Polymer additives can substantially reduce the drag of turbulent flows and the upper limit, the so-called state of ‘maximum drag reduction’ (MDR), is to a good approximation independent of the type of polymer and solvent used. Until recently, the consensus was that, in this limit, flows are in a marginal state where only a minimal level of turbulence activity persists. Observations in direct numerical simulations at low Reynolds numbers ($Re$) using minimal sized channels appeared to support this view and reported long ‘hibernation’ periods where turbulence is marginalized. In simulations of pipe flow at $Re$ near transition we find that, indeed, with increasing Weissenberg number ($Wi$), turbulence expresses long periods of hibernation if the domain size is small. However, with increasing pipe length, the temporal hibernation continuously alters to spatio-temporal intermittency and here the flow consists of turbulent puffs surrounded by laminar flow. Moreover, upon an increase in $Wi$, the flow fully relaminarizes, in agreement with recent experiments. At even larger $Wi$, a different instability is encountered causing a drag increase towards MDR. Our findings hence link earlier minimal flow unit simulations with recent experiments and confirm that the addition of polymers initially suppresses Newtonian turbulence and leads to a reverse transition. The MDR state on the other hand results at these low$Re$ from a separate instability and the underlying dynamics corresponds to the recently proposed state of elasto-inertial turbulence.