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Expert Q&A

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How can I get clean from heroin?

Asked by Kenneth, Illinois

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I don't understand how to get clean off heroin. I want to so bad but why do they make it cost so much? For Suboxone, you pay close to $350 for the visit plus $720 for a monthly prescription. Methadone is cheap, but my treatment center doesn't believe in methadone. Do you think methadone is that bad? I feel so lost.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Kenneth,

In the short question above you've really given voice to the horrible pain that is common in the world of heroin addiction. Recognize, please, that I can give you only general thoughts and that at the end of the day you will need to take concrete action to conquer your addiction with the resources you've got access to.

For the sake of our readers who aren't aware of the medications you refer to, let me make a couple of quick comments in this regard. Methadone, like heroin, directly stimulates opioid receptors in the central nervous system, and thus is subject to many of the same risks and liabilities as heroin. However, whereas heroin rushes into the brain when consumed, leading to an intense and very psychologically addictive "high," methadone comes into the brain slowly and stays there for quite a while at stable concentrations. These qualities allow it to take the place of heroin in terms of protecting against the horrors of opioid withdrawal and to do so in a legal and medically controlled manner.

Suboxone is a combination of a medication called buprenorphine and naloxone. Unlike methadone, buprenorphine acts like an opioid at lower doses and like an "anti-opioid" at higher doses. As a result it can protect against heroin withdrawal, but is not as likely to lead to abuse as is methadone. Naloxone is included in Suboxone as a strategy for further reducing the danger of abuse, because its presence guarantees that if the medication is abused it will immediately set off severe withdrawal symptoms.

People have very strong feelings about methadone. Some clinicians swear by it, others (such as your clinic) stay away from it altogether. If you take all the studies together, my sense is that methadone works as well as Suboxone for keeping people off heroin, but with a higher abuse potential. Neither Suboxone or methadone work all that well -- meaning that lots of people still find themselves unable to quit using heroin.

I truly believe that the best way out of your predicament is to get help that would allow you to come off the heroin all together without being chained to some type of opioid or partial-opioid agonist therapy for the rest of your life. This is not something you can do yourself. Given the desperation of your question I am pretty sure that you would need inpatient detox and then intensive outpatient follow-up. I have seen this strategy release many people from the bondage of heroin. But having said this, if you cannot face doing this, or if it is not an option for you for monetary reasons, let me strongly emphasize that being in a methadone maintenance program is infinitely better than being enslaved by heroin.

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