Opiate drugs are derived from the poppy plant which can be used as the illicit drugs opium or heroin or manufactured into prescription painkillers like codeine and morphine.
Opioids include newer, synthetic drugs like Fentanyl that mimic the effects of traditional opiates, and also carry similar risks for addiction. Both natural and synthetic opioid drugs are highly addictive and cause painful withdrawal symptoms, helping to explain why recovering from an opioid addiction is so difficult.
Contrary to popular belief, opioid withdrawal is usually not dangerous, and is almost never fatal.
Still, withdrawing from opioids is extremely uncomfortable and many people find that medication and treatment is helpful during and after the detox period. Most of the available treatments for opioid withdrawal include medications that prevent or reduce the discomfort during the withdrawal period.
The most commonly prescribed medications for opioid withdrawal are methadone, buprenorphine, and Suboxone (brand name for buprenorphine mixed with naloxone).
Methadone was first to come to the market, and is a synthetic opioid medication that prevents a person from experiencing opiate withdrawal symptoms when taken daily.
Buprenorphine is a newer alternative to methadone, preferred by some because it carries fewer side effects and does not require daily trips to a clinic (unlike methadone).
Suboxone is a blend of buprenorphine and naloxone, which blocks the effects of opioids, making it much harder to abuse than buprenorphine alone.
A person prescribed any of the above medications for treatment of opioid withdrawal is receiving Medication-Assisted Treatment (also called MAT).
People who seek formal treatment for an opioid addiction are often recommended to start MAT, but this might not be the right option for everyone. Some people prefer to stop using opioids “cold turkey”, or without any medication to ease withdrawal symptoms.
Read on to learn more about what the research says about people who stop using MAT versus those who use the cold turkey method, and to learn about the pros and cons of each method.
Medication-Assisted Treatment: Pros & Cons
Because opioids are so addictive and the withdrawal is so unpleasant, the primary advantage of Medication-Assisted Treatment is that it helps people lessen or avoid the withdrawal period.
The discomfort of the withdrawal is believed to heighten the risk of relapse, which is higher in those who quit cold turkey. Because of the improved success rates in patients engaged in MAT, there are a range of other benefits associated with the treatment including: improved survival rates, decreased illicit drug use, decreased criminal activity, improved engagement in treatment, and higher employment rates (3).
Still, MAT has some potential downsides. Critics often liken the use of medications like Methadone, buprenorphine and Suboxone as a “substitution” instead of a treatment.
Individuals who are placed on MAT will often remain on these medications for years, without any outlined plan for tapering off of them.
Those who do choose to come off of these medications often find that they experience withdrawal symptoms similar to those associated with opiate withdrawal. Acute withdrawal symptoms when stopping MAT often lasts 10-20 days, which is longer than a typical opioid withdrawal (1).
Some research also suggests that these medications have negative side effects. Research has shown that people receiving MAT drugs have poorer memory and cognitive speed (2). Others have highlighted that these medications can have intoxicating effects (especially Methadone), with one study showing that those receiving MAT were twice as likely to be involved in car accidents (2).
Some people prefer not to use these medications for this reason, wanting to be completely free and clear of any drug that has mind-altering effects.
Of all MAT drugs, methadone is most likely to cause serious adverse effects, including a higher risk of heart attacks, respiratory problems, and even death, although these risks are also present with other MAT medications (4). Methadone is also believed to have more intoxicating effects than buprenorphine or Suboxone, carrying a higher risk for abuse. Another downside of Methadone is that in most instances, people receiving treatment need to come to a clinic each day for their dose, which can significantly interfere with their routine, ability to work, travel, and fulfill other obligations.
Quitting Cold Turkey: Pros & Cons
Some people who want to stop abusing opioids opt to quit “cold turkey”, or without any medication to facilitate the detox and withdrawal process. The biggest advantage of quitting opioids cold turkey is that after the withdrawal period is over (acute withdrawals tend to last 4-10 days), the physical withdrawal symptoms are completed.
Psychological withdrawal symptoms like depressed mood, fatigue, trouble concentrating, anxiety or irritability can last longer, even up to 6 months (1).
For some people, the main appeal of quitting cold turkey is that they are completely free and clear of any dependence on a drug, even one which is prescribed. Because some MAT medications can be recreationally abused or even sold to others, some people in recovery find that having access to these medications increases their risk of relapse. Other people choose the cold turkey method to avoid the potential negative physical and mental health side effects associated with medications used in MAT.
Other advantages of quitting cold turkey include lowered treatment costs over the long-term (especially for those who are uninsured or with high-deductible plans) and less frequent appointments (especially when compared to daily methadone treatment).
Those who receive MAT are often required to attend group or individual counseling as a part of their treatment plan, in addition to consenting to urine drug screens.
Those who quit cold turkey may have more flexibility in their choice of treatments or treatment providers, as there are often limited options for MAT, especially in more rural settings.
Still, MAT is often considered a “front-line” treatment for opioid addiction recovery because it has been found to promote higher success rates. Those quitting cold turkey are more likely to relapse than those engaged in MAT (3). The detox and withdrawal period is one of the most vulnerable times for relapse, as the physical and psychological discomfort often drives people back to using.
The primary downside of quitting cold turkey is the inability to avoid these painful withdrawal symptoms.
Some of the uncomfortable withdrawal symptoms (1) that people quitting cold turkey may experience include:
- Flu like symptoms
- Hot and cold chills
- Sweating
- Restlessness & restless leg syndrome
- Running nose and tearing eyes
- Cramping, aches and discomfort
- Nausea and vomiting
- Diarrhea or loose stools
- Excessive yawning
- Extreme fatigue
- Insomnia
- Strong cravings
Final Thoughts
Recovery isn’t one-size-fits-all, which is why a range of treatment options exist for those struggling with addictions. Medication-Assisted Treatment can make early recovery a lot more comfortable, and is linked with higher success rates.
MAT might be especially appealing to heavy users who are at high risk for overdose, for those with failed recovery attempts in the past, or for those with more severe discomfort during the withdrawal period.
Still, others will prefer the cold turkey method of quitting because it allows them to break completely free from any chemical dependency and protects them from the potential side effects of medications.
Those who quit cold turkey might also have more flexibility and choice in their treatment than those who opt for MAT. Other factors which might compel someone towards the cold turkey method include an inability to afford MAT, a lack of MAT providers in their community, or a less severe addiction.
Regardless of which option is chosen, most people in recovery also benefit from a structured form of treatment, like an outpatient or inpatient rehab program. Typically, these programs will be able to help people opting for either an MAT recovery plan as well as those quitting cold turkey.
In addition to helping people get through withdrawals, these programs also help meet ongoing treatment needs, including group, family or individual counseling. Many of these programs will also focus on helping people build the knowledge and skills needed to maintain their sobriety, as well as tools and resources to help them rebuild areas of life impacted by their addiction.
Sources:
- Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
- Effects of medication assisted treatment (MAT) for opioid use disorder on functional outcomes: A systematic review.
- Substance Abuse and Mental Health Service Administration.
- Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds.