How do you deal with PAWS?

[Binge_Artist]

^Fair enough.

I agree 100% that the Binge Artist Method of dealing with PAWS will almost certainly lead to relapse. So, yes, I agree that it's not "sustainable" for keeping clean..but the question is, Is it a sustainable lifestyle in general?

 

[Cane2theLeft]

Also, there is a big difference between being clean and being recovered.

This.

Since I moderate in OD, I CONSTANTLY see threads where people are only concerned about getting past the acute phase of withdrawals and nothing else. They don't deal with any of the reasons for or consequences of their use and inevitably go back, usually very quickly.

Getting clean takes a lot of work and no offense, b_a, but I can't help but think your claims that you'll never feel contentment without drugs is bullshit if you've never fully tried the recovery process. When you're in active addiction you can rationalize almost anything and one of the most common rationalizations is that you'll never be happy/content/ok, etc. if you aren't using something. MOST addicts believe that.

I'm not saying you should go to treatment or anything, that's completely your choice but if you haven't fully committed to getting clean, you have no idea how you'd feel once you are.

 

[Mehm]

Is it a sustainable lifestyle in general?

Could you please elaborate on what exactly you mean by this? Sure a person can live like this....I'll bet they die of disease and sickness before a healthy person though.

 

[Binge_Artist]

Cane (and for folks who don't know, this man is a genius) and mehm, to address both of your posts..

The general consensus in OD, from what I've read, is that "chipping" with opiates is not inherently unhealthy. Or perhaps a better way of putting it is that "it's theoretically possible that chipping is not necessarily unhealthy." Or, whatever.

Now, with my "system", I split my year up with roughly 4 months dependent on opiates, 1 month fucking around with random BS like cocaine, speed, alcohol, cigarettes, booze-drenched chocolate covered whoreburgers, etc, and the rest of the time is spent living the kind of life that would make Jack Lalanne (RIP) proud.

So, looking just at the opiates (the only chemical I would possibly consider myself "addicted" to), I'm basically high only 1/3 of the time. Now, I would be using the same amount of opiates if I were getting high one time every three days. And by most standards, that would be considered chipping, since 1 day in 3, for most folks, would skirt physical dependency. (And the other stuff would amount to, say, using cocaine about once every two weeks, which almost everyone on BL, it seems, would agree is non problematic.)

Of course, the difference with me, is that, since I use on fairly long "binge blocks", I develop physical dependence. Some folks say physical dependence is some kind of magical line where you cross from a rec user or chipper into an addict. IMO, it's semantics. "Getting clean" has never been a big deal, per se. Even if I don't treat myself to the luxury of a taper or immodium or benzos, the detox is really no worse than a flu coupled with insomnia.

 

[Regenesis2]

cane2theleft -Taking drugs distinct from the ones someone was addicted to probably will alleviate the symptoms temporarily but I think in the long run is not a good idea.

I try to tell this to people going on an opiate WD all the time. People always want to take benzos during this shit. There is no way that it can help in the long term and there are serious short-term risks with them too.
Addicts going on WD often make the mistake of cold turkeying because they will be tempted to do more during a taper. There is no better way to set yourself up for PAWS than that. Even if you are out of control, tapering with the drug of addiction is a good way to discipline yourself and will be much easier on your CNS and body. Some say it just prolongs the WD but that is not usually the case -- especially in benzos. Sometimes with short-half life drugs like xanax and alcohol you should switch to a longer-acting thing like valium or librium and needing a longer half-life is really a decent reason to switch.
In all of my research and experience done on WD, tapering with the drug of addiction or the most similar substitute is the way to get off. Going CT off an opiate and dosing up with benzo just confuses the brain more.
BTW what's a "booze-drenched chocolate covered whoreburger" ? Must be a lunch special at TGI Fridays I think...

 

[Binge_Artist]

IMHO, PAWS is somewhat of a misnomer anyway.

I think it comes from thinking of all the opioid WD symptoms as a single ailment. If we break down typical fast acting opioid withdrawal by individual symptoms and their duration, we get something like this:

GI issues (nausea, vomiting, shits, etc): ~3 days
Chills, cold sweats, goosebumps: ~5 days
Body aches: ~2 weeks
Sleep disturbances (RLS, insomnia, etc): LOL..quite some time..

So, if you wanna call the "acute phase" that ~3 day period where you have ALL the symptoms, that's all well and good..but the only "immediate" consequence of transitioning from acute WD's to "PAWS" is that you're no longer puking and shitting your brains out. But you still have all the other symptoms.

 

[Regenesis2]

^I can agree with that in someway. What is the line between acute and protracted? Sometimes I feel good but never at pre-use levels and sometimes I feel as bad as I did during the first days of it all. With benzo WD it seems common to acquire and lose different symptoms during this shit. I lost some anxiety but gained worse insomnia, I lost the sweats and tremors and gained restless legs and tinnitus. This is some fucked up shit. That's why I'm an anti-benzo nazi. I've done opiates like crazy for months at a time and never got much of a WD. Same with other drugs too like nicotine and coke, but benzos were my unlucky one.
It would be nice to think that using stims would reverse benzo WD by driving your nerve receptors in the opposite direction, but it doesn't work like that. Don't take ginseng on benzo WD. I think my experience with it last saturday proved that the PAWS is very physical, not just psychological, but I get stuck in my old psychological habits of cannabis though, which I would say is a type of PAWS. I'm still used to revolving my life around blazing up.

 

[poopie]

It's been over a month after taper down from 1mg of Suboxone every two to three days.

When the hell do the night sweats go away? It's way gross to strip my bf's soaking shirt off him and see his sweat outline in the sheets!

 

[Binge_Artist]

^The sleep issues are the longest part of PAWS, ime.

 

[Regenesis2]

^yeah me too. My cycles are saturated with REM dream stage sleep and still the odd sweaty night. This part can take years. I often never have trouble falling asleep but wake up very often during vivid dreams. What kind of long term sleep problems do you typically experinece with the opiate WDs? Do you get lots of vivid dreams? Wake up often? have trouble intitially getting to sleep?

 

[Binge_Artist]

What kind of long term sleep problems do you typically experinece with the opiate WDs? Do you get lots of vivid dreams? Wake up often? have trouble intitially getting to sleep?

IDK if I'd call the sleep problems I got from opiate WD's "long term".

Basically, the first month or two, it's very difficult to get comfortable enough to fall asleep. And you're constantly exhausted. Very unpleasant. And when you do finally fall asleep, it's usually "bad" sleep. Lots of tossing & turning, bad dreams, sweating, etc.

But it all gets back to normal after that 1-2 month period. AFAIK, there are no "long term" sleep problems from getting off opiates (at least, not with fast acting ones, like heroin, oxycodone, hydromorphone, etc).

 

[grizz88]

As many of you probably know from experience, Post-Acute Withdrawal Syndrome can be more of a barrier to sobriety than the torturous acute withdrawal and can plague substance users long after quitting their drug of choice.

Only recently has the treatment world started to recognize the role that managing PAWS plays in preventing relapse and have begun to offer some concrete suggestions on how to prevent and manage the symptoms as well as expedite resumption of normal functioning.

I'm hoping to learn more about what helped those of you who have experienced this but first a few basics... (Based on Terence Gorski's writing on the subject)

Wow, where do I start? FIRST OFF fuck suboxone or any long acting partial analgesic.

Been clean for 11 days, after tapering (been waiting for this day)

Tapering basically didnt do jack shit. Every day, I exercise, listen to music i love, smoke weed, work out, eat fried chicken all day (emphasis on the iron) keep the work game goin, keep hittin up class, study, do what you gotta to in between

SYMPTOMS: WAKING UP AT 3 am, NO SLEEP FOR A FEW DAYS. APPETITE gone, but EXPLOSION of hunger once you get there EAT BIG, HEADACHE, OH MY GOD. No remedy, time heals wounds. Cant BELIEVE how bad they were, holy shit. Got a crippler over a week into it.. whoa holy fuck

Im living it, loving it, not afraid. I wanna move around, get around. I never felt this in the fog of opes (unless i would hit a fat line of H, BTW took OP oxys for over a month during the holidays, then switched to 17 suboxones jan 15, got to Feb 15? with em and regretted every day

so yeah, keep it real BL, enjoy everything, take nothing for granted, keep pumpin, take every opportunity to do so

and fuck JAY Z

 

[gingerjunkie]

^I believe you were more thinking of acute withdrawals than post-acute withdrawal syndrome. PAWS is described as lingering effects people have AFTER the typical withdrawals end. These are often characterized by depression, clumsiness, cognitive deficits, stress and inability to cope with stress as well as many other symptoms.

PAWS can occur after cessation from many different types of drugs not limited to opioids and some of the worst PAWS can occur in people with large, long-term benzodiazepine habits.

While acute withdrawals can be torturous, psychologically they are manageable due to understanding they are time-limited. One of the reasons PAWS can be so difficult is that it can last months and in extreme cases, even years without an end in sight.

People plan for the acute withdrawal, stock up on the supplies you mentioned, get through the few days of utter sickness but then it still may take weeks, months or even longer until they start to feel right.

Despite lacking the intensity of acute withdrawals, many people say that PAWS is much worse and leads more people back to using due to the depression, anxiety and other symptoms.

Fortunately, more and more information is coming out on ways to manage the symptoms and even shorten the period that one experiences this and I was hoping, with this thread, for people to share what did and did not work for them.



_______________________________________
Regarding the question about loperamide- when I came off ~150mg oral morphine/day after 4+ years for pain, I started at 24mg and tapered from there. This stopped about 80% of the withdrawal symptoms and didn't cause any excess constipation or other problematic side effects.

B_A - thank you, that's very kind of you to say! I definitely appreciate your input here as well, brother.

Cane,
Are you familiar with the PAWS associated with Suboxone?
My specific situation is as follows: I was a heroin addict for two years (first smoking then iv) and went to a short term in patient detox 8 months ago, in which I was tapered with Lortab (which was surprisingly unbearable). I was clean for four months and relapsed for four months. I lost all connections and had to quit. I bought roughly 40 mg of Suboxone (5 8mg strips). I was on a dose of ~2mg IV. First daily, then adding a day between doses. It's been an extremely smooth ride, however now on the 7th day of complete abstinence of opiates I'm still feeling a bit down. Exhausted, terrible GI cramps, and insomnia like you would not believe.

What would you reccomend I do to ensure that maintain sobriety? I feel like I made it, but I really still want to use.

 

[Cane2theLeft]

The ONLY way to maintain sobriety is to attack this from all angles. There was something you were missing or trying to cover up with drugs and unless you address THAT, that desire to use will continue. People make the mistake of trying to get through withdrawal and PAWS solely through addressing it physiologically.

Mitigating the physical discomfort is relatively easy- Exercise, eat right, get into good sleep habits and establish a solid routine. Add to this benign supplements and medications to address the remaining symptoms and you're golden but then whatever drew you to get into that habit in the first place will still be staring you in the face telling you that you NEED that substance all the time. You need to address that.

For many people, sober support structures are absolutely necessary to remaining sober and they need something like AA or NA. Many other addicts don't do well with this approach. Regardless, if you have tried to stop on your own and haven't been able to, some external support is almost always necessary. The American Society of Addiction Medicine outlines different levels of treatment starting with outpatient treatment and up through inpatient and hospitalization. You can meet with drug counselors in your area for an assessment of what type of treatment would be most beneficial and what may be necessary.

On Bluelight, I see addicts making the same mistake over and over again- thinking THIS TIME they will be able to do it on their own, trying to quit and putting no plan in place to maintain their sobriety, only focusing on getting past withdrawals, getting smacked in the face with PAWS and then going back. Again and Again.

To put it simply, you have to figure out WHY you were using and address that whether through formal treatment, 12-step groups, your support system (which most addicts have destroyed) or another means. Once you physically get away from the drugs, unless you address the root cause of why you were using, that nagging need to medicate yourself will remain.

If you'd like to speak privately at more length about specific options and ways to address your situation, please feel free to private message me. I've worked individually with dozens of people in similar situations through this site and have formal education and training in this field.

 

[Moeeejoeee86]

Cane2theleft please pm me i cant figure it out

 

[Moeeejoeee86]

Please help me asap brother

If you can please contact me id TRULY appreciate it and will not go un forseen 480 939 1426
thx in advance

 

[embryo923]

DXM works amazingly well for opiate WD's and so does gabapentin.

 

[Patricia66]

Hi. I?m a new member here tho have constantly googled this site. Anyway way you write is really helpful. I have a question. I have been taking Suboxone for 2 weeks. I started them the morning after I last used oxy which I?ve learned from BL is not the way to do it I believe bc of PAWS or something like it. I continue to have bad leg pain every day and wake up once a night in acute pain everywhere. I?m also quite clumsy. I want to stop the sub and get sober again (had 17 years at one time). How do I stop the sub? Taper? (I got the sub NOT from a clinic so am flying blind) thank you!!!

 

[NY2soFlo]

^There certainly is truth in that!

If you impose too many rules, make it too rigid then just like a teenager with a 9pm curfew, you're going to want to rebel. I've found personally whether its with drugs, diet, exercise or whatever else; if I make it too rigid, I'm FAR more likely to just abandon the effort.

Its a fine line and of course moderation isn't the strength of junkies but if the pendulum swings too far the other way, chances are its just going to swing back.

Sorry to totally dig this one out of the grave, but its a good topic. Im on day 7 of a fent detox and finally starting to "come down the mountain"... naturally my next anxiety is dealing with the paws.

I think the diet and excersize thing is extremely different person to person. I've detoxed from opiates several times, and I remember lifting chairs and doing pushups in the detox facility when the techs werent watching... and this isnt even past Acute withdrawals, this was just stabilized on bupe. But it felt good. For me, once I can start moving without a 30 min pep talk, starting in the gym light is great. Within weeks im back to it full on, and its probably my biggest credit to speeding through the malaise of PAWS... or at least the dopamine depletion end of it. But hey, if its not your thing, overdoing it could definitely be NOT helpful.

 

[NY2soFlo]

Let's start with things that don't work:

DXM - You would think any kind of anaesthetizing chemical would help, and DXM is over the counter, I mean, it couldn't hurt, right? It'll make you feel like your head is a helium balloon, and you'll still feel all of the negative effects of PAWS, plus more nausea. Bad idea. In desperation, I took 150mg, and it basically ruined half my day (as if it couldn't get any worse).

Recreational Stimulants - Ecstasy makes you feel worse. So does speed. I'm sure some people will tell you otherwise, but even if it did help temporarily, the crash will be magnified times a jillion. It's just not worth it. The bad feelings from PAWS don't go away. They just sit alongside all the stimulation and scatterbrain-ing.

---

Let's finish with what does work. This has been my regimen:

Naproxen (Aleve) - For muscle cramps, helps a little. Take two or three twice a day.

Ranitidine (Zantac) - This pill will help all your stomach related issues, save for vomiting. When I've withdrawn from tramadol, I get incredibly awful stomach cramps from stomach acid, bordering on peptic ulcer status. I was at work once during PAWS, and I was having trouble standing from the pain and cramps. I took two Zantac, and it made all the difference. I was pretty shocked.

Loperamide (Immodium) - I've never felt its peripheral opiate effects (they say it's supposed to help you feel a little better in general, supposedly), but it definitely helps with the diarrhea. I still take beyond the recommended dosage; I'd rather be constipated for a few days than having to run to the bathroom every thirty minutes. Does anyone know at what dosage it helps with peripheral withdrawal effects? I mean, I thought it might have helped a little at 10mg, but it might have just been placebo.

Benzodiazepines (Xanax, etc.) / Carisoprodol (Soma) - This is optional, but it really does negate a huge percentage of the dysphoric effects of PAWS, so it's really almost essential. It will help you sleep at night, and help you relax during the day. The worst of PAWS really only lasts two or three days; after that, you don't really need the benzos. It's not enough time to worry about addiction; you just have to remember to cut yourself off after a few days. If benzos aren't available, and for a lot of people they aren't, carisoprodol (Soma) is much more readily available (unscheduled in most places, available OTC in a few, and you can order it online pretty easily everywhere else) and it's not a bad substitute.

Ensure - Good healthy smoothies that substitute for meals. Good if you can't eat.

Gatorade - For fluids.

Some hilarious DVDs to watch - Comedy heals the soul.

Energy drinks - Usually okay after the first day or two; be careful drinking them too close to bed time, or you'll have a hell of a time getting any sleep. This isn't as big of an issue if you have benzos or Soma. In fact, the caffeine will negate some of the hypnotic effects of the depressants during the day, while leaving the anxiolytic effects (what you want primarily). DON'T go overboard. I only have used a lot of caffeine when I really cannot take off a few days and have work to do. If you can manage without caffeine, it's for the best.


If all else fails, I usually write the words "I'm okay!" along with a happy face on the palms of my hands with an indelible black marker the day before withdrawals. If things get bad, just look at your hands: it's your non-PAWS self reminding you that things will be better soon. I know it sounds a little silly, but to me, it's levitated me out of the worst of lows during PAWS.

As a side-note, I only have experience withdrawing from prescription opiates, primarily tramadol. So I can't speak for everyone with my post, but tramadol is known to have some of the worst withdrawals of all opiates, at least in terms of mental anguish, so I can speak with a modicum of experience behind me.

If the issue with opiate post acute withdrawals is mostly sleep problems and lack of energy than none of these things really addressed that. I would start with L phenylalanine or L tyrosine and some other over-the-counter supplements or herbs that help encourage dopamine production.

And exercise at the appropriate amount, ramping up is going to be huge on its own and synergistically with the right supplements.