Personal stories are really important when it comes to drug withdrawal and addiction treatment. Each individual’s circumstance is affected by and affects his or her drug use and recovery. Here’s an interview with someone who started experimenting with heroin in his teens and became an addict in his early 20s. He’s now 40 years old, a heroin-free junky on methadone. Here’s what he has to say:

What can people expect when they experience methadone withdrawal?

They can expect to be—at the very least—very, very uncomfortable for at least 30 days.

Define “uncomfortable.”

No sleep. You’re not going to sleep for 30 days. You’re not going to eat. You’re going to feel like you’re going to die. You’re going to hallucinate. You’re going to, really pretty much feel like you’re about to die at any moment.

How many times have you gone through a methadone withdrawal?

One, two, three…four…. Four times.

Have you ever done a medical detox off of methadone?

No.

So you kicked “cold turkey”?

Uh-huh. Two times. But the dose was really low. The dose was like down to 8, 8 milligrams, and even that felt like, you know, something harder than I ever did before because I didn’t sleep for like three weeks straight off of that alone, 8 mg. But I didn’t feel the, you know, the flu-like symptoms but I suffered from the insomnia and anxiety part of it, where your legs are twitching.

If you detoxed four times and twice “cold turkey,” how did you detox the other two times?

I went right back. I’m talking about, I got arrested for a parole violation, and it took six working days to get let out, and I went five of those six days off of an incredibly high dose because they don’t give you methadone in San Quentin. That happened twice. The first time I was on 220 milligrams and the second time I was on 110 milligrams.

Why do you take methadone?

I take…. Well, at that time, I took 120mg a day at the clinic, on maintenance and I have a prescription for 100mg a day from my doctor for pain. The second time I got violated, arrested for a parole violation, was only two months after the first time, and it was so bad the first time that I had started to go down on my maintenance dose at the clinic. On my own, I had cut down my pain prescription so I was already kind of sick when I got arrested.

Did you get arrested for drugs? Were you trying to buy something because you were sick?

No. I got arrested because I’m on high control parole. I had a chain on my wallet and they call that a “dangerous weapon.” Plus I tend to talk loud when I get excited about something and he [the cop] took it as I was yelling at him. He had a rookie cop with him who said, “You’re going to let him talk to you like that?” He later told me that if I hadn’t done that he would have let me go.

Bad day.

Yeah, I was sick and I didn’t feel like getting f*cked with when I was just walking to the corner store. But I mean, I’ve been in San Francisco for 20 years and the cop stopped me because he knows me. We’re not, you know, exactly friends. I wasn’t doing anything wrong but “high control” means they can come in your house, stop you anywhere, anytime, search you, whatever. Not to say I deserved it that day but being on parole, you know, your rights are limited.

Sounds like it’s a precarious situation. You could get picked up anytime.

Yeah.

Do you ever think about getting off methadone completely so that you won’t have such a hard time in withdrawal if it happens again?

No.

Why not?

Because…I don’t know. I’m more or less gambling with it.

So being on methadone is worth the risk of a nasty withdrawal?

Yeah. If the end result of the methadone is to stay out of prison, yeah. The reason I’m taking methadone is so I’m not using heroin. And if I was using heroin, I’d have to pay for it and I would more than likely be committing crimes to pay for that heroin and I’d be back in jail regardless. So by being on methadone, it’s satisfying that part of my head that needs to take something but it gives me room to function and maintain a normal, somewhat normal lifestyle.

Have you ever considered Suboxone?

I have. I have to be on a much lower dose of methadone to do that and right now I need to stay at least at a blocking dose. I’m not going to rush it. Methadone has given me a chance to get off heroin, off the street, out of prison. I’ve got a family, a wife and kid, a job. I’m not going to risk losing that by going too fast or detoxing too quickly off methadone before I’m ready. I’ve seen Suboxone work really well for some people, and maybe one day I’ll be one of those people. Getting away from the methadone clinic is a big step for someone like me. You go down there, you see all these people you know. People offer you free this and that, pills, heroin, speed, whatever. You hear about who’s doing what, you know, what’s going on. Suboxone lets you get out of that world, fully commit to making a new life. So it’s good. But one step at a time….

There seems to be a little confusion about the difference between the two “nal-xone” drugs, naltrexone and naloxone. Two very different drugs, the similar names are confusing but what makes it worse is the fact that both are related to the treatment of drug and alcohol abuse. Hopefully this will clear up the misconceptions.

Naltrexone

Naltrexone, like naloxone, is an antagonist that binds to opioid receptors and blocks the effects of opiates. However, naltrexone is used primarily in the treatment of alcohol addiction in an effort to reduce the craving to drink. Its generic name is naltrexone hydrochloride, but it’s sold under the brand names Revia and Depade. An extended release formula is also sold as Vivitrol.

After detox off of opiates or alcohol, naltrexone may be prescribed to help people stay off the sauce—in any form. It effectively blocks any opiates from binding to your opiate receptors so if you do try to get loaded while you’re taking it, it won’t work. You won’t get high at all. But for some reason, it’s rarely prescribed to people who suffer solely from opiate dependence but rather to those who need help fighting the urge to drink. With studies to back it up, it works well to prevent relapse and decrease the severity of relapse when it does occur. For those who need help with opiate addiction, a better medication is Suboxone, which combines buprenorphine and naloxone.

Naloxone

Sold under the brand name Narcan, naloxone is injected into a muscle when overdose on an opioid-based drug occurs. Whether you overdose on a prescription painkiller like Fentanyl, Vicodin, Dilaudid, Darvon or Darvocet, Norco or OxyContin or you overdose on a street drug like heroin or morphine, naloxone stops the overdose dead in its tracks (no pun intended).  It works by heading straight to the opiate receptors and knocking off any opiates that are there, which stops the respiratory depression they cause and the subsequent overdose. It doesn’t work for benzodiazepines like Valium, Xanax, Valium, or Klonopin, nor does it work for stimulants like methamphetamine and cocaine.

Naloxone stays active in the system, blocking opiates from binding to your opiate receptors for 30 minutes to 90 minutes. When it wears off, the opiates that caused the overdose are still in your system and their effects will kick in again and, possibly, slam you right back into an overdose. This brief reprieve, however, can be what you need to keep you from dying before you get emergency medical help.

A few things you should know:

- Naloxone won’t let you give a clean drug test.
- Naloxone is effective in fighting an overdose even if you hit a vein.
- Naloxone is ONLY meant to be delivered with a needle in the event that someone is dying.

Suboxone

If you are addicted to opiates and taking Suboxone to detox off of your drug of choice, then you are taking naloxone. Suboxone is a combination of buprenorphine and naloxone, and it comes in a pill that you take by dissolving it beneath your tongue. The naloxone remains dormant unless you should try to abuse the Suboxone by dissolving it in water and inject it. If you do this, the naloxone will kick in and prevent you from experiencing any of the relief that the buprenorphine provides for those trying to avoid withdrawal symptoms.

So hopefully that clears that up! Any questions?

Hepatitis C is truly a global issue and a group of scientists in Adelaide, Australia, have started a five-year project to find better treatment options and to create vaccines to fight the disease. More than 170 million around the world are infected with hepatitis C, and University of Adelaide virologists Dr. Michael Beard and Dr. Karla Helbig are putting themselves on the battlefield’s front lines and trying to identify antiviral proteins that will stifle the disease.

No effective vaccine exists right now and the interferon treatment currently used is basically a form of chemo and debilitating in itself. It also doesn’t work on all strands of hepatitis C or necessarily work the first time you take it. Its success rate is only between 50 percent and 80 percent. Hopefully this new project will give birth to better treatments and an effective vaccine.

Dr. Beard is an NHMRC RD Wright Research Fellow and head of the Hepatitis C Virus Research Group at the University of Adelaide and Institute of Medical and Veterinary Science. He says that this is the first time that anyone in Australia has studied both HIV-AIDS and hepatitis C: “The development of vaccines and better treatments for both these viruses are urgent global health priorities. This program brings together a team of researchers with skills in basic virology and immunology with experts who can translate laboratory findings into human clinical trials.

“In Australia, more than 264,000 people have been infected with the hepatitis C virus and there are approximately 10,000 new infections per year. A proportion of these are intravenous drug users.”

Until a better treatment and vaccine are developed, IDUs can practice harm reduction by changing their method of use. Rather than using needles to shoot heroin, they can choose a maintenance program or take an even greater step and detox off of heroin using Suboxone. With Suboxone treatment, you can be off needles immediately and off drugs entirely in as few as six weeks depending upon your situation. Get more information about Suboxone here.

For more information about this project, check out the University of Adelaide website.