overdose prevention methods. While it might not always be possible, using with another person can greatly recude the chance of an overdose death. If one person overdoses, the other can administer naloxone or call for help. It’s nothing short of a miracle that such laws are being passed, given the harsh language around drugs and addiction from politicians, and it’s equally amazing that harm reduction methods are being accepted in the medical community. Such developments give one hope that more effective treatments for drug use and recovery will gain broad acceptance and save more lives in the future.

Mental Illness and Emotional Trauma
Many longtime users of hard drugs suffer from some form of mental illness. These conditions are generally present before the user starts drugs, but are frequently exacerbated by the drugs and withdrawal. It is extremely common for drug users to self-medicate these mental illnesses or pain, or a combination of both. I suffered from bipolar disorder, general anxiety, post-traumatic stress, and other conditions, which certainly existed before I started using drugs. It’s unclear whether this was made worse by the drugs, but it certainly made the acute withdrawal, and especially the extended post-acute withdrawal, more difficult, and probably contributed to many relapses. After tapering off suboxone I finally sought professional medical treatment from a psychiatrist (not a therapist, which I feel only increased anxiety issues and a tendency to relapse). This treatment and the medication have helped me to maintain abstinence from opiates. While I don’t feel “normal,” I feel more functional than I did before or during my drug use.

Even if you don’t wish to stop using drugs right now, if you have the resources you would be well-advised to seek a mental health evaluation from a medical professional. It should go without saying, but a blood test for hepatitis C and HIV would be a wonderful idea also.


National/International Resources:
Harm Reduction Coalition: http://harmreduction.org/
SMART Recovery: http://smartrecovery.org/
Students for Sensible Drug Policy: http://ssdp.org/
Methadone Clinic Locator: http://www.methadonecliniclocator.org/
Suboxone Doctors Locator: http://www.suboxone.com/treatment-plan/find-a-doctor
National Alliance on Mental Health: https://www.nami.org/
Heroin Helper (helped me many times): http://heroinhelper.com/
Drug User Activism and Unions: http://druguseractivism.org/

Resources in the Southeastern US:
Atlanta Harm Reduction Coalition: http://www.atlantaharmreduction.org/
Georgia Overdose Prevention: http://www.georgiaoverdoseprevention.org/
Nashville Harm Reduction: http://street-works.org/
New Orleans Harm Reduction: http://nolaharmreduction.tumblr.com/
North Carolina Harm Reduction Coalition: http://www.nchrc.org/
Southern Harm Reduction and Drug Policy Network: https://www.facebook.com/Southern.Harm.Reduction.Network