Detoxing off heroin or opioids without medication is sheer hell. I should know.
For many users, full-blown withdrawal is often foreshadowed by a yawn, or perhaps a runny nose, a sore back, sensitive skin or a restless leg. For me, the telltale sign that the heroin was wearing off was a slight tingling sensation when I urinated.
These telltale signals -- minor annoyances in and of themselves -- set off a desperate panic: I'd better get heroin or some sort of opioid into my body as soon as possible, or else I would experience a sickness so terrible I would do almost anything to prevent it: cold sweats, nausea, diarrhea and body aches, all mixed with depression and anxiety that make it impossible to do anything except dwell on how sick you are.
You crave opioids, not because you necessarily want the high, but because they'd bring instant relief.
Quitting heroin was my plan every night when I went to sleep. But when morning came, I'd rarely last an hour, let alone the day, before finding a way to get heroin. My first time in a detox facility, I made it an hour, if that. As I walked out, a staff member said something to the effect of "I didn't think you'd last long."
After my parents moved out of town, in part to get away from me, I would show up at their new home five hours away with big hopes of kicking the habit and starting a new life. But after a night of no sleep, rolling on the floor convulsing while vomiting into a steel mixing bowl, I'd beg them for gas money to drive the 300 miles back to where I lived and a little extra cash for heroin. I did this so often my mother once told me in frustration, "You show up, throw up and then leave."
Going through "cold turkey" withdrawal is, not surprisingly, impossible for many. That's why the medical community has largely embraced the use of methadone and buprenorphine -- known medically as medication-assisted treatment, or MAT -- combined with counseling, as the "gold standard" for treating opioid addiction. As opioids themselves, these drugs reduce craving and stop withdrawals without producing a significant high, and are dispensed in a controlled way.
"Detox alone often doesn't work for someone with an opioid use disorder," said Marlies Perez, chief of substance use disorder compliance at the California Department of Health Care Services, who estimated that it might be a realistic option for only 15 out of 100 people.
Studies have also shown that MAT reduces the risk of overdose death by 50 percent and increases a person's time in treatment.
Yet even with strong evidence for MAT, there is debate over whether to offer MAT for people struggling with opioids. Some states, like California, have vastly expanded programs: The Department of Health Care Services has 50 MAT expansion programs, including in emergency rooms, hospitals, primary care settings, jails, courts, tribal lands and veterans' services; the state has received $230 million in grants from the federal government to help with these efforts. But many states and communities hew to an abstinence or faith-based approach, refusing to offer MAT as an option. In 2017, only about 25 percent of treatment centers offered it.