They say recovery from opioid addiction is impossible, but it’s not. 96% of people have gotten over their opioid addictions historically.
Most people would have you believe that nobody ever gets over an opioid addiction. In fact, some of the nation’s most influential authorities on addiction are now saying that anyone who’s ever had an opioid addiction needs to be on a Maintenance Therapy (Methadone or Buprenorphine aka Suboxone) for the rest of their lives, because they will never recover. I’m not exaggerating about this; consider this excerpt from Overcoming Opioid Addiction by Columbia University’s Adam Bisaga, published in May 2018:
Treatment with medications should be offered to all people with opioid use disorder (OUD), whether the disorder is mild, moderate, or sever; current, or in partial or full remission. This includes those who are actively using opioids at the time of evaluation; those who have never developed a daily routine of opioid use but suffer from the adverse consequences of occasional use; those who recently stopped daily use of opioids and are not physically dependent at the time of evaluation; and those who have remained abstinent for some time but may have a recurrence of cravings or simply undergo additional stress or problems in their lives.
OUD is a chronic disorder and once it develops it remains present whether the patient is using or not.
He continues to say that all have a disorder that requires treatment, no matter what their present state. Notice the parts of that quote that I bolded. The message is that nobody ever really gets over an opioid addiction. This sentiment was repeated recently in a New York Times interview with Dr. Elinore McCance‐Katz, who did pioneering research on buprenorphine treatment for opioid addiction, and now serves as the director of the Substance Abuse and Mental Health Services Administration. She said that she responds to opioid addicts who’ve relapsed but still want to become abstinent thusly:
Here’s what you just told me about your life and history. I’m going to tell you that based on my history with people who have the kinds of problems you have, you have zero chance of being able to maintain your abstinence.
SOURCE: New York Times, The Trump Appointee Who’s an Addiction Specialist
“Zero chance.” Here’s a reality check on that depressing, fatalistic claim.
Rates of Recovery from All Drugs Including Opioids
3 decades worth of epidemiological surveys show that at any given moment, about 80% of people who’ve ever been addicted to any drug other than alcohol are currently recovered from that addiction. But the probability of eventually overcoming any drug addiction is over 96%.
- 80% currently recovered from any drug addiction
- Over 96% eventually recover.
- Only 25% ever get treatment.
SOURCES: Over 90% of addicts will recover even though less than 25% will get treatment
Rates of Recovery from Opioids
People can and do get over their addictions, usually without treatment. This is a well established but little known fact. But we have this idea that the exact numbers for opioids alone must be far worse – because they’re so incredibly “addictive”, right?
Wrong. The last major epidemiological survey (data collected 2001-2002) to give detailed information on prescription opioid addiction shows that these drugs are no exception. It found that:
- 17.7% of opioid addicts recover within one year of developing the addiction
- 50% recover in 5 years or less
- 67% recover within 10 years or less
- 96.1% will eventually recover
Those numbers are very good news. The only bad news is that there is a portion of opioid addicts, less than 20%, who struggle for more than 20 years.
[NOTE: Because this was a study of the general population, it includes both treated and untreated opioid addicts.]
That same survey included heroin addicts as well, but there were not enough of them to draw as reliable of conclusions as could be drawn from the much larger sample of prescription opioid addicts. Only 146 people with a history of heroin abuse or dependence were located for the survey, whereas 521 people with prescription opioid use disorders were found. As a result of the smaller sample, study authors did not give the same breakdown of recovery rates and eventual probability as listed above. Nevertheless, heroin and prescription opioids are essentially the same drugs, acting the same basic way in the brain. In fact, some prescription opioids are more potent than common street heroin. There is no reason to believe that recovery rates should be any different. Here’s what they found about their heroin user sample:
…those with [DSM-IV] heroin abuse (94%) or dependence (96%) were remitted from the most recent episode, and that proportions of remission did not differ by history of any substance abuse treatment service use. This pattern is in line with other studies that have reported recovery without substance abuse treatment or self-change (“natural recovery”), which appears to be a common pathway to remission.
This is also in line with one of the most famous studies of heroin addicts, conducted in the early 1970s on the thousands of Vietnam vets who’d been addicted overseas. Over 90% of them did not receive any treatment, and were simply required to detoxify before returning home to the United States. Half of them tried heroin again when they returned, but within the first 3 years only 12% of them relapsed. That is to say that 88% of them immediately recovered from their heroin addictions after detoxifying “cold turkey.” A very long term follow up was conducted, and showed that another 8% recovered some time in the following 24 years, for a total of 96% recovered.
We cannot ignore the similarity, 96 of NESARC heroin addicts recovered, 96% of the Vietnam vets recovered from heroin addiction, and 96.1% of prescription opioid addicts would recover in the NESARC sample. This gives us every reason to believe that the prescription opioid recovery rates are applicable to non-prescription opioids as well.
Gene Heyman 2013; Quitting Drugs: Quantitative and Qualitative Features
There is one sure caveat, and that is that fatal overdose rates were much lower at the time of the NESARC data collection, probably around 1% annually, and today there is a spike with a 2% annual overdose rate for opioid addicts. This would obviously lower the current probability of recovery, but it is a spike that will hopefully pass. The other caveat is that heroin users may be generally more deviant than prescription opioid users, in the sense that they are more willing to break social norms – the taboo against heroin is much stronger than the taboo against recreational use of prescription opioids. If better data ever comes out showing a significant difference in probability of recovery between heroin and prescription opioids, my guess is that this would be the only factor that could explain the difference. After all, these are basically the same drugs, pharmacologically speaking, but the culture that surrounds them is the main thing that differs.
The bottom line is that most people with heroin/opioid addictions will get over their addictions – we have every reason to believe that 96% will, and that anyone can. If you know one who needs a boost of encouragement and hope, pass this information along to them. There are people out there, professionals no less, with plenty of authority telling them that they will never get over their problems – that is misinformation, and struggling people need the wonderful truth that they can overcome their opioid use problems.
The stats discussed in this article are historical trends. That is to say, these numbers represent what has happened in the lives of people with drug problems in the U.S. over several decades. They don’t determine what will happen in the future, and they don’t tell us what will happen in the life of any given individual. But they do show us that there is no reason to believe the worst, and every reason to expect the best. If you have a drug problem, you can find your way out of it as countless millions of others have throughout history.
