Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

How To Detox From OxyContin And Other Opiates

OxyContin

OxyContin tabs in a candy-colored rainbow.

Dunno why, but I seem to have paid short shrift to sharing detox experience on this blog. Which is weird, because I’ve got so many stories about opiate detox and recovery.

Received an inquiry recently about how to detox.

What do you know about getting off of OxyContin?—the length of time it takes, how safe it is, and what could the consequences be of going off too quickly. Do you have any idea?

Yes, I have some idea. Thanks so much for asking.

First I must say that none of this is medical advice or a substitute for it. If you want medical advice, please consult a doctor.

From one addict to another. About the length of time it takes to get off OxyContin—this depends on a few factors:

  • The level of Oxy you’re taking. (It could be any other drug. Not to put too fine a point on it: with the exception of methadone, Suboxone and tramadol, an opiate is an opiate. Heroin is Oxy is morphine is Vicodin is dilaudid. Even fentanyl is pretty similar, though it’s fat-soluble. They’re all short-acting full-agonists—though their dosage equivalencies differ.) If you’re taking maybe up to 120mg of oxycodone, chances are you could taper just using Oxy, following some rules for tapering that are few but non-negotiable. If you’re on a level that’s a lot higher than that, you might need some help. However, only you can tell, right? You know your own limits. I’ve known people who have detoxed cold-turkey off 600-800mg Oxy.
  • The reasons you started taking pharma-grade painkillers in the first place. If you have pain, you’ll need to work on figuring out other ways of managing it. Many non-opiate treatments exist that may help, depending on the circumstances. It may take time, consultation with professionals, patience, and a process of trial and error.
  • Whether you’re taking the drug “as prescribed” (i.e., swallowing it whole), or “not as prescribed” (i.e., chewing/snorting/shooting). OxyContin is also a bit difficult to taper from because you can’t split them. So another factor is the strength of dose you have available to you. One of the cardinal rules of a taper is: swallow whole, on schedule. If you can’t take your proper dose of Oxy on time and swallow it whole (I mean what addict can?), then you may need the help of a reliable detox doctor. (Operative word here: reliable. How I chose my doctor: I called the most reputable rehab in town and asked if I could please pay them to run my outpatient detox. When they said No, I asked for the name of someone else who might do it. Then I called my primary care physician and asked for her top referral. When they turned out to be one and the same person, I knew I had my guy.)

Let me also mention that the person who asked today’s question apparently got the idea from this blog that Suboxone treatment was Not Good. I’d like to correct this impression: Suboxone can be a very effective tool if it’s used properly. I myself got off an enormous level of opioids using Suboxone and Subutex. The danger comes when vulnerable, fearful detoxing addicts are encouraged to stay on enormous doses indefinitely rather than to use it as they often want to use it—as a tool to claim their right to lower their chemical load.

Using Suboxone or another drug as a detox tool doesn’t necessarily mean we’ll be “substituting one drug for another.” I mean, in a sense we are, but only for a short period, and under a doctor’s guidance. This can mean all the difference between addiction and recovery. … When I was detoxing with Suboxone, I did not write the taper schedule, my doctor did. I had to visit him every week, and later every other week; I paid him $80 a crack, aside from what I paid the pharmacy for the weekly prescriptions, and it was worth every penny to get free. I keep the receipts for my detox doctor’s visits in the drawer of my nightstand. The equivalent of my parents burning their mortgage (which they did, literally).

The reason I chose to taper off drugs using Suboxone is that I was on such an enormous level—more than 100mcg/hr of fentanyl. I was prescribed one patch every two days, and because I did not always take them as prescribed, I used a bit more than that. Fentanyl is a crazy-strong drug, it’s what they give you when you go in for surgery, and this level is roughly equivalent to 400-600mg morphine or oxycodone per day. Somehow my lizard-brain knew it was going to be impossible for me to taper off that level of fentanyl, or get enough of another drug to equal that level so that I could taper. And anyhow, I’d never been able to taper off a full-agonist—a drug that plugs into the receptors and stimulates them fully, like heroin, oxycodone or morphine.

Read Dr. Scanlan’s interview about Suboxone: it has a long half-life, which means it doesn’t create as much of a buzz as the short-acting drugs like oxycodone. As long as you keep tapering, and you have a doctor willing to help you keep the taper short, you can get free with Suboxone.

How safe is detox?—Opiate detox is not life-threatening. In contrast to alcohol withdrawal and detox from benzodiazepines (Valium, Xanax, etc.), both of which can cause life-threatening seizures if done too quickly, detox from short-acting opiates can be done safely at home. A “cold-turkey” detox happens in two phases:

  • Acute detox, which lasts 10-14 days or so (depending on level of use), in which the body excretes the drug and, in doing so, experiences signs of active withdrawal such as runny nose and eyes, sneezing, goosebumps, shivering, loose bowels, and restless legs and arms (kicking). All this means the body is healing.
  • Post-acute withdrawal syndrome (PAWS), which lasts an indefinite period (depending on level of use and how well we take care of ourselves), in which the body’s opiate receptors heal and the body learns to produce endorphins again. Most people find exercise and good nutrition help a great deal, as does some kind of support plan.

I can hear some folks out there thinking, “I think I’m endorphin-deficient.” I love hearing people register this claim. I used to believe this about myself before I got on drugs like fentanyl. Then, after I got on drugs like fentanyl (and morphine, and OxyContin, and whatnot), I used to believe that I’d MADE my body permanently endorphin deficient, so I should just stay on the drugs forever. Addiction lizard-brain. … Today I lift weights and cycle 30 miles and play tennis. I do all this having been diagnosed with two painful neurological disorders. I’m not bragging here, I’m just saying: I’m NOT endorphin deficient. If I can get off this stuff, I think anyone can.

The consequences of going off “too quickly”?—There is no “too quickly,” imo. If one is addicted, the only dangers are not quickly enough, or not at all. However, if your level of use is high, and you have kids and a job and still want to function during detox (as I did), it might be worth it to slow the detox down. I’ve always compared detox to learning how to land a plane. Not that I’ve ever landed a plane. But I imagined being in the pilot’s seat, and taking direction from the tower (higher power/physician/recovery community, etc.), and telling the tower I needed either to make a quick-and-dirty landing or a long slow smooth landing.

You can do either one safely. The first takes a lot less time, but it might be a rougher ride. The second is much smoother, but there’s more time to worry about whether you’re gonna crash. Which is why it’s helpful to get support, not only from a doctor but also from a community of people who have been through similar stuff.

Detoxing was one of the best decisions I ever made. It was the start of a new life.

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3 Comments

  1. I’m up with insomnia right now 10 days after detoxing cold turkey from Dilaudid (Hydromorphone) which had initially been very therapeutic medically but, like so many others here, became a crutch for me during a time where I was forced to face intense PTSD and other old emotional issues. I was popping pills like candy, and always hiding it from my partner. He knew I was taking them, he knew I was a bit concerned about addiction, but he had no idea how many I was taking or how often. The shame of it all was weighing on me so heavy, it was influencing my mental health enough to take even more. So I say – tell your wife. There is no shame in struggling – we are all human. It sounds as thought you are struggling with guilt and shame and a great desire to change, and I’m certain that anyone who loves you will want to help you. We can’t do this alone. I thought I could, and didn’t even tell my extended family until after I was ‘done’ my detox (doctor said 2 days…pfft. ya right, I wish) because of embarrassment as my family is religious also. This was an old post so perhaps you’re already past all this but I wanted to share, and hell, I’m awake with intolerable insomnia anyways so might as well! Blessings to you.

  2. I came online tonight about 10 days into insomnia from detoxing on Dilaudid – I originally was just looking for good crystals or a good meditation to help with the insomnia that has been plaguing me, and somehow stumbled across this site. I am grateful to see the honesty that the acute phase of detox is actually 10-14 days, rather than the ‘2 days’ or ‘weekend from hell’ that my doctor described. I am trying to take care of my body best I can during this time to maintain a good physiological balance (energy work, chiropractic, acupuncture, herbs/supplements, etc) but the insomnia has not abated. They gave me Valium – it made me depressive and didn’t work so I threw it out. Then they gave me Zopiclone – again, made me feel like I had no point in living and didn’t really keep me asleep through the night. So instead of tossing and turning and keeping my poor partner awake, I figured I’d come find a solution, or at the very least switch my brain power a bit before heading back in for another go. Thank you Guinevere for your honest website. I plan to keep up with it while I am struggling through this phase – at least now I know its normal and I will eventually sleep again. If there’s a light at the end of the tunnel, its much easier to go through. 🙂

  3. Sound advice. Touching upon the “endorphin-deficient” mindset is incredibly important. I work at a treatment center and a number of my patients tell me that they lost all hope for ever feeling “normal” or experiencing a normal level of happiness because the high from drugs was just too great and incomparable to sobriety. But in my opinion, the extreme levels of happiness being “high” gives you comes at a price – the withdrawal stages, the comedown, etc… What goes up must come down sort of thing.

    I think a common denominator between everyone going through detox is learning how to stay at ‘base level’ and how to be OK with that. Life naturally brings you up – and down – and up again… and you don’t need to artificially recreate those “waves” drastically using substances…

    I went on a tangent a little, I think, but this was a good read. Thank you for touching upon the myth of the endorphin-deficiency. For anyone reading this, recovery is possible for anybody. I’ve witnessed it firsthand with a number of patients. And while it is incredibly admirable that you were able to detox at-home, I do want to add a disclaimer that there is no shame in seeking help.

    Just my two cents.

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