August 24th, 2010
08:34 AM ET

How can I get clean from heroin?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Kenneth, Illinois

I don't understand how to get clean off heroin. I want to so bad but why do they make it cost so much? For Suboxone, you pay close to $350 for the visit plus $720 for a monthly prescription. Methadone is cheap, but my treatment center doesn't believe in methadone. Do you think methadone is that bad? I feel so lost.

Expert answer:

Dear Kenneth,

In the short question above you've really given voice to the horrible pain that is common in the world of heroin addiction. Recognize, please, that I can give you only general thoughts and that at the end of the day you will need to take concrete action to conquer your addiction with the resources you've got access to.

For the sake of our readers who aren't aware of the medications you refer to, let me make a couple of quick comments in this regard. Methadone, like heroin, directly stimulates opioid receptors in the central nervous system, and thus is subject to many of the same risks and liabilities as heroin. However, whereas heroin rushes into the brain when consumed, leading to an intense and very psychologically addictive "high," methadone comes into the brain slowly and stays there for quite a while at stable concentrations. These qualities allow it to take the place of heroin in terms of protecting against the horrors of opioid withdrawal and to do so in a legal and medically controlled manner.

Suboxone is a combination of a medication called buprenorphine and naloxone. Unlike methadone, buprenorphine acts like an opioid at lower doses and like an "anti-opioid" at higher doses. As a result it can protect against heroin withdrawal, but is not as likely to lead to abuse as is methadone. Naloxone is included in Suboxone as a strategy for further reducing the danger of abuse, because its presence guarantees that if the medication is abused it will immediately set off severe withdrawal symptoms.

People have very strong feelings about methadone. Some clinicians swear by it, others (such as your clinic) stay away from it altogether. If you take all the studies together, my sense is that methadone works as well as Suboxone for keeping people off heroin, but with a higher abuse potential. Neither Suboxone or methadone work all that well - meaning that lots of people still find themselves unable to quit using heroin.

I truly believe that the best way out of your predicament is to get help that would allow you to come off the heroin all together without being chained to some type of opioid or partial-opioid agonist therapy for the rest of your life. This is not something you can do yourself. Given the desperation of your question I am pretty sure that you would need inpatient detox and then intensive outpatient follow-up. I have seen this strategy release many people from the bondage of heroin. But having said this, if you cannot face doing this, or if it is not an option for you for monetary reasons, let me strongly emphasize that being in a methadone maintenance program is infinitely better than being enslaved by heroin.

soundoff (331 Responses)
  1. SubBoy

    Acupuncture works for about an hour. If you can't afford Suboxone, ask your doc for generic subutex, way cheaper, but does have abuse potential becasue it lacks the Nalaxone and some docs won't prescribe it. I read that Suboxone is coming out with a generic soon though.

    August 25, 2010 at 14:48 | Report abuse | Reply
  2. athena

    athenarising.blogspot.com Think about the innocent victims of heroin use, please.

    August 25, 2010 at 22:25 | Report abuse | Reply
  3. Dana Marie

    Acupuncture actually does work, but it is not a "magical" one-time deal. I will agree that the first time or two that you go, it only lasts for an hour or two, but the more you go the longer it lasts. I am lucky enough to have a free acupuncture clinic near me as it can be kind of pricey. However, if someone is SERIOUS about stopping an addiction, I think many places would be able to work with you on the fees.

    Another place you could look into is Teen Challenge. It's almost **FREE** (they do ask for a $500 donation, but the program is a YEAR LONG and they feed, house and clothe you. If you don't have that kind of money, they work something out with you) Don't let the name fool you - it is 90% ADULTS (plus adults & teens are not together). It is a 12 -18 month long Christian based program and there are facilities all over the nation. If you have insurance, they will take it. If you are living in the gutter and have nothing... they'll just take you.

    This program is highly successful. Depending on the year and the participants at any given time, it has between an 84% – 97% success rate for those who *Complete* the program. (Some people go in the program and leave after a few weeks). State run rehab programs average about 7% success rates.

    The first 8 weeks or so (depending on the person) is focused on the addiction aspect and the rest of the time is spent teaching people how to live an Addiction Free life. Before you are released from the program, they make sure you have a place to live and proper social support, etc. This is WHY it is so successful. Many places take you in for 30 – 60 days, get you off the stuff, but don't teach you how to live a 'clean life' and then set you back out where you came from.

    Teen Challenge even has facilities for people with children... where they can live together as a family, but with proper supports. The parent does have to go through the first phase alone and get past the addiction part before being reunited with their children.

    I have NOTHING BUT PRAISE for Teen Challenge. When I came home from the Army, a number of my friends were in over their heads in addiction. Mostly crack, meth and/or heroin. It was the most heartbreaking thing I could ever imagine.

    I've been able to help quite a few people into Teen Challenge - and while a handful weren't quite ready to give up their addictions - the ones that were... My heart just smiles with how awesome they are doing in life!

    Obviously, this isn't for everyone as not everyone is Christian, but I'll tell you this much - when a person quits their addiction, there is a HUGE Void in their life. TC teaches how to fill that vacuum with Positive activities. If an addict has too much time on their hands, it can lead right back to the trouble they came from.

    Here is a link to Teen Challenge in case you are interested: http://teenchallengeusa.com/

    And anyone who finds they appreciate what Teen Challenge does... feel free to donate - and it doesn't have to be money.
    They need clothing, towels, bedsheets, blankets, you name it. Clean out your closets and give what you no longer use to someone who would use it as they get their life back together. Or, if you only have a couple bucks and think your $5 or $10 wouldn't make a difference... go hit up a $1 Store and pick up a couple soaps or deodorants or toothpastes/brushes.

    I'm telling you, EVERYTHING is provided for these lost souls as they put their lives back together and it comes through 100% donation.

    Hopefully this information will be able to help someone. 😉

    August 25, 2010 at 22:57 | Report abuse | Reply
  4. Joycelyn Woods

    Dear Kenneth and Dr. Raison:

    It is unfortunate but heroin addiction and opiate addiction is a chronic disease and you will be living with it for the rest of your life. I also have a degree in neuroscience and did some of the early studies on opiate receptors at Rockefeller University. Right after that the HIV epidemic arriced and I felt that I was needed elsewhere - I knew how to reach drug users at risk and I knew research. Withdrawing from any opiate followed by a program works for some who have not used opiates for very long. However for some people it does not matter how long they have used for the remained of their days they willl need a medication. And there is nothing wrong with needing a medication for a chronic disease. Like all chronic diseases methadone and buprenorphine do not cure the disease but they will allow you to live your life like a normal person. The problem with opiate addiction is the great risk of relapse. Everyone who was an addict thinks their way is best. What is really best is what is best for you and only you can figure that out. Realize also that opiate addiction can damage the brain and that evertually it will heal but when the brain is placed in a steady state with medication iot will heal faster. Depending on your age this may not be a factor because it will take a long time to heal - maybe never. The problem is that if you relapse you are the one that suffers - so use others advise as only that. I know it is perhaps the most difficult when you are using drugs because your brain is not working at its best to start with and now you have to make decision that are live saving. Buprenorphine is better for younger addicts who evertually will probably be abstinent. Even then take your time and if you realize that you may need medication for the rest of your life you can move to methadone. Methadone works for just about everyone. It does not have the issues that buprenorphine has - if you need pain medication, are neat the age of needing pain meds it is not for you. If you have used heroin for a long time it is also probably not for you because the dose has a ceiling effect and probably will not stop on drug craving. Methadone has its problems too. It is highly stigmatized and greatly misunderstood. No it is not harder to get off of than heroin. It you do it right. However getting off drugs should not be your focus - what you should be doing is to get your health and then life back together and for most people that have used heroin that is many years of long work. I have been a methadone patient for over 30 years and no I will never withdraw because I know I would relapse - I always did before and I don't want to risk what I have gained. If you use methadone as a tool for recovery and find a program that provides quality s treatment in three years if you follow the program you can be moved to once a month. If you live in some areas you can actually be treated in a doctors office. That is called Medical Maintenance for patients that have recovered and just need their methadone.

    I also suggest you can get help from our advocates at National Alliace for Medication Assisted Recovery (formerly National Alliance of Methadone Advocates). We have advocates and healthcare persons (and both) that can help you at our forum We Speak Methadone. (but we also speak buprenorphine too).

    Joycelyn Woods, M.A., C.M.A.
    Executive Director
    National Alliance for Medication Assisted Recovery
    NAMA is an RCSP Recipient
    Together we can make a difference.

    August 29, 2010 at 18:10 | Report abuse | Reply
  5. SubBoy

    Thank you Ms. Woods! That was some of the best information I've read! I wish there were more doctors with your knowledge. Thank you!

    September 14, 2010 at 14:13 | Report abuse | Reply
  6. kwitcherbellyakin

    No one mentioned why people get addicted, not the pharmacological chemistry, but the high. For those who don't know, it is an other worldly internal warmth, false peace and chemically induced serenity (during the honeymoon phase. After that, well Rollingstonemag wrote a very succint article about 25 years ago on maintenance junkies and there is NO fun in being 70 and needing just enough junk daily as elderly may not make it through the electrolyte imbalance caused by detox puking.) Never having done Oxy or Meth, I can't compare. Thank you God as I think I'd be dead by now had Oxy been around before I quit. Meth was being shot-up right before my eyes but in the early 70's Frank Zappa and some other musicians did some PSAs on getting methed up (Zappa pun intended.) Frank said Meth was bad, so I did everything else. In recovery what I learned; life is a pie chart with sections of stuff we like and can tolerate and stuff that is downright awfully painful. All part of the life~pie. Instead of avoiding reality, be glad to have a new day to give instead of get. Giving feels good. If everyone gave a little more, complained a little less..... Of course when addicted all your personal brain pharmacy is getting dumped and you're out of enough Dopamine & Seratonin to not scream at the Girl Scout ringing your doorbell to sell cookies, forget the altruism. It becomes all about me. My stash. My fix. My high. Get high on life clean is corny as hell, but is do~able and worthwhile! God bless each who is clean today, those looking for help, those offering help and those still suffering but having what they think is a really good time. God Bless, 22 years clean.

    September 21, 2010 at 14:09 | Report abuse | Reply
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    Vicodin is a drug widely used in hospitals and that this proved that it is good to control chronic pain, but as stated in findrxonline, has side effects that can be dangerous if not taken in an appropriate manner.

    October 2, 2010 at 18:57 | Report abuse | Reply

    My son is addicted to heroin, he just got arrested and has been calling me constantly to get him out of jail because he is going through withdrawal symptoms, he is going through alot of pain, throwing up, diarrhea, this is what he tells me when he calls me asking desperately to bail him out, can he go cold turkey in there, will something happen to him? I am going out of my mind, My heart is hurting terribly, this is my child no matter what age he is. I don't want to bail him out just yet, how long do you think it will take him detox in jail. Thanks, depressed MOM

    December 11, 2010 at 06:57 | Report abuse | Reply
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