Alcohol, Benzos, and Opiates—Withdrawal That Might Kill You

Along with teaching and telling stories, part of my goal here is to get important information out to those who can benefit most from it.

Most drug users who quit "cold turkey" have to go through withdrawal of some sort. Withdrawal is never comfortable, but sometimes it can actually be dangerous. The list below outlines some drugs that should never be quit suddenly without medical supervision. This is the reason why some rehab treatment is preceded by a medical detox period lasting anywhere from two days to a week or more.

Which withdrawals can actually kill?

1. Alcohol. Yes, after long term use, withdrawal from alcohol can kill. Alcohol withdrawal syndrome can take on mild, moderate, or severe forms. If while withdrawing from alcohol a person develops a fever, extreme nausea, diarrhea, or DT (delirium tremens), they need to be taken to a doctor as soon as possible. Alcohol withdrawal after heavy, chronic use is best managed under the care of a doctor or a professional medical detox unit. By using medications that relieve withdrawal symptoms, these professionals can largely eliminate these risks.
2. Benzodiazepines. Benzos were introduced as a replacement to barbiturates that were causing overdose cases which resulted in death. Nevertheless, withdrawal from the extended use of benzodiaepines can kill. Whether Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam) or other variations, long term use of Benzodiazepines requires medical supervision to be completed successfully with minimal side-effects and risk to the patient. Normally, the withdrawal process is managed by slowly reducing the dose and transferring the patient from a slow-acting form of the drug to a long-acting one. Still, full resolution of benzodiazepine withdrawal syndrome can take up to six months (or even longer).
3. Opiates. In most cases, withdrawal from many opiates is not deadly. Still there are some very important exceptions. Methadone, a long-acting opiate often prescribed as a replacement for heroin, can cause death during withdrawal if it's consumed in high enough doses for a long enough period. (Note: A literature search failed to find any documentation of methadone withdrawal death risk and so this statement relies on anecdotal evidence. Death by overdose of methadone is far more common and the statement regarding death by methadone withdrawal should be considered with caution.) The debate over whether the state should be prescribing drugs like methadone should be saved for a later date. It is one of the better ways of getting people off of heroin, although obviously it replaces dependence on one substance with another, more manageable one. Also, some recently popular methods of rapid-detox from heroin addiction can themselves cause death and other negative side-effects. Overall, I would recommend checking with a physician and conducting opiate withdrawal in a controlled setting. Withdrawal under Suboxone or Subutex can be less horrific although many still report severe discomfort at final cessation.

Much of the danger in withdrawal from all of these drugs has to do with the body's response to the extreme changes in the chemical processes going on in the brain and the rest of the body. Alcohol, Benzos, and Opiates interference with the GABA system, the body's most common downregulator. Withdrawal from these drugs is like trying to turn the heat up in a cold house with a broken thermostat and an out-of-control heater—it won't always lead to disaster, but it's a bad idea.

"Cold Turkey" withdrawal from cocaine, marijuana, crystal meth, ecstasy, GHB (never mix GHB with alcohol) and many other recreationally-used drugs will not lead to death or anything near it in the vast majority of cases. While it may make you uncomfortable, and you may feel moody, constipated, dehydrated, hungry, or nauseous, among other symptoms, the chances of someone actually dying are small.

© 2010 Adi Jaffe, All Rights Reserved

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