By Crystal Lindell, PNN Columnist
Maybe your doctor cut off from your medications. Maybe you had a pain flare and ran out of pills a week before your next scheduled refill. Maybe you just don’t want to deal with opioids anymore because they’re harder to get than Beyonce tickets.
Whatever your reason for going off opioids, it’s likely you’ll have to deal with physical withdrawal — especially if you’ve been taking them for a while. But there are ways to minimize the symptoms.
I also would be remiss if I didn’t mention that my boyfriend, Chris — who also has chronic pain and gone through opioid withdrawal more than once — helped me compile and write this list.
So from two people who’ve gone through it more than a few times, here is our opioid withdrawal survival guide:
1. Talk to a doctor first
If you have access to a doctor, and you feel comfortable doing so, talk to her about it. I’m not a doctor, I’m just a patient, so please keep that in mind with everything else I say.
2. Be aware of what the symptoms are
Know thy enemy, as they say. There are a lot of symptoms caused by opioid withdrawal that you may not be expecting — especially if your only reference point is pop culture. I like to say that opioids sort of shut down your systems, and withdrawal turns everything back on at full volume.
You’ll probably experience some or all the following, and they’ll likely start kicking in within about 24-48 hours.
Nausea and vomiting
Sneezing and runny nose
Anxiety and panic attacks
Fatigue (Your natural instinct may be to reach for caffeine or other stimulants, but be careful. They likely will just make your anxiety worse and it won’t touch your fatigue)
Yawning and watery eyes
Restless legs (Your legs move on their own while you’re sitting or lying down. I know, I thought it was fake too, but it is very real and difficult to deal with).
Hyper-libido and increased sex drive (Remember, opioids turned off everything and withdrawal turns it back on)
Increased fertility (Being on opioids can make it difficult to get pregnant and withdrawal will have the opposite effect. If you want to avoid pregnancy, make sure to use birth control)
Thrill-seeking behavior and mood swings (As the ups of your day give way to the lows, you may find yourself seeking out risky behavior as a way to improve your mood and receive the adrenaline that you so desperately crave).
3. Suicidal thoughts
I wanted to pull this one out separately from the other symptoms because it’s potentially so dangerous.
There are a lot of news reports about opioid users who kill themselves after they get clean. Reporters often frame it as though the person got off opioids, took a look around and decided that what’s left of their life just wasn’t worth living. That’s not usually the case though. Withdrawal itself will make you suicidal.
The good news? Knowing it’s being caused by withdrawal and not by crappy life circumstances may make it easier to push through it.
The best way to combat this symptom is to know it might happen and have a plan in place to deal with it if does. I once went seven days without any opioids when I had a full-on, hours long anxiety attack and planned to kill myself. I eventually gave in and took just one small hydrocodone, and within an hour my mind and spirit had calmed.
Which brings me to my next piece of advice.
4. Taper, Taper, Taper
Popular culture has perpetuated the idea that quitting opioids is all about will power. That’s a bunch of B.S.
Most relapses occur because people don’t properly taper their dose. Regardless of why you take opioids, your body has likely gotten accustomed to having them, just like it would have gotten used to a heart medication.
The best and safest way to successfully get unaccustomed to opioids is to taper off them as slowly as possible.
What does that look like? Well, if you take five pills a day, go to four for a couple weeks (yes, weeks), then three, then two, then one, and then even half. I personally noticed a lot of symptoms even going from one pill a day to zero — so if you can split a pill in half, do that.
If you are using drugs illegally, tapering might look a little different. One thing you can do to taper is switch to a weaker drug. Another important step would be changing how you take it. So if you’re snorting it, switch to taking it orally as part of the tapering process. If you’re injecting, try taking it in any other fashion that will allow you to bridge the gap.
5. Consider using kratom
Of course, tapering only works if you still have access to pills or drugs. If you don’t — there’s still help available. Kratom is your new best friend. It will drastically reduce your withdrawal symptoms.
Personally, I think kratom is also a good long-term solution for chronic pain and is a lot milder than pharmaceutical-grade opioids. Assuming it’s legal in your state, kratom is much easier to get than opioids and does not require a prescription. You can get kratom online, at most smoke shops, and even some gas stations.
For the record, the FDA has not approved kratom for any medical condition — including addiction treatment. And some researchers say kratom is a public health threat because it is unregulated.
6. Consider using marijuana
If you can’t get kratom for whatever reason, marijuana will also help you taper down. Edibles in particular will help with insomnia, anxiety, muscle aches, and restless legs.
But beware, if you haven’t taken edibles before, even a very small dose may knock you out for a few hours.
7. OTC medications
There are some over-the-counter medications that will help reduce symptoms:
Imodium (to help with diarrhea and nausea)
Benadryl (to help with the sneezing and insomnia)
Tylenol (to help with aches and pains)
B1, B12, multivitamins and potassium (to help replenish what your body loses from the sweating and diarrhea, which is a huge step toward feeling better)
8. Avoid alcohol
You may be tempted to reach for a glass of wine or a shot of vodka to ease your symptoms — but trust me, they will just come roaring back even stronger after it quickly wears off. Try all other options before you resort to a stiff drink.
9. Consider Suboxone and methadone
Depending on what you were taking and for how long, you may not be able to get through withdrawal without medication assistance treatment.
Suboxone (buprenorphine) and methadone are two opioid medications that can help you through withdrawal, and they are medically proven to be effective. You’ll have to get both from a doctor, and they may not be covered by insurance. But they may also be your best shot at getting off opioids long-term.
10. Don’t go back to your old dose
You start off strong. You tell yourself you’ll never take even one more hydrocodone again. But seven days later, the hell of withdrawal has finally beaten you down enough that you decide it’s just not worth it.
It’s okay. It happens. It doesn’t mean you’re a bad person.
BUT DO NOT TAKE YOUR OLD DOSE!
I can’t be clear enough about this. In just one short week, your body’s tolerance levels have already shifted. And your old dose is going to hit you like a freight train. It may even be strong enough to kill you.
Sadly, this is how a lot of opioid users die. They assume their bodies can handle the same fentanyl patch they were using just a short seven days ago, and it’s suddenly way too strong. This can also happen when someone goes through a formal rehab program, gets out and goes right back to their old dose. It’s enough to stop their breathing.
You may have heard of this phenomenon when it comes to celebrity deaths, like Cory Monteith from Glee. As it explains on Monteith’s Wikipedia page: “After a period of cessation from opioid drug use, a previously tolerated drug concentration level may become toxic and fatal.”
In other words, he was just clean enough for the opioids to kill him.
Even if you’re used to a small dose, like 60mg of hydrocodone a day, once you’ve gone through a couple days of withdrawal, those 60mg are going to hit you incredibly hard.
11. Have Narcan on hand
Along those same lines, I highly recommend you have Narcan (naloxone) on hand just in case, as it can reverse the symptoms of an overdose and potentially save your life. In many states you can even it get it over-the-counter, without a prescription.
Narcan is one of those things you think you’ll never need until you need it. I keep a dose in my house because I regularly take prescription opioids and I want to be as safe as possible. Even if you don’t personally need it, you never know if a child or someone else might find your medications. And you’ll want to have it on hand if that happens.
12. Remember it’s a marathon
In the movies, withdrawal is like three days and then you’re healed. Even though most of the physical symptoms will be gone in about a week, you can still have withdrawal symptoms for up to two years.
It’s called Post-Acute Withdrawal Syndrome (PAWS) and it can include things like panic attacks, insomnia, restless legs, anxiety, risk taking behavior and suicidal thoughts.
13. Get help from family and friends
It’s so important to have a least a couple friends or family members around to help you through it. My best friend and my boyfriend are my go-to because I know they won’t judge me and they’ll be supportive.
If you have the option to be around another person as much as possible, definitely do that. They can help take your mind off the physical symptoms and help you cope with the long-term psychological ones you may experience. Anxiety is a lot easier to deal with when you’re hanging out with your best friend.
14. Find a therapist you trust
If you were getting opioids with a legitimate prescription from a legitimate doctor, you may not think you need long-term addiction treatment. But you still have a medical condition that warranted a long-term opioid prescription. That means you probably would benefit from having a therapist to talk to about how you’re coping with all of that.
Your doctor may be able to refer you to someone, and Psychology Today also has a decent directory. These days, you can even do it all online, with sites like Better Help, which offers access to counselors via phone and text.
I also personally found a low-dose SSRI helpful for dealing with the long-term anxiety and panic attacks, so you may want to talk to your doctor about an antidepressant or anti-anxiety medication.
15. Don’t be too hard on yourself
You’re doing better than you think you’re doing, I promise.
And we’re all rooting for you. You’ve got this.
Crystal Lindell is a journalist who lives in Illinois. She eats too much Taco Bell, drinks too much espresso, and spends too much time looking for the perfect pink lipstick. Crystal has hypermobile Ehlers-Danlos syndrome.
Crystal writes about it on her blog, “The Only Certainty is Bad Grammar.”
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.