Opioid Withdrawal Treatment and Strategies V2. Still Ill Says The Smiths

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Purpose of this Thread

This thread is a place where we can discuss the withdrawal symptoms of opiates and opioids, coping strategies and medication.

The intention is to have one place where people going through the physical and psychological withdrawal symptoms can find ways of dealing with them. Where there are risks involved in medication, we need to make this clear too.

It should be a self-help guide, although self-help can include going to your doctor and asking for specific treatment. It's not about rehab, overcoming addiction, or staying clean - although it should help people who are trying these. It's not about encouraging abstinence. It's about dealing with the symptoms of abstinence, and the symptoms of the process of becoming abstinent, whether it's temporary or permanent, self-imposed or forced upon us.

 

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The Summary

In this post I will try to summarise what gets discussed in the thread. For instance, if someone mentions that X medicine or coping strategy will help with Y withdrawal symptom, I will note that medicine or coping strategy under the relevant withdrawal symptom heading. I'm not sure at the moment how this will work, exactly, but given some time I hope a handy reference guide will emerge. I'll start off with a couple drawn from my own experience.

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General Strategies for Becoming Abstinent
There are two ways to cease your opiate or opioid use: Immediate cessation (cold turkey) and gradual cessation (tapering). In both cases, the body will eventually restore it's normal chemical balance, and you should be able to cease symptomatic treatment. However it's not possible to give a universally applicable figure for how long this will take as it depends on the drug(s) you are taking, the dosage, the frequency of use and your own personal biology.

Cold Turkey
In this strategy, you simply stop taking the drug.

This method will lead to the most severe withdrawal symptoms, possibly so much that you are driven to resume use - however the aim of this thread is to help you manage those symptoms, so this is not necessarily a reason to avoid this method.

You may in fact be less tempted to resume your original dose. You can throw out your stash, cut off your supply to the drug, so you won't have it readily available and it might play less on your mind.

Tapering
In this strategy you continue use of your drug at the current dose and frequency for a period of time. Then you reduce your dose by a certain amount and continue again for a period of time, and so on, until you eventually reduce your dose to zero.

This method should reduce the severity of all withdrawal symptoms. However, for some, it may not be possible. You may no longer have access to your drug of choice. You may have a requirement to immediately cease use of your drug - for example, to pass a drugs test.

You may also be inclined to abandon your abstention. Because you're planning to take the drug, you will certainly have it available, and therefore if the temptation arises to go back to your original dosage, you will be able to do so.

Comparison of Cost

Depending on the cost of your opiate or opiod, and the cost of any medications you might use to treat withdrawal symptoms, one method may be more expensive than the other. If you're tapering, because you're still taking your drug, you're probably still paying for them. However, if you're using medicines to treat withdrawal, they may also be expensive. If the medicines you would take to combat withdrawal using the Cold Turkey method are more expensive than the amount of your opiate or opioid, then tapering might in fact be more affordable.

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General Withdrawal Symptoms

• Switching to a different opioid may be useful. For example, Tramadol may alleviate the withdrawal symptoms in a general way. Kratom may also help general symptoms.
• Dissociatives can provide temporary relief from withdrawal symptoms. Methoxetamine in particular has been used to good effect.
  

Specific Withdrawal Symptoms

Sweats
Withdrawal can lead to quite extreme levels of hot flushes and sweating. This may be continual, sporadic or associated with specific times, like during sleep.
If you're sweating a lot, it's important to keep hydrated. Drink plenty of water, or vimto, or ribena or something.

Treatments

• Clonidine
• Exercise may help restore the body's temperature regulation

Sniffles
One of the most common withdrawal symptoms is a bit of a runny nose.

Treatments


Nausea and Vomiting
Treatments

• Cannabis
• Antihistamines (H1 histamine receptor antagonists)
• Ginger
• Peppermint

Diarrhoea
Treatments
Immodium


Depression, Apathy, Lethargy and Anxiety
Treatments

• Kratom
• Various stimulants
• Benzodiazepines such as diazepam may help for some people

Chills and sensitivity to the cold
Treatments
Baths

Fevers
Treatments
Baths

Aches and Pains
Treatments
Baths

Insomnia and other Sleep Disruption
Treatments

• Temazepam
• Melatonin
• Phenibut
• Exercise - wear yourself out!
• Don't watch TV, or use laptops or phones with bright screens, in bed. The light will trick your brain into thinking it's not bedtime. Reading in bed is a much better way of encouraging sleepiness.
• Sex and sex "alternatives" are usually a good way for men, in particular, to get to sleep
• Avoid excessive alcohol. Contrary to much popular opinion, alcohol can keep you awake, but for some people a glass of red wine (Merlot in particular as it contains significant levels of melatonin) can help.
• Milk contains tryptophan which encourages sleep. A mug of warm milk may help you slip off into unconsciousness. Chocolate contains stimulants such as caffeine and theobromine, so hot chocolate may be counter-productive. A banana milkshake might be a suitable alternative if you can't face drinking raw milk, and if you make it with real bananas you get a bit more tryptophan too, and they're full of other useful minerals.

Restlessness, Restless Leg Syndrome
Treatments
Wikipedia's notes on RLS treatment suggests the use of dopamine agonists or gabapentin enacarbil.

• Cannabis has been reported to help with this.
• Clonidine is also mentioned as a potential treatment for RLS.
• Exercise may also help; however it is also possible that it will (temporarily) make your RLS worse! So you should try it and see what works for you.
• A Chinese burn just above the ankle!
• Sex and sex "alternatives" release dopamine and should help with RLS, at least for a short time - hopefully enough to get to sleep.

 

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Notes on Medications

Some of the medications which we might use to treat withdrawal symptoms carry their own risks. Some have the potential to cause dependency; some may be dangerous to use in combination with others; and some may be dangerous for those with certain medical conditions. It is advisable, wherever possible, to plan your treatment of withdrawal symptoms in consultation with a knowledgeable doctor. However, doctors sympathetic to opiate users and familiar with the possible treatments for symptomatic relief may be difficult to find. But it's always worth asking.

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Clonidine

Clonidine's primary use in opiate withdrawal is to control sweats and hot flushes.

Clonidine (trade name Kapvay or Nexiclon) is a sympatholytic medication used to treat medical conditions, such as high blood pressure, ADHD, anxiety/panic disorder, and certain pain conditions. It is classified as a centrally acting α2 adrenergic agonist. An alternative hypothesis that has been proposed is that clonidine acts centrally as an imidazoline receptor agonist.

Clonidine may be used to ease withdrawal symptoms associated with the long-term use of narcotics, alcohol and nicotine (smoking). It can alleviate opioid withdrawal symptoms by reducing the sympathetic nervous system response such as tachycardia and hypertension, as well as reducing sweating, hot and cold flushes, and general restlessness.[5] The sedation effect is also useful although its side effects can include insomnia, thus exacerbating an already common feature of opioid withdrawal.

Clonidine treats high blood pressure by stimulating α2 receptors in the brain, which decreases cardiac output and peripheral vascular resistance, lowering blood pressure.

Total daily dosage for the treatment of opiate withdrawal range between 0.5 and 1.5 mg[citation needed], depending on the stage as well as the severity of withdrawal symptoms. If the clonidine patch is used to treat nicotine withdrawal symptoms, dosages that deliver 0.1–0.2 mg daily are used. For oral therapy (tablets), a total dosage of 0.2–0.4 mg daily is taken in divided doses.

As Clonidine will lower blood pressure, it may be dangerous for those who already suffer from low blood pressure.

...sudden discontinuation can cause rebound hypertension due to a rebound in sympathetic outflow. Clonidine therapy should generally be gradually tapered off when discontinuing therapy to avoid rebound effects from occurring. Treatment of clonidine withdrawal hypertension depends on the severity of the condition. Reintroduction of clonidine for mild cases, alpha and beta blockers for more urgent situations. Beta blockers never should be used alone to treat clonidine withdrawal as alpha vasoconstriction would still continue.

So use of clonidine itself should be tapered. Rebound high blood pressure can be very dangerous; I personally know of a man who cut his blood-pressure medication which resulted in a burst blood-vessel in his eye, permanently damaging his already poor eyesight.

Clonidine may also have some promise in controlling restlessness / restless legs:

A 37-year-old man developed severe symptoms of RLS. Treatment using combinations of levodopa, opioids, benzodiazepines, and baclofen provided only partial benefit or resulted in intolerable adverse effects. Higher dosages of clonidine than previously reported in the literature (0.9 mg/d in divided doses) were needed to completely relieve his RLS symptoms. The only prominent adverse effect was dry mouth. The RLS symptoms returned after subsequent reductions in the dosage. After the dosage of clonidine was again increased, complete relief of the symptoms was achieved again. After several months, clonidine was tapered to zero and the patient entered a period of spontaneous remission. When his symptoms returned four months after clonidine had been discontinued, clonidine therapy was restarted.
DISCUSSION:

Clonidine alleviated RLS symptoms in 30 of 41 patients reported in the literature, indicating that the adrenergic nervous system may play a role in RLS.
CONCLUSIONS:

High-dose clonidine appears to be useful in treating RLS when other therapies fail. However, well-controlled, polysomnographic studies are needed.

One interesting fact about Clonidine is that it's cheap as chips if you can locate the cheap-as-chips source. Like 99p for 10 pills.

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Kratom

Kratom contains many alkaloids including mitragynine (once thought to be the primary active constituent), mitraphylline, and 7-hydroxymitragynine (which is currently the most likely candidate for the primary active chemical in the plant). Other active chemicals in kratom include raubasine (best known from Rauwolfia serpentina) and some yohimbe alkaloids such as corynantheidine. Kratom also reportedly contains at least one alkaloid (rhynchophylline) that is a calcium channel blocker, and reduces NMDA-induced current. There is considerable research as to the role of NMDA receptor activity in the formation of dependence, and the symptoms of withdrawal. In 2005, Inturrisi demonstrated that co-administration of d-methadone (the isomer that lacks opioid activity, but is an NMDA antagonist) in small doses with morphine prevented the development of morphine tolerance in rats.

Kratom is a µ-opioid agonist so can itself lead to dependency, and it's been reported that the withdrawal symptoms can be unpleasant. However, at low doses, say 5-10g a day, and if used for a short period of time, it's likely that you will not develop a tolerance, and that any withdrawal symptoms would be mild.

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Stimulants
Stimulants may help with lethargy, apathy and general low-mood. Choice of stimulant will depend on various factors:
- severity of the symptoms
- any other medication you're taking
- availbility
- preference.

Typically, when trying to achieve "normality", what you'd look for is a mild stimulant which provides focus, motivation and clear thinking, and with minimal "crash". A longer-lasting stimulant is probably more desirable, so you don't need to redose frequently. It should be something that you can use regularly without building a serious tolerance, or indeed a dependency. Things like Cocaine, MDMA, Mephedrone etc. are probably unsuitable

Different people have differing results with the same stimulant. I find ethylphenidate works very well for me. I don't get any crash, I can think clearly and with focus, I don't feel a compulsion to redose, and it gives me a lot of motivation. It's also, currently, legally available (in the UK anyway) as a research chemical. However there are many other alternatives which might suit others better.

 

[Mrsjuice]

Linky to V1.

Round Two, batten down the hatches!

~Sprout



And I do have subs too....... Just not sure I can induct those once I use the lope and have it cross the bb....

 

[mydrugbuddy]

Just stick to the Lopes if you find they are working OK for you. Introducing subs unnecarily isnt a great idea. That is unless the Lope completely fails to help you, though i cannot see any reason why it would.

 

[Eveleivibe]

Mirtazapine is an atypical antidepressant with moradrenergic n serontoninergic activity. It's a complex one using antidepressants for opiate withdrawal. Some people feel that they help them while other people feel that they interfere with the brain further, instead of letting it repair naturally. As MDB says Mirtazapine is meant to aid sleep but it is known for what weight-gain n making people ravishingly hungry. [MENTION=401344]Mrsjuice[/MENTION] you say you've read about Mirtazapine but I've included this link for anyome else also interested I would advise doing as much research as you can (someone I've not done as often as I should n often regretted). Different things work for different people. Good luck with it

It does make sense. And without the pgp inhibitors it still helps wth withdrawals right!? I could care less about feeling a high from any of this ( the lope or Kratom ) I just want to be clean and be able to function some during the process.

I have four kids and a husband that works a terrible shift. Cold turkey is not an option for me. I have no family or friends in the area as we haven't lived here long, so no help. Lope and Kratom are going to be my saving grace I hope. We shall see tomorrow. I will start a thread tonight to be able to check in all week and hopefully get some support from wonderful people like yourselves.

Can I ask what opiate you are coming off? You say you've got subs? Do you enough to maybe do a short taper? Many people have done a short taper off subbies for, say, 2-3 weeks m have benefited from this. There is suboxone/Buprenorphine megathread in Other Drugs that may have some useful
Infotmation for you.
Subuxone / Buprenorphine Mega Thread (Other Drugs).

Evey

 

[mydrugbuddy]

Almost miraculously before starting this quit i had gradually stockpiled what turned out to be exactly bang on the right number of Lopes i would need to help with the quit. The Lope taper has worked perfectly, i now have 3 left, so 2 tomorrow, 1 on saturday and then finito. I know that as i didnt take any GFJ or anything its only having a peripheral action on my gut, but i just want to give my gut the time to adjust, and hopefully all will be well in that department.

Also no longer taking any Clonidine during the day or evening, and reducing down from 1 whole pill by 1/4 of a pill every night, so I'll be on 1/2 tonight. It's very strong stuff, and i dunno if its because ive kept the doses as low as possible but there have been no tolerance or w/d issues from Clonidine. I will probably find it much more difficult to get to sleep when im finally off it, but i'll adjust to that sooner or later.

I'm a bit worried about Pregabalin. Anyone online with any experience? Im taking 150mg when i get up and another 150mg later in the evening to relieve what's left of the grotty ill feeling of this prolonged WD. I know that is very low doses, and deliberately so, but at what point does it become habit forming?

I'm also taking too many stims, finding it hard to stop taking them. 8(

 

[pistolPedro]

I have heard that gabapentin was good for withdrawls, but also heard it lowers the amount of opiats in your system. these are opposite things. does anyone have any clearity?

 

[mydrugbuddy]

Yeah it's too good imo, if you know what i mean, i forced myself to reduce to 75mg when i got up and another 75mg a bit later on today. And I'll be stopping it completely in a few days.

I'd rather feel a little less comfortable for a few days than risk developing another dependency, and then have to go through the whole WD process all over again, but with yet another substance.8(

 

[mydrugbuddy]

Which comedian subtitled the new thread? :D

"I'm too tired, I'm so very tired
and I'm feeling very sick and ill today" Not!!!! :D

What a difference a day can make, but for the first time since quitting im not feeling tired, sick, or ill. If this carries on all day I'll be able to quit Pregabalin today too. Then I'll just need to taper off Clonidine which ive mostly been 'abusing' to help me sleep anyway, after the first couple of weeks, when it really did help a great deal with the WDs.

Based on this experience I'd recommend using comfort meds to help quit every time, it really has been upwards of 90% painless all the way through. It just needs a bit of careful management of the comfort meds so that one doesnt stay on them any longer than is strictly necessary, because each one could become habit forming in it's own right.

Plus I've not had any stims (yet) either, for the first day in as long as i can remember, ive not even felt the need.

 

[Tryptamite]

I t ook 900mg a day for a few months and came down 50mg a day over a few weeks. Can't say I noticed much WD. I was detoxing from valium too so I can't be sure. I think most of the sickness was because of the valium.

Anyway I can take it now 250mg a day prescribed along with another gradual benzo taper. I don't miss the lyrica if I don't have it.

I am saving them for my upcoming opiate wd but I will be taking doses from 600-900mg over a week and stopping. I don't anticipate any rebound. I would certainly have issues if I hammered the benzos for a week after being off them for a while.

 

[mydrugbuddy]

Thanks for posting. Yeah i think im gonna be able to get off the pregabalins without issue. I spoke slightly too soon yesterday as in the evening started feeling unwell again. But i only took 1 x 75 mg the whole day (plus some more clonidine that evening) too much Clonidine i think as ive been absolutely exhausted today after any period of longer than 5 minutes trying to do any constructive physical activity. And I'm 45 not 95.

I'm also trying to quit RC stims too, perhaps attempting that at the tail end of a Kratom WD after 2 years of heavy daily use is too much too soon. If i could resign myself to just vegetating for a few days im sure thats all it would take, but the apathy and lack of drive and energy is hard to live with, even if its only for a few days. I think I'll wait until I've fully recovered from my kratom quit and then try again on quitting the stims. I'm already not taking the first dose until much later in the day, so am part way there already.

 

[Tryptamite]

Yeah one thing at a time.
Im gonna keep tapering benzos. Come off methadone in the summer. Then come off the remaining valium after the 10-14 days of wds and another 2 weeks of recovery/break.

After the valium taper I would like to use clonidine to regulate adrenaline levels. even a beta blocker would be ok.
I will also use phenibut and lyrica semi regularly for relief and "break days" while my gaba a system gets back to normal.

Will look into kava kava as well. If it doesn't work on gaba a I would like to try it.

If I use opiates in future i will stick to buperenorphine as its so much more forgiving in terms of addiction and wds than heroin. Perhaps i will look into kratom too.
I need to accept that i cannot take h any more.
I love iv h and coke. Pehaps a sub and coke "Speedball" would substitute.
Hopefully I won't need a substitute and be happy with less dangerous drugs and ROAs.

 

[mydrugbuddy]

Sounds like a plan!

Clonidine also helps massively with the feverishness/chills/sweats aspect of Opi WDs, but it does have the side effect of making you feel incredibly tired and sleepy, especially at first. I slept 20 hours a day the first 2 days into my WD that i took it, that was a blessing tbh, as i didnt have anything pressing to do at the time, but obviously not so great if you have things you need to do.

I was taking minimal doses too, at the extreme low end of the dose range, apart from at bedtime when i took the maximum dose, guarenteeing falling asleep within minutes and sleeping right through. As with everything unfortunately a tolerance does build quite quickly and I'm pretty wary about exceeding the maximum recommended amount per dose, given it's strong action on lowering blood pressure, it could potentially be very dangerous.

 

[Sprout]

20 hours of sleep over Day 1 and 2 is quite remarkable...
Did you take any BP or HR readings? If you've been using Kratom there is the adrenergic activity to consider more so than with other opi's. Adding Clonidine to quasi-NRI cessation could result in excessive suppression to the point of Bradycardia and subsequent issues - I would suggest taking some numbers and reducing your Clonidine dose a little further.

 

[mydrugbuddy]

I'm about 3.5 weeks into the WD now [MENTION=139374]Sprout[/MENTION] ,and i have been steadily reducing Clonidine. I think I'd burnt out the adrenergeric activity of kratom ages ago.

At this point I'm only using Clonidine at bed time and if the symptoms flare up in the evenings, presumably when the dose from the previous night clears my system.

Thanks for your post & concern. I will reduce the bed time dose tonight.

 

[Sprout]

*Restored the OP history*

 

[Eveleivibe]

Awhbthank you, Sprouty, that's thoughtful of you to do that

Evey

 

[zzzlll]

Could do with some help im going out my mind wanting use but don't want it set me back to day one. Im 7 days into my opiate detox, been using heroin for nearly 17 years although been on and off for first 4 years but constant for the last 13 years. Iv been on methadone for 6 years but not really stuck to it. Used heroin every day an didnt take my methadone until the last month wen I had to be tested weekly so used heroin for 3 days and stuck to my methadone for 4 days. Now started a new detox called the Bristol regime. Would definitely recommend it as the withdrawl are no where near as bad. When iv been using heroin for 3 days then stop an start 24mls of meth i have worse withdrawl than im having now. Anyway my question is, if I was to use today, meth in my system still and still feeling rough, would it set me back to day one, and what if used on say day 12? I no I shudnt but I just want to experience it one last time without having to go through all this again.

 

[Shambles]

Hey, Zzzlll. I moved your post into the main opioid w/d thread as it should hopefully receive more replies here.

Had a quick google of "The Bristol Regime" and only came up with another thread on here and the notes from a psychiatry conference that were a bit long to trawl though so I'm not going to be very familiar with that particular approach. I have been though a number of heroin and other opiate/opioid detoxes both self-administered and "official" though so have enough experience to feel confident in saying that using during acute w/d is pointless. You either want to quit or you don't. Any time I've cracked early on and had "one more hit" I've gone straight back into full-on addiction without passing Go and certainly without collecting £200 (although spent several more £hundred in the process ).

Depending on what regime you are on, you may or may not get the desired effect from the drug itself. You will of course also remind yourself of the good bit about heroin whilst conveniently side-stepping the really, really shitty bits. At least for a while. Ultimately the chances are you will end up having to go back into detox of one kind or another. Why put it off?

If you feel it is time to stop using then the only thing to do is to actually stop using. There are no short cuts and the temptation to use will be there for the rest of your life. If you can't last the length of your detox regime it may not be time for you to quit yet. If you really do want to quit now then I'm afraid you just have to bite the bullet and stick to your detox schedule. Whatever the specifics are they all basically involve not taking heroin as the most fundamental aspect. That's the one thing you really have to sign on for.

If you are simply asking do you get one free hit with no w/f effects if you only use once during detox the answer is no. You just have to go through it all over again. Admittedly probably not as intensely as if you went on a massive bender but your body will be craving opiates so intensely during acute detox that it feels like it kinda wrings every last molecule out of it. Most importantly it is the mindset though. If you still on some level think there is anything approaching a free ride when it comes to using strong opiates (even mild ones actually) you have to know that just ain't the case. Once dependent it only gets harder every time you go around the detox/relapse cycle. Best off jumping off at the earliest possible opportunity tbh.

Best of luck and do please keep us updated