Opioid withdrawal "kindling"

Hi everyone. Quick to the point: In opioid withdrawal, is anyone aware of the existence of a phenomenon analogous to kindling as seen in alcohol withdrawal?

Based on reading reports of those who have had multiple episodes of opioid withdrawal, it seems that each subsequent withdrawal becomes more severe. It seems reasonable that something akin to alcohol induced kindling could be occurring within the opioid system, though obviously differing at the neural level. Or I could be completely wrong!

I've tried to find papers on the topic, but have come up with nothing. Have any of you come across something on the topic?

Thanks!

-Brief paper on alcohol withdrawal kindling, for reference:
http://pubs.niaaa.nih.gov/publications/arh22-1/25-34.pdf

http://suboxonetalkzone.com/2010/05/08/opiate-dependence-treatment-options/

Dr. Junig is one of my most highly regarded sources when it comes to opioid addiction. Here's the relevant passage:

I suspect a ‘kindling’ effect in opiate withdrawal where symptoms become more and more severe each time withdrawal is experienced, so that eventually there is no such thing as ‘mild withdrawal.’ Instead the addict experiences withdrawal as severe as the worst episode endured up to that point, regardless of the degree of tolerance going into the withdrawal episode.

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It is an interesting subject. I wish I had something constructive to offer. One thing I feel very firmly about is that a relapse after a prolonged abstinence increases euphoria and possibly potency of a given amount of an opioid. My most intense and euphoric opioid experiences were not from when I was opioid naive, but instead were the first use of a relapse after a minimum of 4 months of abstinence. This does seem to imply that opioid tolerance and withdrawal is a complicated subject.

From anecdotal experience, I do firmly believe there's no such thing as a stagnant opioid addiction in terms of intensity of withdrawal. Tolerance itself seems as if it can remain stagnant, but intensity of withdrawal seems to be only partially tied to tolerance. If say someone is on a low dose of methadone for 5 years, versus ten or twenty years. The inevitable withdrawal will keep getting worse even after the effect from the substance levels off. Back when buprenorphine was only available as a detox drug before suboxone was being used for maintenance, there was a general consensus on the street that it would only provide some relief for about 3 detoxes before it wouldnt help anymore. I also think that the traumatizing effect of a detox works to make subsequent withdrawals worse from a psychological standpoint. If something is traumatizing to you, everytime you endure it, it will probably seem worse just from anticipation.

I swear, buprenorphine has turned junkies into straight babies. I have this same argument with my wife all the time. After 21 cold turkey withdrawals from heroin, the only thing that comforts me when I need to quit is that the withdrawal experience will be entirely predictable. I'll take a week off from work, do my last few bags the Friday before and turn my apartment into the Bat Cave for the next 6-8 days. Same shit every time.

I'm not saying it doesn't utterly suck, but since my 1st withdrawal in 1998 the cold bird has been the same every time.

I swear, buprenorphine has turned junkies into straight babies.

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I resent that statement.

Yeah, I heartily disagree. The first 3 years of daily heroin use for me withdrawals were nothing compared to what I experienced later. Of course a hydromorphone habit and stints up to a decade on a methadone clinic didn't help. I've never taken suboxone or subutex only those ampules of buprenorphine occasional doctors would give out for detox.

In my experience my withdrawals have actually become more bearable. So I disagree with that kindling theory. I know what expect now and my mind doesn't go all crazy anymore. My first couple of withdrawals I would do anything for a fix, now I can bear it out and not go all crazy.

Ive found withdrawal to usually get worse every time ive gone through it. The physical and mental symptoms get worse every fucking time. Ive never been on bupe but ive been addicted to morphine (both oral and IV), hydromorphone (mostly IV but also snorted), oxycodone (oral) and the fentanyl patch. I guess i have been addicted to codeine as well but only when i was tapering off other opiates.

It never gets easier it only get's worse though certain factors do make it easier or worse.

IMO opioid wd:s are a walk in the park compared to benzo wd:s...

I've only been through opiate withdrawls once, so I can't really say, but my suspicion is that the reason they are worse is a larger habit.

There, in my opinion, is most definitely a genetic factor in terms of how your individual enzymes are affected person to person, I know some who, through life, their bodies handle it easier each subsequent time and others for whom it is much worse as time goes by and new bouts of withdrawal are thrust upon them down the road of life.

dread said:

I resent that statement.

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Sorry man, I probably brought too much of my personal problems into this. She's only withdrawn with bupe before and she says the bupe don't work for her no more and that it's impossible for her to quit. I wish she were old enough to have gone through w/d without bupe--without anything--so that she could know it can be done. Withdrawal sucks, but if you've been through it cold turkey before you at least know what you're in for.

@thread: I think a myth is being spread here and if it catches wind it'll become a self-fulfilling prophecy and all of a sudden everyone's detoxes will be incrementally less tolerable. A mechanism for the purported kindling would be illuminating, as well as corroborating anecdotal reports of credible 20th century writers (for whom the only treatment options were cold turkey or methadone).

In contrast, I submit that Burroughs (for one) never mentioned any such thing in his biography.

^agreed. i didnt even go through withdrawal until someoneo told me about it.

Also my suboxone dr. kept telling me each w/d would get worse and worse and in my head im like "fuck you trying to scare me." just like that use once and u'll die bullshit.

i believe it is roughly the same if not better for me bc i know what to expect. i have been through it lots of times w/o bupe and w/bupe w the bupe not working bc i spiked my tolerance too high, cause precip. w/d, or just messed up my reaction to bupe.

So yea, back to the original point. i believe in a self-fulfilling prophecy so i try to avoid and not believe negative nancies and bad news bears.

seep said:

In contrast, I submit that Burroughs (for one) never mentioned any such thing in his biography.

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I agree with you that this discussion has the potential to become a self fulfilling prophecy. Burroughs surely had an extreme addiction and an adventurous life. However, his works are works of fiction and I think it's a mistake to try to interpret accurate medical information from his writings. In the naked lunch he took the chapters and shuffled them together before beinging to his publisher.

Turing Machine said:

Burroughs surely had an extreme addiction and an adventurous life. However, his works are works of fiction ...

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I thought at least "Junkie" was autobiographical... that one I liked, the rest of his books were total crap anyway IMO.

Sorry man, I probably brought too much of my personal problems into this.

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Nah, no problem, was just giving you a hard time lol...

I know what you mean actually, I personally have gone through enough wd:s in my time, and some of the "new generation junkies" really do seem a bit spoiled by bupe. I'm currently on a steady bupe medication because it is currently a solution that works for me - it's not just for the wd:s, it's for keeping me from starting using again. Some day I'll feel confident enough in myself that I can quit the meds but that day is yet to come...

My first pod habit I quit cold turkey and it definitely put a fear in me, which has made subsequent withdrawals more feared but probably not as bad because I prepared for them better and had an idea of what to expect.

Benzo withdrawal really traumatized me though the first time, and as a result one of my worst fears is probably having to go through benzo wd cold turkey again. I know it's not safe and so did my doctor when it happened the first time, but due to miscommunication between the pharmacy and my doc and a pharmacist that pretty much viewed me as junky scum I ended up having to endure a seizure behind the wheel because of a completely unnecessary cold turkey xanax wd. Every event that took place during that four day period is painful to remember.

Anyway, opiate withdrawal is bad and the mental part can be hell but in my experience it doesn't touch the hell of benzo wd. I do think Suboxone is an amazing wd tool though, I could see how old school opie addicts would get a bit jaded though.