I can say from recent experience that Clonidine does not always help RLS during opioid withdrawal. I found that Clonidine combined with benzo's was the only way I could sleep; and even then only 30-45 minutes at a time, and then I'd wake up from my legs kicking and if someone massaged my legs for a few minutes I'd fall back asleep for another 30-45 minutes, rinse/repeat.
Aside from drugs mentioned by other posters, (and if anyone mentioned these and I missed it I apologize), there is the new 'gold standard' RX for RLS: Requip (Ropinirole), though I don't know anyone who has been prescribed it or what the side effects are or whether it helps opioid withdrawal RLS specifically or if it can be safely mixed with other common RX and OTC withdrawal aids. While I cannot attest to the efficacy or play down the safety concerns, Quinine used to be available OTC for RLS, is sometimes prescribed off label for RLS by doctors, and is still available OTC as an herbal extract (Cinchona Bark x6 generally) with other herbs and extracts for RLS- in the same aisle as OTC pain medication for back and joint pain. Again, Quinine in and of itself has the possibility for negative (i.e. harmful) side effects and the other herbs and extracts within said OTC pills would have to be further researched to decide whether or not they can be used safely and effectively with other opioid withdrawal aids.
The 'Sleeping Cure' in it's furthest state was tried back in the 1950's (possibly into the early 1960's). William S. Burroughs wrote about trying it; I believe he documents his experiment with it in his "Letter From A Master Addict To Dangerous Drugs" written in 1956 and soon after published in the British Journal of Addiction Vol.53 #2.
http://www.cs.cmu.edu/afs/cs.cmu.edu/user/ehn/Web/release/BurroughsLetter.html
I have undergone ten "cures" in the course of which all these drugs were used. I have taken quick reductions, slow reductions, prolonged sleep, apomorphine, antihistamines, a French system involving a worthless product known as "amorphine," everything but shock. (I would be interested to hear results of further experiments with shock treatment on somebody else.) The success of any treatment depends on the degree and duration of addiction, the stage of withdrawal (drugs which are effective in late or light withdrawal can be disastrous in the acute phase) individual symptoms, health, age, etc. A method of treatment might be completely ineffective at one time, but give excellent results at another. Or a treatment that does me no good may help someone else. I do not presume to pass any final judgements, only to report my own reactions to various drugs and methods of treatment.
. . .
Prolonged Sleep.--The theory sounds good. You go to sleep and wake up cured. Industrial doses of chloral hydrate, barbiturates, thorazine, only produced a nightmare state of semi-consciousness. Withdrawal of sedation, after 5 days, occasioned a severe shock. Symptoms of acute morphine deprivation supervened. The end result was a combined syndrome of unparalleled horror. No cure I ever took was as painful as this allegedly painless method. The cycle of sleep and wakefulness is always deeply disturbed during withdrawal. To further disturb it with massive sedation seems contraindicated to say the least. Withdrawal of morphine is sufficiently traumatic without adding to it withdrawal of barbiturates. After two weeks in the hospital (five days sedation, ten days "rest") I was still so weak that I fainted when I tried to walk up a slight incline. I consider prolonged sleep the worst possible method of treating withdrawal.
Seroquel can be used and as far as I know is used in certain inpatient rehab facilities for detox. However, using it outpatient let alone at home under no medical supervision is not wise to say the very least. For an outpatient, at home detox from opioids, Clonidine (Or Lofexadine if in the UK), and a Benzodiazepine (or Benzodiazepine
s) are pretty much necessary to make it just bearable. There are studies showing the addition of a weak opioid (specifically Propoxyphene, but also something like Codeine or Dihydrocodeine) in conjunction with the above medications allows for less Clonidine and less Benzodiazepines to be necessary for patient comfort (and those weaker opioids would be tapered over the course of 3 or 4 days to nothing; during the worst of the acute withdrawal phase). I can dig up the article that best outlines this method of treatment if you like- its been posted on BL before.
I've never used Loperamide as a WD aid, but enough people swear by it and since it is OTC and very cheap it's worth having and trying regardless. Plus symptoms of withdrawal vary by addict, as Burroughs wrote, that certain people experience severe nausea and vomiting while others (like me) suffer none; etc. In these cases drugs like Meclizine (OTC as 'Dramamine II') can help. Some anti-histamines like Diphenhydramine and Doxylamine help certain people sleep or slow their rapid heartbeat; while in others it excacerbates symptoms of withdrawal (Diphenhydramine makes my RLS turn into Restless Body Syndrome during withdrawal)- while other anti-histamines like Phenyltoloxamine* and Cyclizine help me sleep and take away the CNS stimulation (*I have mentioned this drug many times on BL, and have used it hundreds of times during days when I had run out of Methadone and it worked great; gave me back my appetite, let me sleep, and even in instances of early withdrawal from Methadone provided a mood lift- as euphoria is a 'side effect' of certain anti-histamines at times; however, when I recently did my stint of detox to get on Buprenorphine, I found that the company that makes Percogesic and Percogesic Maximum Strength- the latter being the product containing 60 pills of Phenyltoloxamine and APAP - had completely changed their formula that it now only contains Magnesium. . . so it appears, in the US anyway, Phenyltoloxamine is no longer available OTC
).
Keep in mind, for your friend, that acute withdrawal times vary by person and 'the worst of it' being over after approximately 72 hours following the last dose doesn't mean that by day 5 she will be up and about feeling good and eating well etc. Length of habit, drugs used, amount of said drugs being used, etc plus personal biology all play into how a persons withdrawal syndrome will effect them. It would be very naive to think that after a few days of hell she'll be back to 'normal'. Addiction doesn't work that way, and abstinence only programs do not have a good success rate to begin with and those numbers get worse when you add in the persons environment, whether they will still see the people they bought from or used with on a regular basis, if they go into a treatment program of some kind whether 12 step or seek the aid of a therapist, doctor, etc to get to the root of why they became addicted to opioids, etc.
Reckitt-Benckiser and state and Federal government programs will pay for Buprenorphine treatment, if she is unemplyed or makes less than $20,000 a year and doesn't have health insurance, Reckitt-Benckiser has a form the sub doc fills out and faxes them that will pay for a whole months supply of Buprenorphine for her for free. If she does have insurance, Reckitt-Benckiser has a $40 off coupon for the new sublingual film Suboxone that can be used in conjunction with health insurance at the pharmacy, and like I said most local governments plus Federal programs related to Medicaid and Medicaid-like programs will pay for most if not all of Methadone or Buprenorphine.
My personal recommendation would be to get on a free Methadone or Buprenorphine program for a 21 day detoxification followed by prescriptions of Clonidine, Benzodiazepine(s) and if needed additional withdrawal aides by either the sub doc or urgent care doc.
