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cashtothemoney
05-03-2006, 06:23
I thought this would be helpful to all of you trying to get clean. I spent the last hour revising it, and editing it. Feel free to pass this along.

A Guide to Opiate Withdrawal by cashtothemoney
(w/ help from our over-the-counter friends)

DISCLAIMER: I'm not a doctor, but I have been reading about this sort of thing extensively for a very long time. This is not medical advice, but rather my own experience which you can take from what you want. In order to be in line with my own morals (and the LAW!), I have to say that it would be best to review this with a doctor before making any decisions. All drugs listed, with the exception of one, can be bought over-the-counter, but this does not mean that it is automatically "safe".

Introduction

Expect the worst in withdrawal. It might not be "crazy", but it sure as hell won't be comfortable. At the same time, for some of you, it will be the hardest experience of your life. Lack of energy, muscle/bone aches, diarrhea, insomnia, depression, anxiety. It can be hell, but you can ease all of these withdrawal symptoms with over-the-counter drugs. I've survived it a few times, and as long as you keep yourself busy it can be made a bit easier. The physical part is somewhat similar to having the flu, but magnified depending on the dose/frequency of use/duration of use; however, I think I can speak for most people when I say, the mental struggle that follows the physical withdrawal is MUCH worse. This is given as a possible alternative to therapies such as methadone, buprenorphine, etc. Good luck to all of those attempting to rid themselves of addiction.

The intensity and length of opiate withdrawal will depend on a few factors. The larger the dose, the more intense the withdrawal. The longer you have been using, the longer and more intense the withdrawal will be. If you did it once a day, it might take a few days for the withdrawal to kick in. If you took opiates shortly before bed, insomnia might be the biggest problem. If you took opiates when you woke up, you might not feel like getting out of bed without them. All of this could be wrong, or it could all be right on the money. The point is opiate withdrawal will differ for everyone; however, it will universally suck.

The Essentials

Positive mindset
A multivitamin
Courage
Determination
An understanding that this is not forever.


Diarrhea


Immodium A.D. - 4-6mg loperamide per 50-60mg of oxycodone/hydrocodone. (May vary!)
Try not to take this too often as it can make you REALLY constipated, but it can get rid of (in my experience as well as others) the majority of the physical withdrawal symptoms. Just remember that loperamide is an opiate, so it's better to only take if NEEDED. Laxatives can counter the constipation or try the natural route, fruit or olive oil.
Note: It is very important that you keep in mind that loperamide is an opiate, so you must also taper yourself off of loperamide, which can be done over the period of a few weeks to a month. This will let you start dealing with any mental dependency issues almost right away, which will be the hardest part of coming off opiates.


Insomnia


Benzodiazepines: Exercise EXTREME caution if you plan on using any sort of benzodiazepines to ease the insomnia. Examples of benzos include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin/Rivotril). For myself alprazolam and clonazepam work the best, although I will not recommend obtaining these illegally. ;) Working your way up from 0.5mg (assuming you have no tolerance) until you find your dose may be helpful. ONLY take these if you absolutely need them. I can't stress that enough. Benzodiazepines are, in my humble opinion, more addicting than opiates, and it is a fact that they are more dangerous. They are one of the few classes of drugs that can include DEATH in the withdrawal. Another positive aspect of using benzos would be the fact that it can really take the edge off if/when you are feeling stressed out and anxious. Research them extensively before you use them, as you do *NOT* want to trade addictions. If you are taking buprenorphine as an aid during withdrawal, do not take any benzodiazepines, as this combination has resulted in death.
Diphenhydramine: This is an antihistamine which includes drowsiness as one of the side effects which makes it a great candidate for a sleep aid. It works wonders for many opiate addicts and I think this would be better to use than any benzos.


Bone/Muscle Aches (with a little bit of advice for the mental part as well)

Ibuprofen, Naproxen (Recommended dose/as needed)
ABSOLUTELY NO OPIATES! The only way one can use opiates is if they are tapering. There are hardly any people with the willpower, and self-discipline to actually complete a successful taper. The road to becoming clean must be taken one day at a time, maybe even one hour or one minute at a time. Tell yourself to get through the next minute or hour. Reward yourself for getting through that period of time. If you start thinking about the next week, month, or year, you WILL overwhelm yourself.


Lack of Energy/Depression

EXERCISE! This is, by far, the number one way of combating the physical and mental part of withdrawal, including depression. You may not want to do anything, which could even include getting out of bed, but if you can motivate yourself to exercise, you will notice a dramatic increase in your energy levels and your mindset. This is what has made a dramatic difference each time I've gone through withdrawals. It is THE wonder drug, not to mention you can obtain the infamous “runner's high” after running for a certain amount of time.
L-Tyrosine: (Available at GNC) Studies show l-tyrosine will help with depression, energy levels, and other mood disorders. It is a precursor to dopamine (the Almighty), norepinephrine, epinephrine, and L-dopa. Epinephrine and norepinephrine are two of the body’s stress-related hormones, and l-tyrosine’s role in their creation can help ease the negative effects of stress. Starting at 2000mg per day, and adjusting is one way to begin. Vitamin B6 is essential in the creation of the neurotransmitters, so be sure to take the it along with the l-tyrosine.
Vitamin B6: Vitamin B6 helps in the creation of serotonin (the “happy” neurotransmitter), dopamine, norepinephrine, and GABA (the mechanism in which benzodiazepines work through; reduces stress levels; induces relaxation). So one can easily see why B6 is beneficial. It also provides energy, and as said before, is essential in the conversion of l-tyrosine to the various neurotransmitters.
FIND SOMEONE YOU CAN TALK TO! We all need to vent. Find a friend, someone on this forum, a psychologist, etc. It is essential if you want to succeed.
Think about all of the things that can be done now. Money in the bank, be around for family/friends, not worry about your next fix, not be sick all the time, etc.


Other supplements that could help: Kava (anxiety), valerian root (anxiety/insomnia).

Closing Notes

The worst of the physical withdrawal will most likely be over after the 4th day. It typically lasts 3-5 days and fades off after that, but can last as long as a week (longer with opiates with a long half-life, such as methadone). I've found the fourth day to be the worst, and once you are over that hump you start to feel physically better. Then, it is time to deal with the mental problems that result.

If you have friends that do drugs, you have to separate yourself from them. Unless you are superman, or have an abnormal sense of self-discipline, you will have to do this as the temptation is too great for most. Getting away for a week can really make all the difference in the world. Staying clean is a lifelong journey, and if that is what you are after, YOU CAN DO IT! Don’t give up if you have a bad day or are feeling a bit down. Keep yourself busy. It can make all the difference in the world. Start a new hobby, continue an old one, spend time with the family, go hiking, go for a walk, talk to a stranger, have a cup of coffee (avoid it in the beginning as this can worsen anxiety), etc.

As addicts, we might have started doing opiates for fun, or maybe to cover up problems. It might have only been a weekend romance, but that changed into a daily obsession. We might be broke, losing friends, and at rock bottom. Sometimes there are problems that we try to cover up, and a lot of emotions come out as the drug leaves our body. We have to get used to living a “normal” life, and dealing with “normal” problems. It is important to get to the root of the problems, and face them head on. There is no more hiding. After all, the REAL you is coming out from hiding as well. You mine as well make the most of it.

Best of luck to all of you in your endeavors. Godspeed.

Additional Reading:
L-tyrosine - http://www.mothernature.com/Library/Ency/Index.cfm/Id/2919008
Vitamin B6 - http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB6/

Blind Melon
05-03-2006, 06:32
Thank's, that was pretty helpful. I had completely forgotten about Kava, I should go get some tomorrow.

nexigram
05-03-2006, 07:42
That was very well done, although I am a little concerned about recomending Benzos. You did very clearly state that you should not cross-addict yourself and that you should not obtain them illegally when trying to kick opiates. The parts about how if you took opiates in the morning when you woke up were dead on. Same thing goes with if you took them to go to sleep. I personally take Buprenorphine and trazadone to help myself kick. Buprenorphine helps me get through the day without opiates and Trazadone helps me get to sleep at night but is widely considered a non-habit forming drug. It is one of 2 sleep aids my doctor would prescribe an addict. He says the rest are all habit-forming.

Anyways very good job. You might not be a doctor but it was very well done anyways. You don't have to be a doctor to be intelligent enough to do the research on why you are feeling the way you are feeling. I hope this helps many people kick the most incredibly addictive drugs out there, opiates.

Good Luck and Enjoy Life, to everyone.

cashtothemoney
05-03-2006, 22:28
Feel free to make suggestions... I'd be happy to edit it and give credit where it is due! I think this could be very beneficial for everyone. Thanks for the compliment nexigram.

-hollywood

sylvan Wanderer
06-03-2006, 03:52
phreex had a opiate withdrawal guide as well somewhere and it seemed quite good.

cashtothemoney
06-03-2006, 23:02
Perhaps they could be combined...

JenniD
06-03-2006, 23:15
Thanks for the info, I unfortunately am a long time opiate user whos managed to quit and relapse many times. I used methadone for maintance for about 9 months and just realized i was just as addicted maybe even worse. The withdrawl from methadone was horrible, worse then heroin by far. I managed to come off of 120 cutting back 5mgs every 3 days and then at 30 all toghther i was sick for a good month, and still felt syntoms for a few months. i then relapsed on heroin about 3 months ago, and Im trying over and over to kick the habit with out cuasing any other habits. I always get to about 24 hours and it just becomes to much and i start back up. I wish I could quit and want to more then anything, but i find myself still using and making it even worse. I am week and just wish for the strength to just quit. My yearning to quit makes me so depressed, but some how when i put it down and start withdrawl i feel as though that is all I want. then im high and want to quit and keep saying this is my last bundle and really at the time feel it is, until i feel the pain mentally and physically and just forget about everything that matters and just want to get high. its a never ending bad cycle. Any suggestions on kicking would be great.

Spucky
07-03-2006, 03:02
Also Clonodin is very effektiv for the Pain and it's calm you!
Attention, can be very dangerous- get the rigt info. before!!!

axl blaze
07-03-2006, 06:42
very well done. however, if this is an OTC guide to w/ding - why are benzos included since they are obviously not OTC drugs?

besides this you included everything I could think of.

cashtothemoney
07-03-2006, 15:47
I put them in there because they are practically OTC for some folks! (Though that is very dangerous thinking.) Maybe I should create another section of the guide and put it there... what do you think?

axl blaze
08-03-2006, 00:41
I think it is perfect the way it is. it was just a misnomer of sorts because the title was misleading. maybe you could just change the title or something... ? I don't know, it's your call. I have to say this guide is up there with phreex's opiate w/d guide - which is saying more than I can express :)

staypuft
08-03-2006, 02:28
great work on the guide...

just to add some hearsay: eating lots of cheese helps with the w/d

oh...and since benzos were included in the guide and they're not exactly OTC i can probably also add that Ketamine completely stops (postpones...?) all the physical and mental withdrawl from opiates...

i managed to not get dopesick for a couple of days by doing an IM every hour or so a while back...but i would NOT recommend this to anyone

cashtothemoney
08-06-2006, 14:35
-bump-

PIC
08-06-2006, 16:41
I can't belive that you have to taper from Immodium, are you sure?

hazejunk
08-06-2006, 23:06
we schould make this a sticky

oldhead
11-06-2006, 13:41
This is a great help but I go with good old Pepto Bismol. The mental part is a MFer and tapering is real hard when I know I have more available to do.

cashtothemoney
23-06-2006, 22:33
I can't belive that you have to taper from Immodium, are you sure?

Positive.

Tokey-tokerson
23-06-2006, 22:43
Im normally a pretty energetic guy and excercise all that mumbo jumbo, but when withdrawing I just lock myself up in a room curl up and spend the next 3 days sweating and going mentally insane.

'medicine cabinet'
23-06-2006, 23:32
great guide...i just recently kicked myself. i had 2 8mg suboxones about 10 1mg xanax 5 10mg valium, 6 .2 mg clonidines and weed and booze...in the peak of the WD the clonidine really helps with the "shock" feeling, although too much xanax/valium and clonidine you will fall out of bed and bump your head...i know i did....i got outta bed and had an insane headrush and str8 fell over in blackout mode for a hot second haha..but thats what i did this time to kick, done it dozens of times....no easy way to do it, the way that works the best imo is straight cold turkey

^^its what tokey said, locked in a room fetal position going bonkers for 3 days. its the most cathartic experience i think ive ever felt...getting so sick you are almost immobilized because it feels like your skin is melting and it hurts so bad to move. i always seemed to stay cleaner longer when i did it that way...relapses are part of the "road to recovery" but they still suck...

MTGG
24-06-2006, 00:48
depending on where u are. GBL will stop most of the cluck. although-hardly-otc-in-america-and-some-evidence-it-acts-on-opiod-receptors-but-no-withdrawal-from-it-after-3-4-days-which-should-cover-the-rattle

drfeelgood1
24-06-2006, 23:11
Loperamide IS NOT an opiate...

PIC
25-06-2006, 01:57
I'm sorry but I really don't think that you have to taper with Immodium, do you have any scientific literature to back that up? On the other side, I remember reading somewhere that it is an opiate which has a quite similar chemical structure to fentanyl.

TheTripDoctor
25-06-2006, 02:35
OK look fuckers, loperamide is a piperidine, its not related to phenathrenes like moprhine or oxycodone, but then again neither is fentanyl, so whats your definition of opiate?

You can discount what i say all you want, but i have plenty of credibility here both on this board and from real life experience and education, and i know for absolute certain that loperamide IS ACTIVE, it WILL stop withdrawl, not just symptoms, withdrawal itself. I've theorized as to the route of its action numerous times, one of the following is true.

A) it does make it into the brain in amounts far less than huge doses with enzymatic inhibition

B) a metabolite of it makes it into the brain in normal doses with enzymatic inhibition, if you stop metabolism of the primary route, secondary routes then become active in larger percentage.

C) loperamide or a metabolite bind to opiate receptors peripherally, and cause CNS activity that way.

Every single one of those routes is both possible and likely, so dont post crap about drugs having to get into the CNS for activity, and yes loperamide likely DOES get into the brain in only slightly higher than normal doses if you use an enzyme inhibitor like cimetidine, i have 3 years experience screwing with it every way possible.

And yes, if i had stopped taking it by itself there would have been withdrawl from it alone, so by implied logic you therefor have to taper it if youve taken enough for a period of time.

6mg isnt going to do shit though, in a tollerant person 6mg isnt even going to be capable of putting a dent in withdrawal, your not going to get to the point of needing to taper if you only take 6mg.

48mg, yes, that point you would need to taper it back down, because 48mg is active.

PIC
25-06-2006, 18:00
"i have plenty of credibility here both on this board and from real life experience and education"

Yeah, whatever man, do you have scientific literature to back it up? I just want to see where it says that one can withdrawal from Immodium. Forget your credibility, that is quite subjective.

EudoXia
25-06-2006, 18:57
TripDoctor,

What dose of loperamide would you recomend someone start out if they were taking around 60mg of hydrocodone/daily, but quit taking it and is in w/ds? I've used loperamide to help stop up my liquid G.I. tract, but have never noticed it helping with anything else. Just keeps you from shitting the bed when you are in withdrawal, basically.

cashtothemoney
25-04-2007, 07:00
-bump-

this might be able to help someone...

Beans
25-04-2007, 19:40
Great work here!

AlphaOdure
04-05-2007, 18:58
TABLE OF CONTENTS



Description and Pharmacology of Opioidergic Drug Replacement Therapies


Methadone


Levoacetylmethadol (LAAM)


Buprenorphine


Propoxyphene


Codeine


Tramadol


Full Agonist Opioids




Description and Pharmacology of Non-Opioidergic Therapies


Ibogaine/18-methoxycoronaridine


Naltrexone Maintenance


Rapid Detoxification




Listing of Pharmaceutical and Herbal Treatments for Withdrawal


Opioid Based Medicines (For treatment of dysphoria)


Non-Opioid Based Medicines (Classified by the symptomatic relief they provide; Generally non-dependence prone)
-Insomnia/Anxiety/Hypertension
-Diarrha/Abdominal Cramping
-Rhinorrhea (Increased salivation)/Lacrimation (Increased tear production)
-Pyretic Sensations (Chills, fever)
-Nausea
-Aches, Pains


Non-Barbituate & Non-Benzodiazepine M03B Class Muscle Relaxants (May help with anxiety, insomnia, and pain; Some may be habit forming)




--------------------------------------------------------------------------------------------------




OPIOIDERGIC DRUG REPLACEMENT THERAPIES


Methadone
--------------------------------------
Methadone is a diphenylheptane-derivative, a potent mu-agonist opioid, and both an effective treatment for narcotic addiction and pain. Its duration of action is quite long, lasting anywhere from 12 - 36 hours, based on dosage. It has similar risks to that of traditional opioid narcotics regarding dependency, tolerance, and withdrawal. However, b/c longer acting drugs take longer to metabolize; less drug is introduced during a given interval of time--the result is a longer retained but less intense psychoactive effect. An example of this: dia-morphine (heroin) is metabolized more quickly than morphine due to its attatched diactyl-group; the result is heroin's shorter duration in action but more intense effects, producing more euphoria and a stronger rush.

Methdone also has a unique pharmacological action in having minor, non-competitive antagonist activity at NMDA receptors, similar to but weaker than drugs like dextromethorphan and ketamine. In a small percentage of people this can facilitate a varied response of unwanted side effects including: amnesia, catalepsy (sensation of rigid muscles), confusion, dysphoria, agitation, ataxia, and/or catatonia.

However, methadone is also is a weak inhibitor of serotonin and norepinephrine reuptake. These properties give methadone an added benefit of being a minor anti-depressant. But because hypertension associated with withdrawal is attributed to elevated norepinephrine levels, methadone's SNRI activity can cause persisting, residual stimulation and hypertensive symptoms for a few days if MRT is started after a bout of withdrawal.

Methadone does have an added benefit of a blocking other opioids at and around 70 mg. Methadone isn't a competitive agonist, so it will not completely block other mu-agonists or precipitate withdrawal. This exact mechanism of blocking isn't known, but is sometimes attributed, and controversly so, to the fact that there is usually a ceiling effect on the euphoria and analgesia caused by most opioids that attain their primary psychoactive action from the activity of their corresponding metabolites. And b/c only so much of a certain molecule can be converted into a metabolite at once, a ceiling effect comes into play. But drugs which are active in themselves are still blocked to some degree by methadone. Other theories involving a maximum limit on immediate mu agonism are proposed but have no significant scientific evidence to date.

Unfortunately, withdrawal from methadone is notoriously unpleasant. If not tapered correctly, withdrawal and extreme discomfort can last up to 1 - 4 weeks. But even when done properly it can cause malaise-conditions (dysphoria associated with drug use) for 3 - 10 days. This disadvantage in MMT withdrawal can potentially instigate a relapse.

Also, there has been one reported case of death from methadone withdrawal (>175 mg daily intake). The victim died from complications during episodes of seizuring. But due to her unfortunate circumstances it was not known whether she was previously epileptic (she was incarcerated and had no known family or doctors to contact for medical information); thus it can not be definitively concluded if her death was directly due to methadone withdrawal or epilepsy complications.

So generally speaking, methadone is more effective as a long term DRT maintenance medication due to its full mu-opioid agonist pharmacology. It can cause euphoria and has relatively high abuse potential, but when used properly these effects can be minimized. But methadone can still contribute to complications when tapering b/c of its similarity in action to typical narcotic analgesics. Therefore, methadone maintenance is more suited towards substituting, regulating, and minimizing illicit opioid addiction rather than promoting eventual abstinence. Experimental, case-study evidence for this can be found at http://opioids.com/methadone/tapering.html.


Levoacetylmethadol (LAAM)
--------------------------------------
LAAM is also a diphenylheptane-derivative, like methadone and propoxyphene. Its risks and benefits are nearly identical to that of methadone's but with one major difference. LAAM's duration of action is roughly double that of its counterpart and only requires dosing 3 - 4 times a week. Generally though, it is less favored to methadone (i tend to agree) b/c of its tendency to take longer to relieve withdrawal.

Recently, LAAM's metabolites have shown signs of cardiotoxicity at normal maintenance doses, therefore it has since been discontinued for medical use in the U.S. but is still available in MMT clinics. There are also suspicions of hepatoxicity being caused by LAAMMT as well. Its dextro isomer has shown less toxicity but has significantly less duration of action and more abuse-potential; methadone is more appropriate if LAAM isn't well tolerated.


Buprenorphine
--------------------------------------
Buprenorphine belongs to a small group of opioids known as benzomorphane derivatives. Buprenorphine is a novel medication b/c it has both mu-opioid agonist and antagonist properties. It is highly competitve at receptor sites, making it similar to nalaxone and naltrexone. But unlike these drugs, it also has an inherit mu-opioid agonist effect. It produces typical narcotic analgesia at lower doses and can ward off withdrawal for up to 48 hours.

Buprenorphine's competitive affinity for opioid receptors means that it has an advantage in the fact that full-opioid agonists will have no neurological action when taken during maintenance therapy. However, at amounts less than 2 mg this effect is less pronounced and wears off 12 - 24 hours after last dose.

Because buprenorphine is not a full mu-opioid agonist, it has a ceiling limit on its effects. Over 8 - 16 mg, the analgesic and euphoric properties do not increase; only duration in action is extended. Also, buprenorphine's unique pharmacological profile means that once BMT is mantained for a few weeks euphoria, sedation, and the potential for abuse becomes of relatively less significance.

Buprenorphine also has action at the ORL1 nociceptin (a newly discovered opioid receptor-class) receptors as a partial agonist and antagonist. In low doses, this can result in novel anti-depressant like effect; but when sudden, higher doses are used during maintenance therapy, this can result in lethargy, sedation, and mild dysphoria. This has an added detering effect in patients seeking to abuse buprenorphine when in maintenance therapy.

Buprenorphine's anti-depressant effect is thought to make tapering on the drug significantly more tolerable than more selective opioid agonists. Also, due to its less euphoric properties, BMT is more effective at relapse prevention than at actual drug replacement therapy (DRT). This gives the patient considerably more experience at living a seemingly "sober" life than MMT or LAAMMT, making complete abstinence a more easily achievable goal during buprenorphine therapy. As a result, BMT is usually used for a maximum of 3 years.

However, b/c buprenorphine's neurological action is different from full-opioid agonists, it is less effective as an actual alternative replacement for opioids. For this reason, individuals who aren't quite ready to stop abusing opioids respond better to methadone maintenance than to BMT.

Also, buprenorphine's antagonist properties will cause precipitated withdrawal if taken by an opioid tolerant individual who has used within 24 - 48 hours (depending what opioid was last taken). Therefore, to start BMT the patient must wait till her or she is in withdrawal to start the maintenance therapy.

From my experience: if an individual precipitates withdrawal by taking buprenorphine while on other narcotics, the symptoms can be expected to last for at least 12 hours and can not be reversed. Expect it to last at least 24 hours in severely addicted individuals. Taking other opioids or more buprenorphine will not alleviate the symptoms either. The best recommendation I can offer is to wait it out for 36 - 48 hours. Then take buprenorphine at normal doses as needed.


Propoxyphene
--------------------------------------
Being a diphenylheptane-opioid like methadone and LAAM, propoxyphene does have some anti-depressant like properties. But its disadvantages are too numerous. It has a short duration of action and weak opioid agonist activity, needing very high dosing to be effective in opioid tolerant individuals. It also has higher antagonist activity at NMDA receptors than methadone; making it less tolerated, with more side effects.

Norpropoxyphene, a metabolite of propoxyphene, is highly cardiotoxic and suspected of being neurotoxic. It has an extremely long half-life and accumulates in the body, potentially causing delayed atrioventricular conduction, psychosis, cardiac arrhythmias, circulatory impairment, impaired psychomotor function, and in some cases cardiorespiratory arrest after long periods of use. The risk of some neurocardio effects occuring immediately after one-time-use increase considerably over 800 mg.

For these reasons, propoxyphene is only effective as a short term detoxification drug. It should only be used in individuals with low to moderate tolerance due to its dangerous cardiovascular side effects.


Codeine
--------------------------------------
Codeine is an non synthetic, weak mu-opioid agonist and can be used for tapering to avoid minor withdrawal. But b/c codeine must first be converted into its active metabolite, morphine, it has a ceiling effect of 400 mg--thus it is not suitable for severe withdrawal. Also, norcodeine, another metabolite of codeine, facilitates a severe histamine reaction--another unfavorable side effect.


Tramadol
--------------------------------------
Tramadol is a synthetic opioid which is classified indepdently of all other narcotic analgesics. Tramadol is similar to codeine in that it has weak analgesic qualities. It too has a ceiling effect, but its active metabolite isn't morphine and is denoted as M1. While tramadol isn't an effective medication to relieve severe opioid cravings, it does have unique mechanisms of action that make it useful in treating other severe withdrawal symptoms: its prevention of serotonin and norepinephrine reuptake can mediate depression and its agonist activity at alpha-2 adrenergic receptors (similar to clonidine) can also relieve insomnia, fever-symptoms, and hypertension. However, tramadol can cause nausea and vomiting in higher doses and its SNRI action can leave minor yet persisting stimulation and hypertensive symptoms when taken to alleviate withdrawal.


Full Agonist Opioids: Semisynthetics (oxycodone, hydrocodone), Anilidopiperidinic derivatives (fentanyl) and Phenylpiperidinic derivatives (meperidine/pethidine)
--------------------------------------
These drugs can be effective in the short term when used for tapering. However, they are ineffective when used for long term maintenance b/c of their euphoric properties, short duration of action, and high abuse potential. Other strong mu opioid agonists like methadone, LAAM, and buprenorphine are accepted as having medical value in maintenance therapy b/c of their anti-depressant effects, limited euphoric properties, ability to block other opioids, long duration of action, and their success of use in structured, maintenance programs. Other mu-opioid agonists do not share all of these qualities. Full agonists are therefore more likely to be abused by a detoxing individual compared to other narcotic DRT medications. They are ultimately less effective in acheiving eventual sobriety unless the patient is adhered to very strict conditions and regulations, or held in a controlled environment.

Compared to typical opioids, phenylpiperidine derivatives can have added disadvantages due to their more generalized neurological effect. For example, Meperidine has strong anticholinergic activity and has some effect on kappa-opioid receptors. This can cause aggravating side effects that include: confusion, dry mouth, ataxia, hallucinations, agitation, amnesia, anesthesia, catalepsy, dysphoria, catatonia, delerium, and even psychosis. Meperdine can also precipitates stimulant effects by inhibitioning the dopamine and norepinephrine transporter cells (DAT and NAT, respectively).




NON-OPIOIDERGIC THERAPIES


Ibogaine/18-methoxycoronaridine
--------------------------------------
Ibogaine is pharamcologically unique in its relevance to treating opioid dependance. The main neurological action that is responsible for addiction surpression is noncompetitive antagonist activity at α3β4 nicotinic receptors. B/c NMDA and α3β4 nicotinic channels are located within lumen binding range on the same ligands--α3β4 nicotinic antagonism usually facilitates NMDA antagonist activity as well. In plain english: this neurological action is responsible for ibogaine's dissociative effects. This neurological action is also responsible for curbing compulsive behavior; to a lesser extent, drugs like buproprion (zyban) also have this neurological action. Ibogaine also has strong hallucinogenic and psychedelic effect, this is mediated by agonist activity at the 5HT2A receptors.

12-hydroxyibogamine, an active metabolite of ibogaine, is a selective serotonin reuptake inhibitor, and a -kappa, -mu opioid agonist. These actions are responsible for ibogaine's long duration and surpression of opioid withdrawal symptoms, respectively.

But most importantly... unlike methadone or buprenorphine, ibogaine is unique in that it actually creates a desire to become abstinent. While its nicotinergic and opioidergic effects seem to diminish mental and physical craving; its combined action on NMDA channels and 5HT2A receptors cause a deeply reflective, hallucinogenic experience in which preconcieved, positive perceptions pertaining to an individual's addiction are shattered.

Drug addiction forces an individual to rationalize one's harmful actions--its the brain's way of ignoring atypical and immoral behavior inorder to maintain use (Drug consumption to an opioid addicted brain becomes a survival skill, the brain will instinctively try to sustain it any cost). Ibogaine rips down these false, built up notions and allows the addict to see things for what they really are. This is a milestone in addiction treatment, since it was thought to be impossible to induce this in an addicted individual, i.e.- "they can only quit when they really want to." Well, now it seems most dependent users can also really quit if they take ibogaine once every few months.

Ibogaine also has some action on sigma2 receptors (a neuron-system that is involved in stimulant toxicity, anti-cholinergic delerium, and dissociative-drug induced hallucinations); but the neurological, behavorial cause and effect profile of such pharmacological actions is still poorly understood.

A synthetic derivative of iboagine is 18-methoxycoronaridine. Its neurological action is as a selective α3β4 antagonist, which is ibogaine's main mechanism for physically surpressing the compulsiveness of addiciton. But b/c it is selective, it is barely hallucinogenic and thus less intense than ibogaine. This ultimately is a major flaw in 18-methoxycoronaridine b/c it will theoritically be no more effective at mediating addiction than other selective α3β4 antagonists; it is no better than drugs like buproprion.


Naltrexone Maintenance
--------------------------------------
Naltrexone is an opioid antagonist, typically used in maintenance of sobriety in opioid dependent individuals who've already undergone detoxification. Naloxone and nalmefene are also opioid antagonists that are used to treat acute overdose and alcoholism, respectively. Naloxone has application in treating opioid overdose due to its higher potency and relatively low duration of effects (1 - 2 hrs). Nalmefene is used in alcoholism more extensively due to its low potency and high plasma half life.

Opioid antagonists have very high affinity for mu- and kappa- opioid receptors and therefore will displace any other non-competitive opioidergic drug present at the actual receptor site. This is, in essence, the pharmacodynamics of neurological antagnostic activity. Since naltrexone, naloxone, and nalmefene have no inherit mu- opioid agonist properties themselves; they will block the neurological aciton of any narcotic and cause habitual opioid users to go into precipitated withdrawal.

Naltrexone is usually prescribed following rapid detox treatment as a post procedural medication. However, the effectiveness of opioid antagonist maintenance is low due to non compliance in patients. Therefore, another procedure in which a naltrexone "pellet" is subcutaneously inserted into the patient, is sometimes utilized. The pellet has its advantages to medication b/c daily compliance in the patient is not an issue and the effects can last anywhere from 4 - 24 months.

Opioid antagonists in general are considered to be less advantageous compared to other treatment options. These drugs have absolutely no inherit opioid agonist properties, and thus do not help in treating cravings in opioid dependent individuals. Therefore, other DRT medications as a whole are considered more useful.


Rapid Detoxication
--------------------------------------
Rapid detox refers to a medical procedure used to speed up the detoxication process. Generally, the procedure can last anywhere from 30 minutes to 4 hours, depending on an individual's subjective withdrawal symptoms.

Typical medications used include a mitazolam and ketamine mixture for anesthesia, followed by high quantities of naloxone, and then nalmefene. Medicines like tracrium (a mixture of ten atracurium stereoisomers) are also sometimes used as peripherial movement inhibitors (peripherial muscle relaxants).

The effectiveness of rapid detox seems to be debated within the addiction-treatment community. For patients with high tolerance who have been using for multiple years or more, withdrawal duration can last a relatively extensive amount of time. In these cases, rapid detox seems to be less effective at condensing symptoms into a 4 hour period.




-------------------------------------------------------------------------------------------------




LISTING OF PHARMACEUTICAL AND HERBAL TREATMENTS (IN ORDER FROM MOST EFFECTIVE TO LEAST EFFECTIVE)


Opioid-Based and/or Dysphoria Treating Medicines (Most of these can cause dependence):
ibogaine
methdone
buprenorphine
levoacetylmethadol (LAAM)
buspirone
oxycodone/hydrocodone
tramadol
codeine
propoxyphene
benzodiazepines
carisprodal
dextromethorphan
-------herbs-------
kratom


Non-Opioid Medications (Categorized according to symptomatic relief provided; Not dependence-prone):

Insomnia/Anxiety/Hypertension
baclofen
chlorzoxazone
cyclobenzaprine/orphenadrine
methocarbamol
zolpidem
tizanidine
amitriptyline
gabapentin
hydroxyzine
acomprosate
trazadone
dextromethorphan
clonidine
melatonin & other steroidal sleep remedies (insomnia only)
diphenhydrinate/dimenhydramine
--------herbs--------
kava kava (piper methysticum)
valerian (valeriana officinalis)
passionflower (passiflora incarnata)
reishi (ganoderma lucidum)
chamomile (matricaria recutita)
skullcap (scutellaria lateriflora)
hops (humulus lupulus)
damiana (turnera diffusa)

Diarrha/Abdominal Cramps
loperamide
amitriptyline
hydroxyzine
anticholinergics (atropine, dimenhydrinate)
------herbs------
bilberry (vaccinium myrtillus)
peppermint (mentha x piperita)

Rhinorrhea (ncreased salivation)/ Lacrimation (increased tear production)
anticholinergics
hydroxyzine
loperamide
amitriptyline
dextromethorphan
-------herbs------
belladonna alkaloids

Pyretic Sensations (chills, fever)
clonidine
propranolol
acetaminophen
NSAIDs
acetylsalicylic acid

Nausea
diphenhydramine/dimenhydrinate
meclizine
bismuth subsalicylate
hydroxyzine
calcium carbonate
------herbs------
chamomile (matricaria recutita)
ginger (zingiber officinale)
peppermint (mentha x piperita)

Aches, Pains
ropinirol
baclofen
NSAIDs (ibuprofen, naproxen)
acetaminophen
acetylsalicylic acid
chlorzoxazone
cyclobenzaprine/orphenadrine
methocarbamol
gabapentin
trazadone
------herbs------
reishi (ganoderma lucidum)
willow (salix spp.)


Non-Barbituate & Non-Benzodiazepine M03B Class Muscle Relaxants (May help with anxiety, insomnia, and pain; Some may be habit forming)
chlormezanone
tolperisone
febarbamate
phenyramidol
mephenesin
phenprobamate
styramate
thiocolchicoside
pridinol

AlphaOdure
04-05-2007, 19:07
If anyone has any comments or anything to add... please do so.

sushii
05-05-2007, 02:40
Thanks! This looks like a great resource. I'll add it to our list of helpful links. :)

AlphaOdure
05-05-2007, 07:09
^ ^ ^
Huh? I'm not following you??

AlphaOdure
05-05-2007, 07:13
^ ^ ^
Huh? I'm not following you?

Quit what? Trying to help people w/ withdrawal? Or were you referring to my personal drug use? B/c if you were, then you should also have observed from my posts that i don't use any drugs; unless you count my Rx to suboxone.

sushii
05-05-2007, 07:30
Zophen, you're confusing enough without ketamine. I have no idea what any of your posts in this thread mean. And I'm pretty sure the first one was pre-K, too. :D

AlphaOdure
05-05-2007, 07:41
The reason being if you are taking methadone Ketamine does not work!....IME!!

Since both methadone and ketamine are non competitive antagonists at NMDA receptors (obviously ketamine having more activity there)--hypothetically, they wont literally block one another, like naloxone would heroin. However... although I am not as familar with the pharmacodynamics of glutamte and NMDA receptors systems, i am pretty sure second-dosing metabolism is very ineffective.

Meaning.... just how redosing K a few minutes after you've just taken it wont work; so too would be the case when taking K 12 - 24 hours after dosing methadone or LAAM. Hypothetically, propoxyphene would block it as well.

Or so it logically seems.


sincere apologies for my immature outburst!!!! {Ketamine induced}

Makes sense. No need for an apology... if it makes you feel any better.. i really wasn't offended b/c i couldn't understand what the hell kind of point you were trying to make. But now i see it was just incoherent ketamine babble. haha

B9
05-05-2007, 07:47
hypothetically, they wont literally block one another,

Quite possibly true!!!


Howeva!! for me actually massively untrue!!


I took about 250mgs [intranasally] and watched telly [fucking dinnertime news:X :( ]


But after quitting some 4 months later KETAMINE actually worked!!


Hypothesise that!;) =D

AlphaOdure
05-05-2007, 08:02
^ ^ ^
Damn dude you must be fucked up, ha! I explained in my post... what i meant by that was, neurologically they wouldn't block one another like competitive antagonists would, like naloxone and heroin. But the blocking mechanism you experienced was probably due to rapid tolerance build up... i.e.- how you can't get any strong effect out of redosing dissociatives in rapid sequence; the same could be true of taking dissociatives after dosing any sort of diphenylheptane opioid.

what i posted...


However... although I am not as familar with the pharmacodynamics of glutamte and NMDA receptors systems, i am pretty sure second-dosing metabolism is very ineffective.

Meaning.... just how redosing K a few minutes after you've just taken it wont work; so too would be the case when taking K 12 - 24 hours after dosing methadone or LAAM. Hypothetically, propoxyphene would block it as well.

AlphaOdure
05-05-2007, 08:07
BTW, that sucks. what a waste of ketamine.

Did it take 4 months of complete abstinence from methadone to get any effect? If so, that could imply mild glutamate neurotoxicty from diphenylheptane opioids.

B9
05-05-2007, 08:10
Did it take 4 months of complete abstinence from methadone to get any effect? If so, that could imply mild glutamate neurotoxicty from diphenylheptane opioids.


Go to ADVANCED DRUG DISCUSSION!!!

Believe me you'll love it there!;) =D

AlphaOdure
05-05-2007, 09:38
mwhahahahaha; yeaa thats a good topic to take up over there.

but i like to post in TDS b/c of the recovery orientated atmosphere here. I know, my pharmacological mumbo jumbo can get sort of confusing and annoying at times though.

In plain english.. what i meant by that question was... did it take you 4 months after stopping methadone to get any effect from ketamine? If it did, that means methadone may do some lasting damage to glutamate receptors.

mepat1111
05-05-2007, 12:08
Don't worry man, I'm enjoying the pharmcology 'mumbo jumbo' :P I'm quite interested in pharmacology but unfortunately fucked up my year 12 with too many drugs and didn't get the marks I need to get into the pharmacology course.

Very interesting read, from my own personal experience, your points on buprenorphine are completely valid. I get almost no high, or really any effects at all, it simply keeps me from withdrawing - therefore allowing me to lead a normal life.

Thanks for going to all the time and effort to do this, will make a very useful resource.

B9
05-05-2007, 15:21
id it take you 4 months after stopping methadone to get any effect from ketamine?


Correct!!!



but i like to post in TDS


I like you to post in TDS as well, you bring plenty!:)

Sorry about my pissed and drugged up crap !:|

I frequently think I am amusing when in these states.8)

Only to realise I am most certainly not once soberness returns.:(

savagebuddha
07-05-2007, 20:08
I read someone that you should not take L-tyrosine with any serotonin reuptake inhibitors such as paxil, prozac and other psychiatric mood elevators. Anybody know the reason for this?

I'd also like to thank the OP for all this advice. I'm currently on day 2 of heroin detox using this method and i find the pains to be minimal, i can actually get up and excercise and do stuff after a good night's of sleep with benzos

Will01996
07-05-2007, 20:23
This is a good piece of writing.

cashtothemoney
11-06-2007, 03:48
Why thank you!

cashtothemoney
12-06-2007, 01:26
You do have a point there. A hot bath (or hot tub, if you have access) is great for RLS, supplemented with extra potassium.

~*geNeRaTiOn E*~
12-06-2007, 02:22
will any NSAID work? i have some samples of 200mg celebrex and took some last night but it didn't seem to help until a few hrs later. i'm slightly worried about taking pain reliever since i'm sure my liver has been through enough already but i cannot bear with the w/d pains.

i'm thinking about doing a taper but i'm worried that i won't be able to stop. the w/ds are just too much to handle.

sixpartseven
12-06-2007, 05:44
"i have plenty of credibility here both on this board and from real life experience and education"

Yeah, whatever man, do you have scientific literature to back it up? I just want to see where it says that one can withdrawal from Immodium. Forget your credibility, that is quite subjective.

Apparently you werent around when Bluelight exploded with all the Loperamide discussions.

Now, there is really no need for "scientific literature" to know it is possible to withdrawal from immodium. All you need is this thing called "logic" (the 2+2=4 kind of logic. Youll see what I mean) and the fact that loperamide is an opioid, or at the very least similar enough to have the effects of an opioid. Now, using that and logic, you can start with Loperamide being an opioid, then take into consideration that opioids, when used on a regular basis and in high enough doses (or even low doses, but we need to think high doses for the next part. And also, usually the stronger the substance, the worse the withdrawals will be e.g. Codeine withdrawals versus Fentanyl withdrawals, and structurally, loperamide is similar to, if not stronger than, fentanyl) for an extended period of time can cause dependence. Now, when dependant on an opioid, if you do not ingest your drug of choice, you will withdrawal.

Therefore, if you take loperamide (2) in high enough doses (+2) over a period of time, you should probably taper or you will withdrawal (=4).

Welcome to 2nd grade.

cashtothemoney
12-06-2007, 06:36
There actually is scientific literature to back up the fact that loperamide can cause physical dependency. When loperamide was first introduced in the United States, it was a scheduled substance; schedule V to be specific. The reason it was introduced as a scheduled substance was because during clinical trials a physical withdrawal syndrome was observed. The trials involved long-term, high dose loperamide. After it was found that loperamide did not act on any opioid receptors in the brain (for the most part), it was unscheduled. This all happened very quickly, so many people don't even know that it was once a controlled substance. I'll see if I can dig up the literature, but it's most definately buried, as it is probably a few decades old.

SOURCE: http://www.thatspoppycock.com/opiates/loperamide.htm

CTdopeLove
18-06-2007, 00:06
Two things that can help quite a lot in dealing with withdrawal, although they both have their setbacks (doesn't everything?)

1. Alcohol - At least for me, getting drunk doesn't exactly eliminate the withdrawal, but it makes it more bearable by allowing me to ignore it for the time being, and sometimes helps to warm the "deep freeze" feeling inside you. It also can help a lot with getting a few hours of sleep, but be warned, it has it's downsides. Besides the fact that it's an addictive substance, which means you could trade one addiction for another, when drinking during withdrawal you may feel even shittier the next morning. What I do is get drunk, but not overly drunk, and make sure to drink plenty of water before bed (I always do this when I drink, AT LEAST twice as much water as alcohol I drank) so you don't wake up with a hangover. It's a little tough getting the alcohol to go/stay down when your stomach is upset, but after 15 minutes or so it should be settled (I suggest hard alcohol, as I can't imagine getting drunk off beer, with all that carbonation, would be very friendly on your stomach, but then again I never drink beer).

2. Masturbation - For one it's nice to finally be able to get off, and it gives ya a bit of a "rush" so to speak (maybe not an opioid rush, but it does feel good). Some people say it makes them feel good for a bit, but makes them feel even worse afterwards, but for me it helps a lot. When going through withdrawal, I can easily get off 5+ times in one day.

~CTdopeLove

enoughorangejuice?
10-09-2007, 00:17
i've heard that taking benadryl can help with insomnia and opioid w/d's and i've heard it can make it worse. whats the truth on this ?