IT HAPPENED TO ME: I Spent New Year's Eve in the ER Thanks to Precipitated Heroin Withdrawal

Precipitated withdrawal is “the rapid and intense onset of withdrawal symptoms initiated by a medication.”
Publish date:
January 23, 2015
heroin, addiction, recovery, drugs, hospital, New Years Eve, Harm Reduction

So I'm pretty sure it isn't news to anyone at this point that heroin is back in a big way. A slew of articles came out in 2014 about the “New Face of Heroin,” and I'm not going to waste your time by rehashing them in detail here. Basically, all of these articles used the same study to point out that today the majority of heroin users are white, middle-class Americans who live in the suburbs; just as many women use heroin as men (duh), the average age of today's user is 23 (however, it is not a “twenty-something” specific drug, and users ages range from pre-teen to senior citizen). This is not news, it's bullshit hype that probably sold a few extra newspapers and generated a higher number of website hits. (Here's why.)

I'm not writing this anonymously because I don't feel the need to hide anything anymore. If “epidemic” numbers of people are using heroin, half of them are women, and their average age is 23, I know I'm not alone here. And if there are so many people whose lives have been affected by heroin, then they/we should be the ones talking about it.

My name is Annie. I'm 23 years old and I live in Brooklyn. I'm an Aries and I have two cats. Also I'm a heroin addict.

Well, recovering addict. Recover-ing, not recovered. I'm certainly not sober-sober; I have no plans to get that way, and I don't think I should have to be in order to write about drugs and how they've affected my life. I'm all about harm reduction as opposed to abstinence (which in my experience just leads to an extra-devastating relapse), and I'm surprised that the whole harm-reduction philosophy isn't more widely embraced, since we have definitely been losing the war on drugs pretty much since Nixon declared it.

I know that heroin users are stigmatized even within the larger drug community, so I understand why anyone would want to keep it a secret (and I did for a long time). But the bottom line is that opiate addiction isn't a character flaw, it's a medical issue, and needs to be treated like one. Whatever guilt, shame or fear you feel isn't worth compromising your health or safety.

I got addicted to heroin the same way a lot of people did. I used OxyContin and other painkillers recreationally throughout high school, and switched to heroin during college.

By the time I graduated, the way I used could no longer be described as recreational but rather as “high-functioning” addiction (as in, I was functioning exceptionally well for someone who was high all the time).

If you're trying to quit heroin, don't move to an area with a thriving open-air drug market, even if the rent is cheaper. Don't invite your sibling-slash-best friend to move in with you the week they get out of rehab, no matter how much you've missed them. These are a few of the lessons I've picked up along the way, after repeated failed attempts to stop.

I went to detox, then I relapsed once the methadone wore off –– typical ride on the merry-go-round of opiate addiction. When I wanted to stop again, insurance would no longer cover my stay in detox or rehab, and I was too physically dependent to stop on my own. At this point, the whole experience felt less like a merry-go-round ride and more like being stuck in a spider-web.

Then one day I called a phone number I saw online. I described my situation to the operator, and he told me I should see a Suboxone doctor, since it didn't require detox or a hospital stay, just a doctor visit, which my insurance would cover.

I had to abstain from using heroin for at least 12 hours before seeing the doctor, which I managed to do. I scored high enough on the COWS (Clinical Opiate Withdrawal Scale) to warrant a prescription, which I filled but didn't take; after 15 or so hours of increasing opiate withdrawal and general psychic hell, I wanted more immediate relief.

I went on a thoroughly depressing post-holiday bender, and then decided to cut the shit and really actually stop, which I thought would be easy. I did still have a full prescription of Suboxone.

Now here is where I made a VERY BIG MISTAKE. Instead of calling my doctor, who would have told me that I absolutely needed to wait a full 24 hours after using to take my first dose, I did a fucking Google search: “How long after heroin can I take Suboxone?”

And the results varied. One page said you only had to wait 24 to 48 hours if you were on methadone, because it stays in your system longer than heroin. It said that heroin should be out of your system somewhere from 12 to 24 hours later. In retrospect, I realize that's kind of a huge time gap and I probably should have looked for a more specific answer, but at the time it seemed good enough.

As it turns out, the number of hours you have to wait depends on a few factors, like how much you used, and if you shot up or sniffed it.

At the 12-hour mark, I was feeling pretty uncomfortable and decided that I'd waited long enough. Exercising some flawless junkie logic, I told myself that it would be best to just take the subs now, because if I got any sicker I'd break down and call my dealer. (Pro-Tip: Delete your dealer's number before you start the process of kicking dope). So I stuck the little orange film (it looks like a Listerine strip with letters and numbers printed on it) under my tongue and closed my eyes, hoping I would wake up feeling like a normal person for the first time in a while.

Precipitated withdrawal is “the rapid and intense onset of withdrawal symptoms initiated by a medication.” Regular opiate withdrawal is grueling and hellish enough; kicked into high gear, it can actually kill you under the right circumstances. My doctor had warned me about this possibility, something I remembered far too late.

“Normally heroin withdrawal happens gradually, it takes a few days. But if you take your first dose of Suboxone before all the heroin is out of your system, the buprenorphine will basically knock all the remaining heroin off of your opiate receptors, so you experience a sort of instant, accelerated withdrawal, with the symptoms being worse than if you were quitting cold turkey. But that won't happen if you give it enough time.”

I woke up drenched in sweat and immediately began projectile vomiting, like, full strength exorcist-style jet-stream of puke. That happened a few more times in the first half hour of being awake, and my strength was diminishing pretty quickly. I ran back and forth from the bathroom, then hobbled, then practically crawled. My bones hurt, my skin crawled, and it felt how I always imagined being poisoned would.

I would be sitting on the toilet, while simultaneously throwing up in a garbage can, (and crying!) and those were the moments that held the most relief. I spent the minutes in between groaning in the fetal position, letting my snot run down my face because blowing my nose seemed pointless. There was just no end.

Then there was no more food for my body to regurgitate, and I couldn't hold down water. I started chugging Gatorade just so I could feel some relief by puking up something other than bile.

Things were looking grim, so I gathered all the strength I could to make some phone calls. I was surprised that on New Year's Eve that my doctor even called back. I told him that “something has gone horribly, horribly wrong,” and explained what I did, sobbing and moaning like a woman in labor. He said I should go to the emergency room immediately, because I only had a few hours left before the New Year's Eve drunks would be showing up in droves, and I needed to get an IV of fluid as soon as possible.

Before I got any weaker, I put on my shoes, called a cab, and grabbed some bags to puke in on the ride over the bridge.

Every bump in the road or sudden stop made me heave; the cab driver looked more sympathetic than grossed out, which I appreciated. He joked that he didn't usually have passengers throwing up in his car until after midnight.

Drunk people in sparkling top hats stumbled on and off the sidewalks, in and out of packed dark bars, and they seemed far away from inside the car, like aquarium fish, a whole other world just out of reach behind glass.

Then we passed Stuyvesant Square, where I spent a week in detox over the summer, and that made me feel like a real asshole. What if the same doctors saw me? Would they even be surprised that I was back?

At the ER, I got the bed next to the bathroom, which was nice, but I had lost all shame about vomiting and got one of those plastic pink buckets hospitals always have so I could puke from the comfort of my bed.

My doctor had recently arrived from Japan, and explained that he wasn't familiar with the brand names of some medication, and this seemed to be the case when I told him I was on Suboxone. A nurse overheard and pulled him aside to explain what it was, and how it made it somewhat impossible for them to medicate me. The only way to stop the symptoms of opiate withdrawal is with opiates (in the hospital, probably methadone), but Suboxone blocks other opiates (including methadone) from the brain, meaning the precipitated withdrawal was irreversible, and they wouldn't be able to relieve the symptoms so much as they could just make sure I didn't die while I went through it.

I just had to wait it out, which is the last thing anyone lying in the ER wants to hear. They hooked me up to an IV pretty quickly, and I bled all over the jacket I just got for Christmas, which I kept on anyway, because in the ER it's always freezing and the blankets suck.

They injected anti-nausea meds into my IV on three separate occasions, but it didn't help. They refused to give me water because it induces vomiting, but I couldn't stand the dry mouth on top of everything else, so I kept going in the bathroom and putting my head under the faucet, and then I'd come out and sit in my bed and throw up some more, and cry and shake and cry.

A drunk man was put in the bed next to me, probably the first of many that night. He asked his nurse if she knew anyone else who had his disease (alcoholism); she said yes, her mother. I considered chiming in just to distract myself (“fellow addict, over here sir!”) but he quickly shut the curtain and became belligerent, screaming “GO FUCK YOUR MOTHER,” and I still have no idea how that escalated so quickly.

I noticed that the hospital staff were clearing beds more quickly than I had ever seen in the ER, which I can only assume was for the impending flood of other people who were, in their own way, just totally partied out.

After two bags of fluid from the IV and more nausea meds, they checked my vitals and said I was good to go. The nice Japanese doctor explained to me the best he could that only time would help, so they were sending me home. More drunk people were being wheeled in. I thanked the doctor and walked to First Avenue, and only then did I realize I was still in pajamas.

I got in a cab and threw up in the pink hospital bucket the whole way home. The driver made a similar joke about people vomiting in his car, and that I was the first of the evening. I wished him a Happy 2015 as I exited the cab, being sure to dump the puke bucket far from his car.

Time did help, and a few days later I was able to do things like walk and eat solid food. I have not used heroin since 2014, largely thanks to my traumatizing New Year's Eve incident and my intense desire not to repeat it, along with my overall desire to live.

I realize there will always be those weirdo, militant death-to-junkies people, and on top of that there will always be someone telling me I'm not “really” clean because I'm on Suboxone (among other things, sorry-not-sorry), and I really don't give a shit.

Maybe I'm not “clean,” but I'm better; I can eat, sleep, go outside, talk to people, I don't have to worry about getting arrested or robbed, or dying, and I can basically re-join the world, which is a good enough start for me.

To anyone else going through the hell of addiction and wants to end it: Don't try to do this alone. It's too hard and you don't have to. Suboxone definitely isn't right for everybody, and no single way is, but you won't know what is right for you until you talk to someone who is trained to deal with this.

I wish I could say that getting into treatment is a seamless process, and I know from experience that it often feels like the opposite at first (it's pretty fucking tragic to watch someone get turned away from a detox, or be told that their insurance won't cover a rehab stay), but that doesn't mean you should stop trying.

Call your insurance company if you have one, apply for government assistance if you don't, and just keep making calls until you can get the help you need, because help is out there somewhere, and you deserve it. You're not alone in this, and you should never have to feel that way.

Here are the websites with the phone numbers that I started with, but two are NYC-specific; if there are any you guys would recommend, please feel free to add to the list in the comments.