The exact timetable for the first few days of opiate withdrawal will depend on which opiate you are coming off of. A shorter acting opiate (such as dilaudid) will accelerate the timing a bit. On the other hand, methadone and buprenorphine (suboxone) are in a class by themselves because they are so long acting. Methadone is particularly difficult to detox from because it is fat soluble and has to be slowly released by your fat as part of the detox process.
Not allowing enough time for withdrawal before resuming “life” and the responsibilities that go with it is probably the number one reason for relapsing. Assuming this is not your first time through withdrawal, you know how long it might take. However, generally it gets harder every time through withdrawal. But by working the suggestions below, you might be surprised how much easier it can be.
The following is a list of symptoms you might have during the first few days and what you can do to manage them.
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2. Synergistic ratios of nutrients are already worked out so you don’t have to figure this out yourself.
Spacey feeling/Unable to Concentrate: Ride it out with an inspiring book (if you can hyper focus by reading) or a selection of inspiring, funny or positive movies. (Actually, I go through TED talks, but I’m weird that way.) Stimulants such as dexadrine, methalphenidate (Ritalin), coffee, guarana, ginseng or rhodiola help. It is difficult to get a potent enough extract of the last two to be useful at this phase.
For that burning sensation in your insides, gabapentin works pretty well.
Fatigue or muscle weakness: This is actually a continuation of the spacy feeling from the first day. So, again, dexadrine, methalphenidate (Ritalin), coffee, guarana, ginseng or rhodiola all help. But make sure that you don’t take so much that they mess with your sleep! In addition, a potent B vitamin complex helps. Unfortunately, gabapentin can make fatigue somewhat worse, but its ability to help with sleep more than offsets this difficulty.
L-Tyrosine can also help fight fatigue. As with the stimulants mentioned above , the trick is getting the dosage right. That dosage is likely between 2000 mg and 4000 mg.
Twitchy feeling or RLS: having enough potassium and magnesium helps a lot. You need a lot of both of these minerals every day anyway, so it is easy to become deficient. You can get supplements containing just these two minerals. The best thing is to work on these deficiencies ahead of time. However, bananas or avocados have a lot of potassium in case you can’t find a potassium supplement. It is almost impossible to get enough magnesium anymore because almost all soils that food are grown in have been depleted of magnesium. Slomag (available at Walgreens) or its cheaper knockoff, MAG64 (available on the amazon.com and ebay.com) work well if you take 6 tablets a day. But again, start at least a week before you plan to go through opiate withdrawal for best results.
High quality ginseng also seems to help with RLS.
Diarrhea: If I had one medication to take with my to a desert island to stave off a impending withdrawal, it would be Imodium, generic name Loperamide Hydrochloride. It works wonders for all aspects of withdrawal except for the fatigue. This is because Imodium IS actually an opiate – it just does not get into the brain, so it does not feel like an opiate. (Now, it’s not supposed to get to the brain… but I’ve gotten high from it anyway.) However, your body will be spared the withdrawal, which turns out is actually 90% of the battle. The trick is knowing how much to take. If you do it right, you will feel “normal” with hardly any withdrawal symptoms. You might only need an attack dose of 6 mg of Imodium (3 tablets) if you are coming off 15mg/day of Oxycontin. Follow up with 4 mg every 12 hours. If the withdrawal symptoms come back, take another 4 mg. If you are coming off a more serious opiate dependency you may need more… lots more. I wonder if that is why I’ve seen a “frequent flyer” program for Imodium at Walgreens?
Start taking the Imodium when the first serious signs of withdrawal start to kick in. You can scale the dosage for different opiates and different daily amounts. Do the math over at the opiate comparison chart. I’ve heard of people taking 40 mg Imodium for a more serious opiate dependence. Like I said, you’ll know you have the amount of Imodium right because you’ll feel normal, if perhaps a bit weak. It only takes about half an our for the Imodium to kick in on an empty stomach, and if you run low (relative to your need) the withdrawal symptoms will come back with a vengeance. Just take more of your calcuated dose. Imodium has a rather long half life of about 12 hours, so keep that in mind when deciding when to take more.
Advantage: less cravings, less anxiety, less depression.
Disadvantage: more spacey feeling, possible constipation.
You may still experience constipation while taking Imodium, so keep taking the stool softener (Docusate Sodium) until you can taper down from both after the first 4 days.
Another thing to consider – It is little known that opiates raise body temperature. What happens without this support is that the body temperature drops below the optimum range without this support. This is a temporary hypothyroidism. Among other things, this triggers painful diarrhea. Fortunately, there is a fairly easy way to raise body temperature by using thyroid hormones. Synthroid is very common medication, especially as you get older. Tablets usually come in one grain sizes. Somewhere between 2 and 8 grains, taken throughout the day, raise the body temperature enough to compensate for the temporary hypothyroidism. There is also a supplement made my Natural Source called “Raw Thyroid.” However it is not very strong and it appears that it takes about 4 capsules to equal one grain. Don’t expect to find it in your health food store. You need to order it from http://www.iherb.com/Natural-Sources-Raw-Thyroid-90-Capsules/6016?at=0
Insomnia: Anything drug that raises GABA neurotransmitter levels at night. Examples are Valium, Xanax, benzodiazepine like sleeping pills. On the herbal side, valerian works well only if you have not recently used any of the drugs mentioned in the previous sentence. Another option is gabapentin if you have not used it in the past year. Gabapentin works really well the first few days you take it which happens to match the fact that you need something strong the first few days of opiate withdrawal. If I had a second drug to take with me to a desert island to stave off withdrawal, it would be gabapentin.
A streetdrug that works well is GHB. However, it is easy to overdose on it. Be careful.
A safer alternative is Phenibut, which is available on eBay. However, it is possible to build up a tolerance to Phenibut in a matter of days. Then you’ll have a Phenibut hangover – which includes a headache and grogginess.
L-Theanine has neurologically complex calming effect and works well if taken before bed time. By the way L-Theanine also helps decrease symptoms of ADD.
Chills and Hot Flashes: Clonidine. This helps lower your blood pressure as well. This is a heavy duty drug. I’ve not used it so do your own research. A over the counter choice that works well is Imodium, once again.
Pain: Over the counter pain relievers are the obvious choice, but what if that is not enough? Supplement pain relief formulations such as Natural Tumericforce can be stacked on top of the over the over-the-counter products because of their low toxicity. But, what if that is still not enough? This is where you can quickly slip into dangerous territory because there is a herb available as “incense” that works very much like the opiates that you are trying to avoid, namely Kratom. Google it. Fair warning: you may end up having to detox from Kratom
Also gabapentin helps with pain as well. This is one of the common “off label” uses for this drug.
Acetyl-l-carnitine (ALC) reduces the increased pain sensitivity you have as part of opiate withdrawal.
Fourth Day and After:
Because low level pains are likely to be felt more, depression ( or feeling blue ) is a danger. Note that you don’t have to consciously be feeling pain for this phenomena or process to take effect. Also, you will continue to have some difficulty with sleep. These effects will gradually taper off. This tapering time will be longer with if you are coming down from a high dosage, or from a long use period or if this withdrawal was preceded by lot of previous withdrawals. As you can see, because of the various factors, its hard to predict how quickly this tail will taper down.
It is important to treat the tail end of withdrawal because a relapse is much more likely if a proper treatment is not applied. Various natural and pharmaceutical anti-depresents seem to work. Gabapentin works particularly well. It decreases anxiety and makes sleep easier. For this reason, take the gabapentin in the evening. Remember that it works really well for the first few days, and then the effect starts to wear off. This closely matches the need during withdrawal.
SSRIs (such as prozac) also work, but they kick in slowly, they don’t match the need. SAMe, and St.Johns Wort also help and do not require a doctor visit. You can get them at a good health food store as a supplement.