Opiates have attracted more and longer-running public concern than any other drug except alcohol. (An online search for alcohol rehab in Los Angeles still returns 8–10 times the results as one for opioid rehab, though few official statistics are available.) Opium poppies were cultivated in the Middle East nearly 5,500 years ago; opium was used as medicine in ancient Greece and China. The first opiate to generate widespread addiction awareness was morphine, discovered in 1806 Germany but drawing major attention after its use by Civil War army doctors led to high addiction rates among veterans. Heroin was the drug of addiction concern from the 1960s through the early 1980s—the same time period when the medical community’s indiscriminate use of oxycodone-based painkillers was laying foundations for today’s prescription-opiate-addiction epidemic. As recently as 2000, the hospital-accrediting Joint Commission declared, “There is no evidence that addiction is a significant issue when persons are given opioids for pain control.”
Of course, all this should be adequate evidence that the odds are against a non-addictive opioid’s ever being discovered. Even methadone, still used in heroin treatment centers as a safe replacement drug, causes enough addiction to rate a pageful of its own drug treatment centers in Los Angeles alone—and so far, no alternate opiate has been proved to have a better record.
All of which to say, there’s a pile of opioid types and a dozen ways to become addicted—and getting off is never easy or pleasant. The #1 rule to remember:
1. Always get professional help.
While “cold turkey” withdrawal is somewhat less dangerous than with some other drugs (the opiate-addiction world has few stories like those of actor Nelsan Ellis, who died during an attempt at home alcohol rehab, the Los Angeles Times reported last year), that doesn’t make it safe. Detox treatment centers are prepared to deal with medical emergencies arising from impaired thinking, intensified opiate cravings, vomiting and chills. Home detoxers aren’t.
2. Know what symptoms to expect and how long they’re likely to last.
It’s easier to stick out even major discomfort if it doesn’t catch you by surprise and if you can see an end point. The typical opiate withdrawal timeline goes as follows (except for methadone, with which onset and symptoms take 2–3 times longer):
- 8–12 hours after last drug dose: Feelings of depression and wakefulness, nausea, cramps, diarrhea.
- 48–72 hours after last dose: Increasingly severe nausea and abdominal cramps, heavy diarrhea, vomiting, violent shivering, cramping in legs, high agitation or a sense of despair, severely impaired thinking accompanied by delusions or hallucinations.
- 3–14 days after last dose: Most physical symptoms abate. Patient continues to experience anxiety, insomnia and recurrent relapse cravings.
- 14–90 days after last dose: Emotions stabilize, relaxing becomes easier. Periodic urges to relapse persist, especially in stressful situations and old “need a fix” settings.
- 1–2 years after last dose: Most temptations to relapse are gone, though susceptibility to reactivated addiction usually lingers for life.
Your detox center will provide more information.
3. Know the risks of treating opiates with opiates.
Google “methadone treatment center Los Angeles” and taste a frustration rarely experienced by anyone researching prescription-opiate or heroin treatment centers: you get as many results for clinics treating with methadone as for methadone. Although methadone rarely causes the physical and social problems of heroin addiction, it does numb mental facilities—and it’s extremely difficult and often dangerous to withdraw from. The best defense is prevention: if you’re planning to get off heroin or a prescription painkiller, think long and hard before considering any treatment center that uses alternate-opiate maintenance. Talk with your own doctor about how your body will likely react to drug-assisted vs. non-drug-assisted withdrawal. And never risk a methadone-maintenance program without verifying in advance that the treatment center will help you discontinue it as soon as possible.
4. Choose your clinic carefully.
Whatever approach you prefer, be aware that drug treatment centers in Los Angeles (and the rest of California, and much of the United States) register and operate with few legal restrictions. Double-check your clinic for an established track record and sound reputation. And visit in advance for a tour of the facilities and a talk with treatment providers.
5. No matter how bad withdrawal symptoms get, remember that mid-detox is the most dangerous time to take another dose.
As your body struggles to wean itself from opiate dependence, it not only becomes physically weak, it begins to lose its tolerance—its ability to resist the most dangerous effects of the opiate. In that condition, what was recently a “normal” dose puts you at major risk for a deadly overdose.
6. After the worst of withdrawal is over, treat yourself gently and rebuild your physical strength.
Get lots of rest, drink plenty of water, and eat lots of healthy food (without gorging yourself—your digestive system is probably still weak). As your energy returns, talk with your detox supervisor—and, later, your doctor—about easing into regular healthy exercise.
7. Plan on staying in rehab for a while—up to three or four months—after physical symptoms abate.
You aren’t out of danger yet: going straight back to “real life” means you’ll likely react to the same old provocations with the same old self-medication—which could mean greater overdose risk and a harder second-time-around in detox. You need a break from as many stressors as possible.
8. Get therapy to explore the issues behind your addiction.
Most detox treatment centers provide counseling as a matter of course—it’s vital for finding alternate solutions to your problems and learning to avoid situations that might trigger relapse.
9. If your addiction was to a prescription drug, explore alternate ways of coping with the problem it was given to treat.
There are many ways to ease physical pain without drugs: the most common involve relaxation, mindfulness and/or some form of touch therapy. In any case, make sure that any doctor who writes you a future prescription knows about your addiction history and understands any possible risks—and never go outside official directions for taking any prescription.
10. Create a long-term sobriety plan to minimize relapse risks.
This plan—designed with help from detox therapists—should include an understanding of likely relapse temptations, how you’ll cope with them, whom you’ll call for support in a tough situation, how you’ll help your loved ones support your recovery, and (just in case) how you’ll minimize damage in case of relapse. Also create a list of goals based on your personal passions, to ensure you’ll have plenty worth staying sober for. Being prepared for life’s inevitable challenges, and taking whatever control you can, is essential for not only getting off but staying off opiates.
Inland Detox is the top alcohol and drug treatment center for Los Angeles and the rest of southern California. If you or a loved one struggle with opiate addiction, please call (888) 739-8296 for more information.