Clonidine for Opiate Withdrawal

Introduction

Hi Folks and welcome to my blog about opiate addiction. This is now my 18th post and I am proud to say my blog, number of followers, and topics are growing each day. This really provides a sense of success for myself and I am so happy I have the opportunity to help others while sharing my own experiences, thoughts, and stories while being to able to express myself. I can't say it enough, thank you guys!

I must admit, the ideas regarding what to write about on my blog are getting more and more challenging. I want to provide you guys with solid information, fresh topics, and things that many opiate addicts search for in their quest for sobriety. After doing some thinking, I came up with the idea to dedicate a few posts to specific drugs that may aid in opiate detox or recovery.

For this particular post, I would like to discuss the drug Clonidine. This drug is a high blood pressure medication that also has several off label uses, one being helping opiate withdrawal.  The drug is supposed to help with symptoms such as high blood pressure, sweats, cold chills, restlessness, insomnia, and anxiety.

This drug is often considered one of the top medications to prescribe for patients undergoing opiate withdrawal and has been used in the addiction community for quite some time. As far as reviews go, they're pretty mixed. Some people swear by this drug when experiencing opiate withdrawal while others say it provides little to no relief. Then of course, there are many who feel somewhere in between. I am currently on the drug myself (more on that later) and would have to say that I'm one of those people who are somewhere in the middle when it comes to judging the effectiveness of Clonidine.

 

What is Clonidine and What is it Used For?

 

According to the RX list, Clonidine is described as:

 

A centrally acting alpha-agonist hypotensive agent available as tablets for oral administration in three dosage strengths: 0.1 mg, 0.2 mg and 0.3 mg. The 0.1 mg tablet is equivalent to 0.087 mg of the free base.

The inactive ingredients are colloidal silicon dioxide, corn starch, dibasic calcium phosphate, FD&C Yellow No. 6, gelatin, glycerin, lactose, and magnesium stearate. The Catapres (clonidine) 0.1 mg tablet also contains FD&C Blue No.1 and FD&C Red No.3.

Clonidine .1 mg Pill

Clonidine is a sympatholytic medication used to treat high blood pressure, anxiety/panic disorder, ADHD, migraines, drug withdrawal, sleep disorders, and certain pain conditions. The drug is commonly used for patients experiencing opiate withdrawal as it helps with many of the common symptoms that accompany withdrawal.

Clonidine can be administered in three ways; orally, injection, and transdermal. For those of you who don't know, transdermal is when the medication is prescribed as a patch, which is worn by the patient throughout the day or night. The patch then provides dosing throughout the day. This method of administration is usually only received under doctor supervision such as in the hospital or in a rehab facility so you'll be likely be dealing with the pills if you are partaking in a rehab or detox center program. Based on what I have read, injection of Clonidine is rarely used, especially for the treatment of opiate addiction.

Possible Side Effects of Clonidine

 

Possible side effects (courtesy of drugs.com) of Clonidine include any of the following:

 

• Fast or pounding heartbeats

• A very slow heart rate (fewer than 60 beats per minute)

• Feeling short of breath, even with mild exertion

• Swelling, rapid weight gain

• Confusion, hallucinations

• Fever, pale skin

• Urinating less than usual or not at all

• Numbness or cold feeling in your hands or feet

• Feeling like you might pass out

• Severe skin irritation, redness, swelling, burning, or blistering where the patch is worn.

Less serious clonidine side effects may include:

• feeling dizzy, drowsy, tired, or nervous
• dry mouth
• dry or burning eyes, blurred vision
• headache, muscle or joint pain
• nausea, vomiting, constipation, loss of appetite
• sleep problems (insomnia)
• urinating more at night
• mild skin rash or itching
• decreased sex drive, impotence
• skin rash, discoloration, or mild irritation where the patch is worn

"Clonidine is classed by the FDA as pregnancy category C. It is not known whether clonidine is harmful to an unborn baby. Additionally, clonidine can pass into breast milk and may harm a nursing baby. Therefore, caution is warranted in women who are pregnant, planning to become pregnant, or are breastfeeding." -Physicians Total Care, Inc.

Suddenly stopping Clonidine after continued use can lead to rebound hypertension, meaning that your blood pressure may spike if you stop taking the Clonidine. Therefore, you should taper off of the Clonidine to avoid rebound hypertension. The following is from Wikipedia:

"Clonidine suppresses sympathetic outflow resulting in lower blood pressure, but 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."

Clonidine for Opiate Withdrawal

 

Most of you reading this post about Clonidine are probably here because you currently are taking Clonidine for opiate withdrawal or are considering it. Therefore, lets start talking about how the drug is used in opiate withdrawal.

 

Everyone here probably has experienced or are aware of the symptoms that accompany opiate withdrawal and how they can make quitting opiates seem impossible. Drugs like Methadone and Suboxone are great in that they help you avoid opiate withdrawal for the time being, allowing one to get his or her life together and decide their plan for recovery but they also come with their disadvantages as well. Unfortunately, these drugs do result in a dependence for the user and one will most likely experience some withdrawal when they come off of a drug like Suboxone or Methadone. The good thing about Clonidine is that it is not as addicting as drugs such as Methadone or Suboxone and withdrawal, if any, will be relatively painless compared to the withdrawal from most opiates.

 

Clonidine isn't a drug you would want to abuse to get high as it has little recreational value so that's a plus for addicts really looking to get clean and turn their lives around. The drug also doesn't have the withdrawal symptoms that come with opiate withdrawal besides rebound hypertension. In other words, when you stop taking Clonidine, you won't be sitting there experiencing the cold sweats, aches, restless legs, the runs, and an overall feeling of crap. Once again, a plus.

 

In a study conducted by PubMed involving 30 patients, the following information was found regarding the effectiveness of Clonidine for opiate withdrawal:

 

"In a placebo-controlled, double-blind crossover trial, clonidine caused a marked and significant reduction of objective signs and subjective symptoms of opiate withdrawal in thirty hospitalized opiate addicts. In an open trial of clonidine in opiate withdrawal, clonidine was found to suppress opiate withdrawal signs and symptoms, allowing all of the patients to detoxify successfully from chronic opiate addiction. Clonidine was demonstrated to reverse and suppress the signs, symptoms, and effects associated with opiate withdrawal."

 

To obtain Clonidine, you will need a doctor's prescription. Based on my experiences and what I have read, there are a few ways to do this. The first is going to your primary care doctor and explaining to him or her your situation. Tell them about your addiction and how you are looking to get clean but feel as through you need something to help get you over the hump and keep withdrawals at bay. Most doctors will be willing to prescribe Clonidine as it is often highly recommended and well known for its ability to aid with opiate withdrawal. This technique also works if you go to the ER and explain to them your situation. The final way that I know of to obtain a prescription for Clonidine concerns those of you who are currently in a Suboxone or Methadone treatment program. I have been able to obtain a prescription by telling my Suboxone doctor during my taper that I am having trouble sleeping at night and experience random chills and restlessness throughout the day and night. Without hesitation, my Suboxone doctor prescribed me Clonidine. Overall, it shouldn't be too difficult to get a prescription for Clonidine. However, everyone's doctor is different and has different views/methods so take a careful look at your options.

 

 

Clonidine typically comes in pills that contain .1 mg each. Please note that this is .1 mg not 1 mg. There is a big difference right there so it is important you are careful with your dosing and are aware of what and how much you are putting in your body. The typical dosing protocol is usually .1-.3 mg 2-3 times per day or as needed. Higher doses are also prescribed depending upon the patient and situation at hand but these doses are usually the most common. I currently take .2 mg once at night and find this dose to be sufficient but again, everyone is different.

 

The use of Clonidine for opiate withdrawal is quite common in rehab facilities and outpatient detox as the drug is seen as both an effective and relatively safe drug in combating opiate withdrawal. The following link provides a typical protocol when it comes to dealing with opiate withdrawal and medications that can help provide relief for patients.

 

http://www.quadrant.net/cpss/pdf/Opioid_Withdrawal_Protocol.pdf

 

 

Some Good Links Regarding Clonidine for Opiate Withdrawal

 

Like most of my previous posts, I'll leave you guys with some links to websites that discuss the use of Clonidine for opiate withdrawal. These links are found below this paragraph.

 

http://www.drugs-forum.com/forum/showthread.php?t=46291

This link provides experiences and thoughts about Clonidine for opiate withdrawal by several people who have used the drug.

 

http://www.soberrecovery.com/forums/substance-abuse/108952-anyone-taken-clonidine-opiate-w-d.html

This is another forum that provides stories and experiences by people who have used Clonidine.

 

http://drugsdb.eu/drug.php?d=Clonidine&m=Physicians%20Total%20Care,%20Inc.&id=b65742b7-5db5-41cf-bf69-41700cdd2c59.xml

This link provides an in depth look the drug Clonidine including dosing protocol.

 

http://www.drugs.com/clonidine.html

This link also provides a brief description of Clonidine as well as commonly asked questions about the medication.

 

How Effective Is Clonidine for Opiate Withdrawal?

 

I don't know about you guys, but whenever I come across a new drug that can help minimize, avoid, or aid withdrawals from opiates, I instantly become extremely interested and curious about the drug. I begin to hope and pray that I have finally found something that will make opiate withdrawal a hell of a lot easier. Sometimes the drug ends up being a great tool while others don't quite seem to live up to expectations. Well, Clonidine is one that falls somewhere in between.

 

The following excerpt is from the book, Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy regarding the effectiveness of Clonidine in opiate withdrawal:

 

"Studies in animals and humans have demonstrated that clonidine hydrochloride, an alpha-2-nor-adrenergic agonist, significantly attenuates the opiate withdrawal syndrome. Inpatient and outpatient clinical studies have shown that clonidine is a reasonably safe, specific, and effective agent for detoxifying opiate addicts. Clonidine seems best suited for use as a transitional treatment between opiate dependence and induction onto the opiate antagonist naltrexone. Dosage regimens of clonidine must be individualized according to symptoms and side effects and closely supervised because of varying sensitivity to clonidine's sedative, hypotensive, and withdrawal-suppressing effects. Clonidine is an important new treatment option for selected opiate addicts and may be the treatment of choice when detoxification using methadone is inappropriate, unsuccessful, or unavailable. Lofexidine, a structural analogue of clonidine, may be safer and more effective as an opiate detoxification treatment. It has similar withdrawal-suppressing actions but causes little hypotension and sedation. Although clonidine and lofexidine may be highly effective in helping opiate addicts achieve initial abstinence, a multi-modality aftercare treatment approach including naltrexone and psychotherapy may be necessary to maintain an abstinent state."

 

Study on 21 people on the effectiveness of Clonidine

 

 

Dr. Janaburson writes about Clonidine in her blog (I highly recommend checking it out) stating: 

 

Since clonidine works by calming the locus ceruleus, clonidine reduces many of these unpleasant opioid withdrawal symptoms. So how effective is clonidine? Most patients say that it helps somewhat, but they still feel withdrawal symptoms. My impression from what patients have described is that clonidine is mildly to moderately effective.

The following link provides several cases of patients who were prescribed Clonidine for opiate withdrawal. These cases are interesting as they deal with a variety of patients ranging from what the researchers describe as hardcore addicts, casual users, and everyone in between. When you click on the link, you will see three little pages near the top of the website. Each page comes from a study provided by PubMed. Simply click on any of these pages to read these cases about Clonidine. The link is below.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1862300/

So, exactly how effective is Clonidine when it comes to going head to head with opiate withdrawal. There is no universal and definite answer to this question and it appears that the effectiveness of the drug varies based upon several factors such as the patient involved, his or her tolerance, their general health, the dose they are taking, the length of time they have been taking the medication, and more. I have read probably close to a hundred forums about the effectiveness of Clonidine and have talked to some addicts who have used Clonidine and still have no clear-cut answer for you guys. Some people swear by it while others find it little help. At the end of the day, I think it comes down to what does and doesn't work for the person using the medication. Some people may find this medication to do wonders for their withdrawals while others may notice little to no difference.

Conclusion

 

I am currently prescribed and am taking Clonidine once a day at night. My dose is .2 mg (2 .1 mg pills) and I have found this dose to be quite helpful. I have been on Suboxone for just under a year now and am currently going through a taper regime. I recently went from 2 mg to 1 mg of Suboxone per day and have experienced some withdrawal since my drop in dose. These withdrawals usually start to arise right before bedtime (around 8 p.m.), which I believe is a result of my morning dose wearing off. This is where the Clonidine has come in handy as it really has helped me with sleep, restless legs, and minor anxiety.

 

As I mentioned earlier in this post, getting a prescription was easy and painless and it was actually something that both my Suboxone and primary care doctor recommended. I haven't had any negative side effects from taking the mediation either which is always a good sign in my book. However, please be careful with taking this medication and to talk honestly and openly with your support network. Some people say they get dizzy on the medication or feel as if they are about to fall over when they get up after sitting for a long period of time. Make sure you are cautious if you must drive or work on this medication.

 

I have no experience taking the drug in full blown withdrawal so I can't say much as to how effective it is in a situation such as this. I have read and can imagine that Clonidine probably only provides minor relief to one who is full blown opiate withdrawal (what drug besides Suboxone or Methadone truly takes away or masks all the withdrawal) but I could be wrong. Again, I think it all depends on the person taking the medication as everyone and their reactions to certain medications is different. At the end of the day, I don't think having a prescription for Clonidine can hurt provided that the patient has talked it over with their doctor and has no health conditions that could interfere with the drug.

 

I would love to hear from you guys about what you think about Clonidine. If you have taken it before for opiate withdrawal, please tell us how effective it was for you and would you recommend it? I will be making the jump off of Suboxone in the near future and see Clonidine as one of a few tools I have in battling the dreaded opiate withdrawals.

 

As always, thanks for reading my blog and remember to continue seeing the light!

 

Take Care Friends,

 

Seeingthelight

I'm Back!

Hi Guys,

Hope everyone is doing well. I want to start this post off by apologizing to my fellow readers and friends. It's been awhile. I got a new laptop a few months ago and ended up losing my password and user name for my blog. Because of this, I have been unable to post on my blog. I plan on getting back to posting as often as I can and I hope I can continue to help some people in regards to opiate addiction.

I would also like to take a second to thank you guys for not only ready my posts but for also commenting on them. I think discussion can be really beneficial and helpful for everyone involved in this blog (myself included). I will try my best to read and reply to every one's comments. So please, keep the comments, questions, and thoughts coming!



I think the best way to write this post is to give you guys a quick update on how my recovery is going and where I am. I have some good news and some bad news...

I'll start with the bad news. I have been on Suboxone for about a year now and have been for the most part, pretty successful in my recovery. However, I have had a few bumps. I made it about 6 months of doing no drugs besides the Suboxone before I eventually caved in and messed up. I went on what I would call a "binge" and ended up getting high on my drug of choice, Oxycodone, for a couple of days. I actually had 3 periods of this. Each time lasted about 3 or 4 days before I ended up back on the sober train. I'm upset I did this after the hard work and dedication I put into my recovery but have learned to come to terms with myself and get back to a life of sobriety. I have now been clean for 45 days as I am writing this post (3/27/13).

It hasn't been easy but I'm surviving. It actually made me realize just how difficult recovery can be and how quick and easy it is for old habits to sneak up on you. I looked back on myself and the things that were going on at the time and have decided the most likely reasons for my relapse were stress, hanging out with the wrong people, boredom, and simply giving in to wanting to get high.

Despite these relapses, I have managed to continue my Suboxone treatment. I was able to avoid testing positive for Oxycodone during my drugs tests by providing myself with enough time (3-4 days) before having to take my weekly drug test at the Suboxone clinic. I want to be honest with you guys and not be someone who preaches something yet doesn't think the rules apply to his or her self. I never told my consular or doctor of my relapses and instead simply went on with the program. If you want my recommendation on what to do if you find yourself in a similar situation, I would tell you to be honest with not only your doctor, consular, and support team but with yourself as well. Once again, that's what I would recommend, not what I actually went out and did myself.

To give you guys a quick history of my story with addiction, I'll start out with what was my drug of choice. I had about a 2 year addiction with the Oxycodone 30 mg pills. I would snort/sniff these pills and was doing them daily, usually taking at least 150 mg a day but would take as much as I could afford/get my hands on. I came clean about my addiction with my girlfriend, family, and some friends and decided to seek help at a Suboxone clinic. I was initially prescribed 4 mg of Suboxone once a day. After about 4 or 5 months on 4 mg, my dose was reduced to 2 mg a day. I would take 1 mg in the morning and 1 mg at night. I was on this dose for about 3 months until my dose was lowered once again to 1 mg a day (.5mg in the morning, .5mg at night). I have been at this dose for about 2 months now.

The jump from 4mg to 2mg was actually very easy. In fact, I felt absolute no withdrawal at all or any negative side effects from my reduction in dosage. However, the jump from 2 mg to 1 mg has been somewhat of a different story. While I feel pretty good and normal most of the day, I can usually begin to feel some discomfort by the end of the day before my second dosing. These withdrawals are minor and usually consist of a runny nose, restless legs, random cold chills, and minor anxiety. I also begin feeling these withdrawals in the early morning around 5 or 6 in the morning before my next dose (usually around 10 a.m.). My best guess is I am feeling my previous dose wearing off and my body is looking for the next dose. Again, these symptoms have been pretty minor but can still suck when I have to work or go to school.

To help combat these symptoms, I talked with my doctor and was prescribed a few medications. These include Clonidine, Requip, and Advil. The Clonidine has been great at night for sleep and does seem to help a little bit with chills and restlessness. I haven't really noticed much of a difference with the Requip, which was prescribed to help with the restless legs. Surprisingly, the Advil has actually been pretty effective with the aches and pains I sometimes get.

While I am certainly happy I am now at a relatively low dose of the Suboxone, I am somewhat fearful of how difficult it will be when I again have to lower my dose when the time comes. I am even more scared about when the time comes to make the jump off of Suboxone completely. My plan is to jump off the Suboxone at as small of a dose as possible to help avoid or limit any potential withdrawal symptoms. If things get tough after I make the jump off of the Suboxone and I am feeling overwhelmed or facing intense cravings, I think I will give the Vivitrol shot a shot (no pun intended).

That's basically where I've been over the past few months since I last posted on here. I am so glad to finally be able to once again access my account and talk with you guys. It really helps to vent, hear others share their experiences, and to have the opportunity to help others as well. My next two posts are going to be about the rapid detox method and ways to taper off of Suboxone. I would like to dedicate the rest of this blog to you guys. In the comment section, please comment about a topic you would like me to address, ask any questions or comments you have, or simply pop in to say hello.

Thanks a lot Guys for reading and it's great to be back. I haven't said this in awhile so here it goes: Through times of desperation, difficulties, and darkness, remember to keep seeing the light!

-Take Care Guys,

Seeingthelight

Getting Some Sleep During Opiate Withdrawal

Introduction

Hello everyone and welcome to what is now my 11th post on my blog about opiate addiction. I would like to use this post to discuss something we so often take for granted; sleep. For someone who hasn't had a problem with opiate addiction and has no sleeping problems/conditions, sleep is often a natural occurrence that comes with relative ease. Sleep is what allows our mind and body to rest, heal, and rejuvenate itself and is something we all need in order to survive. Well for someone who suffers from opiate addiction, getting and staying asleep can be quite difficult. It is not uncommon for opiate addicts to have restless nights of sleeping, trouble going to sleep, or to have to wake up early as withdrawals begin to creep their way in. It gets even worse for opiate addicts when they decide to quit opiates cold turkey or to discontinue their use of opiates after tapering or treatment (Suboxone or Methadone). I've been there before and can vouch that it is one of the worst parts of opiate withdrawals. Therefore, I would like to dedicate this particular post to talk about sleep when the time comes for us to quit opiates.

If you are interested in reading other posts in my blog about opiate addiction, click on any of the following links (in order from 1st post to most latest post).

Welcome Post (1st Post)
My Experience With Suboxone
The Dreaded Withdrawals
Why We Got Addicted To Opiates
Suboxone Vs Methadone
The Vivitrol Shot
Addiction And Our Bodies
A Soldier's Addiction
Cold Turkey Or Opiate Replacement Therapy
Some Good Quotes About Opiate Addiction


When one stops using opiates, a variety of withdrawals will begin to come into play and can leave the person involved feeling like they are in a state of absolute hell. For this post, I will be referring to those who have either quit opiates cold turkey or who have stopped using all opiates after their tapering or treatment is completed. Basically, this post is for people who are no longer taking any forms of opiates (be it Oxycodone, Methadone, Suboxone, Morphine, ect...). When one quits opiates, they often have difficulty in getting and staying asleep due to a variety of factors. Restless legs (the withdrawal I hate the most), a racing mind, the chills, cold sweats, anxiety, and aches/pains are some of the more common withdrawals that affect our sleep patterns the most when going through withdrawals. I can remember a few times in which I attempted to quit opiates cold turkey and couldn't get more than a couple hours (if I was lucky) of sleep in a night. During the day, we are faced with withdrawals such as lack of energy, chills, cold sweats, diarrhea, and aches/pain. One basically feels like they have a really, really bad case of the flu. Come nighttime, our bodies are often tired and hurting after a long day (minutes seem like hours) of experiencing withdrawals, only to face even more agony at night. When the sun finally rises the next day, we have to experience this cycle all over again until withdrawals begin to calm after a period of time.

How many of us feel during Opiate Withdrawal at night.

I want this post to talk about a few things in regards to sleep and opiate withdrawal and I think the best way to do this is to break down this post into a few sections. I would like to touch upon the importance/role of sleep, the process of sleep for an opiate addict, and finally some methods that may help one get a good night's sleep (or at least a few hours) when experiencing opiate withdrawal. On that note, lets begin.

The Role & Importance of Sleep

 

Sleep is defined as a natural periodic state of rest for the mind and body, in which the eyes usually close and consciousness is completely or partially lost, so that there is a decrease in bodily movement and responsiveness to external stimuli (Free Dictionary by Farlex). Sleep is what allows our mind and body to have the opportunity to rest and perform several important tasks. Without sleep, one will not survive for very long and unhealthy sleeping patterns can result in both physical and mental health conditions. Sleep helps restore and strengthen our immune system, which is critical to our bodies as it helps heal or prevent wounds/injuries, infections, diseases, viruses, and much more. Sleep also aids in the brain and development of it. Despite there still being a lack of total understanding of the roles sleep has in living organisms, one thing is clear, sleep is essential for our survival.

 

There is a lot of information out there about sleep and of course not all of it has to do with opiate addiction or withdrawal in regards to sleep. This blog is meant to focus on opiate addiction so I don't want to be throwing a total lecture about sleep at you guys when that's probably not what you're looking for here. I just wanted to provide everyone with a brief understanding about sleep to get things started and to show how important it is to our survival. If you guys are interested in knowing more about sleep, I have included a few links below this paragraph that discuss the topic.

http://healthysleep.med.harvard.edu/healthy/science
http://science.education.nih.gov/supplements/nih3/sleep/guide/info-sleep.htm
http://www.nhlbi.nih.gov/health/public/sleep/index.htm
http://www.helpguide.org/life/sleeping.htm

 

The Sleeping Patterns of an Opiate Addict

 

As most of you probably know already, opiate addicts tend to live a life quite different from those who do not suffer from addiction. The old saying "don't judge a person until you walk a mile in their shoes" is perfect for this scenario. As I said before, for someone who doesn't suffer from opiate addiction and has no sleeping problems/conditions, sleep is something that comes natural and takes little challenge to accomplish. However, for someone who does suffer from addiction and is currently going through opiate withdrawal, sleep can seem almost impossible at times. The withdrawals from opiates affect not only our bodies, but our minds as well resulting in our bodies being somewhat different than that of your average Joe who isn't addicted to opiates. Now I'm certainly no doctor (I can't count how many times I've said that before) but I believe the reason an opiate addict's sleep patterns become so disturbed are a near direct result of the effects opiates have the brain. I know it isn't rocket science that the physical withdrawals can keep one awake but I also believe that the mental aspect of opiate withdrawal is far too often overlooked. My guess is that the opiates play some kind of role in messing around with our brain chemistry resulting in some kind of imbalance or in something up there being "off". I mentioned before in my previous posts about the effect opiate addiction can have on not only our bodies but our minds as well, if you wish to check that post out simply click HERE.

 

Having an addiction to opiates can have quite an impact on our brain receptors whose purpose is release endorphins. Endorphins are basically opioid peptides that function as neurotransmitters. In other words, Endorphins are released in the brain as result of doing something we enjoy or find pleasure in such as exercising, having sex, or spending time with someone who we enjoy being with. Unfortunately, these same endorphins can be created and released each time we use opiates which ultimately result in one's mind and body enjoying the presence of opiates in the body. By continuing to use opiates over a period of time, the brain will begin to crave the presence of these endorphins eventually resulting in the person feeling the constant need to please the brain with the use of opiates. This is why it can sometimes be difficult for former opiate addicts to find enjoyment in things they once enjoyed as well as also resulting in depression or anxiety among other things. After reading all that, you can probably imagine the true effect opiates have on the mind and body which are what can ultimately control your sleeping patterns.

 

Once again, there's a lot of information out there about endorphins, the reward system in our brains, and the effects opiate addiction can have on these matters. I'll leave you guys with a few more links that address these topics in more detail below this paragraph.

http://www.allaboutaddiction.com/addiction/addiction-brain-effects-opiate-addiction-heroin-oxycontin
http://neuro.psychiatryonline.org/article.aspx?articleid=103089
http://www.canadianmedicaljournal.ca/content/164/6/817.full
http://en.wikipedia.org/wiki/Pleasure_center
http://curiosity.discovery.com/question/reward-center-in-brain-work
http://learn.genetics.utah.edu/content/addiction/reward/

 

Some Methods To Help With Sleep During Opiate Withdrawal

 

Getting some sleep during opiate withdrawal is something that nearly each and every one of us desires and wishes for when we choose to stop using opiates. Some people may be able to get some sleep during opiate withdrawals while others may feel as though they've been wide awake for what seems like a week straight. Like I always say, everyone is different. Some people experience certain withdrawals more or less than others and there is no universal law out there that will tell how good or bad your withdrawals will be. Unfortunately, there is no miracle drug or method out there that will prevent withdrawals but there are some methods that can help ease them. For this section of the post, I am going to talk about a few of these very methods which may help one who is suffering from opiate withdrawals and can't achieve sleep.

 

Over The Counter Medications- There are a few over the counter (OTC) medications out there that might be able to help you find sleep when going through opiate withdrawal. A common one is the drug Diphenhydramine, which is found in the OTC medication Benadryl. For some people this works great for in achieving sleep but for others (myself included) it has little to no effect. It is important to note that Benadryl when taken in high enough doses can result in restless legs and a jittery feeling similar to if one were take some caffeine. In even higher doses, Benadryl can result in hallucinations or even death so be smart when using this medication as a sleep aid. Basically, if you're not feeling much of an effect after taking the recommended dose, quit while you're ahead and don't look to take more in hopes of achieving sleep.

Another OTC medication that can be used to help with sleep is Doxylamine, which is most commonly found in the OTC drug Unisom. I have used Unisom and from my own personal experience feel that it works better than Benadryl. Tylenol PM is also another alternative to help with sleep as well as the aches/pain that often come with opiate withdrawals. Tylenol PM contains both Diphenydramine and Acetaminophen. The Diphenydramine in Tylenol PM is the same ingredient found in Benadryl and is what will help with the sleep. The Acetaminophen helps with aches, pains, and fever. All of these OTC medications should be used with caution as most are meant for short term use only. Ingesting to much of these medications can have severe consequences so be sure to be smart and talk with your doctor before doing anything drastic.

A final OTC medication that I feel is worth mentioning is Melatonin. Melatonin is a natural ingredient and works by replicating what the naturally occurring compound N-acetyl-5-methoxytryptamine does in our bodies. This compound is basically what aids our brain in determining when to sleep and has been getting more and more attention as of late. It is important to note that this medication takes time to work (usually at least a couple weeks) and that the dose needed to help aid with sleep varies from person to person. The good thing about Melatonin is that it is not addicting which is a huge plus for the addiction community. I gave Melatonin a shot before and didn't find it to help much with getting to sleep but I have seen other people praising how well it works. Like always, everyone is different so be sure to talk with your doctor if you do decide to give Melatonin (or any of these medications) a try.

Prescription Medications - Prescription sleep aids are usually more powerful and effective in helping one achieve sleep but do come with their risks. Many of these medications can be habit forming and addictive so anyone who has suffered from addiction in the past should be cautious with these medications. I have given a few prescription medications a try before and to no surprise would have to agree that they are far more effective than OTC drugs. A common prescription sleep aid is the drug Zolpidem, which is found in the medication Ambien. Ambien is a pretty powerful medication that has a pretty high success rate in terms of achieving sleep. I have tried Ambien before and found that it works great for getting some sleep but eventually canceled my prescription to it as I felt there was to great of a chance I would develop an addiction to it. There are also some side effects with Ambien such as sleepwalking, nightmares, and hallucinations so once again be careful my friends with these medications.

The drug Eszopiclone is another option and can be found in the medication Lunesta. I have no experience with this drug but have been told it is similar to Ambien but slightly stronger. Lorazepam is a option as well that is found in the medication Ativan, which works by slowing activity in the brain to allow for relaxation. Ativan also helps with anxiety which is something that can certainly arise during opiate withdrawal. Clonazepam, found in Klonopin, is yet another option as a sleep remedy. This drug is commonly prescribed for seizures, anxiety, and insomnia and based on what I have heard is quite powerful. I have no experience with Ativan or Klonopin so be sure to do your research and talk with your doctor if you think either of these may be an option.

Benzodiazepines are a class of drugs that are commonly used to treat sleeping problems and conditions. These are usually the more powerful sleep aid medications but carry the risk of developing an addiction. Withdrawal from Benzodiazepines is said to be quite severe, long, and painful with many saying the withdrawals from Benzodiazepines are far more dangerous and worse than those of opiate withdrawals. Some examples of Benzodiazepines include Klonopin (see above), Estazolam (ProSom), Flurazepam (Dalmane), Quazepam (Doral), Temazepam (Restoril), and Triazolam (Halcion). If you feel these drugs are capable of causing you to develop an addiction to them, your best bet is to stay away from these medications and look elsewhere. Another option is to use these drugs short-term (under 2 weeks) to help with the early stages of opiate withdrawal. These are powerful drugs guys, so be sure to be safe and to use these only under your doctor's supervision.

Another medication that may help with finding sleep is the drug Trazodone. I have used Trazodone before in the past and found it to work pretty well. While the Trazodone did help me, it was no where near as effective or powerful as the Ambien. Trazodone isn't as addictive as Ambien or some of the other drugs mentioned but it can still be considered somewhat habit forming. One will most likely not get too many physical withdrawals when stopping Trazodone, there is the chance of having trouble getting to sleep, having nightmares, and a sense of restlessness if suddenly stopped. The dosages prescribed for Trazodone vary greatly (any where from 25 mg to as high as 600 mg) so you and your doctor may have to slowly work your way up to a dose that works well for you.

Natural Remedy's - There are also other alternatives to sleep aid medications that can help during opiate withdrawal. One thing that works well for a lot of people is the use of hot baths, hot tubs, and trips to the sauna. These methods help relax the body and can be great for dealing with the chills and aches/pains. Exercising is another option but is something that can be quite difficult to do when going through withdrawals. When one exercises, their body releases endorphins just like how our bodies do when we use our drug of choice. Not only is exercise healthy for you, it will also often leave you feeling tired at the end of the day. Some decaffeinated tea, warm milk, or hot coco before bed can be soothing for some as well and is great for helping with the chills. Coffee isn't a bad idea during the day to get you up and going while withdrawing but should be avoided close to bedtime. The great thing about these methods are that they are not addicting or habit forming.

There are also several relaxation techniques that can be beneficial as well. When I first heard of these, I thought they were just a bunch of B.S. but must admit they did actually help a little after finally giving them a chance. Relaxation techniques include breathing exercises, mediating, and listening to those audio tapes that play peaceful sounds or music. Lets face it, when you're withdrawing you're basically willing to try anything to help yourself get through those rough times. I also find creating and sticking to a going to sleep and waking up schedule helps a lot to with sleep. What I mean by this is to not have nights were you're up until 3 A.M. and wake up the next day at 11 A.M. then following the previous day by going to bed early and waking up early. Make a schedule and stick to it.

 

A breathing exercise that I have found to help with not only getting to sleep but relaxing works by lowering your pulse and clearing your mind. For some people, this works well while others may not notice much of a difference. It takes a little practice to get used to as well. It can also help when you have a panic attack or are frustrated. This breathing exercise is called the 4-7-4 technique and works as follows:

 

1. Sit down in a chair with your back straight and hands together meeting at your stomach.
2. Your fingers should interlock at your stomach with the backside (opposite of your palm side) of your hands facing out.
3. Inhale and take a 4 second continuous breath of fresh air and hold it in for 7 seconds.
4. After holding your breath for 7 seconds, release your breath for 4 seconds continuously
5. Continue this 3-5 times

Another thing that may help is simply reading a book, surfing the web, or watching a little television before bed. It will help keep your mind busy while giving you some entertainment to pass the time and relax. However, don't just sit there for a few hours watching television, surfing the web, or playing video games as this can have the opposite effect. Try doing something that you really enjoy that doesn't take up a lot of your energy. Having a good environment around you before you go to sleep can make quite the difference so make sure you're in a relaxed, quiet, and comfortable environment each night.

Herbal Methods - There are also some natural herbs out there that are said to help with sleep. While I have never tried any of these herbs, the ones I most commonly hear about are Valerian Root and St. John’s Wort, which can usually be found at stores like GNC or Vitamin World. There are other herbal remedy's out there as well. I have also heard Lavender can help. Don't look at these herbs as something you shouldn't talk to your doctor about as some of them carry side effects or can have adverse effects with other medications. As always, be smart and talk with your doctor!

Other - A final thing that may help some of you guys may come across as somewhat controversial so please note that it is not my purpose or intent to offend anyone or to seem contradicting. When some people look to quit their addiction to opiates, they also look to end their use of all drugs and alcohol, which I think is probably the best route to go. This includes drugs such as tobacco and marijuana. In my opinion, I believe that marijuana is without a doubt a drug and can also serve as a gateway drug meaning that it's use can eventually lead to the user moving on to other harder drugs. However, I think for the most part, marijuana is quite harmless and agree that it is not addicting. It might become a habit but you won't see anyone having chills, cold sweats, extreme anxiety, diarrhea, and the other classic symptoms of opiate withdrawal when they stop using marijuana. As someone who enjoyed smoking marijuana and did so often in the past, I would often use the drug as a way to help control the anxiety that would so often accompany opiate withdrawal. It would sometimes also help me get to sleep which can seem close to impossible during opiate withdrawal. I no longer smoke marijuana due to the rules of the Suboxone program I am now in as well as just trying to make drugs a past part of my life but I still personally have no ill feelings towards the drug. I'll leave this one up to you guys. If you think it may help, give it a shot. However, if you think it might do more harm than good, then by all means stay away from it (and other drugs).

After debating with myself whether or not I should have included the use of marijuana to help with sleep during opiate withdrawal, I came to the conclusion that I want to be able to provide you guys with whatever I think can help you guys without causing any harm or bad consequences. That's why I often write about medications but never recommend dosages or regimes besides telling you guys to talk with your doctor and to never take more than told/recommended. The biggest reason I had debated on whether or not to include marijuana as an option in this post is that for some people, when they use marijuana, the high they get from it brings on too much of a temptation to get back to using the opiates again. Sometimes the high from marijuana is just to much for a person and it can begin to bring out our inner demons with addiction. While I personally believe marijuana can have its benefits, I would have to say that the best route to take is to probably just avoid it along with any other drugs or alcohol.

I also want to state that I defiantly wouldn't advise anyone to use alcohol as a means of getting to sleep. Not only is that an unhealthy and potentially dangerous thing to do, but that alcohol itself can become an addiction. This is especially true for any addict as we tend to develop addictions quicker and easier than most people. In addition, while the use of alcohol may make one feel good and able to get to sleep, it will most likely leave the person feeling even worse the next day. It is already shitty enough having to deal with opiate withdrawals so why add a nasty hangover to the mix. Both alcohol and marijuana can impair the way we think and act, which could result in one making some poor decisions such as deciding to use opiates adding yet another reason to avoid any drugs or alcohol during opiate withdrawal.

I know I might sound somewhat contradicting to some about what I have just said but I just want to add what I found has worked for me in the past. If you asked me what to do in regards to the marijuana, I would say to defiantly stay away from any drugs/alcohol and to only use the marijuana if you feel confident enough it won't have any negative impacts and as a last resort if possible. Remember, the whole point of getting off the opiates is to live a sober life. Like I've said more times than I can count, everyone is different with some people being able to handle things differently or better than others. You shouldn't even consider looking to drugs such as cocaine, heroin, meth, hallucinates, and the like to help ease withdrawals. Believe me, drugs like those will do much more harm than good and can lead you into a whole another world of problems.

Some Other Quick Tips For Finding Sleep

 

• If you can't get to sleep within a half hour or so, don't just stay in bed tossing and turning! Get up and go to a lightly lit room and do something that requires little energy and is relatively boring/dull. Some examples include reading the newspaper or a book, writing in a journal, going for a short walk, ect. You must train your body and mind that your bed is a place for sleep so that when you enter your bed in the future, your mind and body will know it's time for sleep. Or the other thing...

 

• Try to limit television, video games, or exercise right before bed as both can tend to get your mind and body up, focused, and ready to go.

 

• Limit any caffeine, high Carb, or sugary foods at night. Eat right during the day and limit (or even quit if you can) any tobacco products. Too much of these things can keep you up at night.

 

• If you're religious, calm yourself by spending a few minutes saying your prays before bed. If religion isn't your cup of tea, give mediation a shot and try relaxing and meditating for about 15 minutes before bed.

 

• Try to keep your mind occupied on something calming and something you enjoy. Don't worry about your addiction, bills you have to pay, work, or any other things that can get you worked up and worrying while you are in bed at night.

 

• As I mentioned before, make sure to set up a sleep schedule where you wake up and go to bed around the same time each day. Try to limit long naps during the day by either not napping at all or limiting your naps to less than 45 minutes (cat naps). It can be tough for some people (myself included) but try not to sleep in late on weekends or days off from work/school as this can further disrupt your sleeping patterns.

 

• Make your sleeping environment comfortable by having a nice, comfortable bed, a room temperature that's comfortable for you, and keeping noise to a minimal.

 

• If you continue having trouble in getting and staying asleep, don't continue to just put it off! Make a visit to your doctor and discuss with him or her what the two of you think is the best route of action to take in getting some sleep.  

Conclusion

 

Well guys, that's all I got for you and I really hope this post was helpful for you. In my opinion, the lack of sleep that comes with opiate withdrawals is one of the worst symptoms. You end up feeling so tired after not getting any sleep from the night before but still cannot fall asleep the next night, it really sucks. For some people, these methods may work great for while others may have mixed results. I'm sure there's a lot more information out there and I would love to hear some feedback from you guys about this matter. Comment below in the comment section if you have any thoughts, experiences, or recommendations that can help with achieving sleep during opiate withdrawals. I have also put up a new poll which can be found at the bottom of this page and would love to hear what you guys think. I'll end this post by wishing everyone nothing but the best and ask that each and every one of you guys to continue seeing that light! I have also included yet another a link for you guys below this paragraph that has some good information about some of the methods to achieve sleep. Some of the stuff on this website we have talked about already in this post but there is also much more. Here is the link below.

 

http://www.helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm#otc

 

Until next time, take care guys.

 

-Seeingthelight





Cold Turkey or Opiate Replacement Therapy?

Introduction

Welcome back everyone and thanks again for checking out my blog about opiate addiction. I want to once again thank everyone who has taken a moment to check out my blog and note that I am quite pleased at the direction in which this blog is going (could still use some comments!). I'm going to make this post here about two common routes opiate addicts can on when deciding to quit opiates. Each has its own advantages and disadvantages, but at the end of the day, they are here to help us in battling our addiction to opiates. The two routes are Cold Turkey and Opiate Replacement Therapy. I have used each method in the past and am currently going the Opiate Replacement Therapy route as I have been on Subxone (and clean off Oxycodone) for almost 5 months now. It certainly isn't easy but I can honestly say I'm happy with the choice I have made. Quite honestly, I don't think I would be where I'm at right now if I went the cold turkey route but as I always say, everyone is different.

I've touched upon both methods before in previous posts so I won't bore you guys with repeating myself about either. The cold turkey route is basically stopping all use of opiates without the aid of any opiate medications such as Suboxone or Methadone. In my opinion, I believe one can still go cold turkey with the help of comfort medications such as Clonidine, Imodium, and some  benzodiazepines (be aware that these can be addicting and deadly if abused/mixed with other drugs so please be careful my friends). When one goes cold turkey, they will most likely experience the dreaded withdrawals that occur when we abruptly stop using opiates. One can also slowly taper themselves down to a lower dose and than go cold turkey in hope of lessening the withdrawals.

 

Meanwhile, Opiate Replacement Therapy is a route one can chose to go on by using drugs such as Suboxone or Methadone. I'm not including the Vivitrol shot in this post as it's almost like a combination of both due to the fact that one must first detox themselves of any opiates (any where from 7-28 days depending upon the drug) before they can get the Vivitrol shot which will help with cravings and by not letting the person get high. I did write a post about the Vivitrol shot if you guys are interested. Drugs like Methadone and Suboxone must be obtained by meeting with an addiction specialist/doctor. These drugs will help greatly with the withdrawals/cravings you would normally experience if you were to go the cold turkey route. Like I've said numerous times, it isn't a miracle drug and you may still experience some withdrawals/cravings. The problem with Opiate Replacement Therapy is that one day you will eventually have to come off these drugs and will probably feel some withdrawals and cravings. I disagree that these medications are just switching one drug for another as there not really there for getting high off and can help patients get their lives back together before making the jump off opiates altogether. Lets take a further look with a comparison of these two routes.

Time

 

When one stops opiates cold turkey, they will experience withdrawals for period of time. Depending upon the drug, amount used, length of time used, and other factors, withdrawals can last any where from a few days to weeks. I only have experience with Oxycodone and the basic rule of thumb is that you feel like absolute shit for about 3-5 days, then feel "crappy" for about 2 more weeks before things start to feel "normal." However, while the physical withdrawals will eventually leave, the mental cravings and mind games last quite longer. Another rule of thumb is that it takes about a year before your mind starts to feel "normal" again but that we will all most likely have an addicts train of thought for quite some time, perhaps the rest of our lives. The one thing I'm always told is that "with time, it does get better." Based on my 5 months of being on the Suboxone, I would have to agree with that statement.

 

The withdrawals from opiates can be quite painful, annoying, and uncomfortable so one may have to do a few things before they decide to go cold turkey. If possible, it is advised that you take some time off from school or work to really focus on yourself as going on with your every day life can be an absolute nightmare while going through withdrawals. Imagine trying to work or go to school while having the chills, restless legs, body aches, runny nose, diarrhea, and the sweats. Not to mention the anxiety and depression many of us get when going through opiate withdrawals. It's a tough thing to do so if you're lucky enough to get some time off and to yourselves, I highly suggest you do so if you do decide to go cold turkey. The good thing about going cold turkey is that once you get a year of sobriety under your belt, things do start to get better and if you don't mess up, you'll never have to face these awful withdrawals again.

 

 

The most common way with going about Opiate Replacement Therapy is that the patient will be put on a medication like Suboxone or Methadone for a certain period of time (months, or in some cases, years) before they eventually begin to taper off the drug. Patience is key for this route of getting clean off of opiates. Because the user is still getting an opiate with Suboxone or Methadone, they will experience little to no withdrawal. The day will eventually come when the patient, after tapering, must come off of all opiates. Unfortunately, this will usually result in withdrawals. There is really no easy way of getting off opiates and avoiding withdrawals. However, you can to a certain extent control how good or bad your withdrawals will be. If you taper slowly and patiently, eventually getting down to a small enough dose, you might be able to lessen the withdrawals. For some people this works great while for others, they feel like tapering had little to no effect in lessening withdrawals. Once again, everyone is different.

 

Basically, the cold turkey route is a quicker way (through often quite difficult) than going the route of Opiate Replacement Therapy. I won't sugar coat it for you guys, you'll most likely face some form of withdrawals either way. It sucks, I know but I guess this is the price we pay for getting into this situation in the first place. If you ask me which route I think is better, I don't really have a clear-cut answer for you guys. I think most people (myself included) lack the willpower to go cold turkey and remain clean. Some people can do it, while others fail. I think Opiate Replacement Therapy is great for someone who is really struggling to get clean and needs to get their lives in order. It allows you to get a job, go to school, take care of your kids/family, or to continue doing these things whereas doing these kinds of things while going cold turkey can be an absolute nightmare. On the other hand, if you go cold turkey you're basically stuck with about 1-2 weeks of hell and than another few weeks of feeling pretty crappy and kind of "off". Either route you choose to go, getting and staying clean is a lifelong job. Believe me, this stuff can really screw around with your head if you have been abusing opiates long enough. I want to stress this as it isn't as easy as just stopping, feeling out of it for a month, then going to back normal. You'll most likely feel "off" for quite some time after the initial physical withdrawals. This is where forming a good, solid support network, doing the right things, hanging with the right people, going to AA/NA meetings, seeing addiction specialists, and really focusing on taking care of yourselves is critical. Despite all the shitty stuff that comes with getting clean, there is a whole another life you can live, one that once you weather the storm is certainly worth living, and most importantly, enjoying.

 

Costs

 

I'm going to be brief here on this section as you can probably get what I'm saying after a few words. When you attempt to get clean by going the cold turkey route, the only money you're probably going to spend is on comfort medications (see above) and the money you may lose if you take time off from work to detox yourselves. Meanwhile, going on Suboxone or Methadone can be quite costly for some. It really all depends on your insurance and the treatment center you are going through. It is not uncommon for people to have to pay hundreds to even thousands of dollars for Suboxone or Methadone treatment. However, some insurances are pretty good at covering these costs and some treatment centers are cheaper than others. It really all depends on your situation.

 

Risks

 

Like anything in life, both these routes come with their own risks. Going cold turkey can sometimes be dangerous, even deadly for some. Once again, it all depends upon the person and their situation so this is why it is important that before you do anything drastic to talk with your support network, family, close friends, and your doctors about your decision to go cold turkey. Some people can have seizures from going cold turkey, and there have been a few cases of people actually dieing. I don't want to scare you guys, I just want to warn everyone of the risks of going cold turkey and also want to note that cases such as these are usually very rare. However, please, please, please be safe and don't do anything drastic on your own.

 

 

The risks that come with the Opiate Replacement Therapy route is that some people may have bad reactions to drugs such as Suboxone and Methadone, so once again, it is important that you are honest and talk frequently with your doctor and support network. These medications can also be addicting, habit forming, and abused so be cautious. I have been using Suboxone for almost 5 months now and I haven't had any negative experiences with the drug but everyone is different. It is also important that you have given yourself enough time from your last dose of any opiates before you start Suboxone or Methadone. If you don't, you risk the possibility of going into precipitated withdrawals which can be pretty ugly. Be smart my friends.

 

 

Concluesion

 

Unfortunately there is no easy way out there currently to get off of opiates. It can often be a lifelong task of getting and staying clean and is not by any means something easy to do. Like I said before though, it is possible. It takes a lot of work, willpower, and self determination to get and stay clean but anyone can do it if they set their mind straight and give an honest effort. You might be able to achieve sobriety your first time. Or, like many others, you may relapse. However, if you do relapse, remember that you always have the option to get clean. That is something nobody can take from you. Please remember that. Some people get it their first time, others their 100th time. It is often said relapse is part of recovery. It is important to understand that this is not an excuse to relapse and use through. Rather it means that if you do mess up and relapse, learn from your mistakes and get back on the wagon. There is a great quote out there that I really love that concerns addiction. I do not know who came up with this quote but would like to share it with you guys as I think it sums up opiate addiction perfectly. It's "Why give up everything for one thing when you can give up one thing for everything".

I have no experience with either of these organizations but know that they are pretty well praised and known. They are drug addiction organizations who provide information online and also offer a 24 hour hot line to help anyone who is suffering from drug addiction or problems related to drug addiction. I put the following links below this paragraph if anyone needs any help, has questions, or just wants someone to talk about their problem with. Here they are:

http://drugabusehelpline.net/

http://www.24houraddictionhelp.org/
 

I would really like to get every one's input on this topic so please don't be shy and feel free to comment anything you may wish to add in the comment section below. Also, anyone is welcomed to ask any questions they have in the comment section and I (maybe even some other readers) will try to the best of my ability to give you an answer. I'm also open to any feedback or criticism regarding this post or my blog, so feel free to shoot. Don't forget to vote in my poll below as there are only a few days left to vote before it closes. I'll end this post like all my other previous ones by wishing everyone nothing but good fortune, luck, and happiness (I'm starting to sound more and more like a fortune cookie!). Take care my friends and keep seeing the light!

 

-Seeingthelight

 

 

*The two charts in this post were obtained online through the website U.S. Pharmacist. This website has some great information, check it out. The link to the website is below: 

http://www.uspharmacist.com/content/d/feature/i/874/c/16525/