Can I Quit Heroin Cold Turkey?

The term cold turkey probably comes from the observation that when individuals abruptly discontinue use of heroin or another opioid, they often exhibit goosebumps on their skin that resembles the skin of a plucked “cold turkey.” Hence, the phrase “quitting cold turkey” became popular. The phrase was most likely first used in 1921, and today, it is associated with attempting to quit numerous drugs of abuse, eliminate bad habits, or even dissolve dysfunctional relationships without the use of any aides or assistance.

With respect to stopping the use of drugs or alcohol “cold turkey,” the phrase typically refers to individuals who choose not to use any form of intervention to deal with withdrawal symptoms that result from discontinuing certain types of drugs. Many of these individuals believe that “natural detoxification” has significantly more benefits than the use of medications or medical assistancee when an individual goes through a withdrawal syndrome. Unfortunately, the whole idea of natural detoxification, and the idea that quitting a serious drug of abuse like heroin cold turkey, is safer and healthier than using medical assistance is a serious myth.

Detoxification, Physical Dependence, and Withdrawal

Nearly every medical organization, website, and medical journal debunks the notion of natural detox. For example, according to WebMD, the common notion of natural detox is a myth, and the use of diets, vitamins, herbs, smoothies, etc., to facilitate the process of detoxification is simply a scam. The claims by various individuals and organizations that tissues store toxins, and these types of approaches help to rid toxins from the body are simply not true.

The only useful type of detoxification diet that has any value is a diet that limits the use of high-fat, sugary, and processed foods, and substitutes natural foods like fresh fruits and vegetables. However, this diet is simply a healthier diet that helps an individual’s system function more efficiently, but it does not significantly result in facilitating the process of detoxification, which is a natural process that occurs in the body, whether one is habitually using drugs or not.

Detoxification is a natural process that occurs within the human body, and it cleanses the system of waste products and other materials. This function is primarily accomplished by the liver, and substances are excreted through urine. Other methods of excretion do exist, such as through perspiration, breath, etc., but the liver performs the major function of metabolizing and breaking down substances, and helping to eliminate them. This function is ongoing and occurs regardless of drug use.

Obviously, individuals who are actively using heroin continue to have amounts of the drug in their system even though the liver continually works on metabolizing the drug and eliminating it from the body. When individuals quit using heroin, the natural functions of the liver can eliminate heroin from the body over time. Remaining hydrated, not using other drugs like alcohol, eating a balanced and healthy diet, and getting exercise and proper rest can help the liver function to its maximum capacity; however, there is no dietary approach that can speed up the process beyond the person’s natural ability to metabolize and eliminate substances from their system.

When individuals continue to use certain types of drugs or alcohol for extended periods of time, they may develop physical dependence on these substances. Physical dependence occurs as a result of the development of two other syndromes: tolerance and withdrawal.

Tolerance occurs as the body habituates itself to the effects of drugs or alcohol. It is a relatively common syndrome that results from using numerous medications, drugs of abuse, or other substances. When tolerance has developed, individuals find that they need more of the drug to get the same effects that were once achieved at lower doses. Because most drugs used medicinally are taken at far smaller doses than the doses used by individuals who abuse drugs, the development of tolerance is not considered to be particularly alarming when an individual is using a drug under the supervision of a physician. When individuals are abusing drugs, tolerance can result in a dangerous situation where individuals begin to take extremely high amounts of drugs.

A withdrawal syndrome occurs related to alcohol and some drugs as a result of an individual’s system attempting to adjust for the presence of the drug. Typically, a person’s body attempts to maintain a state of balance or homeostasis. When the level of certain drugs in an individual’s system declines as a result of the normal detoxification process, this new level of homeostasis is disrupted. The individual begins to experience the negative or counter symptoms that previously resulted in a state of homeostasis while the person was actively using the drug. These are withdrawal symptoms.

As with the development of tolerance, individuals who develop physical dependence (both tolerance and withdrawal) while under the supervision of a physician and as a result of the medicinal use of medications typically do not present a significant problem. When these individuals stop using their medication, they can be weaned off it and monitored by their physician. Individuals who abuse drugs do not have this luxury unless they become enrolled in a formal physician-assisted withdrawal management treatment plan (also termed medical detox).

In some cases, withdrawal symptoms can be potentially fatal, such as withdrawal from alcohol; in other cases, they can be extremely uncomfortable but may not be potentially fatal, such as with heroin. However, some of the complications of the withdrawal symptoms from heroin, such as dehydration, poor judgment, or becoming extremely irrational, can be dangerous and lead to accidents, overdoses, or serious medical conditions that can result in significant organ damage or even fatalities (e.g., complications from severe dehydration).

Can I Stop Heroin Cold Turkey?

The simple answer to the above question is “yes,” but why would you want to do so? In order to expand on this answer, a few other facts about heroin should be noted.

First, heroin is categorized as a Schedule I controlled substance by the Drug Enforcement Administration (DEA). All drugs in this classification are not believed to be safe to use even if they are used under the supervision of a physician; they do not have significant medical uses; and they have an extremely high abuse potential and are likely to lead to physical dependence. Heroin is often referred to as the most addictive illicit drug that is still in use in the United States.

Because the withdrawal syndrome associated with heroin abuse can be extremely severe, individuals who abuse the drug are often caught up in a cycle of bingeing on the drug, not using it when it is unavailable and they cannot afford it, suffering significantly uncomfortable withdrawal symptoms that often result in individuals becoming desperate and irrational, and resorting to behaviors that can be dysfunctional or antisocial in order to obtain more of the drug. Individuals may often attempt to procure heroin and may use it frequently in order to avoid any sign of withdrawal symptoms.

The two-volume academic work Opioids provides the general blueprint that is used to understand withdrawal process associated with heroin.

Once a person stops using the drug, withdrawal symptoms can appear within hours in heavy users. Typically, individuals will start to develop withdrawal symptoms within 12-24 hours following discontinuation, but heavy users who have developed significant levels of tolerance may begin to feel them even sooner. The symptoms that most commonly appear in the early stages of the withdrawal syndrome include:

• Anxiety, jitteriness, nervousness, or feelings of restlessness and/or agitation
• Flulike symptoms, such as fatigue, headaches, nausea, vomiting, and chills or fever
• Runny nose, watery eyes, muscle aches, and muscle spasms
• Changes in mood, such as depression, mood swings, and delusional behaviors
• Significant cravings
• The withdrawal symptoms will often peak within 1-3 days and then begin to subside in intensity. However, many users find the combination of emotional and physical distress so discomforting that they are driven to eliminate it by using the drug again.
• Typically, within 3-5 days after stopping heroin, most individuals begin to notice a reduction in withdrawal symptoms, but there often might still be issues with anxiety, mood swings, aches and pains, nausea, gastrointestinal issues, appetite loss, insomnia, and cravings. Often, individuals experience an increased sensitivity to perceived stress that exacerbates any of the withdrawal symptoms they are experiencing.
• Within 7-10 days after the person has stopped using heroin, most individuals find a significant reduction in the intensity of their symptoms and are able to begin the process of moving forward without heroin; however, relapse rates are extremely high and the majority of individuals who have opiate use disorders also have other co-occurring psychological issues or disorders that also need to be addressed.
• Many individuals may experience mood alterations, decreased motivation, sensitivity to perceived stress, and cravings for heroin for a significant period of time after undergoing the withdrawal process. Some sources still refer to a prolonged period of distress associated with recovering individuals that can last for months or even years as PAWS (post-acute withdrawal syndrome). However, this alleged syndrome has never been formally identified by any major professional medical organization as being a withdrawal syndrome. It most likely represents other interacting psychological and social factors, and it does not represent a formal withdrawal process as described above.

While most sources adhere to a general blueprint for heroin withdrawal, there is significant individual variability in withdrawal syndromes that individuals express. This is because any withdrawal syndrome is affected by numerous personal factors that include:

• How long the person abused the drug
• The typical amount of the drug that the person used (their level of tolerance)
• Whether or not they used other drugs of abuse
• The method in which they typically administered the drug, with methods that result in a more efficient delivery of the drug to the central nervous system, such as snorting or injecting the drug, producing more severe withdrawal syndromes
• How they stop using the drug, with abrupt discontinuation resulting in more rapid and severe withdrawal syndromes than weaning off the drug
• Individual differences in metabolism
• Numerous other interacting personal, social, and psychological issues

Why Stopping Heroin (or Any Drug) Cold Turkey Is Not Recommended

Anyone can attempt to quit using heroin without any professional intervention. There are numerous anecdotal reports of individuals who have done so successfully; however, these reports often cannot be validated and significant follow-up data on these individuals is rarely, if ever, presented.

Because the withdrawal syndrome itself is not potentially fatal, there is little danger that individuals will die as a direct result of the withdrawal syndrome; however, as mentioned above, other complications can occur that can be potentially serious and even fatal. In addition, there are numerous other considerations that indicate that one should not attempt a “cold-turkey” approach to quitting heroin or any other serious drug of abuse.

The potential for relapse during the withdrawal syndrome is significantly increased in everyone. This is because one of the most efficient ways to counteract the distressing symptoms of withdrawal is to begin taking the drug again. However, relapse that occurs during a withdrawal period can be particularly dangerous because individuals have often lost some of their tolerance to the drug and are often desperate. These factors make the probability of an overdose far more likely during a relapse that occurs when an individual is withdrawing from heroin. A heroin overdose can have serious physical effects and, of course, it can be fatal.

Because individuals are often emotionally distraught and not thinking clearly when they are undergoing withdrawal from heroin, they are far more likely to engage in behaviors that can be potentially dangerous as a result of poor decision-making or impulsive actions. These can include being involved in accidents, needle sharing, becoming involved in criminal activities, being a victim of crime, and even engaging in self-harm, such as suicide attempts.

There are numerous secondary considerations that occur during the withdrawal process. These include issues that can produce dehydration and significant malnutrition, or lead to potential emotional or physical damage (e.g., vomiting that can lead to choking or irrational actions that can affect relationships).

When a person adopts a cold-turkey approach to withdrawal, they rarely attempt to change their environment. Attempting to undergo a complicated withdrawal syndrome while remaining in the same environment in which one used heroin is not conducive to recovery.

Individuals adopting the cold-turkey approach typically do not seek involvement in a solid aftercare program of recovery. Individuals who simply go through the withdrawal syndrome and do not proactively address their issues with their substance use disorder relapse at rates that approach 100 percent. Just going through the withdrawal syndrome is not a sufficient plan of recovery from a substance use disorder.

Ultimately, there is really no need to go through all the discomfort of the withdrawal syndrome. The use of a physician-assisted withdrawal management program can significantly reduce or even eliminate all withdrawal symptoms, and allow the person to begin addressing other issues that are conducive to a successful recovery.

Physician-Assisted Withdrawal Management for Heroin Abuse and Addiction

A physician-assisted withdrawal management program is designed to establish a safe and more comfortable environment for an individual who has developed physical dependence on a drug like heroin. The approach for heroin withdrawal most often involves the administration of an opioid replacement drug, such as methadone or a drug that contains buprenorphine like Suboxone, on a tapering schedule. The opiate replacement medication occupies the same receptors in the brain that heroin and other opioids occupy, and this results in an elimination or significant reduction in withdrawal symptoms. These drugs do not produce the same psychoactive effects (the same high) that heroin produces, and individuals do not become disoriented or irrational while on these drugs.

The supervising physician monitors the individual’s recovery, adjusts the dosage accordingly so no withdrawal symptoms are experienced, and then over specified intervals, slowly tapers down the dosage to wean the person off the drug. This practice results in a longer discontinuation time compared to a cold-turkey approach, but it is far safer and more comfortable.

For some individuals, there may be some residual symptoms that require attention either medically or behaviorally, such as cravings or mild distress (e.g., the use of ReVia [naltrexone] to deal with cravings). Some other medications that might be used for individuals recovering from heroin abuse include Catapres (clonidine), an antihypertensive drug that also addresses anxiety and insomnia that occur as a result of withdrawal from heroin, and Robaxin (methocarbamol), which may be used for the treatment of muscle aches, muscle spasms, and jitteriness or anxious feelings. Potentially, any medication that can address any specific symptom that occurs in the recovering person could be used, including medications for co-occurring conditions like depression.

It cannot be stressed strongly enough that simply going through a withdrawal process whether one uses a cold-turkey approach or a physician-assisted withdrawal management program is not a sufficient approach to recovering from a substance use disorder. The cornerstone of recovery from an addiction to heroin or any other drug is substance use disorder therapy and involvement in a social support group, such as a 12-Step group. Just getting through the withdrawal period without engaging in a formal intervention to address the issues that fueled the substance abuse and developing a recovery program is doomed to failure. Individuals who simply go through medical detox without engaging in an aftercare plan that includes therapy and/or participation in social support groups relapse at rates that approach 100 percent.

It is often puzzling to addiction medicine physicians and therapists when individuals who have used a seriously dangerous illicit drug like heroin for extended lengths of time maintain that they do not want to use any medications during their recovery. This attitude may reflect the common trait that many individuals with substance use disorders have regarding trying to maintain control over all occurrences in their life. Individuals in treatment for substance use disorders are often challenged to understand what issues they can control, what issues they should attempt to control, when they should accept advice from others, and that there are many things they want to control that are totally outside their ability to control.

Because many individuals who attempt to withdraw from heroin via a cold-turkey approach are those who want to maintain a sense of control over their situation, it is important that these individuals understand that they do have control over their recovery, and there are things that can help them become successful in recovery that are within their control. These include:

• Becoming an active participant in an aftercare program that includes therapy and social support
• Making positive lifestyle changes that can facilitate the process of recovery through the withdrawal period and afterwards, such as maintaining a healthy diet, staying hydrated, getting sufficient rest, learning to deal with stress, changing one’s environment so it is supportive of recovery, understanding personal triggers and developing strategies to deal with them, exercising, staying in close contact with friends and family, developing new relationships with people who are also in recovery, and practicing what one has learned in recovery on a daily basis
• Staying in treatment-related activities for sufficient periods, often for years following abstinence
• Understanding that the responsibility for one’s recovery lies within oneself and not with anyone else

Yes, one can utilize a cold-turkey approach to heroin withdrawal; however, this approach is not as efficient or safe as medical detox.