Going Cold Turkey
June 4, 2006 1:28 AM   Subscribe

How do I go cold turkey? Several months ago I had an injury and was prescribed pain killers (synthetic opoid, medium dosage). The injury is mostly healed and although I still have some pain it's at a level I can probably live with until I'm fully healed. But now I find that I'm addicted to the pain medicine. When I stop taking it, within 24 hours I'm itching and twitching so much that I have to start taking it again. I've decided not to prolong the situation and pick a suitable time to just stop taking it. But I'm nervous about the process and the risks involved. How do I go about setting up a time and place to go through withdrawal? How long will it take, what will it be like? I want to handle it myself, with help from friends and family. I'm looking for pointers to websites, personal stories, anything that can help me prepare for going through this.
posted by anonymous to Health & Fitness (20 answers total)
While I understand you wish to "handle it" yourself, I would suggest either setting an appointment with the physician who prescribed the medication or (if they are not one in the same) your primary care provider and talking to he/she about the situation. If there are risks involved, you need may their assistance to manage them.

Look up the medication here. There are sections relating to precautions, etc. that may give you the information you seek.

In the future, since you seem to have a proclivity toward dependence with this type of medication, you may want to avoid further prescriptions of its type and inform the prescriber who attempts to write a rx for you that you would prefer a non-narcotic alternative if one is available.

Suggestions all. YMMV.
posted by sillygit at 3:38 AM on June 4, 2006

I agree with sillygit. See your physician. There may be uncomfortable side effects and there is a fairly new drug on the market for people in your situation. You can take it to get you through those rough spots, which will greatly increase your odds of successfully getting off the drugs.

There is lots of information Here
posted by Jandasmo at 3:56 AM on June 4, 2006

(Sillygit and Jandasmo posted while I was writing this. Basically, I'm thirding their advice to see someone about this.)

If I were you, I'd want to talk to an actual health care provider about this, if only because you might have health issues that might cause risks if you go off the medication cold-turkey.

The most obvious choice would be the person who prescribed the medication. In fact, I'm surprised that they haven't been monitoring you for the kind of withdrawal symptoms that you're having, since you're probably not the first to develop them.
Your general practitioner, if you have one and if they weren't the one prescribing the medication in the first place, would be another obvious choice.

My second choice, and possibly something to pursue anyway, is to find someone who has experience with this particular type of problem. If there's a clinic or organisation in your area that deals with educating the public about addiction and helping people with addiction problems, that would be a good place to start.

Best of luck.
posted by rjs at 5:09 AM on June 4, 2006

Having to come off a 10 percoset a day level (from kidney stones) was handled improperly by the specialists involved.

Their attitude was just "Stop." My inquiries when I started coming off fast (I halved the dose each day based on my very limited supply)....10 to 4 to 2...and was going crazy with symptoms of withdrawal. (Chills, emotional, more)

I called my GP, he saw me that day, we formed a plan, and I came down from 4 at a 1/2 pill a week for 4 weeks. This was easy and painless. The last week I forgot to take it entirely and that's how I knew I was done.

So, I'll echo: go see your GP.
posted by filmgeek at 5:55 AM on June 4, 2006

Do not stop taking it cold turkey. While opioid withdrawal is not (generally speaking) fatal, you will get some fairly significant withdrawal symptoms if you stop taking it all at once, making it considerably more difficult to stop taking it in the long run. You need to be on a taper, which, depending on the medication and dosage, may take a couple of days to a couple of weeks. Go to the doctor who prescribed the pills in the first place; he/she should be happy to write you a prescription for a taper. This is a really common situation (although still deleterious to your health), so they won't be surprised by your request. If you can't go back to that doctor, try to go to another one that knows you. Don't go to an ER, since they usually won't prescribe for this, given how many drug seekers they see. If you have a history of seizures, your doctor needs to know about that.

Good luck. The good news is that withdrawal symptoms usually only last about 72 hours, but it's better to avoid them as much as possible.
posted by LittleMissCranky at 6:05 AM on June 4, 2006

(IANA-MD) Opiate wirhdrawal is not fatal. You can, if you want, just stop and deal with the discomfort for 2-3 days. I have patients who do this all the time with heroin and they're fine. The length and depth of their habits far exceed your own. It usually takes them 3 days to start to feel ok again.
posted by OmieWise at 7:25 AM on June 4, 2006

I had a back operation for which I was prescribed lots of pain killers. At first they were good at killing the specific pain from the surgery. Then I took them to kill any pain. After 6 months I finally ran out of them and prescription excuses with my doctors. I had no choice but to quit. I left work early on Thursday, called in sick on Friday and by Monday after going cold turkey I was good to go.

I found the hardest part of withdrawal was THINKING I needed another pill. I would get anxious. I did get sweaty and "twitchy", and it sucked, but I drank a few beers to calm down. While I would not like to go through it again, it could have been much worse.

I advise cold turkey with some wild turkey. IANAD -- obviously.
posted by JohnnyGunn at 8:03 AM on June 4, 2006

I've never dealt with a serious addiction problem, but as a kid, I was on various painkillers for quite a bit - morphine, vicodin, ultram (spelling?), codeine, etc. The list goes on. Don't screw around here - that's strong shit you're dealing with, and one of the problems of addiction is that even when you're sober, you're not really objective about judging your level of dependence. Nor are you really all that objective about judging your level of sobriety at the moment.

Get help - by which I don't necessarily mean go to AA/NA or rehab. Ask your GP and/or the prescribing doctor. Given what these drugs are like, there is no shame in that. And if you do end up going for rehab, stay the hell away from Narconon - it's a Scientology front group.
posted by spaceman_spiff at 8:25 AM on June 4, 2006

In the interest of actually answering the question:

Going cold turkey from opiates is hard, potentially one of the hardest things you'll ever have to do. I don't know what a 'medium dose' is, but here's what you can expect:

Symptoms will begin to kick in about 8 hours after your last dose. You will alternate between being very hot and very cold, though no matter what you feel you'll get sweats, shakes, body aches (especially in the legs), irritability, anxiousness, loss of appetite, nausea, and just extreme feelings of general pain. Time will slow down to a near standstill; minutes feel like hours, hours feel like days. Attempting to distract yourself from the pain will not work, as you will be unable to concentrate and quickly become frustrated with the fact that normal 'zone out' behavior that speeds time along - like watching TV - isn't working. Sleep will be difficult, but unconsciousness will be a godsend when it finally does come. During your sleep you will perspire prodigiously, often to the point of waking yourself up.

Managing the symptoms is difficult since nothing really works. Well, except for more drugs, like JohnnyGunn suggests. But assuming you don't want to go that route, set yourself long tasks that are impossible to escape from, goal oriented, and involve physical exercise. Walk a loop from your house to somewhere and back that takes an hour or so to do. Repeat it 4 or 5 times. Hot baths also help enormously. Have several sets of clean clothes by your bed when you go to sleep so when you soak through one set with night sweat you can quickly change into another and go back to bed.

Mostly, however, kicking opiates cold turkey involves being in lots and lots of intransigent pain that dominates your every thought. Your body - every cell - will seem like its screaming out for drugs. You'll spend alot of time just writhing around in bed. You will probably curse the being that created you a great deal, and depending on your proclivity for these things suicide may seem like a very good option at times. Definitely have someone around if this is something you're prone to think.

Physical symptoms typically peak between 3 and 5 days, and full recovery - being symptom free - takes around 7 to 10. The night sweats and mood disruptions will carry on for longer, sometimes for weeks or more. It may take up to a year for your brain chemistry to return to normal.

Remember - you can quit cold turkey. Though it is total fucking hell and the kind of pain I wouldn't wish on my worst enemy, it can be done. Try to stay positive, try to distract yourself as much as you can, even when it doesn't work. Nothing will work, but don't get discouraged. Every ounce of effort you put into feeling better without drugs is an ounce you don't put into using.

There are also several drugs, like clonidine, that can be used during acute withdrawal that significantly reduce the intensity of the symptoms. I would strongly suggest looking into them, perhaps along with a non-narcotic sleep aid. Benadryl can also be useful to help relax you, but be careful not to OD on it. OTC pain relievers might also help. But probably not.

The other option is a replacement like methadone or the more current bupenorphine, which acts like methadone as a replacement but also is an antagonist, so that if you slip up and do end up using your drug of choice you won't feel a thing. The downside to drugs like these is that you quickly become addicted to them, instead.

Cold turkey can be done. Good luck.
posted by ChasFile at 8:40 AM on June 4, 2006 [1 favorite]

I almost forgot: due to the months of constipation you experienced as a side-effect of the opiates, be ready for some pretty impressive diarrhea, especially in the first few days.
posted by ChasFile at 8:44 AM on June 4, 2006

It sounds to me like you have developed a very natural dependence, rather than an addiction. Here's a discussion of the difference between the two.

Tapering off gradually should work well, or cold turkey, whatever you feel is right for you. But please don't think you are addicted unless you have the three psychological elements of loss of control, continuation despite significant adverse consequences, and obsession with thoughts of the drug.
posted by overanxious ducksqueezer at 10:56 AM on June 4, 2006

Cold turkey with some opiates can be a real health risk.
Methadone is considered by some to be more addictive than heroin. "While there is much debate over the treatment schedule and duration required, treatment at a methadone maintenance clinic is intended to be for an indefinite duration."
Another suggestion for a visit to an MD.
Also, acupuncture has been found helpful in a supporting role in addiction recovery.
Good luck-- this is something that you can do.
posted by pointilist at 11:02 AM on June 4, 2006

Omiewise hit it. See also
There are many points in this cycle at which a person can be called addicted. Conventional definitions emphasize the appearance of the withdrawal syndrome. Withdrawal occurs in people for whom a drug experience has become the core of their sense of well-being, when other gratifications have been shunted into secondary positions or forgotten altogether.

This experiential definition of addiction makes the appearance of an extreme withdrawal understandable, for some kind of withdrawal reaction takes place with every drug that has a noticeable impact on the human body. This may be simply a straightforward example of homeostasis in an organism. With the removal of a drug that the body has learned to depend on, physical adjustments take place in the body. The specific adjustments vary with the drug and its effects. Yet the same general unbalancing effect of withdrawal will appear not only in heroin addicts but also in people who rely on sedatives to sleep. Both will tend to suffer a basic disruption of their systems when they stop taking the drug. Whether this disruption reaches the dimensions of observable withdrawal symptoms depends on the person and the role the drug played in his or her life.

What is observed as withdrawal is more than bodily readjustment. Different people's subjective responses to the same drugs vary, as do the responses of the same person in different situations. Addicts who go through extreme withdrawal in prison may hardly acknowledge it in a setting like Daytop Village, a halfway house for drug addicts in New York City, where withdrawal symptoms are not sanctioned. Hospital patients, who receive larger doses of a narcotic than most street addicts can find, nearly always experience their withdrawal from morphine as part of the normal adjustment to coming home from the hospital. They fail even to recognize it as withdrawal as they reintegrate themselves into the routines of home.

If the setting and a person's expectations influence the experience of withdrawal, then they influence the nature of addiction. For instance, Norman Zinberg has found that the soldiers in Vietnam who became addicted to heroin were the ones who not only expected it but who actually planned to become addicts. This combination of expectation of withdrawal and fear of it, along with a dread of being straight, form the basis of the image addicts have of themselves and their habits.
Addiction: The Analgesic Experience
posted by y2karl at 12:09 PM on June 4, 2006

Oops, there's that link for Addiction: The Analgesic Experience.
posted by y2karl at 12:11 PM on June 4, 2006

The excerpts from the book The Meaning of Addiction - Compulsive Experience and Its Interpretation from the ">Stanton Peele Addiction Website are also of value here.
posted by y2karl at 12:19 PM on June 4, 2006

If you're a little dehydrated to start with (and lots of people are), the significant perspiration and diarrhea you'll likely experience when going cold turkey can quickly progress to dangerous levels of dehydration and electrolyte imbalances. While you probably won't die, you definitely could. What you'd be experiencing comes with significant risks to your health.

What's the appeal of going cold turkey rather than tapering gradually? The risks of rapid withdrawal are completely avoidable, as is the hell you'll go through. There's no need for it.

At the risk of sounding like a total ass: it seems like you're trying to punish yourself for becoming addicted, like somehow it's your fault and this is just the price you'll have to pay for it. But it's not your fault, and you don't have to pay any price. See your doctor.

One last thing: your friends and family, unless they have already helped someone quit an opiate cold turkey, are probably unprepared for what you'll go through mentally and physically, and once it starts they probably won't feel equipped to help. Don't put them in that situation--it's a terrible feeling. Get help from someone whose job it is to help, from someone with the knowledge and resources to provide it.
posted by jesourie at 12:20 PM on June 4, 2006

Oh, man, I am sloppy at the formatting this morning...
posted by y2karl at 12:21 PM on June 4, 2006

Von't know if this will help, but it seems apposite
posted by IndigoJones at 1:27 PM on June 4, 2006

If you're a little dehydrated to start with (and lots of people are), the significant perspiration and diarrhea you'll likely experience when going cold turkey can quickly progress to dangerous levels of dehydration and electrolyte imbalances. While you probably won't die, you definitely could. What you'd be experiencing comes with significant risks to your health.

This isn't something I would've thought of, but I'd definitely pay attention to it. Dehydration is not only physically risky, but could easily compound the problems associated with withdrawal. Panic attacks, irritability and anger, and confusion are common symptoms of severe dehydration, and you don't want to add those on to the emotional rollercoaster you'll be on anyway. Plus, when dehydration gets really bad and you end up in the ER, they will often give you an analgesic and or anxiolytic - anything from Valium to morphine (I've been treated both ways for dehydration). Not something you want, since you're trying to quit, but if you end up in the ER because of dehydration, you won't necessarily be clear-headed enough to make that understood.
posted by spaceman_spiff at 2:59 PM on June 4, 2006

It is not necessary for you to go cold turkey-it is very uncomfortable and even if you can endure the physical aggravations, there are mental and emotional components (depression and malaise) that may drive you back to the pills- you should step down your intake gradually and wean yourself over the course of a couple of weeks. Keep in mind that the depression will likely outlast the physical withdrawal. Routine exercise helps greatly with this, if you are able.

It is up to you to judge whether or not to consult your physician- they vary widely in their understandings and biases when it comes to dependence and addiction, are often misinformed, and can easily give very bad advice- by being either overly dismissive of the situation or overly alarmed. If you have an enlightened physician, he/ she may be able to prescribe you medications that will alleviate withdrawal symptoms such as clonidine, xanax, certain anti-depressants- you yourself will have to assess your doctor. One thing you might do is consult a pain physician- as they encounter these situations often when treating patients with chronic conditions. I highly doubt a pain doctor would tell you to go cold turkey.

Another thing- you did not mention in your post whether you were taking more pills than prescribed- whether you were trying to get high- these actions indicate more of a problem than the dependency that can develop after long term proper use of pain pills. It would be a good idea for you to be honest with yourself about this when attempting to stop- you may face a harder road if, indeed, you were overdoing it. But, don't despair- it's beatable either way. But I would strongly recommend against cold turkey- it's self punishment and will stress your body and mental well-being unnecessarily.

Good luck- you'll be okay and don't beat yourself up with shame over this- it's very common.
posted by mistsandrain at 1:35 PM on March 1, 2007

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