Content note: this post talks about heroin and opioid withdrawal. There is no how-to here, on purpose.
I used heroin. I don't anymore, and haven't for sixteen years. I'm not going to tell you how I got off it, step by step. Partly because it's mine. Mostly because what happened to me is not a plan, and the last thing anyone needs is a guy on the internet acting like his story is a protocol.
What I will tell you is the one thing I'm sure of. The safe way through opioid withdrawal is with medical help. Not by yourself in a room. Not with a list of tips from a forum. A doctor, a clinic, an emergency room, a detox service, a helpline that can get you to one of those. Withdrawal itself is brutal, and it can make you dangerously dehydrated. But the scariest risk comes after withdrawal, and almost nobody using knows about it until it's too late.
Why you shouldn't do opioid withdrawal alone
Here's the part I wish someone had told me first.
When you stop using opioids, your tolerance drops. Fast. Your body forgets what it used to handle. If you go back to using, even once, even "just a little" compared to before, the amount you used to take can now kill you. According to MedlinePlus, from the US National Library of Medicine, most opioid overdose deaths happen in people who have just detoxed.
Read that again. The danger isn't only the withdrawal. It's the week after, the month after, when you feel a bit better and think you can handle one more time. I wrote a whole post on why relapse after years clean is so dangerous, because the same thing applies years later.
That's the biggest reason to do this with a medical team. They don't just get you through the sick part. They help you plan what happens next, so you're not walking out of withdrawal with a tolerance of zero and nothing in place.
What withdrawal is actually like
I'm not going to make it sound like a cold. It isn't. MedlinePlus describes symptoms like anxiety, muscle aches, sweating, insomnia, then cramps, nausea, vomiting and diarrhea. It calls them very uncomfortable but usually not life-threatening on their own. The problems come from what they do to you: vomiting and diarrhea can dehydrate you and throw off your body's salts and minerals, and that can turn serious.
What nobody puts on a symptom list is the head part. The dread. The bargaining. The voice telling you one more and you'll do it properly next week. For a lot of people, me included, fear of withdrawal is a big part of what keeps them using. If that's you, it's worth knowing that withdrawal with medical help can be much more bearable than the version you're imagining.
What medical help actually looks like
You don't need to have it all figured out before you call. That's their job.
Depending on where you live and how you're doing, it might be:
- An outpatient plan with your family doctor or a clinic, so you stay home with check-ins.
- A detox or withdrawal-management service.
- A hospital, if symptoms are severe or you have other health problems.
There are also medications for opioid use disorder. I'm not naming them and I'm not telling you what to take. That's a conversation for you, a doctor and a pharmacist. What the research says is clear enough to repeat: the National Institute on Drug Abuse reports that people with opioid use disorder who get these medications are less likely to overdose or die than people who don't get treatment. They also reduce cravings and withdrawal symptoms. Some people feel ashamed of them, like they're "not really clean". I think that's nonsense. Staying alive is the point. And if your use was covering something else, like depression or an undiagnosed brain difference, read dual diagnosis. It was for a lot of us.
Where to start, today
If you're in Québec:
- Drogue : aide et référence: 1 800 265-2626, free, confidential, 24/7. They'll tell you what exists near you.
- Info-Social 811, option 2, any time.
- Your family doctor, your CLSC, or the nearest emergency room.
In the rest of Canada, your provincial health line or an ER is a good first call. In the US:
- SAMHSA National Helpline: 1-800-662-4357, 24/7, English and Spanish. It's for treatment referral and information.
- FindTreatment.gov to search for services near you.
If someone is very drowsy, can't be woken, or is breathing slowly or not at all, call 911 right away. And if you or someone you live with uses opioids, ask a pharmacist about an overdose-reversal kit. Keep it where people can find it.
Asking for help isn't failing
For years I thought going to a doctor about my use meant I'd lost. Like real men white-knuckle it. That idea nearly cost me a lot. It's a stupid idea and I'd like it to die with my generation.
Peer support helps too, once you're through the worst. Narcotics Anonymous, SMART Recovery and other groups are free. I've got a post comparing NA and SMART Recovery. But groups are for after you're medically safe, not instead of it.