About the Myths of Self-Medication for Drug Addiction.

From the very outset we would like to stress our professional opinion:

• taking any drug in any quantity and form is unequivocally harmful;
• division of the drugs on  "heavy" and "light" ("dangerous" and "safe") is unlawfull. Consequently, there are no “safe” narcotics.

People who are in a constant need of addictive psychoactive substances, can not avoid development of specific aberrations  in their outlook and  personality , identified by us as an "addictive personality deformation" . In accordance with this strain of personality, rather specific in its manifestations, the myths  about drug addiction are born.

The main sense of these myths (and that  is extremely important for all drug addicts) is  a psychological self-defense in front of a horrified awareness of being seriously ill and hope for self-recovery.  In accordance with this idea, the most common myth among all drug addicts is that if necessary they can easily stop using drugs. Modification of this myth is the notion that with the help of certain medications or drugs (either pharmacies or home-made)  you can  overcome, for example, the opioid addiction (to "jump" off heroin).

The drug addicts often avoid medical treatment, relying on their own capabilities to overcome the addiction. Theoretically, any patient has  a chance for it , but only few can handle it by themselves.  Ungrounded belief in their own volitional mechanisms,  exaggeration of their potential  is one of the many pitfalls that drugs create for enslaved people.  To make a person don't feel humiliated in this enthralment  the myths are called on help him to stay away from awareness of his own enslavement. Sick  person, carefully guided by his addiction, builds up a reliable barrier between himself and the possibility of recovery. And one of the cementitious components of this barrier  is an idea of ​​the possibility of  overcoming drug addiction easily.

Overcoming physical dependence on opioids (heroin, opium poppy,, morphine, etc.) is nothing else but  the reduction of  tolerance  of opioid brain receptors to opiates. The term "tolerance" means addiction to the  drug, the  decreased  susceptibility to its action. Many patients say that when they are "on system”, the drugs don't bring them desirable pleasure.  They have to use drugs regularly just  " not to be in pain ". This reflects the tolerance of opioid receptors to the  desired “high”. When people reduce the dose, the drug in some way begins to act more strongly, and the pleasure of taking it grows and remains until  tolerance doesnt increase again. The growing tolerance to the drug is a major cause of progressive dose escalation unavoidable in any kind of addiction.

Reduced tolerance may be partial (when the patients intentionally reduce  the dose by themselves, or when they just started treatment at the clinic) or almost complete (when even the smallest dose of opioids  begins to act like it was at  the dawn of " freaky drug biography”).

Most drug addicts use the following methods to overcome heroin withdrawal:

• ·use of methadone, substitol, tramal and other opioid substituents;
• ·use of hypnotics and sedatives;
• ·use of alcohol;
• ·use of non-opiate drugs (eg psychostimulants);
• ·use of  combination of these methods;
• ·without any help. ( “cold turkey”)

It is easy to see that all the ways to "get off the needle”, except for the last one, are based on the replacement of  one psychoactive substance by the other.

Lets consider these methods in details.

Opioids substituents. Tramal (Tramadol) is most often used in order to overcome the physical addiction to heroin ( or wthdrawal syndrome). Tramal is a moderate opioid with  fairly pronounced analgesic properties (it is really effective  as a pain-killer for healthy  people with low tolerance to opioids). The drug is manufactured by factory method and, therefore, does not contain impurities. Tramal is relatively easy  redistributed from the pharmacy network and  hospitals  into illicit drug use. Tramal  theoretically represents a relief  from withdrawal syndrom  by  binding to opiate receptors (namely, "denuded" state of opioid receptors  causes pain, insomnia, intestinal disorders and other manifestations of opiate withdrawal) with  progressive  reduction of dose (in slang of  drug addicts it is called a "ladder"). Tramal is available in form of capsules of 50 and 100 milligrams.

Despite the theoretical possibility to overcome heroin addiction by Tramal, the attempts of the patients to do this in practice almost always turn out to be fruitless due to the following reasons:

• after relatively short  period of  remission  the patients return to heroin  because of the continuing craving for it (psychological dependence), or because of the "stress" which encourages patients to use the drug "once" as a means to solve their problems with all following consequences;
• the patients can not achieve supposed gradual abolition of Tramal (the notorious "ladder") because of a strong  fear of deconditioning.  In addition,  Tramal, as  any  other opioid has  an addictive potential, and the growing tolerance to it  occurs as naturally as a tendency to increase the dose of heroin in case of its regular admission.

Another drug, often used to overcome heroin addiction is Methadone.

It should be noted that Methadone is a highly addictive substance with the addictive potential is much higher than that of Heroin . Due to  rapidly  growing tolerance  to Methadone the scheme of gradual dose reduction is not possible for the most of the  patients.  And instead of  solving the problem of heroin dependence, the patients simply turn into much harder methadone addiction.

It should be noted that long-term  experience in the use of "methadone programs” in many countries  does not inspire optimism.

More information about Methadone you can find on the same web site in “Opioid Replacement Therapy: pros and cons” option.

Summarizing the problem of self-medication to overcome heroin addiction  with the help of Tramal or Methadone (as well as with any other opioid substituents), we should say that the vast majority of such attempts is not successful due to the natural laws that underlie opioid addiction. The failure can be explained by two major factors: 1) the rapidly  growing  tolerance to substituents and, as a result, the need to increase the dose while it must be "decreased", 2) the fear of physical deterioration, which also encourages the patients to increase the dose and thus consolidates their drug dependency.

Cases of successful self-recovery with use of opioid substituents exist, but they are too rare to talk about the reliability of this approach.

The problem of the gradual drug discontinuation is feasible, but only in hospitals, where dosage and mode of drug intake are determined by a doctor.  The possibility of deconditioning, in other words, possibility of development the  withdrawal syndrome can be solved by appointing different group of medications, unknown to an addict. Parallel can be made: only an expert can make explosives from household chemicals, only a doctor-psychiatrist is able to overcome withdrawal with medications that don'tt cause any interest to a drug addict.  Carrying out another analogy  between the drug and alcohol abuse, we can say that the  attempts to overcome heroin addiction with the help of tramal similar to attempts to overcome addiction on vodka with the help of beer. Such attempts (and they actually are widely spread among the patients with alcohol problem) lead either to the fact that the need for beer  dramatically increases and low degree of alcohol in a beer is compensated by its increased amount  or to the fact that after beer  an alcoholic quickly returns to vodka.

Hypnotic-sedative group of medications.  An alternative approach to overcoming addiction are the attempts of patients to 'oversleep' the abstinence.  Reladorm, radedorm, valium, dormicum, rivotril, lexilium  phenazepam and other bensodiazepines are popular in drug addict media for that purpose. Futility of these attempts is  evident. Harm of this approach lies in a special state of drug intoxication produced by immoderate use of these drugs. The patients  intoxicated by sleeping pills are paranoid and their behavior is absolutely irresponsible.  In addition, drug intoxication has very negative impact on liver function. Cases of  respiratory failure due to overdose of sleeping pills  are also well known.

The massive intake of alcohol.  Overcoming heroin withdrawal “through the glass" is not so  popular nowadays as it was  few years ago.

Usually the attempts to overcome heroin addiction by drinking the massive doses of alcohol are unsuccessful. There are two main reasons for that failure. First, alcohol cant  adequately facilitate "heroin withdrawal". Second, alcohol in any doses cant fight a persistent desire (craving) for heroin even in those rare cases when  a physical dependence on drugs with the help of  alcohol has been overcome. Besides, there is a risk of development of a secondary alcoholism, when a former drug addict begins to abuse alcohol during the  drug remission in order to overwhelm (“to drown”) psychological dependence on heroin.

The greatest danger to patients who refer to this method  is the  impairment of liver function under the influence of alcohol. It is known that at least 98% of heroin addicts are infected by HCV.  Some "lucky" guys are positively tested for  two or even for three different types of hepatitis (eg, B, C and D). Alcohol  even in small quantities is a highly toxic substance to the liver which is already badly affected by the drugs and hepatitis viruses. Therefore even if the patient  stops using heroin  and consumes only “good quality” alcohol sparingly, he runs a relatively high risk of developing  liver failure. Besides, alcohol consumption by the drug addicts is often accompanied by perverted reactions,  when even the small dose of alcohol may cause inadequate intoxication with pronounced depression, paranoid ideas of persecution, hallucinations and other mental disorders.

The next morning the patients experience hungover (regardless the amount of consumed alcohol)  which is not  typical for alcoholics, but with the signs of opioid withdrawal:  back pain, pain in legs, watery eyes, running nose, diluted pupils and other symptoms. Reduced tolerance and perverted reactions to alcohol  is the result of the altered cerebral reactivity under the influence of psychoactive substances.

All this makes  use of alcohol  as a means to solve problems with heroin addiction meaningless.  Judgement,  that for the ex-drug addicts alcohol is the lesser of two possible evils, is  mistaken.

Non-opiate drugs. Non-opiate drugs are the psycho-stimulants such as cannabis, hallucinogenics, cocaine, amphetamines and etc. which are also used as a tool of self-medication in  attempts  to kick off addiction on  heroin.  Very rare these attempts are successful. But for the brain and, consequently, for the  mental health such  zigzags are comparable with the physiological experiments on animals (where, for example, laboratory rats are exposed to alternating electric current, acetone, laser glare, and etc. and then slices of the affected brain are examined under a microscope). In most cases the result of such experiments is very disapponting.  Non-opiate drugs cant solve the problem of  opioid addiction. And what is even more frustrating, the opiate addicts often develop dependence on psycho-stimulants in addition.  The toxic affects of the stimulants on the brain cortex and internal organs are much more destructive  than that of heroin  (which in its pure form  is a low-toxic substance).

The combination of different approaches. The most common approach in an attempt to fight opioid addiction is  the combined use of opioid substituents (for example, Tramal) with the sedatives and hypnotics  (eg, benzos). Tramal is intended to remove painful symptoms of withdrawal syndrome , while  sedatives are supposed  to reduce anxiety, to suppress "craving" for drugs and to ensure sleep. The most daring addicts in their attempts  to get off heroin expose themselves to the most sophisticated experiments. They mix up use of hypnotics and opioids with  massive doses of alcohol, psycho-stimulants and marijuana. The success of such attempts  is comparable to that of the other ways of self-medication with summation of all negative aspects.

Overcoming opioid addiction by"cold turkey"(without any medication). Though it is a painful process, for relatively strong individuals  this method is practically safe because  it is absolutely  non-toxic.

If a person has been using  drugs for years,  has a couple of hepatitis, HIV, tuberculosis and etc, he should be very carefull to resort to such a heroic trial as "cold turkey".

The number of successful recoveries by "cold turkey", unfortunately, is  low.  But this approach  is "clean" and people who resort to it deserve a respect. This is the only approach that does not represents a target for criticism from professionals  and it could have been recommended for widespread use, had the success rate nad been at least a bit  higher.

The main drawback of all methods of self- medications is the absence of treatment for psychological dependence, which is the  major  problem for all kinds of drug addiction and, in fact, determines  an extremely low rate of recovery from drugs without special medical treatment.