Relapse after stopping opiates

This is the part that cannot be softened.

When you stop taking opioids, your tolerance falls. It falls faster than most people expect. Your cravings and your memory of what a “normal” dose was do not fall with it.

NIDA puts it plainly: if a person uses as much of the drug as they did before quitting, they can easily overdose, because their body is no longer adapted to it. MedlinePlus goes further and notes that most opioid overdose deaths occur in people who have just detoxed.

Fentanyl makes this worse. The supply may be stronger than it was when you stopped, and a pill or powder can contain far more than you expect.

If you are going to use after a break, or think you might, these steps lower the risk:

• Have naloxone within reach, and make sure someone with you knows where it is.
• Do not use alone.
• Assume your tolerance is gone, whatever you used to handle.
• Do not mix opioids with alcohol, benzodiazepines or other sedating drugs.

See risk and overdose for the signs and the steps to take.

Call 911 if someone is not breathing or cannot be woken. Call or text 988 for a crisis or thoughts of suicide. For a free referral at any hour, the SAMHSA National Helpline is 1-800-662-4357.

1. Deal with safety first. If you are still using, follow the steps above. If you feel hopeless or are thinking about ending your life, call or text 988.
2. Tell your prescriber or program. Do it soon and tell them the whole thing. This is information they need, and they have heard it many times. A return to use is a reason to adjust care, not to end it.
3. Keep taking your treatment medicine unless your prescriber says otherwise. Do not stop methadone or buprenorphine because you feel you have “ruined it”. Ask your prescriber what to do next.
4. If you are not in treatment, start now. You do not have to wait for a set number of days. The treatment directory lists providers by state, and SAMHSA’s National Helpline, 1-800-662-4357, gives free referrals at any hour.
5. Look at what led up to it. Do this with a counselor if you can, and without beating yourself up. The useful questions are about what was happening that week and what support was missing.

NIDA says that when a person relapses, it means they need to speak with their clinician about resuming treatment, changing it, or trying something else. In practice that might look like:

• A change in medication or dose, decided by your prescriber.
• Staying on medication for longer than first planned. See medication for opioid use disorder.
• More frequent visits for a while.
• Adding or changing counseling to work on the specific triggers involved.
• A stronger aftercare plan, including peer support.
• Treating pain, depression, anxiety or sleep problems that were pushing you toward use.

One slip does not erase the months before it. The skills you built and the trust you rebuilt are still there. People who recover have very often relapsed along the way. Our page on recovery has the national figures.

It is frightening, and it can feel like a betrayal. Anger is a normal reaction. So is exhaustion.

A few things help more than others. Check that there is naloxone in the house and that you know how to use it. Say what you have noticed without an ambush. Ask what they need to get back to their prescriber or program.

Shame tends to push people further into hiding, and hiding is where the overdose danger is. You can be clear about your limits and still keep the door open. Our guide to setting boundaries covers how to do both.

You also need somewhere to put your own fear. Family support groups and counseling exist for exactly this.