Kicking an addictive painkiller habit often requires prescriptions and counseling.
By the time Elvis Rosado was 25, he was addicted to opioids and serving time in jail for selling drugs to support his habit.
“I was like, I have to kick this, I have to break this,” he said.
For Rosado, drugs had become a way to disassociate from “the reality that was [his] life.” Plus, he’d wake up physically craving the drugs “just to get well.” His body couldn’t function without it.
So his decision to finally stop using propelled him into another challenging chapter of his addiction and one of the most intense physical and mental experiences he could have imagined: detox.
“The symptoms are horrific,” Rosado said.
There are recovery and treatment centers that can help — in fact, it’s a multi-billion-dollar industry. But, despite ubiquitous TV ads, this help isn’t always easy to access. It can be expensive, and waiting lists for state- and city-funded programs are often extremely long.
So can detoxing on your own be the answer? Google do-it-yourself drug detox and the advice is endless.
But a growing movement within the field of addiction medicine is challenging the entire notion of detox and the assumption that when people cleanse themselves of chemicals, viola, they’re on the road to recovery.
“That’s a really pernicious myth, and it has erroneous implications” said Dr. Frederic Baurer, President of the Pennsylvania Society of Addiction Medicine.
Detox Part I: Flu on steroids
Rosado said he’d had a longtime love affair with codeine. Like oxycontin and morphine, it’s a strong pain medicine, a type of opioid. In jail, these drugs were just as easily available, Rosado recalled, through friends and cell mates.
But when he decided to stop, he didn’t ask for help from the jail’s clinic staff, who could have given him medicines for the withdrawal symptoms. He wanted to tough it out and detox on his own. Rosado said that, if he took anything, “in my head I was like, ‘I’m still using.’ That’s how I was seeing it.”
The first few hours were gradual, like the onset of the flu, he recalled. But then, the flu went on steroids. He was sweating and shaking. His heart was racing, and he was throwing up. 12 hours in, Rosado was reminiscing about how pleasant his weeks-long bout with severe food poisoning was compared to this. The stomach cramps felt like “having Freddy Krueger inside you trying to rip his way out.”
“It just gets really really bad,” he said. “I had days where I felt like I wished I was dead.”
He couldn’t sleep. He found comfort lying on the cold floor, shivering.
“My cellmate kept saying ‘Look at you! Use a bag or go to the nurse.’”
Detox Part II: Anxiety and “corrupted thoughts”
Over the next week that intense, worse-than-food-poisoning-Freddy-Kreuger-flu-on-steroids slowly subsided. He was exhausted, depressed, irritable, and sore.
But then came the next phase: the temptation to slide back.
“It’s a battle,” Rosado said.
He remembered a voice in his head telling him, “you can make it so much easier for yourself if you just give in. Take something, take a little bit. I’d tell myself that if I do a little bit, maybe I can gradually detox myself and get myself off of it and it would be so much easier.”
Anxiety kicked in. He couldn’t sleep.
When he did, drugs took over his dreams.
“Even though I wasn’t using, my thoughts were still corrupted,” he said. “There was this constant, like, ‘there’s something missing, there’s something missing.’ Obviously, the chemical.”
But is detoxing dangerous?
Most people can’t tolerate detoxing from opioids without support or medications to ease the withdrawal symptoms, according to Dr. Kyle Kampman, a psychiatrist who specializes in addiction at the University of Pennsylvania.
While withdrawing from alcohol or benzodiazepines can induce life-threatening seizures, when it comes to opioids, “for people who are healthy, it’s generally not a life threatening condition.”
Yes, diarrhea and vomiting from withdrawal can make a person dehydrated, and that can lead to severe complications, even death in some cases. And Kampman worries about the big risks of patients trying to self-medicate to avoid these side effects or drug cravings.
“If you’re going to use the medications that a doctor would use to do detoxification, which might be methadone or buprenorphine, or even a blood pressure medicine like clonidine or sedatives, all those medications are dangerous,” said Kampman.
They can have adverse interactions with other drugs, and in the case of Methadone, “there is a possibility that you could overdose” without physician oversight.
Regardless, is detoxing effective?
But Kampman’s biggest concern when it comes to detoxing is the extremely low success rate.
“What bothers me most in thinking detox is adequate treatment is that we know that it just doesn’t work,” he said. “We have a long history of putting people into detox, followed by drug free treatment that results in relapse in an overwhelming number of cases.”
And, if the patient goes back to using, there’s a higher risk of overdose because their tolerance goes down.
Addiction, Kampman says, isn’t something you can just flush out of your body. It’s a disease.
Three years ago, the director of the National Institute of Drug Abuse told a Senate committee the same thing:
“When people addicted to opioids first quit, they undergo withdrawal symptoms, which may be severe (pain, diarrhea, nausea, vomiting, hypertension, tachycardia, seizures). Medications can be helpful in this detoxification stage, easing craving and other physical symptoms that can often trigger a relapse episode. However, this is just the first step in treatment. Medications have also become an essential component of an ongoing treatment plan, enabling opioid-addicted persons to regain control of their health and their lives.”
Meanwhile, Dr. Frederic Baurer thinks it might do everyone good to abandon the whole notion of detox, period.
“I think the term detox has negative connotations,” said Baurer, who has been treating people with addiction for nearly three decades. He’s also been involved in a city-wide task force assessing the opioid epidemic in the region. “I would like to see detox as re-conceptualized as stabilization treatment planning.”
Baurer is medical director at Kirkbride Center in Philadelphia, a recovery center that has an in-house detox unit of 21 beds. But, according to Baurer, it’s a lot more than getting drugs out of a person’s system.
“It’s structured,” he said. Patients have reflection time. Their symptoms are monitored. They meet with counselors, come up with a long term treatment plan, and, perhaps most importantly, they get medications like methadone to manage the cravings. Such medicines can do this by targeting the same receptors in the brain as other opioids. But, it does so for longer periods of time, to break the withdrawal symptoms and cravings. Other options, like Vivitrol, block the opioid receptors and, in turn, a person’s ability to get high.
Baurer says there’s no one formula.
“We have to consider all the tools that are out there to support someone in getting well,” he said.
Finding his own path
Elvis Rosado said he first developed his coping tools in jail. The bars protected him from the temptations of his old neighborhood. He found support groups and counseling.
Still, he may be one of the lucky few who tried detoxing on his own and succeeded.
Since his own exit from jail, Rosado has since gotten degrees in mental health and social services, and even worked in treatment centers. He now leads overdose prevention efforts across the region.
He doesn’t think his detox approach is for everyone.
“If we don’t give individuals the time to start to have clear thoughts and put a plan together, getting the chemical out of their system, you’re not doing them any favors, you know?”
Rosado also credits his own long term success to a very specific conversation he had while he was still locked up. It came during a phone call with his girlfriend.
“She goes, ‘I’m pregnant, what are we going to do about it?’ And I said, ‘We keep it. We keep the baby.’”
Elvis recalls making a promise to himself in that moment to be a good father. And for him, at least, that’s worked. He recently celebrated 25 years drug-free.