For anyone struggling with opioid addiction today, the path to recovery just got more complicated. A major new national study confirms what many addiction medicine doctors have been seeing on the front lines for years.

Fentanyl, the synthetic opioid that now dominates the illicit drug supply, is making it significantly harder to start patients on buprenorphine, one of the most effective and accessible medications for opioid use disorder.

The findings, published in JAMA Network Open and led by researchers at Penn State College of Medicine and the University of Pittsburgh, are a wake-up call for anyone affected by the opioid epidemic.

This includes patients, families and the healthcare providers trying to help them.

The Opioid Crisis by the Numbers

The survey of 396 clinicians across the United States paints a sobering picture of where opioid addiction treatment stands right now:

Nearly 72% of clinicians reported significant challenges starting patients on buprenorphine when fentanyl was involved. Close to 62% encountered at least one case of sudden, severe withdrawal, sometimes called precipitated withdrawal, when initiating treatment.

More than half, 52.8%, reported cases where withdrawal symptoms dragged on for days rather than the expected hours. And approximately 67% said they’ve had to change their standard treatment protocols to adapt.

These aren’t just statistics. Each one represents a real person trying to get clean who hit a wall.

What’s Driving the Change

Treating opioid addiction used to follow a relatively predictable script. When heroin was the dominant drug, clinicians could confirm use through drug screening and start patients on buprenorphine at established doses and intervals with reliable results. That consistency saved lives.

Fentanyl changed the equation starting around 2017, when it began flooding the illicit opioid supply. The problem isn’t just that fentanyl is more potent — it’s how the drug behaves in the body. Fentanyl can accumulate in fat tissue, where it lingers long after a person’s last use.

When buprenorphine is introduced, it can displace fentanyl from opioid receptors and trigger intense withdrawal far more severe and prolonged than what patients experienced during the heroin era.

“Someone can get really sick or get tired of the whole process that they stop treatment,” said lead author Dr. Sarah Kawasaki of Penn State College of Medicine. “They might start using again and might overdose or die.”

That cycle of withdrawal, dropout, relapse and overdose is one of the most devastating patterns in the current opioid epidemic.

Fentanyl’s Role in the Treatment Gap

Fentanyl is now present in the vast majority of illicit opioid supply in the United States. It has also been found in counterfeit pills and other street drugs, meaning people with opioid addiction are often exposed to it even when they don’t intend to be.

Its unique pharmacology, high potency, rapid onset, and fat-soluble accumulation, means the clinical playbook written for heroin simply doesn’t apply. Clinicians surveyed in the study responded in a variety of ways.

Some dramatically lowered initial buprenorphine doses, others went higher, some added medications to manage withdrawal symptoms and others redirected patients entirely to inpatient treatment or methadone programs.

The patchwork of adaptations reflects a field working without updated, evidence-based guidelines and patients paying the price for that gap.

Understanding Opioids and Overdose Risk

Opioids are a class of drugs, both prescription medications and illicit substances like heroin and fentanyl, that bind to receptors in the brain and body to reduce pain and produce euphoria.

Fentanyl is a synthetic opioid estimated to be 50 to 100 times more potent than morphine, making even a tiny amount potentially lethal. Opioid overdose occurs when the drug suppresses breathing to the point of oxygen deprivation; naloxone (Narcan) can reverse an overdose if administered quickly enough.

Harm Reduction and Treatment Options

Despite the challenges, researchers are emphatic that buprenorphine still works, and it remains one of the most accessible opioid addiction treatments available.

Unlike methadone, which can only be dispensed through approximately 2,000 licensed clinics nationwide, buprenorphine can be prescribed by qualified providers and filled at more than 70,000 pharmacies across the country.

If you or someone you love is struggling with opioid addiction, harm reduction steps include:

1. Carry naloxone (Narcan): Available without a prescription at many pharmacies and through community harm reduction programs. It can reverse an opioid overdose and save a life.
2. Use fentanyl test strips: These low-cost tools can detect fentanyl in a drug supply before use.
3. Talk to a doctor about medication-assisted treatment: Buprenorphine and methadone are both evidence-based options for opioid use disorder.
4. Connect with peer support: Narcotics Anonymous (NA) meetings provide community, accountability, and lived experience that clinical treatment alone can’t offer.

Finding Help for Opioid Addiction

NA Meetings Near You Narcotics Anonymous offers free peer support meetings in thousands of locations. Search for NA meetings in your city or state to find in-person and virtual options near you.

Opioid Treatment Programs Ask your primary care provider about buprenorphine, or search SAMHSA’s treatment locator at findtreatment.gov for opioid treatment programs near you.

Call for Help: SAMHSA’s National Helpline (1-800-662-4357) is free, confidential and available 24/7 for opioid addiction treatment referrals.

Harm Reduction Callout: Naloxone saves lives. If someone in your life uses opioids, or if you do, having naloxone on hand is one of the most important steps you can take. Many local health departments and harm reduction organizations distribute it for free.

An innovative but little known crisis intervention project in West Virginia is helping reduce opioid overdose deaths, addiction experts say. It’s also setting a new standard for how communities respond to opioid addiction and mental health crises across the U.S.

Addressing West Virginia’s Opioid Overdose Crisis

Since the fall of 2023, opioid overdoses have been on the decline nationally. Public health experts aren’t in agreement about the cause, and it has been uneven across the nation. 

Long known as the center of the opioid crisis, West Virginia is among the states showing the highest reduction in overdose fatalities. Many of these deaths have historically been linked to fentanyl and other synthetic opioids, making recent declines especially notable.

Crisis intervention training (CIT) has been increasingly adopted by law enforcement and may be a little explored factor in the state’s recent decline in overdoses. Current research reveals that jurisdictions with CIT programs show a decline in overdose fatalities. 

Enhancing Authorities’ Response to Mental Health Crises

CIT was created in the 1980s to help law enforcement officers recognize mental health conditions and help those struggling get into treatment instead of jail. The CIT programs are increasingly popular with law enforcement in light of the overdose epidemic. 

Yolandah Mwikisa, the crisis response unit supervisor for the police department in Wheeling, West Virginia, stated that “As more police officers recognize that substance use disorders are a pandemic, more have become interested in crisis intervention training.

Mwikisa further added, “Most of them want to do their jobs better. They want to avoid lawsuits. They really want to understand what people are going through.”

CIT programs teach law enforcement officers to recognize individuals in mental health and opioid related substance use crises, how to encourage them and how to speak calmly and empathetically to get them into treatment. 

Prioritizing Treatment Over Prison

Research shows that people in addiction treatment are less likely to commit crimes, suffer fewer overdoses, and live longer, even if recovery isn’t permanent. Jail increases the risk of continued substance use and fatal overdoses. This risk is especially high for people with opioid addiction due to reduced tolerance after incarceration.

Richard Frank was part of the Obama administration and helped coordinate their opioid response. Frank is also senior fellow at the Brookings Institution. He argues that getting people into a treatment program is about effort more than intention. He noted that actually delivering someone to a treatment facility instead of giving them a phone number is important. 

Mwikisa feels that prioritizing individuals’ needs is most important when dealing with substance use. 

She states that people aren’t “going to want to tell their story twice,” so expecting someone to show up to treatment on their own after already having a difficult discussion with a CIT team is asking a lot. Instead, she calls ahead to the treatment facility to ensure an easy transition. 

Mwikisa says that in her years as a CIT coordinator, she has seen a difference in how law enforcement officers behave. She recalls a time she got pulled over for speeding shortly after moving for a CIT job. 

“The treatment I got was brutal. Maybe more brutal than you’d expect,” she said. 

The training changes officers’ behavior. The program does have its skeptics. There are people who believe that individuals engaging in something illegal should go only go to jail. 

Mwikisa states, “Holding people accountable and getting them help are not opposites. The real failure is when we do neither.” 

Find Opioid Addiction Support Near You

Opioid addiction doesn’t have to end in tragedy. Help is available.

Find local Narcotics Anonymous (NA) meetings, peer support groups or treatment programs near you.

You can also call 800-934-1582(Sponsored) for immediate, confidential support.

Since 2007, Massachusetts has provided a national model for its integrated approach to opioid treatment in the primary care setting.

Using a nurse care model (NCM), healthcare providers receive funds to improve access and coordinate care. This is done through a dedicated nursing staff. The NCM model means physician assistants, nurse practitioners and doctors can serve more patients. 

Nurse Care Model Expands Opioid Treatment Access

The NCM model provides office-based addiction treatment (OBAT) as an alternative to specialty substance use disorder (SUD) clinics, which expands access to treatment. Policymakers are recognizing the benefits of implementing this alternative more widely. 

In Massachusetts from June 2021 to July 2022, the majority of substance-related deaths were from alcohol and opioids. Concurrently, more than 50% of all opioid related deaths from overdose involved the stimulant, cocaine. 

In 2022, the model was expanded by the Massachusetts Bureau of Substance Addiction Services to include those with both stimulant and alcohol use disorders. 

The approach is promising and demonstrates that the Massachusetts approach can be a model for other states looking expand services and help individuals with a variety of SUDs, particularly those who are on Medicaid. 

The national median for Medicaid enrollees with OUD to receive medication is 60%. In 2023, 79% of clients enrolled in Massachusetts Medicaid received medication as a direct result of the NCM programs. 

Nurses Expanding Access to Opioid Addiction Treatment

NCM relies on specially trained nurses. Approaching OBAT care this way requires NCMs to screen for SUD. After confirming the diagnosis, an authorized prescriber or physician prescribes buprenorphine as appropriate. 

After initiating medication and management, NCMs educate clients, develop treatment plans, document treatment compliance, and coordinate care among healthcare providers. This frees up prescribers to see more individuals, expanding care access. 

Rethinking Public Policy and Funding Protocols

For the NCM model to succeed, clinicians need incentives to provide this type of care. This makes policymakers a critical component of implementation. The payment approach must provide adequate compensation for the expanded services. 

Massachusetts funds the model through a melange of federal money, state general funds, and Medicaid reimbursement. This includes the State Opioid Response Grant and the Substance Use Prevention, Treatment, and Recovery Services Block Grant. 

The grants provide coverage for services left uncovered by Medicaid. 

Another way providers reach out to those who may need care is by opting to receive funds that go toward wraparound services. 

These services may include partnering with a soup kitchen, providing transportation to appointments, and visiting homeless encampments. Nicole Schmitt, director of the Office of Strategy and Innovation, noted that this type of outreach engaged more people in treatment. 

Nurse Care Managers Aiding Individuals with OUD

The numbers are telling. Three years after the Boston Medical Center developed the new model and expanded it to 14 federally funded health centers (qualified health centers that provide primary healthcare to clients unable to pay), the healthcare providers prescribing buprenorphine from these locations expanded from 24 to 114. 

Patients who remained in treatment for more than a year went from 32% in 2010 to 67% in 2013. Due to the financial stability of the program, half of the locations expanded their programs beyond the initial grant size requirements. 

Studies conducted in five states revealed that NCMs not only increase the amount of OUD treatment provided, but also that individuals participated longer. Individuals in the programs noted that they were motivated to stay in treatment and that the care was non-stigmatizing and nonjudgmental. 

Expanding Office-Based SUD Treatment

The Massachusetts Bureau of Substance Addiction Services enlarged the program in August 2022 to include treatment for those with stimulant and alcohol use disorders. As of 2025, more than 40 locations across Massachusetts offered contracted OBAT treatment services through the bureau. This is a significant increase in treatment services from 2007. 

The bureau provides technical assistance and training to make these OBAT services possible. One example includes grant funding to provide training for managing outpatient alcohol withdrawal so providers feel confident offering the services. 

Jen Miller, director of grants and innovation at the bureau, remarked, “Training can ensure that the person who is given outpatient withdrawal management has the right supports at home or in their community, because outpatient withdrawal management is doable. Not everyone needs an inpatient level of care.” 

The bureau provides a free videoconference training and support program. This 12-session program is offered by Boston Medical Center. According to Ms. Miller, this assistance program is “run and developed by a program that implements OBAT services, so they’re keenly aware of some of the challenges and successes.” 

Reducing Stigma in Opioid Addiction Treatment

Massachusetts officials and clinicians evolved their treatment approaches to deal with the changing nature of substance use. Additionally, they aligned the payment approach with the new treatment model, which allowed them to treat more people with varying needs related to substance use. In 2020, OBAT enrollment was 3,687 and increased 17% to 4,319 in 2024. 

Simultaneously, in fiscal year 2020, non-opioid admissions to OBATS were 639 (17.4% of admissions). These grew to 1,682 (39% of admissions) in fiscal year 2024. 

Providers started admitting clients to their facilities for non-opioid SUD before the official change due to community need, Ms. Miller noted. She also suggested that the nurse-led model may encourage clients to seek care due to reduced stigma and fear. She also remarked that the OBAT centers were simply more accessible. She said, “It feels less daunting to go to, because your primary care might be just down the hall.” 

According to interviews with Pew, Massachusetts’ OBAT model expansion came about in part due to the reality that many treatment centers were already providing care for stimulant use disorder and AUD but they weren’t being adequately paid for the care. 

Before the policy change, in some cases, an individual may have already had another substance as their most important concern, but also needed treatment for OUD. It’s not uncommon to have AUD and OUD. 

Recently, a meta-analysis revealed that in those with OUD, 27.1% had concurrent AUD. As compared to individuals with any SUD, those with AUD are more than five times as likely to have simultaneous OUD. 

With the new OBAT treatment model in Massachusetts, providers can treat clients with co-occurring SUDs and get reimbursed for all the services. The results are clear, as the number of clients admitted to take medication for AUD has increased to 899 (22.5% of admissions) in 2024, from 295 (8.8%) in 2020. 

State Support of OBAT Addiction Treatment Models

Other states utilizing the OBAT model with an aligned payment approach can also expand treatment for those with SUD beyond opioids. This approach will improve health and save lives. 

The director of the Office of Strategy and Innovation at the Massachusetts Bureau of Substance Addiction Services, Nicole Schmitt, said in an interview with Pew that state leaders need to “take a broader perspective and not go down the rabbit hole of focusing on one particular drug.” She also noted that it’s a disservice to be “narrowly focused on opioids and not pay attention to alcohol and stimulants.” 

Virginia and Michigan are both expanding eligibility for OBAT programs. Providers receive enhanced payments for buprenorphine and wraparound services in Virginia, while billing at equivalent rates as those providing treatment to clients with stimulant use disorders and AUD. In Michigan, primary care providers are now allowed to bill for SUD treatment services. 

This includes screening and assessment services, medication, counseling, and care management, no matter the primary substance, as long as the provider can give the client the appropriate level of care. 

Further, access to health home services is allowed in Michigan for individuals with stimulant and alcohol use disorders, which improves care coordination. States currently without these treatment approaches have broader eligibility to establish them. Delaware is doing just that through the Management of Addictions in Routine Care initiative. 

As state leaders establish or expand the OBAT payment model, they should consider dedicated funding. Examples are the state opioid response grants (also used for stimulant use disorder) and the Substance Use Prevention, Treatment and Recovery Services Block Grant, which can be used for any substance disorder. 

These funds can provide technical assistance and ongoing training. Previous research regarding OBAT implementation reveals that offering these supportive services increases the likelihood that providers will prescribe buprenorphine, and may be helpful for other SUD treatment support.

As Schmitt also noted, the technical assistance provided to grant recipients in Massachusetts is “instrumental” and “people may want to do this or see a need to do it, but they may not know how to do it or how to do it well.” 

The experience in Massachusetts illustrates that state leaders can expand services designed for individuals with OUD to those with any type of SUD. Additionally, provider support paired with policy changes can improve access to treatment.

Find Opioid Treatment and Support Near You

If you or someone you love is struggling with opioid addiction, treatment options are available. Medication assisted treatment, including buprenorphine, can reduce cravings and overdose risk while supporting long term recovery.

You can also find NA meetings near you for peer support, or call 800-934-1582(Sponsored) today.

Iowa has recently launched the Save a Life With Naloxone initiative aimed at fighting the ongoing opioid epidemic through increased access to naloxone (Narcan). Naloxone is a fast-acting medication that can reverse the effects of an opioid overdose and save lives when used quickly.

The state of Iowa stresses that the safety of the state’s communities is at the forefront of this continued effort. The program ensures that naloxone is widely available to residents, first responders, schools, and community organizations to prevent overdose deaths and promote recovery. 

How to Get Naloxone in Iowa

Through the program, eligible organizations can request naloxone products for people at risk of an opioid overdose. There are two different application tracks for organizations. One is for law enforcement agencies and non-EMS regulated fire departments, and the other is for Iowa organizations, businesses and schools. 

Since NARCAN is now available over the counter, many community organizations and secondary distributors, such as school districts, healthcare providers, health departments, fire departments and law enforcement personnel, can apply to distribute it locally. 

Secondary Distributors

Some secondary distributors can currently dispense the prescription medication Kloxxado, another FDA approved naloxone medication. However it should be noted that the Iowa Health and Human Services will stop supporting allocation in November of this year, focusing on future efforts on expanding naloxone and community education. 

To simplify the process, Iowa HHS provides a public FAQ document outlining eligibility, distribution requirements, and best practices for overdose prevention.

The Bigger Picture

Naloxone programs like this one play a critical role in the nation’s opioid overdose response strategy. According to the CDC, more than 80,000 people in the U.S. died from opioid-related overdoses in 2024. Increasing naloxone access can mean the difference between life and death while individuals seek long term recovery through treatment or Narcotics Anonymous (NA) meetings.

Find Support Near You

If you or someone you love is struggling with opioid use, you are not alone. Search for NA Meetings near you on Narcotics.com or call 800-934-1582(Sponsored) today to take the next step toward recovery.

Native Appalachian author Barbara Kingsolver has opened a new center focused on women’s opioid recovery in Virginia. Kingsolver won the 2023 Pulitzer Prize for Demon Copperhead, a novel about Appalachia’s opioid addiction crisis.

Now she is opening Higher Ground Women’s Recovery Residence in Lee County, Virginia, which provides a stable home for women who are learning to live sober after release from incarceration or inpatient substance abuse treatment centers.

Witnessing the Devastation

As a native Appalachian who lives on a farm in southwestern Virginia, Kingsolver knows firsthand how the national opioid epidemic “has changed so much of the texture of this place.” She has witnessed the devastation wrought by the pharmaceutical industry’s targeting of central Appalachia with sales of falsely proclaimed addiction-resistant prescription painkillers.

In the author’s words, “They came to harvest our pain when there was nothing else left.” 

Desperately Needed Recovery Services

In the process of researching for Demon Copperhead, Kingsolver delved deeply into the real life stories of individuals struggling with addiction and the loved ones who are often their caregivers.

The facility Kingsolver has opened in response to those stories, funded by proceeds from her Pulitzer-winning novel’s overwhelming success, offers desperately needed services to a region that has been ravaged by the opioid crisis.

Higher Ground fosters a safe and welcoming environment for healing from substance abuse, with private and semi-private bedrooms, a shared kitchen and a communal den. Perhaps most importantly, the center has helped to create a tight-knit support system of women who understand each other and the destructive impact of addiction on families and communities. 

Figuring it Out Together

This past June, an audience gathered at the Lee Theatre in Pennington Gap, Virginia to celebrate the center’s opening. When Kingsolver invited current residents onstage to share their experiences, they were more interested in discussing the bonds they have forged with housemates and staff members. 

35-year-old Syara Parsell, one of the center’s first residents, has already found work and enrolled in college classes. She says, “Together, we figure it out.” As Kingsolver says, in the end, the benefit to residents of the center “is not just sobriety, but belief in themselves.”

Finding NA Meetings

One of the best tools for achieving long-term recovery is meeting with like-minded people who are also sober.

You can find NA meetings in your area or call 800-934-1582(Sponsored) today.

Researchers at the Comprehensive Center for Pain and Addiction in Phoenix and the National Center for Wellness and Recovery in Tulsa have developed a new subatomic approach to stop fentanyl overdoses with a single dose. Their answer lies in NCWR-10, a newly created molecule designed as a new fentanyl overdose treatment.

The need is urgent. Opioid overdoses claimed over 50,000 American lives in 2024. The Drug Enforcement Administration reports that nearly 70% of those deaths involved synthetic opioids—especially fentanyl. Fentanyl’s strength makes it extremely dangerous in which even a trace amount is often fatal. 

While current treatment options like naloxone can reverse overdoses, the protection doesn’t always last long enough.

A Promising New Molecule for Fentanyl Overdose Treatment

Here’s where NCWR-10 steps in. This promising new molecule fights opioid abuse by acting quickly and lasting longer than naloxone. NCWR-10 was originally synthesized by Don Kyle, a leading expert in drug design and CEO of the National Center for Wellness and Recovery in Oklahoma.

From there, it’s off to Arizona where researchers at the Comprehensive Center for Pain and Addiction in the University of Arizona conduct lab tests. Center director Todd Vanderah agrees that a single dose can save lives.

In mouse studies, NCWR-10 restored breathing as quickly as naloxone but for longer. It also acts on opioid receptors that can ease withdrawal symptoms. “This could make the treatment easier for people in crisis,” Vanderah stated. 

A New Tool in the Fight Against Synthetic Opioids

Researchers are also testing NCWR-10 against powerful synthetics such as carfentanil and isotonitazine. Carfentanil is thousands of times stronger than morphine, and the first dose is often lethal. Isotonitazine is equally deadly. Standard treatments can reverse overdoses from these drugs, but only briefly. 

The Tulsa and Phoenix teams hope NCWR-10 can provide longer protection and reduce relapse rates. If their molecule that fights opioid abuse can meet FDA requirements before going on to human trials, NCWR-10 can give medical staff and first responders a greater tool in the fight against the opioid crisis. 

NCWR-10’s future looks promising, but if you or a loved one is struggling with narcotic or opioid addiction, immediate help is available through local NA meetings and treatment programs.

Call 800-934-1582(Sponsored) to get started now.

Naloxone Texas, a statewide program that’s part of the University of Texas at San Antonio’s Be Well Institute on Substance Use and Related Disorders to prevent opioid overdoses in Texas, is deploying a new service on Texas college campuses this fall. It’s aimed at universities and colleges throughout the Lone Star State and offers overdose response training and free naloxone for students, staff, and faculty. 

Naloxone Can Save Lives

Naloxone is the generic of Narcan and rapidly reverses opioid-related overdoses. The drug can save a life when administered immediately after an overdose. The drug is similar to an EpiPen (epinephrine auto injector) or heart defibrillator in that trained bystanders can offer quick and effective life-saving measures before first responders arrive. 

In response to a growing opioid crisis in Texas that inordinately affects young adults, Naloxone Texas will target community colleges, private and public universities, and trade schools.

Dr. Tara E. Karns-Wright is an assistant professor in the Department of Psychiatry and Behavioral Sciences at UT San Antonio and director of Naloxone Texas. She expressed gratitude to the Texas Legislature and Texas Health and Human Services for funding the effort to provide every college campus with the resources and knowledge to respond to opioid overdoses.

“We’re making this life-saving medication more accessible and helping everyone become first responders in moments that matter most,” she said.

How Naloxone Texas Works

Naloxone Texas will be participating in back-to-school events across the state. These include hosting events at campuses in San Antonio, Austin, and Houston. Local staff and students can sign up for free naloxone kits at these events. They can ask questions and learn how to use the kits to prevent and treat overdoses. 

In addition to opioid overdose reversal kids, Naloxone Texas also makes available the following services to enrollees:

Evidence-based training services: There are virtual, on-demand teaching modules where participants learn to identify and respond to opioid overdoses. They can also understand the varied approaches to addiction treatment in general and how therapies are effective.

Naloxone distribution: Individuals and organizations may request free kits in bulk with an emphasis placed on areas where individuals are at high risk of overdose, as determined by county data.

Referrals to support services for adolescents and adults through the Be Well Texas Provider Network and the Be Well Clinic. Both offer in-person and virtual care for substance use issues. Referrals may also be given to NA recovery meetings throughout Texas.

Campus organizations, as well as student health services and college administrators, are urged to schedule customizable training workshops and request free naloxone kits by signing up here.

If you or someone you love is struggling with drug addiction, there is hope. Narcotics.com lists NA meetings around the nation, including online and virtual NA meetings.

For immediate support, call 800-934-1582(Sponsored) today.

Ed smokes five cigarettes a day and wants to quit. Peter has become dependent on opioids and wants to break his addiction. David is ready to give up alcohol, which has taken over his life. All three men are considering quitting cold turkey. They are ready to be done with their addictions, so they want to stop using the substance immediately. Does quitting cold turkey work? 

Is this a good idea? It might be ok for Ed, but Peter and David may want to reconsider. 

Depending on their history of use, quitting cold turkey may be a shock to their systems and cause withdrawal. General withdrawal symptoms can include:¹

• Cravings
• Headaches
• Shaking
• Nausea
• Anxiety
• Sleep issues
• Appetite changes
• Agitation
• Concentration issues
• Sadness
  

Can You Die from Quitting Cold Turkey?

With certain substances, withdrawal effects can be severe or even life-threatening. The body has become dependent on the drug, and an abrupt “cold turkey” approach could be dangerous if the person doesn’t receive treatment.

Here’s a breakdown of what happens with various types of substances:

Nicotine

There are no serious health risks if Ed wants to quit smoking cold turkey. However, he may have better success if he does this with support. A study found that only 3-5% of individuals who tried to quit cold turkey without help achieved long-term abstinence from nicotine.²

Alcohol

David has severe alcohol dependency. If he quits cold turkey, there are severe health risks. Alcohol withdrawal can include delirium tremens (DTs). These can start within two days of stopping alcohol cold turkey and can last up to five days. Without appropriate treatment, the mortality rate for DTs can be as high as 37%.³

DT symptoms can include:⁴

• Hallucinations
• Loss of consciousness
• Severe confusion
• Extreme hyperactivity
• High blood pressure
• Seizures
• Disruptions to cardiovascular function

Opioids

Like David, Peter may be putting his life in danger if he abruptly quits opioids without treatment. Opioid withdrawal typically causes flu-like symptoms. This includes vomiting and diarrhea. If severe, these can cause dehydration, which can lead to chances of heart failure.⁵

Other Drugs

Other drugs, such as meth and benzodiazepines, can cause similar withdrawal symptoms, including seizures, dehydration, heart issues, and psychotic reactions.⁶ If untreated, these can be life threatening.

Alternatives to Quitting Cold Turkey

Fortunately, there’s good news for Peter and David (and Ed, too). To avoid these physical dangers of quitting cold turkey, and to increase their chances of long-term success, they can turn to an alternative method of quitting the substance.

Their options include:

Tapering

Rather than stop taking opioids all at once, David can partner with a physician or other healthcare provider to taper off the drug. This involves slowly reducing the amount he takes over time until he eventually stops taking opioids completely. 

The length of time it takes to taper off a drug depends on how long you’ve been using it and how much you’ve been using. It can take a few weeks or a few months to complete this process, but it can provide a safer and more effective long-term solution than quitting cold turkey.

Medication

To quit smoking, Ed can use nicotine replacement therapy (NRT). He may choose patches, sprays, or gum to prevent withdrawal symptoms. One study found that NRT can increase the chances of successfully quitting smoking by up to 70%.⁴

Medications are also available to help stop or reduce alcohol use. The FDA has approved acamprosate, naltrexone, and disulfiram for the treatment of alcohol use disorder. Disulfiram and naltrexone alter how alcohol is processed in the body to make drinking less appealing, and acamprosate can help ease withdrawal symptoms.⁷

Several drugs are also FDA-approved for the treatment of opioid use disorder: naltrexone, buprenorphine, and methadone.⁸ The use of these medications to stop using drugs or prevent relapse is known as medication-assisted treatment (MAT).

Medical Detox

To safely withdraw from drugs or alcohol, David and Peter can find a medical detox program. During medical detox, medical professionals offer treatment for withdrawal symptoms and provide 24/7 supervision to prevent complications. This may include sedation or other medications to help David get through the most severe, initial phase.

Medical detox usually lasts several days. When it’s complete, David’s body will be cleansed of alcohol, and he can begin his life of recovery. Medical detox programs are available for all types of substances, so Peter can also choose this method to detox from opioids.

Social Detox

This method can involve quitting cold turkey, but it’s done with support. If Peter’s symptoms aren’t life-threatening, he may find a social detox program where he can be monitored by professionals and receive counseling to help him through his withdrawal symptoms. This method does not involve the use of medication.

Cold Turkey Support

If Ed, Peter, or David choose to go “cold turkey,” it’s crucial that they get support. This may include formal services such as the medical detox described above, but it can also include other types of support. Many resources are available, including:

• Counseling
• Smartphone apps
• Support groups
• Medication
• Drug rehab programs

Does quitting cold turkey work? The bottom line: Yes, quitting cold turkey can work, but depending on the substance, you may need additional support to do so safely and effectively. 

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-934-1582(Sponsored) today to learn about your treatment options.

Sources:

1. Withdrawal management. (2009, January 1). NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK310652/
2. World Health Organization: WHO. (2023, January 4). No level of alcohol consumption is safe for our health. World Health Organization: WHO. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
3. Rahman, A., & Paul, M. (2023, August 14). Delirium tremens. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482134/
4. Rowden, A. (2021, March 23). The risks and benefits of quitting “cold turkey.” Medical News Today. https://www.medicalnewstoday.com/articles/is-it-bad-to-quit-cold-turkey
5. Yes, people can die from opiate withdrawal. (n.d.). NDARC – National Drug and Alcohol Research Centre. Retrieved March 1, 2024, from https://ndarc.med.unsw.edu.au/blog/yes-people-can-die-opiate-withdrawal
6. Ashenafi, W., Mengistie, B., Egata, G., & Berhane, Y. (2021). The role of intimate partner violence victimization during pregnancy on maternal postpartum depression in Eastern Ethiopia. SAGE Open Medicine, 9, 2050312121989493. https://doi.org/10.1177/2050312121989493
7. Medications for alcohol dependence. (n.d.). WebMD. Retrieved March 1, 2024, from https://www.webmd.com/mental-health/addiction/features/fighting-alcoholism-with-medications
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Suboxone withdrawal is worse than heroin withdrawal.

No one has ever been able to successfully taper off Suboxone.

Tapering off Suboxone is something that’s shrouded in both mystery and myth. While the thought of stopping the medication certainly generates a bit of anxiety, the unknowns and “what ifs” are truly the drivers of fear. What will it feel like when your Suboxone dose is decreased? Will it feel like you’re in withdrawal 24/7? Will anyone help you if the taper is going too fast?

By answering the what ifs and shining a light on the unknowns, tapering off Suboxone suddenly becomes a lot less frightening. Once the fear is under control, you’re free to play a leading role in your own recovery process.

What is a Suboxone Taper?

First thing’s first; let’s talk about what a Suboxone taper is and why it’s so important. Tapering is defined as gradually discontinuing or reducing the dose of a particular drug required by a patient over a prolonged period of time. Pay close attention to those last six words: “…over a prolonged period of time.”

The process of tapering is, by definition, meant to be slow.

Suboxone is an FDA-approved medication that has changed the way opioid addiction is treated. Its unique combination of two distinctive chemical compounds – buprenorphine and naloxone – give it the ability to virtually eliminate opioid withdrawal symptoms and minimize the risk of abuse. It takes time to recover from opioid use disorders, so most patients take Suboxone for an extended period of time.

Since buprenorphine is a partial opioid agonist, it does carry a risk of dependency. Given this risk, when you’re ready to stop taking Suboxone, a supervised taper is always recommended.

Trying to quit “cold turkey” without assistance can be dangerous and cause painful withdrawal symptoms, both of which increase your odds of relapse. A supervised taper, on the other hand, significantly lowers or eliminates withdrawal symptoms and prepares your body for life beyond Suboxone.

What to Expect During a Suboxone Taper

The road to a successful Suboxone taper begins with open, honest dialogue between you and your clinician. From those conversations, you will work together to develop a plan to reduce the amount of Suboxone you take. The result is a tapering schedule that is highly individualized and focused on your personal needs instead of being focused on adherence to one specific approach.

Your dosage can be lowered a little bit at a time over several days, weeks, or even months. According to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), Suboxone should generally be lowered in increments of 2 mg at a time every few days. Keep in mind, however, this progress relies on your level of dependence and individual experience. If you’re on a well-structured tapering schedule, you should only feel mild withdrawal symptoms for a few days following a reduction in dose.

If, at any point during the taper, your withdrawal symptoms or cravings become more intense, talk to your clinician. He or she can readjust your dose or slow the taper. You may need to go back to a previous dosage level in order to stabilize or increase the amount of time in between dosage reductions.

In some cases, a medication called Naltrexone may be used after you’ve tapered off Suboxone. Naltrexone is an opioid antagonist medication that works by blocking the effects of opioids. When used after the Suboxone tapering process, it offers additional anti-craving properties that can strengthen long-term sobriety. If used before the Suboxone taper is complete, however, Naltrexone can cause precipitated withdrawal.

Getting Help With Your Suboxone Taper

Some people might tell you that getting off Suboxone is impossible – that no one can handle the withdrawals or function without the medication. Thankfully, that isn’t true. With proper treatment and support, you can successfully taper off Suboxone.

10.1 million. That’s the estimated number of Americans aged 12 or older who misused opioids in 2019.

There were an estimated 75,673 opioid overdose deaths that occurred from April 2020 through April 2021.

What are we doing about these alarming statistics? The FDA has approved three drugs to treat opioid dependence. Buprenorphine – sold under the brand name Suboxone – is one of them.

Here’s how it works and what researchers have discovered.

Suboxone 101

Suboxone is an opioid partial agonist. An agonist is a chemical that triggers a response in the body. This drug only partly activates rather than fully. So its effects are weaker than substances like heroin or morphine (which are full agonists).

The drug also has a ceiling effect. This means higher doses don’t increase its effects. And, it’s long-acting, so people don’t have to take it every day.

This makes Suboxone a go-to drug for medication-assisted treatment (MAT) for opioid use disorder.

This medication can:

• Diminish the effects of physical dependency on opioids, such as withdrawal symptoms and cravings
• Increase safety (reduce the chances of overdose)
• Lower the potential for drug abuse

Ultimately, this can help people withdraw from opioids like heroin and reduce people’s use.

How long someone takes buprenorphine varies with each case. Treatment can range from short-term to indefinite.

MAT 101

The US Department of Health and Human Services reports that 1.27 million Americans are now receiving medication-assisted treatment for opioid use disorder (OUD). This combines medication like buprenorphine with counseling and behavioral therapies. This creates a comprehensive treatment plan that treats the whole person.

Research has shown that this combination can successfully treat opioid use disorders and help sustain recovery.

Does It Work?

Researchers recently dug into results from drug tests to find out.

Brendan Saloner, PhD, is an associate professor at Johns Hopkins Bloomberg School of Public Health. Together with researchers from Millennium Health, he published their findings in JAMA Network Open.

These investigators analyzed 150,000 urine drug test results for OUD patients. The patients were prescribed Suboxone between 2013 and 2019. Researchers wanted to find out if the presence of Suboxone made it less likely for a person to misuse opioids.

Of their 150,000 results, 85.49 percent were positive for buprenorphine. Just under half (47.58 percent) were positive for at least one non-prescribed substance.

Specifically, they found:

• Those who tested negative for buprenorphine were 10 times more likely to test positive for heroin.
• Those who tested negative for buprenorphine were seven times more likely to test positive for fentanyl.

In other words, the results indicate that if the patients stuck with their treatment, they were less likely to abuse other drugs. And, that if they stopped taking their medication, they were much more likely to turn to other drugs.

More Good News for Suboxone

Other research supports the theory that Suboxone can be an effective treatment for addiction. One meta-analysis of buprenorphine use found that doses of this medication improved retention in treatment and that high doses reduced opioid use.

And through other research, MAT has been shown to:

• Increase treatment retention
• Increase patients’ ability to remain employed
• Decrease illicit opioid use and other criminal activity among those with SUDs
• Improve patient survival

Call 800-934-1582(Sponsored) to learn more about available treatment options near you.