Ask an Expert: Should I Go Through Detox if I'm Not Sure I Want to Be Abstinent?

By Anna Lembke 05/09/16

Our expert discusses whether or not detox is a good idea for someone who may want to use again.

Should I go through detox if I may use again?
via Pixabay

I have been using a combination of Percocet and heroin for several years. I want to stop, and everybody is saying I should go to detox and rehab, but a couple of people have told me that doesn't make sense for me. They're saying that when you detox, your body adjusts to not having opioids which makes you more likely to overdose if you use again—and that detox and rehab are best for people who are totally committed to abstinence, not using at all afterwards. I guess they don't think that's me—and I'm not sure either. What would you advise?

Anna Lembke: First of all, it’s fantastic that you want to stop. I would advise you to seek out an Addiction Medicine specialist in an outpatient clinical setting, where you can get a complete diagnostic assessment and learn the full range of treatment options available to you. Abstinence from all opioids is one pathway, and one way to get there is to go to “rehab” (a residential treatment program); but it’s not the only way. Another form of treatment, and one with some of the most robust evidence for effectiveness, is opioid agonist therapy (OAT). 

Opioid agonist therapy consists of taking an opioid prescribed by a doctor, either methadone in liquid form from a methadone maintenance clinic, or buprenorphine-naloxone (Suboxone). Both of these opioid medications have unique properties which make them effective for reducing cravings, avoiding the highs and lows that are part of chasing a heroin or Percocet high, re-establishing a more functional lifestyle, and avoiding risky behavior like using dirty needles. The medications can be used long-term, or to help taper down and off opioids. I encourage you to explore these options with your doctor. 

It is true that if you abstain from opioids for a period of time long enough for your body to lose tolerance to opioids, and then you resume taking opioids (relapse) at the doses you were using right before you quit, you are at high risk of an accidental overdose, because your body is not used to seeing those high doses and the opioids will cause your heart to slow and you to stop breathing. Indeed the data show that 80% or more of people with severe opioid addiction who don’t receive ongoing treatment will relapse to illicit opioid use within a year. On the other hand, treatment works, so go for it!

Anna Lembke, MD, is the Program Director for the Stanford Addiction Medicine Program and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Full Bio.

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