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Opioids The Opioid Withdrawal Megathread and FAQ

amapola

amapola

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Welcome to the Opioid Withdrawal Megathread and FAQ!

Introduction
The purpose of this thread is to facilitate questions and discussion for anyone who is considering, in the midst of, or even just curious about, withdrawing from opiates. Withdrawal is no picnic, however not knowing what to expect and what can be done to help ease the pain makes it that much worse. Remember that no matter how terrible your symptoms may seem they are only temporary. Countless people have been there before and have successfully come out the other side. Armed with their knowledge, support, and experience, we'll help you get through it too.

Some of the questions and topics which belong in this thread include:
  • How bad can I expect withdrawal to be from my current habit?
  • How long will my withdrawal symptoms last?
  • How can I use the opiates I have left to help ease withdrawal?
  • What OTC medications and home remedies are useful?
  • What can I do to help with certain symptoms of withdrawal?
  • I just slipped up and used...how will it effect my withdrawal?
  • Should I consider going on suboxone or methadone?
    [*]And any other general advice on your own personal situation and plan to get off.

Background
When taking opiates regularly over a period of time, your body becomes accustomed to them and develops both tolerance (where you need more opiates to achieve the same effects) and dependence (where you need opiates just to feel normal). When a person who is dependent on opiates stops taking them or takes less than they require, they go into withdrawal. The severity and duration of withdrawal depends on how long a person has been dependent, how high/strong the dose is that they are dependent on, and how long the half life of the opiate that they are taking is.

PAWS (post acute withdrawal symptoms) begin after you have finished the physically painful withdrawal process. They can continue to occur for an extended period of time especially in users who have been on opiates for a while. PAWS generally consist of psychological problems like depression, anxiety, etc, which stem from chemical imbalances in your brain. The Dark Side is an excellent resource for those who are looking for information and support on this phenomena.

It is important to note that almost all opioids taken for fun act primarily on the Mu-opioid receptor. This means that there is a cross tolerance between them and taking large amounts of weak opiates can be considered almost the same as taking small amounts of strong opiates.

Methods for Withdrawing
There are three main methods that people use to try to get off of opioids.

Cold Turkey
Going cold turkey (CT) is when consumption of all opiates is suddenly ceased and the person enters acute and full on withdrawal. The advantage of this method over others is that the withdrawal is completed in the shortest amount of time. The downside is the symptoms will be most severe.

A rapid detox is when powerful antagonist are steadily administered to an opiate tolerant individual resulting in instant and extreme withdrawal. This procedure actually condenses the acute withdrawal period, which usually lasts several days, into a matter of hours. Due to the level of pain this inflicts upon the user however it requires a doctor to supervise and the patient is put under generally anesthesia (i.e. knocked out like for surgery) for the duration of the treatment. These clinics are probably a very tempting option for most people however they are expensive, there are still PAWS to deal with, the chance of relapse is higher (because you never had to experience withdrawal), and there are risks similar to that of minor surgery.

Ibogaine is a psychoactive plant that has potential for addiction treatment. It is usually used to send the user on a long introspective psychedelic trip resulting in reduced cravings, lower tolerance, and abatement of withdrawal symptoms. Like the rapid detox above there are clinics which specialize in ibogaine treatment depending on your location.

Tapering
Tapering is when progressively smaller amounts of opiates are taken over time in an attempt to slowly wean off the opiates and minimize negative symptoms. This is probably the most common method of attempting to handle withdrawal and it can be performed over a time-span of anywhere from days to months. The more gradual the taper, the more subtle the symptoms of withdrawal, but of course the longer it takes to complete. At the end of the taper the user will eventually have to switch to zero opiates at some point. This is called 'jumping off' and usually will result in some negative symptoms even if the last dose was very low.

Some people will attempt to taper by switching from a strong opioid like oxycodone, fentanyl or heroin, to a weaker opioid like codeine or tramadol. This way they can use the cross tolerance to help reduce the withdrawal symptoms but won't be as tempted to get high with their DOC (drug of choice) if they can even get high at all on the weaker opioids. In some locations these opioids are available without a prescription. Depending on your location these include:
  • codeine/DHC - preparations often contain other drugs and need to be extracted if consumed in large amounts (Cold Water Extraction Mega Thread & FAQ v2.0)
  • tramadol - has lots of other non-opioid mechanisms of action and can present a seizure danger
  • kratom - a plant naturally containing opioids
  • lopermide - often just used to treat symptoms of withdrawal as opposed to a proper taper

Maintenance - methadone and buprenorphine (suboxone/subutex)
For some people getting off of opiates is too hard or is not as important as getting out of the drug culture and life style. For them opiate maintenance is an option. Opiate maintenance with methadone or buprenorphine is effectively a taper plan overseen by a doctor with the difference that some people choose not to taper for years, if at all, and just "maintain" themselves on the drugs. Choosing to go on methadone or buprenorphine is difficult decision. Many people find it helps them get off of opiates and many find it is more difficult to get off of their maintenance drug than it is their original drug of choice.

People can choose to use methadone and/or buprenorphine in an at home withdrawal setting as well, however these drugs have very long half lives and other special properties which must be taken into account (which is why they have their own threads as linked below). Buprenorphine has such a high affinity if taken while other opiates are still in your system it will rip them off and cause instant and painful 'precipitated withdrawal'.

Where to Start?
The second post of this thread includes most of what you would want to know about OTC and home remedies as well as other advice on dealing with withdrawal and is a good place to start (after reading this first post of course :)).

Although this thread is designed for general questions, comments, and concerns on opiate withdrawal, before posting please review the following threads and see if your topic is more suited elsewhere. For specific questions on OTC and home remedies check out the next post and the relevant links as well.

For detailed information on tapering plans:

For specific information regarding the opioid containing plant Kratom:

For specific information regarding the maintenance drugs methadone or buprenorphine (suboxone/subutex):

For moral support and psychological issues:

As always please try to keep questions, responses, and discussion relevant and on topic.​
 
Treatment of Withdrawal Symptoms

There are only two ways to cure withdrawal. The first is by taking more opiates and it is really not the answer we are looking for. The second is time. No matter what you do to help ease your way through withdrawal, the only real way to get better is over time. During this time, since we can't directly treat the cause of the withdrawal by taking more opiates (or we only partially treat them if tapering), we treat the symptoms of opiate withdrawal.

Supportive Treatment
Supportive treatment is a term in medicine where if you can't treat the cause of a disease to cure it, you manage the symptoms as best you can.
First and foremost (much like surviving on a desert island) we take care of our basic bodily needs.
  • hydration
    Your body needs water to survive and stay healthy. While detoxing from opiates you'll likely be suffering from diarrhea, nausea, and profuse sweating, all of which contribute to dehydration. Maintaining good fluid levels is integral to getting and feeling better and should be a priority whenever you are sick including withdrawal. Water, juice, soup, whatever you can take and keep down you should be consuming. Although people say detoxing from opiates isn't inherently deadly (as compared to benzos/booze), it does put a lot of stress on your heart and other organs and dehydration can be dangerous as well.

  • electrolytes
    Along with needing fluids in your body, you need ions in those fluids which are known as electrolytes. They are integral to proper muscle and nerve function (including your heart) and a lack of them will result in cramps, seizures, and other nasty problems. Just as diarrhea, vomiting, and sweating decrease fluid content, they also decrease electrolytes (especially sodium and potassium) and need to be replaced. Sports drinks are an excellent source, but juice and soup will do as well. Hydration is important but be sure you don't over do it on just water.

  • vitamins/minerals
    Although some of these fall under the category of electrolytes, vitamins and minerals are important for proper bodily functions. Although they can be obtained naturally from dietary sources, in the midst of opiate withdrawal you might not be feeling to hungry and taking a good multivitamin can help supply your body with everything it needs to get back on track.

  • food
    Your heart pounding shivering body will surely be craving some energy, and calories in the form of food is where it comes from. That being said if you are way to sick to eat then there is nothing wrong with sticking to juices and soups until feeling a little better. Getting some fresh fruit in your stomach can do wonders for your mentality though and sometimes help with nausea as well.

  • sleep
    It may be hard, but your body and brain needs sleep to heal and repair. There are drugs which can help but resting and at least trying to sleep is just as important as keeping active and trying to keep your mind off of withdrawal.

OTC Drugs
There are many drugs which are often available over the counter (without a prescription) that can do wonders for helping alleviate certain symptoms of opioid withdrawal. Some of the more commonly used ones are listed here.
  • diphenhydramine (for sleep)
    Diphenhydramine (Benedryl) is an antihistamine which is used to treat allergies. It is also used off label as a sleeping aid and just a few pills will help you get to sleep. Taking too much it acts as a psychedelic deliriant and there is no need to go much beyond the recommended dosage. Some other antihistamines, including promethazine and diphenhydrate, have this property as well.

  • naproxen sodium (for muscle aches and pains)
    Like other NSAIDs (nonsteroidal anti-inflammatory drugs) naproxen (Alleve) is a pain killer which can help treaet pain in your muscles caused by withdrawal. Ibuprofen and aspirin are other drugs in this category which could be used instead though naproxen is often preferred for withdrawal. These drugs should not be used beyond the recommend dosage as they can cause intestinal issues and should not be mixed.
    Acetaminophen is also a non-narcotic pain killer but is less effective for muscle pain.

  • dextromethorphan (opiate action)
    DXM (a cough suppressant) has some opiate action and can be used to help reduce symptoms but is not active enough to be considered a drug you can taper on. It is more commonly used to potentiate other opiates thereby allegedly preventing tolerance. In higher doses it is also a dissociative which people experienced in it's own recreational use find helpful to reach while in withdrawal.

  • lopermide (opiate action) Loperamide
    Lopermide (Immodium) is a very strong opioid. However in low doses it does not cross the blood-brain barrier (BBB) and therefore only acts on your peripheral nervous system and not your central nervous system (CNS). In lower doses it is extremely useful for limiting diarrhea and related symptoms, and in high doses it actually does somewhat cross the BBB and can almost completely eliminate withdrawal and can actually be used to perform a taper of its own.

Prescription Non-Opioids (benzos etc.)
Although the OTC drugs listed above do help with some symptoms, there are more potent prescription drugs which would be considered preferable; if you can get your hands on them. The most notable of these are benzodiazepines which, depending on the specific one, can be a combination of a sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant. Benzos are often prescribed by detox clinics and are definitely a good thing to have.
Some others include:
  • muscle relaxants (eg. carisoprodol) to help with muscle aches
  • alpha blocker (eg. clonidine [prescribed for opiate withdrawal]) lowers blood pressure and limits hot/cold flashes
  • beta blocker (eg. propranolol) lowers heart rate and blood pressure
  • ondansetron - a 5-HT3 antagonist which has been shown to treat opioid withdrawal

Other Recreational Drugs (marijuana etc.)
It is debatable whether substances like weed, booze, coke, ketamine, etc. should be taken during opiate withdrawal. They have the potential to make the situation much worse, however they can help both with physical symptoms and with taking your mind off of withdrawal. It basically comes down to a personal choice but anything that is hard on the body or has a hard comedown is probably not going to help anything (eg. stims and booze). Smoking weed is probably the most common and can definitely help people relax and take their mind off the withdrawal but it does elevate your heart rate and can make anxiety worse.


Endorphins (natural opioids)
Endorphines are natural opioids created by your body in response to certain situations. They are what is needed to get you feeling better again and there are several ways you can trigger their release.
  • exercise
    This is the big one. Getting up and moving about is important for mental reasons as mentioned below, but vigorous exercise (whether running, weight lifting, or playing sports) can really improve how you feel. Even if you feel like utter crap and can't imagine getting out of bed, remember that you don't have the flu and breaking a sweat is a sure fire way to actually feel better. An exercise regime is also very important to getting over PAWS and maintaining your sobriety (never mind living longer and looking super sexy). You might as well start now when it'll also help with withdrawal.

  • sexual release
    If you find there is simply no way of getting out of bed, this can give you a much needed break from the pain. Although reaching orgasm will flood your system with endorphins, even just being sexually stimulated (mentally and/or physically) will help somewhat.

  • chocolate and candy
    Who cares if these release endorphins, (they do by the way) they taste great anyways. Feel free to indulge.

  • spicy foods
    The pain inflicted from spicy foods is another way of getting some endorphins released in your body. This one you may want to leave until after the diarrhea has stopped however.

  • anything else that feels good
    Not all of these release endorphins per se, but they all feel great.
    • hot showers
    • heating pad
    • massage
    • stretching
    • a hug
    • talking to a loved one

The Mental Aspect
One of the worst things about withdrawal is the time you used to spend just lying in blissfully in bed enjoying every moment is now spent lying torturously in bed hating every minute. Time passes slower than can be imagined and thinking about how much longer you have to go is often much worse than any symptoms you are actually experiencing. Along those lines it is important to keep your mind as occupied as possible and once you are able to get out of bed your body as well.

Ideas for things to do include: watching movies or TV shows (laughing at a comedy is the best medicine ;)); playing engrossing games (a complex one like chess completely takes over your mind but something intense like poker or the latest shoot-em-up might give some needed release); or anything else that takes your mind off the situation - like coming onto Bluelight :). If you find yourself just too restless to watch TV or play video games, try doing something more complex. Learning about a subject that interests you for example can hold your attention better than a mindless game and though it seems counter-intuitive to do something harder it often works out.

Sitting and staring at the clock is a lot more difficult than just doing something. If withdrawal doesn't have you stuck to the bathroom floor or physically bedridden then get out of the house, walk to the store, hang out with friends, anything. It might seem like you aren't up for it, but taking your mind off withdrawal is the key to success.

For any detailed and specific information on any of the mentioned substances or concepts beyond simply being used for opioid withdrawal, please search for threads on them or check out
**The Other Drugs Directory**​
 
The big kick...

Ok so I was on Suboxone maintainence for a couple months. They told me if i weaned myself off I wouldn't experience withdraw...WRONG. I felt just as sick as any other opiate withdraw if not worse! I I've been doing heroin for about a week but I really don't want to be doing any of the shit anymore. So tomorrow I'm starting the kicking process and was wondering if anyone could help me out with any ideas that might make the whole process a little more bareable? I'm open to just about anything because detoxing effing sucks and is hell on earth for 3 to 4 days. I'd appreciate any advice! Well I'm off to do the last of my shit. Wish my luck :o
 
Buprenorphine (the primary ingredient in suboxone) is very potent and has a very long half life. The long half life means that you are likely to experience longer duration of effects, and the potency means that dropping down from just 1mg to 0.5mg is actually a very big step.

Check out the first 2 posts in here and ask any other questions you may have.

Good luck!
 
Great stuff... truly

Yeah, Bupe was tough to beat but if you want to you'll do it. I quit cold turkey at 6mg a day and am now on 27 days with no suboxone, even though I've taken painkillers a handful of times. Still dealing with nagging PAWS.

FUCKING PAWS.

I'll never look at a kitten and think, oh what cute little paws. I'll look at it and think, FUCKING PAWS, SICK DEADLY PAWS.
 
I didn't really know where to put this, but I found a fun, but very informative story on erowid, about addiction, it's evil cycle and the decision to quit using. Specifically it is about taking the cocaine, heroin and eventually speedball route, hence the title "For Those About to Rock: A speedball encounter scenario"

And if you haven't figured it out yet, click the title, it's a url to the article/story.

*MODS: Please mention a better place for it if you would like it moved...
 
Tramadol help ease bupe withdrawl?

Ive been taking 8mg/day bupe for the past 3 months or so. I'm afraid that I'm going to run out before my finals are over, and I cant refill my prescription. I have a bunch of tramadol and am wondering if the tramadol will mask/postpone the w.d symptoms.

If I can use tramadol for the w.ds how much should I dose, also will the trams completely get rid of the w.d or just make it less intense?

Again I cant refill my script because I cant afford it.
 
Wolfmans_BrothEr said:
Ive been taking 8mg/day bupe for the past 3 months or so. I'm afraid that I'm going to run out before my finals are over, and I cant refill my prescription. I have a bunch of tramadol and am wondering if the tramadol will mask/postpone the w.d symptoms.

If I can use tramadol for the w.ds how much should I dose, also will the trams completely get rid of the w.d or just make it less intense?

Again I cant refill my script because I cant afford it.
Click to expand...

Depending on how much you have left, taper or take what you have and divide it up for the time you need it. Tramadol helps but it has a set of nasty withdrawals itself if you take it for a few weeks non stop.

I was able to get relief from W/D (after the first 2-3 days) with 100mg. If I were you, take the suboxone when you need it, and then when you're home and you need something take the tram.
 
Great post, amapola.

Does anyone experienced having a strange body smell while withdrawing?

When I used to go through it, I'd notice a weird B.O. and always had to shower and change clothes.
 
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 -
 
yeah, to me it's like I can smell the toxins coming out in my sweat. it smells a lot like vitamin B, actually. plus vitamin b.o. it's a bad combo, and one that required me to change towels with high frequency. my urine smelled like sickening sweet cereal. cigarettes taste and smell awful.

I think I become oversensitive to smell in withdrawal. also to light. also to things in general. as jon wayne said, "I'm a shenshitive man".

I would add to this thread that if you're part of the unlucky few then a lot of the medications listed to help withdrawal (benadryl, dxm, gravol, benzos, etc.) will actually make your RLS worse. in fact, there may be nothing in the world that will help except time and exercise if you're in that camp.

happy hunkering.

SECONAL said:
Great post, amapola.

Does anyone experienced having a strange body smell while withdrawing?

When I used to go through it, I'd notice a weird B.O. and always had to shower and change clothes.
Click to expand...
 
villian said:
define strange? I sweat a lot in withdrawal but I don't think I smell different per se
Click to expand...

Whenever I started getting hot flashes a few hours after my last dose, I'd start sweating all over and smelling like a wet animal. That's how I knew my wd's are starting up again.
 
I had been using the new oxycontin OP's and built my tolerance to around a gram of oxy per day. I was takingit orally, but would break the pills into powder and dissolve in Vit. C. I tried to detox w/ subutex, waited a lil over 24 hours since my last oxy OP but still went into precipitated w/d---horrible. Anyway b/c of the OP's ridiculously long lasting effects (even when I thought I was in mild w/d I wasn't) I decided to switch to heroin and taper with that drug. I've found that switching to a shorter acting opiate has helped me gauge how much I need, as I feel very mild w/d symptoms anywhere from 5-10 hours after my last dose. BUT I have a question:

I know sleepiness (at least for me) is the first w/d symptom I experience. About 4 hours after my dose I become very sleepy, and my body just wants to sleep until I can re-dose. Here's the thing, Heroin itself makes me sleepy, MUCH more so than oxy, oxy made me energetic while high. And since I'm using the H to taper, I can't tell if these bouts of sleepiness I get during the day are b/c I'm high from the H or b/c I'm starting to w/d from the H. (I can kinda figure it out based on how I feel when I redose and the time since my last dose, but I'm still not totally sure...)

SO, does anyone else experience an extreme urge to sleep in the initial phase of w/d?
 
^agreed, although I'm not talking about REAL w/d. To be more accurate, I'm referring to that period of minutes---hours; from the tail end of the high from your last dose until the moment right before you re-dose. I find (IME) that this phenomenon is much more pronounced when one has no opiates left and is playing that insufferable game of waiting for your supplier----that game where 5 minutes becomes 30, which leads to calls going to voicemail, until a few hours after the supposed meeting time you finally resupply. In that scenario, its likely psychological as you know its gonna be longer than you were told so sleeping is the easiest way to pass time. But nonetheless, even with a full supply, b/c I'm tappering down, I wait to re-dose for as long as possible. I don't wait till I'm sick or even in the mildest of w/d, I wait until the buzz has completely gone and I am just tired. BUT, as stated b4, since I'm using heroin now, I'm tired even when I AM high, making identification of when a re-dose is needed more difficult
 
Need help

The wife and I have been on norcos for a lil over 2 yrs ... Today we began an 11 day detox/withdrawal/rehab... At home, using the Thomas recipe.. Plus clonidine,if I can get it. Any advice at all is certainly welcome.
 
I am using roughly 40-50mg daily of oxycodone ir. For 1 year. When I run out I take tramadol. Should I have a bad withdrawal. Is this considered a big or little dose. I do take them for pain but with withdrawal it don't matter! Oh and how come I used to use hydrocodone for the pain and switch to tramadol all the time I never got any withdrawal. But with oxycodone I do? I don't feel like doing anything but sitting around right now. You almost couldnt force my outta my chair. Will it last longer because of the tramadol or as long as I stay on the tramadol I will be ok? I cannot or should I say will not stop my meds for a few years until my kids don't need me to move as fast or as much. I do not get buzzed at all and don't want to.
 
Last edited:
Ftain said:
The wife and I have been on norcos for a lil over 2 yrs ... Today we began an 11 day detox/withdrawal/rehab... At home, using the Thomas recipe.. Plus clonidine,if I can get it. Any advice at all is certainly welcome.
Click to expand...

What is the Thomas recipe? I used search-got nowhere.
 
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