Dunno why, but I seem to have paid short shrift to sharing detox experience on this blog. Which is weird, because I 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 gotta say that none of this is medical advice or a substitute for it. If you want medical advice, please consult your doctor.
OK, one addict to another. About the length of time it takes to get off OxyContin—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.
- Why 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 detox 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 it indefinitely rather than to use it as a tool to get free.
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 strictly 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 my night-table drawer. 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; 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 emergency 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 it?—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 braggin here, I’m just sayin: 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/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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