美国国家公共电台 NPR Without Medical Support, DIY Detox Often Fails（在线收听）

RACHEL MARTIN, HOST:

People struggling with opioid addiction can get help. But waiting lists are long, and treatment is expensive. So some people try to detox all on their own. Addiction specialists say this is not a good idea. WHYY's Elana Gordon explains.

ELANA GORDON, BYLINE: Elvis Rosado grew up in North Philly in the Badlands. It's an area well-known for drugs. He was in his teens when he developed a deep affinity for what was then called pancakes and syrup.

ELVIS ROSADO: I actually had - and I'm going to have to say it - a relationship, a love relationship with codeine.

GORDON: He quickly became addicted. Soon he was selling drugs to support his habit. By the time he was 25, he'd hit rock bottom. He was in jail.

ROSADO: I was like, I have to kick this. I have to break this.

GORDON: This was 25 years ago. But Rosado didn't ask for help from the jail's clinic staff, who could have given him medication to help with the symptoms. For him, if he took anything...

ROSADO: In my head, I was like, I'm still using.

GORDON: So began the most intense physical and mental experience he could have imagined.

ROSADO: The first day is gradual. It's like the onset of the flu.

GORDON: But then that flu went on steroids.

ROSADO: By 12 hours, I literally felt like not only did I have the flu, but I had a stomach virus and God knows what else. It was a difficult night.

GORDON: Full of shakes, racing heartbeat.

ROSADO: The sweats, the throwing up. It just gets really, really bad. The physical pain, it's like having Freddy Krueger inside you trying to rip his way out.

GORDON: Did you worry that it was going to kill you?

ROSADO: No, I don't think I ever worried about that. I had days where I felt like I wish I was dead.

GORDON: But is it dangerous to detox from opioids on your own? I asked Dr. Kyle Kampman, a psychiatrist at the University of Pennsylvania.

KYLE KAMPMAN: It's certainly uncomfortable, and most people can't tolerate it.

GORDON: But...

KAMPMAN: For people who are healthy, it's generally not a life-threatening condition.

GORDON: The diarrhea and vomiting from withdrawing can make you dehydrated. That can lead to severe complications, even deaths. But what Kampman really worries about is patients trying to avoid the side effects or cravings by getting drugs on their own without the understanding of potential adverse drug reactions or knowing how to safely monitor dosages. And beyond that...

KAMPMAN: What bothers me most about thinking that detox is adequate treatment is that we know that it just doesn't work.

GORDON: Some studies show the relapse rate is upwards of 90 percent without prescribed meds and monitoring to control the drug cravings after that initial withdrawal.

FREDERIC BAURER: So this is a detox unit. Their medications are controlled. The environment is controlled.

GORDON: Dr. Frederic Baurer is medical director of Kirkbride. It's a big recovery center in Philadelphia, where he's been treating people with addiction for 30 years. Baurer wants to throw out the old notion of detox.

BAURER: Back then, detox was thought of more as a treatment. Like, you go to detox, and then you're supposed to be well. And that's a really pernicious myth.

GORDON: Baurer says treatment is a lot more than getting the drugs out of your system. You can't just flush out the addiction. It's about counseling and perhaps, most important, medication like suboxone or methadone to manage the cravings. More and more evidence backs this.

BAURER: We have to really consider all the tools that are out there to support someone in getting well.

GORDON: And that can be a lifelong process.

ROSADO: There was this constant, like, there's something missing; there's something missing.

GORDON: For Elvis Rosado, drug cravings haunted him long after he detoxed on his own in jail. They even consumed his dreams.

ROSADO: Even though I wasn't using, my thoughts were still corrupted.

GORDON: Over the last few decades, he's found counseling and support. But researchers would say success with detox is the exception. Rosado, in fact, says his cellmate back in jail tried kicking the habit, too. But within months of being released, he'd relapsed and died of an overdose. For NPR News, I'm Elana Gordon in Philadelphia.

MARTIN: That story was part of the reporting partnership with NPR, WHYY's health show The Pulse and Kaiser Health News.