By the time Elvis Rosado was 25, he was addicted to opioids and serving time in jail for selling drugs to support his habit.
"I was like, 'I have to kick this, I have to break this,' " he says.
For Rosado, who lives in Philadelphia, drugs had become a way to disassociate from "the reality that was life." He'd wake up physically needing the drugs to function.
His decision to finally stop using propelled him into another challenging chapter of his addiction and one of the most intense physical and mental experiences he could have imagined: detoxing.
"The symptoms are horrific," Rosado says.
There are recovery and treatment centers that can help people quit using drugs — in fact, it's a multi-billion-dollar industry. But this help can be expensive, and waiting lists for state and city-funded programs are often extremely long.
So can detoxing on your own be the solution? In most cases, the answer is no.
In fact, a growing movement within the field of addiction medicine is challenging the entire notion of detox and the assumption that when people cleanse themselves of chemicals, they're on the road to recovery.
"That's a really pernicious myth, and it has erroneous implications," says Dr. Frederic Baurer, president of the Pennsylvania Society of Addiction Medicine.
But at the time, Rosado says, he needed to end his "longtime love affair" with codeine. Like Oxycontin and morphine, it's an opioid. In jail, these drugs were easily available, Rosado recalls, through friends and cell mates.
When he decided to stop, he didn't ask for help from the jail's clinic staff, who could have given him medicine for the withdrawal symptoms. Rosado says that, if he took anything, "in my head I was like, 'I'm still using.' That's how I was seeing it."
The first few hours were gradual, like the onset of the flu, he recalls. But then he started sweating and shaking, his heart raced and he started throwing up. About 12 hours in, Rosado says he was reminiscing about how pleasant food poisoning was compared to this. He says his stomach cramps felt like, "having Freddy Krueger inside you trying to rip his way out."
Rosado couldn't sleep; he lay on the cold floor, shivering. "I had days where I felt like I wished I was dead," he says.
"My cellmate kept saying 'Look at you! Use a bag or go to the nurse.' "
Over the next week the intense symptoms slowly subsided. He was exhausted, depressed, irritable and sore.
Then came the next phase: the temptation to slide back.
"It's a battle," Rosado says.
He remembers a voice in his head telling him it would be so much easier to give in. "Take something, take a little bit," he remembers the voice saying.
Most people can't tolerate detoxing from opioids without support or medications to ease the withdrawal symptoms, says Dr. Kyle Kampman, a psychiatrist who specializes in addiction at the University of Pennsylvania.
Diarrhea and vomiting from withdrawal can make a person dehydrated, and that can lead to severe complications, even death in some cases. And Kampman worries about the big risks of patients trying to self-medicate to avoid these side effects or drug cravings.
"If you're going to use the medications that a doctor would use to do detoxification, which might be methadone or buprenorphine, or even a blood pressure medicine like clonidine or sedatives, all those medications are dangerous," says Kampman.
They can have adverse interactions with other drugs, and in the case of methadone, he says there is a possibility that a person could overdose without physician oversight.
But Kampman's biggest concern when it comes to detoxing is the extremely low success rate.
"What bothers me most in thinking detox is adequate treatment is that we know that it just doesn't work," he says. "We have a long history of putting people into detox, followed by drug-free treatment that results in relapse in an overwhelming number of cases."
And if the patient goes back to using, there's a higher risk of overdose because their tolerance has gone down.
Addiction, Kampman says, isn't something you can just flush out of your body. It's a disease.
When people addicted to opioids first quit, they undergo withdrawal symptoms, which may be severe (pain, diarrhea, nausea, vomiting, hypertension, tachycardia, seizures.) Medications can be helpful in this detoxification stage, easing craving and other physical symptoms that can often trigger a relapse episode. However, this is just the first step in treatment. Medications have also become an essential component of an ongoing treatment plan, enabling opioid-addicted persons to regain control of their health and their lives.
Dr. Frederic Baurer goes further, and suggests it's best to abandon the whole notion of detox, period.
"I think the term detox has negative connotations," said Baurer, who has been treating people with addiction for nearly three decades. He's also been involved in a city-wide task force assessing the opioid epidemic in the region. He says the focus should be on a stabilizing treatment plan, not on detox.
Baurer is medical director at Kirkbride Center in Philadelphia, a recovery center that has an in-house detox unit of 21 beds. But, according to Baurer, the unit does a lot more than getting drugs out of a person's system.
"It's structured," he says. Patients have reflection time. Their symptoms are monitored. They meet with counselors, come up with a long-term treatment plan, and, perhaps most importantly, they get medications like methadone to manage cravings. Some of the medications target the same receptors in the brain as other opioids, but they do it for a longer period of time, which reduces symptoms. Another option, Vivitrol, blocks opioid receptors, which inhibits the person's ability to get high.
Baurer says there's no one formula.
"We have to consider all the tools that are out there to support someone in getting well," he says.
Elvis Rosado said he first developed his coping tools in jail. The bars protected him from the temptations of his old neighborhood and he found support groups and counseling.
Still, he may be one of the few who tried detoxing on his own and succeeded.
Since his release from jail, Rosado has gotten degrees in mental health and social services, and worked in treatment centers. He now leads overdose prevention efforts for Prevention Point Philadelphia, a nonprofit organization that provides prevention services across the region.
Rosado doesn't think his detox approach is for everyone.
"If we don't give individuals the time to start to have clear thoughts and put a plan together, getting the chemical out of their system --- you're not doing them any favors," he says.
Rosado also credits his own long-term success to a very specific conversation he had while he was still locked up. It came during a phone call with his girlfriend.
"She goes, 'I'm pregnant, what are we going to do about it?' And I said, 'We keep it. We keep the baby.' "
He recalls making a promise to himself in that moment to be a good father. And for him, at least, that worked. But, he says, his cellmate back in jail tried kicking the habit, too, and within months of being released, he relapsed and died of an overdose.
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.
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. Transcript provided by NPR, Copyright NPR.