Lucy lives with her husband, dog, and cat in a single occupancy room in the heart of Vancouver’s Downtown Eastside, a neighborhood once described by the Vancouver Sun as “four blocks of hell” and depicted in Gabor Maté’s book In The Realm of Hungry Ghosts. “It is just so brutal to live in this neighborhood. I am so tired of watching people die down here,” Lucy told me, “I think that’s why I kept relapsing.” Lucy is addicted to opioids, but is making a steady recovery with the help of vitamin C.
Over the years, Lucy, who is 39 years old, has tried various strategies to quit using opioids, including in-patient hospital detox, living in a halfway home, and using methadone. The methadone was rough: “It was hard on my stomach, hard on my body. It was awful, it was a terrible feeling,” she says.
What keeps her in the Downtown Eastside, besides poverty, is proximity to the community clinic at which she receives injectable opioid agonist therapy (iOAT). She visits the clinic twice a day, every day, to receive high doses of opiates under medical supervision.
Until not too long ago, Lucy still experienced strong drug cravings and withdrawal symptoms, even on the aggressive iOATs regimen. She managed these symptoms with street drugs, namely fentanyl, a synthetic opioid pain reliever 50 to 100 times more potent than morphine. But she hit a crisis point last year when she ran out of money and couldn’t satisfy her body’s screams for the drug. “I was desperate to try anything that would get me any sort of relief,” she says of her withdrawal. At the suggestion of a nurse, Lucy called Trevor Millar, a local healthcare advocate.
Millar drove to Downtown Eastside that night with a bottle of powdered sodium ascorbate – a form of buffered vitamin C – instructing Lucy to take 2 grams of the vitamin every two waking hours. “The next morning, I woke up and I had no withdrawal symptoms. I felt better than I had in years,” Lucy told me. “If I had to come down on my own it would have killed me.” She has been on sodium ascorbate ever since.
Within two months, Lucy was off street fentanyl entirely. Within three months, her iOAT dosage of Kadian (extended release morphine) had been gradually reduced from 1,800mg to 200mg per day, and her hydromorphone dosage dropped from 160mL twice daily to 30mL twice daily. When I spoke with Lucy’s medical doctor, she confirmed that Lucy was indeed tapering down her opioid dosages faster than typical. But was this on account of the vitamin C? The doctor couldn’t say.
Lucy claims that she has had no withdrawal symptoms whatsoever while on the vitamin C regimen. “I never thought something could be such a magic bullet,” she told me – “I am just flabbergasted.”
As compelling as Lucy’s story may be, it is but one anecdote. Millar, however, has more success stories to share. As an ibogaine expert and chair of the board for MAPS Canada, he began recommending vitamin C to his opioid-addicted clients when Health Canada rescheduled ibogaine in 2017, prohibiting him from administering the hallucinogenic shrub.
Millar claims that another client dropped his daily Subutex (buprenorphine) dose from 12 mg to 2 mg in under three weeks – without experiencing a single craving or side effect. Millar now recommends sodium ascorbate over “regular” vitamin C (ascorbic acid), as the latter can cause diarrhea and digestive upset at high doses.
Much has been written on the topic of vitamin C and Opioid Use Disorder (OUD), though the evidence is somewhat patchy, mostly coming from studies performed on rats and guinea pigs. The reports are nevertheless consistent: Vitamin C supplementation makes animals take fewer hits of morphine and clearly mitigates opioid tolerance and dependency.
There have also been some studies examining vitamin C’s potential in helping humans with OUD. A 2000 study by Evangelou et al. found that opioid withdrawal symptoms were reduced in 57% of patients who took vitamins C and E – versus 7% of those who received placebo. In a study by Newmeyer et al. (1) just 1 to 3 grams of buffered vitamin C taken daily offset withdrawal symptoms for those in active detox as well as for those who had recently completed detox.
A 1969 study by Alexander Schauss, PhD further suggests that high doses of oral sodium ascorbate may help those wishing to quit opioids cold turkey. The 20 participants – all of whom were addicted to heroin and had unsuccessfully attempted cold turkey withdrawals prior to enrolling in the study – were asked to consume various doses of powdered sodium ascorbate (1 to 7.5 grams) mixed with diluted fruit juice throughout the day, for several days. Schauss’ 2012 paper in the Journal of Orthomolecular Medicine reports that the cocktail aborted the signs and symptoms of opioid withdrawal in 100% of the participants.
Schauss’ work caught the attention of two-time Nobel Prize laureate Linus Pauling, PhD, who developed a similar vitamin C protocol, to which he added niacin. Schauss’ and Pauling’s observations are echoed in the research of Drs. Alfred F. Libby and Irwin Stone, who, in their 1977 pilot study, supplemented heroin-addicted individuals with a massive 25 to 85 grams of sodium ascorbate daily in divided doses, along with other nutrients. (For comparison, most vitamin C supplements contain 0.5 gram to 1 gram per dose.) They report that 30 out of 30 (100%) of their patients were successfully treated with this regimen.
Erick Turner, MD, a psychiatrist with Oregon Health and Science University, however, is not impressed: “On the face of it, it doesn’t seem biologically plausible,” Turner wrote to me in an email. “How/why would vitamin C affect opioid receptors? Even if there were some plausible sounding mechanism, that’s no substitute for rigorous data.”
Although the scientific literature contains a few compelling case reports (including my review published in 2020 in Integrative Medicine and indexed in PubMed), there’s no way around the fact that there aren’t any double blind, placebo-controlled clinical trials published in peer-reviewed medical journals assessing vitamin C’s potential to treat OUD.
Vitamin C has, however, been shown in clinical trials to reduce opioid dependency by mitigating pain. Human studies have demonstrated that taking just 2 grams of vitamin C one hour before surgery reduces the need for opioid analgesics post-op, as does intravenous (IV) vitamin C. (Vitamin C also supports collagen synthesis and wound healing, making it of further value in surgical settings.)
Vitamin C also interacts positively with harder-hitting pain medications like morphine, yielding additive pain-relieving effects and allowing for lower doses of narcotics in mice. Seventy five percent of heroin users in treatment state that their opioid addiction began with a legal prescription. People undergoing even minor surgery (including outpatient and elective procedures) are at increased risk of persistent opioid use. By reducing a person’s need for narcotic pain medication, vitamin C might save somebody from becoming addicted to opioids in the first place.
Antioxidants like vitamin C are well known to prevent oxidative stress, thus supporting mental health and easing the symptoms of opioid withdrawal. Vitamin C’s anti-inflammatory properties further protect the brain and nervous system against injury and stress. The vitamin is also essential for healthy recovery after stress exposure, dampening the dysfunctional response to stress often seen in those with addiction. It has also been shown in human trials to effectively treat depression and anxiety, as well as to protect the brain in neurodegenerative disorders like Alzheimer’s and Parkinson’s diseases.
In addition, Vitamin C supports the immune system and reduces the risk of infections. It has been shown to shorten the duration of ICU stays and the need for ventilation, and is thus being investigated as a potential treatment for the serious complications of COVID-19. Considering that those with OUD are at high risk for poor COVID-19 outcomes, vitamin C may serve a dual purpose for this population.
While we cannot yet say for sure that vitamin C is an effective treatment for opioid withdrawal, there are nevertheless signs that it may very well be. So why haven’t there been more studies?
“One thing that comes to mind,” offers Wesley Ryan, MD, a physician board-certified in both general and addiction psychiatry, “is that vitamin C has been around for a while. There’s not as much financial incentive for a pharmaceutical company to research it, so it falls on governmental funding to pay for this kind of research, and getting that funding is a really competitive process.”
Schauss, an experienced researcher, doubts that the funding is coming any time soon. He says that at the time of his study, “Anybody doing this type of nutritional research was categorically getting rejected by medical journals.” He now studies the health benefits of açai berries.
While thankfully the medical establishment no longer believes that nutritional supplements just make “expensive urine,” it is nevertheless still true that few parties stand to make money or look flashy by conducting studies on a vitamin that is old, affordable, and widely available. Psychedelics are “sexy,” pharmaceuticals are lucrative, and vitamin C is neither. Vitamin C is kind of boring, actually, and it has a marred reputation among so-called “quack busters” and skeptics of orthomolecular medicine.
But as Lucy told me, “If this can help change even one person’s mind it will be worth it. I wish I could give the whole world vitamin C – it just works so well.”
As a physician, I weigh the risks-to-benefits of any treatment, and always follow my oath to “First, Do No Harm.” While I hope to see more studies on the topic, I must do the best I can with the information available in the meantime. When I consider the devastating cost of opioid use disorder to the individual and to society, along with the long list of vitamin C’s proven health benefits, I’m willing to give C a chance.
(1) Newmeyer J, Inaba D, Smith DE, Waldorf GE, Levine SA. Efficacy of buffered ascorbate compound (BAC) in the detoxification and aftercare of clients involved in opiate and stimulant abuse. Haight-Ashbury Free Medical Clinic. 1983 Jul:1-5.
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Dr. Erica Zelfand is a licensed family physician trained in naturopathic and functional medicine and specializing in integrative mental health. She is also a medical writer, teacher, and international speaker, and offers courses on the medical applications of psychedelic medicine. To learn about Dr. Z, follow her on Twitter and Facebook, join her mailing list, and visit DrZelfand.com.