Glad to see this thread. I've had a great deal of personal experience in managing high dose opioid withdrawals, and can help out a bit here. Understand that I'm not giving medical advice, I'm simply relating my own personal experience.
First, we have to have some standard of severity when we discuss withdrawal amelioration. I propose the following for easy reference:
MILD: Runny nose, sneezing, mild pins and needles in the extremities, anxiety, sweating, diarrhea, restless leg and difficulty sleeping. These withdrawals typically result from a few weeks of oxy or hydro use, most often in the range of 30 - 80 mg/day.
MODERATE: Includes all of the above, but will involve vomiting and stomach cramps, clammy skin 24/7, more anxiety and anger, extreme horniness (at least in my own experience, its weird I know), and total inability to sleep for 2-3 days solid, usually days 2 through 5. These type of withdrawals typically result from use of oxy, hydro or similar in the 80 -160mg/day range for at least six months solid.
SEVERE: Includes the above, except that the vomiting is severe and unstoppable, the cramps are debilitating, rendering the subject unable to get out of bed under any circumstances. Bowel control is usually lost, and it helps to have a someone who can wash the sheets, assuming you have the luxury of withdrawing at home in bed. The pain in the extremities will be severe, often being compared to being "burned" while simultaneously itching terribly. Very nasty stuff. These acute aspects vary in duration, depending on the opioids used. For me, these withdrawals only occurred at doses above 160mg/day for months, more specifically 200-400mg/day, when talking about oxy.
LIFE THREATENING: I know that many people on this forum still believe that opioid withdrawals cannot kill. That is, unfortunately, one of the most harmful myths still propagated in the medical and correctional fields today. I have personally witnessed lethal opioid withdrawals, and have experienced one bout of withdrawals of this nature. The symptomology was inclusive of all the above, except that the vomiting was projectile and dehydrating and intense to the point of forcing me to pass out repeatedly. Vomiting and diarrhea occur simultaneously in these withdrawals. In my term, I vomited every few minutes for about forty hours. I lost 35 pounds in 17 days, and my cellmate died (this occurred in jail.) Mine were the result of high dose Opana use (160mg/day rectally for several months) directly following 400mg oxy/day for about a year, all without a break. The life threatening aspect was primarily a result of the inability to keep any liquid down for days and days, resulting in severe electrolyte imbalance and severe dehydration - dehydration being the single most dangerous state a body can be in.
Anyway, I realize that withdrawals vary from person to person, but we should at least have some sort of reference for discussion of ways to help. Mods feel free to clean up the above, or alter it in any helpful way.
That being said, I offer my experience with mitigating the beast:
The king of non-opioid withdrawal aids must surely be Lyrica (pregabalin). I found that Lyrica alone, taken in doses of 300-600mg, literally wiped out all of the pain and restless leg issues of moderate to severe oxy withdrawals (160mg/day for a few months, cold turkey). It was a Godsend for sure, and if you can get it, get it. It works wonders, believe me.
The best OTC combo is without a doubt loperamide/DXM. Now, you have to be careful with this because these drugs synergize. Indeed, I use this combo to get a great buzz now and again. But for withdrawals, assuming you aren't enzyme deficient or taking any drugs that counteract with DXM, you can try taking 60 mg DXM with 24mg loperamide and a glass of white grapefruit juice. Be sure to take a good senna laxative along with this to avoid constipation issues - but of course you're already managing constipation if you're dealing with opioid withdrawals anyway, aren't you?
The idea of using benzos for withdrawals is one that I used to promote, but no longer do. I've been through benzo withdrawals and they're no joke. I feel like most folks here will never find themselves in the life threatening category of opioid withdrawals. Perhaps in that case a dose of xanax could be very useful. However, the above recommendations really do work for those who find themselves dealing with one of the first three categories I outlined. Hope this helps!
Syn -
