Misc Why are benzo/alcohol WDs potentially fatal, whereas opiate WD is not?

[EveryStar]

I've been wondering this for a while. Why are gabaminergic drugs, such as benzos, barbiturates, and alcohol, potentially fatal when going through withdrawal, while opiates are not? I've know what opiate WD is like and it's pure hell, and I've experienced mild anxiety when not taking my scripted benzos, but nothing too bad; so I wonder, why is one type of withdrawal fatal, while the other is not? I'm sure it has to do with how GABA is responsible for many vital bodily functions required for continuing to be not-dead, but what are the details?

Thanks.

 

[sixpartseven]

As you already know, they work on two different receptor types. Alcohol and benzos are GABA-ergic drugs while opiates work on the opiate receptors we have in our brains.

GABA drugs cause seizures when you withdrawal from them, and the seizures are what can be fatal. Seizures are not associated with opiate withdrawal.

 

[Unknown]

6/7 nailed it right on the head. GABA is a receptor that controls various systems or traits in our body. When tolerance to a benzo grows, your body is creating more receptor sites. Our bodies wern't designed to have drugs introduces into our body, thus fighting back by creating more receptors. When you have a certain amount of GABA receptors in the brain, and body is refused the drug, basically your body can't possibly naturally produce enough GABA agonism, and the receptors die off. This pretty much works this way for all withdrawals.

Now your question is "Why is GABA agonist (alcohol, benzos, etc.) withdrawal fatal?" This is because of the sole responsibility of the GABA receptor. What we know is that GABA agonists, such as benzos and barbiturates, have anti-seizure and anti-convulsion properties. The withdrawal effect would have the opposite effect, which would be convulsions and seizures.

If the withdrawals are bad enough, yes, your body could have a fatal seizure. I don't really know much about seizures to comment further.

Now, your second part of your question is "Why aren't opiate withdrawals fatal?" Simple. The Mu receptor doesn't control any systems in that body that could kill you.

EDIT: I'd like to add that not all GABA agonists are going to produce fatal seizures. For example, zolpidem (Ambien) is a selective GABA agonist, and proves to be more hypnotic than anti-convulsion. As i recall, it requires 100mg to produce notable anti-convulsion properties. We all know that 100mg of zolpidem would make us go crazy!

 

[star1980craft]

i think you can stil have fits from taking heroin though, im sure my drug worker said by hitting heroin it happens ? i know its not from W/D but its still good to know you can still have seizour from hitting

 

[sixpartseven]

"Fits" are not seizures. Opiate withdrawal causes RLS (restless leg syndrome) and the "fits" (a slang term) are the jerking caused by that, as well as the inability to stay still due to the various pains (joints and muscles) and the sensation of your muscles burning/skin crawling. It has nothing to do with seizures or convulsions and are not fatal.

Or do you mean "fits" caused by using heroin? During an overdose, it is possible to seize, but overdose and withdrawal are two completely different things, and if that's what you're talking about, it has nothing to do with what we are talking about. I think everyone knows that a heroin overdose can be fatal, even if you don't seize.

 

[DJ25]

Being from the UK I'm pretty sure star1980 means seizures when he sais fits. It's a slang term in the UK for seizures, at least where I live in Wales. I don't think that your drug worker is giving you accurate informaion star1980. Sure a seizur could happen from injecting some dangerous cut that is in heroin, but not from the actual chemical itself IMO.

 

[Free_Man**]

6/7 nailed it right on the head. GABA is a receptor that controls various systems or traits in our body. When tolerance to a benzo grows, your body is creating more receptor sites. Our bodies wern't designed to have drugs introduces into our body, thus fighting back by creating more receptors. When you have a certain amount of GABA receptors in the brain, and body is refused the drug, basically your body can't possibly naturally produce enough GABA agonism, and the receptors die off. This pretty much works this way for all withdrawals.

when the body creates more receptor sites , its to allow for a faster reception of the gaba-ergic drugs right ? so that they can be cleared quicker - and the more receptors the faster the gaba-ergics are received at receptor sites and there "job" is carried out more quickly - hence tolerance occuring as aresult of an increase of receptor sites - it would take more of the drug in order to have more of an effect because there are more receptor sites ?

is this right ?

the body refuses the drug when all of the receptor sites are occupied - right ?
the body cant possible produce more gaba -agonism because it cant create more receptor sites ? right ?

why do the receptors die off ? its not like they are not being used...

and what part does the receptors dying off play in tolernace ?


i do know how gaba works (basically) with inhibition of the cns at various palce all over the body(anti-spasmodic) including the brain - hence its psychoatcive and relaxing effects it causes

and i know that withdrawal occurs as a result of the removal of a depressant when the body is trying its hardest to counter it.... u sedate the body constantly over a protaracted period - the body tries to fight back and counter it - then u removed the sedative suddenyl - and all of a sudden the body os just fighting back without anythign to push back against it ... spu become stimulated - shakes sweats , sick nausea , inability to eat etc etc

plus the way you have described it - u get the opposite effects after removing it and all that

EDIT: I'd like to add that not all GABA agonists are going to produce fatal seizures. For example, zolpidem (Ambien) is a selective GABA agonist, and proves to be more hypnotic than anti-convulsion. As i recall, it requires 100mg to produce notable anti-convulsion properties. We all know that 100mg of zolpidem would make us go crazy!

and hallucinate

 

[Newbierock]

man, benzo addiction is some serious stuff.

 

[QuasiStoned]

when the body creates more receptor sites , its to allow for a faster reception of the gaba-ergic drugs right ? so that they can be cleared quicker - and the more receptors the faster the gaba-ergics are received at receptor sites and there "job" is carried out more quickly - hence tolerance occuring as aresult of an increase of receptor sites - it would take more of the drug in order to have more of an effect because there are more receptor sites ?

is this right ?

the body refuses the drug when all of the receptor sites are occupied - right ?
the body cant possible produce more gaba -agonism because it cant create more receptor sites ? right ?

why do the receptors die off ? its not like they are not being used...

and what part does the receptors dying off play in tolernace ?


i do know how gaba works (basically) with inhibition of the cns at various palce all over the body(anti-spasmodic) including the brain - hence its psychoatcive and relaxing effects it causes

and i know that withdrawal occurs as a result of the removal of a depressant when the body is trying its hardest to counter it.... u sedate the body constantly over a protaracted period - the body tries to fight back and counter it - then u removed the sedative suddenyl - and all of a sudden the body os just fighting back without anythign to push back against it ... spu become stimulated - shakes sweats , sick nausea , inability to eat etc etc

plus the way you have described it - u get the opposite effects after removing it and all that




and hallucinate

I'm not sure exactly what your understanding is of how tolerance works, but you seem to get the idea. My simple and limited understanding is that your brain is basically always striving for normalcy, increasing and reducing the number of receptor sites and chemicals released to keep things from getting way out of line. There is probably a good reason for this, my assumption would be that it is there to protect us from unexpected problems with neurotransmitters (maybe overproduction or inability to metabolize properly). There's probably many other reasons too but I don't know them (and I dunno if anyone really does).

When you take drugs and introduce them into the brain, I suppose that your brain can recognize that there is too much activity occuring, whether it be at GABA receptors or mu opiate receptors. In order to try and keep things normal, the brain will begin to grow more receptors to try and lessen the effect. It takes more of a drug to activate 100 receptors than 5. In some cases the endogenous neurotransmitters will be reduced too. This happens with opiate addiction, endorphin production can be all but shut down in a heavy and/or long term addiction. Now these are only two ways in which the brain compensates, there are probably many more ways that it does this based upon what drugs are used and which neurotransmitter system they affect. For instance, opiates indirectly increase dopamine levels so any indirect pathways that are responsible for the effects could be modified by tolerance too.

Withdrawals are of the course the result of changes induced by tolerance and and rapidly discontinuing the drug of choice. In the case of opiates, you have a larger number of receptors than you had before the abuse, and you also likely have less endorphins being released. So without the drug of choice, you have a neurotransmitter system that is much more difficult to activate due to increased binding sites, and you have very little of the vital neurotransmitter (and even if you had normal levels of endorphin, it still wouldn't be enough to be comfortable due to the increased receptor sites) which results in an understimulated pathway. Since opiates seem to be responsible for easing pain and keeping us comfortable, it makes sense that withdrawals are very unpleasant.

 

[sixpartseven]

^ That is exactly how it works. Tolerance is the result of having too many receptor sites, while withdrawal is the result of having too many receptor sites and not enough neurotransmitters to active them.

 

[Free_Man**]

i get it i think thank you all for explaining ths to me .... especially you QUASI STONED very well put...

6/7 nailed it right on the head. GABA is a receptor that controls various systems or traits in our body. When tolerance to a benzo grows, your body is creating more receptor sites. Our bodies wern't designed to have drugs introduces into our body, thus fighting back by creating more receptors.

this makes sense

When you have a certain amount of GABA receptors in the brain, and body is refused the drug, basically your body can't possibly naturally produce enough GABA agonism, and the receptors die off. This pretty much works this way for all withdrawals.

ok so when it says and body is refused the drug it means u dont take it - ok cool - god i thought u meant the body rejects it or something confusing myself here.

why would the receptors die off ? because they are not used ? this doesnt play a part in the painful side of it though does it ?

Now your question is "Why is GABA agonist (alcohol, benzos, etc.) withdrawal fatal?" This is because of the sole responsibility of the GABA receptor. What we know is that GABA agonists, such as benzos and barbiturates, have anti-seizure and anti-convulsion properties. The withdrawal effect would have the opposite effect, which would be convulsions and seizures.

why ?

because the body is fighting the GABA and the sedation - ? ahhhhhh i get it !
it happens because of the tolerance and the fact that there are so many more receptors and since they cant ALL be stimulated then there is in adequate stimulation so not enough relaxing = spasm - fit - and anxiety

YES!! i get it thanks

 

[sixpartseven]

The receptors die off because they are not being used, yes. Your body returns to it's normal state over time because it only produces the amount of whatever neurotransmitter is needed which is dictated by body chemistry, and since that is less than what is needed to fill all the new receptor sites that have sprung up during the period you were using drugs, those extra receptors die off.

The withdrawal effect causes seizures because there is no longer enough neurotransmitter to fill all the receptors which would prevent the seizure. Since there isn't enough, not all the receptors are being activated, thus normal functioning of the receptors is not taking place, resulting in abnormal/adverse side effects (i.e. seizures). The risk of seizure is there until all the extra receptors disappear, but the risk diminishes over time as they gradually die off and the body returns to stasis.

From what you've written, you do seem to understand it. I just explained it in different words just in case.

 

[synchrojet]

Uh, people, opioid withdrawals can be fatal too. One of the most dangerous myths propagated throughout the medical community is the notion that opioid withdrawals cannot possibly kill you.

I have personally witnessed a death from a high dose-long term oxy withdrawal while in jail. My cellie died on his second night in (fourth night of withdrwawls btw) from cold turkey of 400-600mg/day oxy for a couple years.

During that same stay, I withdrew from high dose opana (160mg/daily rectally) which is the equivalent of several hundred mg of oxy per day also. I had used about 300 me/day of oxy for a year or so, then switched to opana. After doing the opana rectally for a few months I could chew three OC80s and get a buzz for about an hour and a half. My tolerance was pretty high. Anyway, I went to jail on a bogus charge and stayed there for seventeen days. I withdrew so hard they put me in a suicide cell naked, where I shit, pissed, vomited blood every five minutes for almost thirty hours. Those WDs burned forty pounds off of me in three weeks. My electrolytes were shot to hell and I was so dehydrated that I was in dangerous territory from that alone.

I know that opioid withdrawals are considered nonfatal, and for the most part that's true. But if you have a pre-existing heart condition, say, or are just generally in poor health, and you go cold turkey from a really high dose of some of the stronger meds, it can kill. A quick perusal on the net will produce cases of people dying in jail from methadone withdrawals. /in the case of 'done, its the duration. A person simply cannot vomit and shit and piss all day and night for three or four weeks and maintain proper hydration and electrolyte balance. The sad part is that the jails report those deaths as being caused by "heart failure" or "electrolyte imbalance" or " dehydration" or "dementia induced starvation"...what have you. When my cell mate died screaming in the night, the jailers told his family that he had a heart attack from stress and too much amphetamine. Its just sad. I thought seriously about whistle blowing the whole thing until I realized that the machinery of bureaucracy that propagates such garbage is simply too big to fight.

The reason that the medical community stands by the position that opioid withdrawals are not fatal is because they only take into consideration those people who take therapeutic doses. I have researched the facts on this thing and have found dozens of cases where opioid withdrawals (severe, high dose, long term use - abrupt cessation, like jail) has caused death. The most recent was in Utah when a family was robbing stores for oxy and got caught. The mother was the addict, so to speak, and she was taking several OC80s day and night just to put the withdrawals at bay. When they arrested her, they of course cut her off cold turkey. Four days later they publicly announced that she "committed suicide" while in jail. Um, no. Day four killed her, as reported to me directly from some of the other inmates' relatives. Same thing with her kids. They all "committed suicide" in jail on day four or five. Now think about this. You really believe that four people committed suicide on the fourth day of their cessation of high dose long term oxy abuse while in jail? Jails have a suicide watch policy. I know Utah jails because (sadly) I've been inside several times. Those cops laugh at the folks withdrawing, and scoff at their screams of pain. Hell, they even threatened to taze me when I was in the worst part of my own opana withdrawals because I was "stinking up the joint." I was shitting explosively, uncontrollably, for hours, lying on the floor vomiting and passing out, and these guys were gonna taze me! Anyway, I just wanted to emphasize that opioid withrawals can kill if they are extreme enough or if the person withdrawing is denied access to basic survival needs, like electrolytes, hydration, food, and rest.

 

[Trigeminal]

^No, they can't.

 

[Captain.Heroin]

^No, they can't.

I don't think you read his post.

It's not the opiate WD itself that typically does you in, it's dehydration, malnutrition, or a pre-existing condition aggravated by opiate WD.

For most people, opiate WD will be much less risky than a benzo/alcohol WD in terms of coming close to death. However, it's not impossible for someone to die from opiate WD, just very, very, very unlikely.

I mean...look at your reply. Someone said they witnessed their cellmate die. They were locked in a jail cell with someone who died...how can you just say "no they can't" to that? Did you see the same person come back to life like Jesus did?

 

[lazylazyjoe]

@synchrojet
Glad you chimed in. Opiate withdrawl has about a 5% mortality rate usually due to dehydration. I hate how people assume it's not dangerous and doesn't need to be medically monitored especially in prison. You could be in there on a warrant for not paying your parking tickets and they'll shove you in a solitary room with no supervision and nothing but a bologna sandwhich and a cup of water for all they care.
I w/d with my wife one time. She would puke out any liquids that went in her for days. She had lost about 25 pounds in under a week. She threw up in the same bucket and almost filled a 5 gallon bucket(disgusting i know) That happened another time when she kicked in jail. She came home 20 pounds lighter. Size 6 to size 2 in 10 days. She could have easily died of dehydration/ malnutrition at either time if not in good condition. Her face looked like it was sinking in.

 

[synchrojet]

Youbetcha, bud. Glad she made it through all right. There was a woman in a Florida jail for a minor offense (it might even have been a traffic thing, something miniscule if I recall...) anyway, she had kicked heroin and was getting her life under control, using a methadone taper. Five days into it she was so bad that a judge granted permission for her to be released. When her husband visited her, they wheeled her out in a wheelchair, fifteen pounds lighter and disoriented. The jail refused to release her because when they interviewed her they felt she was being belligerent. They failed to comprehend that she was suffering from dementia and severe electrolyte imbalance/dehydration. She died on day twelve. And get this - when the nurse put a smelling salt to her nose and she did not respond, the nurse wrote on her notepad that the woman was faking! She was in fact already dead. The jail wrote it up as "death by electrolyte imbalance and pre-existing poor health."

I'm not trying to bang a gong and create panic or overstate the severity of opioid withdrawal. It rarely kills when analyzed percentage wise. But when you stop and consider that the vast majority of people going through opioid withdrawals are doing so from a prescribed dose, or are people with homes who can be monitored, or even heroin or oxy addicts who "chip" through their withdrawals with an opioid here and there, you have to wonder just how dangerous a true, bonafide cold turkey, high dose withdrawal can be without proper nutritional support, as is the case in jail. When I went through it, I was a fitness instructor for christ sakes, one ninety of pure muscle. Three weeks later I walked out at one fifty two with sunken cheeks and gasping for air. And I was in prime health. The killer, in my opinion, is the dehydration from the incessant purging of fluids. You take a human body and have it vomit, piss and shit every five minutes (as is the case in actual severe high dose, long term opioid withdrawals, not therapeutic dose WDs) for several days, and fail to replenish those fluids, is it any surprise that heart attacks occur? Dehydration is the single most dangerous state a body can be in, and dehydration occurs rapidly when vomiting and excretion cannot be controlled.

Anyway, just my two cents, but I just wish folks would understand the difference between moderate uncomfortable opioid withdrawals and true cold turkey high dose withdrawals. It does damage.

 

[Trigeminal]

I don't think you read his post.

It's not the opiate WD itself that typically does you in, it's dehydration, malnutrition, or a pre-existing condition aggravated by opiate WD.

For most people, opiate WD will be much less risky than a benzo/alcohol WD in terms of coming close to death. However, it's not impossible for someone to die from opiate WD, just very, very, very unlikely.

I mean...look at your reply. Someone said they witnessed their cellmate die. They were locked in a jail cell with someone who died...how can you just say "no they can't" to that? Did you see the same person come back to life like Jesus did?

Because like you just said, the opiate withdrawal itself is not and cannot be fatal. I don't know nor do I care how his cell mate died, but I know it wasn't from opiate withdrawal itself.

 

[HdoubleODeezy]

Because like you just said, the opiate withdrawal itself is not and cannot be fatal. I don't know nor do I care how his cell mate died, but I know it wasn't from opiate withdrawal itself.

it might not be from opiate w/d itself but it could be from one of the side effects from opiate w/d.. i know when i go into w/d i become a psycho.. im bipolar type 1 with schitzo tendencies.. so all my mental problems go crazy during w/d. so if he had some other health problems they could have been aggravated by opiate w/d. so NO he didn't die from the w/d just by health problems that were aggravated by w/d.


.. just my input (probly already said 1000X tho)


But i agree with everybody about the death from benzo w/ds from having more receptors made during gaba agonist abuse and then when cut off theres not enough natural endorphins to fill the extra receptors.. causing seizures and sometimes death.










Thats my last post of the night/morning.. night OD.. i miss tha social.

 

[kken]

Addiction and withdrawal is very interesting topic. Its very complex subject

How about inverse agonism of a receptor site ? If we still take GABAergic drugs as an example this would lead into decreased GABA activity. Withdrawing from such drug would then hence increase GABA levels ? Specially interesting since inverse agonism of one of the subunits leads into better cognitive performance and memory

also there are GABAergic drugs that work via positive allosteric regulation (i think these are in phase 3 human trials) or directly gating the GABA receptors. Im guessing withdrawal from such drug would be way safer or possibly way more comfortable too