Ready to stop using opiates: first steps

1. Pick who to tell. A primary care doctor, a nurse practitioner, a community health center, a telehealth service or an opioid treatment program can all start the process. NIDA notes that buprenorphine can be prescribed by many doctors, nurse practitioners and physician assistants.
2. Make the appointment and say why. You can say, “I am dependent on opioids and I want help stopping.” Clinics hear this every day. Being plain about it gets you a faster and more useful visit.
3. Write down what you take. Which drugs, roughly how much, how often, and when you last used. Include alcohol, anxiety medicine and sleep medicine. The plan depends on honest numbers, and nobody is grading you.
4. Check your coverage. If you have insurance, call the number on the card and ask what is covered for opioid use disorder. If you have none, see treatment with no insurance.
5. Get naloxone. It is sold over the counter. The days around stopping and starting are risky ones, and it is sensible to have it in the house.
6. Tell one person you trust. You do not need to tell everyone. One person who knows the plan makes the week safer.

To find someone near you, use the treatment directory or the federal locator at FindTreatment.gov. SAMHSA’s National Helpline, 1-800-662-4357, gives free referrals 24 hours a day, and you do not need insurance to call.

The clinician will ask about your opioid use, your general health, other medicines and your mental health. They may ask for a urine drug test. The purpose is to choose a safe treatment, not to catch you out.

Then you will talk through options. For most people that means one of three medications:

• Buprenorphine, often prescribed from an ordinary office or by telehealth and taken at home.
• Methadone, which for opioid use disorder is only available through approved opioid treatment programs.
• Naltrexone, which blocks the effect of opioids and is started after withdrawal is over.

Your prescriber will explain when and how to start. Timing matters with these medicines, so follow their instructions and not something you read online, including here.

What you say is protected. Health privacy law applies to any clinician, and federal rules give substance use treatment records extra protection. If your job is the worry, read will my job find out.

Opioid withdrawal is painful, and MedlinePlus notes that it is usually not life threatening. Some situations are different. In these, get medical advice before you cut down or stop.

You are pregnant

The CDC says quickly stopping opioids during pregnancy is not recommended, because it can lead to serious problems including preterm labor, fetal distress and miscarriage. Methadone and buprenorphine are the first choice treatments in pregnancy. See pregnancy and treatment.

You have been on high doses or long term prescribed opioids

The FDA has warned that suddenly stopping opioid pain medicine in someone who is physically dependent can cause serious withdrawal, uncontrolled pain, psychological distress and suicide. Any reduction should be planned with your prescriber.

You also use alcohol or benzodiazepines

Withdrawal from alcohol or from benzodiazepines such as Xanax can be dangerous in a way opioid withdrawal usually is not. Tell the clinician about everything you take so they can plan for it.

You take methadone or buprenorphine as treatment

These medicines are protecting you. Do not stop them without your prescriber.

You are having thoughts of suicide

Call or text 988 now. Withdrawal can make dark thoughts worse, and you should not sit through that alone.

There may be a few days between deciding and being seen. Those days count.

Do not try to prove something by stopping cold in the meantime. If you do stop or run out, know that your tolerance falls quickly, and going back to your usual amount can cause an overdose. Our page on quitting cold turkey explains the risks.

If withdrawal starts and you cannot keep fluids down, or you feel unsafe, go to an emergency department or urgent care. Some emergency departments can start buprenorphine on the spot.

Keep the plan small: one appointment and one honest conversation. The rest of understanding opiate addiction can wait until you feel steadier.

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.