Heroin Assisted Treatment

Introduction

Hi Guys and welcome to my blog about opiate addiction. Summer is right around the corner and I must say, it feels good. The warm weather is certainly a plus and the combination of free time and nice weather has allowed me, and I'm sure many others, the opportunity to partake in some of our favorite activities, sports, and enjoyments that tend to disappear during the cold winter months. I always thought of summertime as the best time to get off opiates with the warm weather (I absolutely despise the chills associated with withdrawal), time off from school or work (vacation?), and the general sense of mellowness most associate with the summer. I hope my blog can help anyone who is thinking about or currently partaking in a life without opiates.

I also want to alert you guys about a new section of my blog that I have recently created and published. This new section will provide readers with various graphs, photos, charts, figures, and the like that can be used as a reference page for the related post that you are reading. For example, if the post you are reading is about the effectiveness of Suboxone treatment programs, you may read a sentence that says "Suboxone has had various levels of success in relation to specific age groups, which can be seen in Figure 25". You can then check out the new section to view this table, chart, graph, or photo. I will still include these illustrations within the posts themselves as well with the idea of this new section being that users can view these items at later times. The section is simply a normal post created in the usual fashion of my other posts and is labeled as "Tables, Charts, Photos, Figures, and Graphs Reference Page". The section can be found by simply clicking HERE. It can also be found on the homepage of my blog which can be accessed by clicking HERE. This section will be updated constantly and will be effective for any posts published after June 6, 2013.

On that note, I would like to use this post to discuss a topic that I recently came upon that has been meet with much criticism and debate; heroin assisted treatment.

Heroin assisted treatment is a method of treatment that is used to help treat opiate addicts (heroin addicts) by using the drug diamorphine/diacetylmorphine, commonly referred to as heroin. The drug is given to addicts under supervision with dosages being gradually lowered over time to help minimize withdrawal from the drug. I must say, I was really shocked when I first heard of this method and was pretty curious as to how effective this method of treatment really is. A doctor giving heroin to an heroin addict to help combat addiction seemed almost surreal and bizarre when I first came upon this treatment option.



Pharmaceutical Heroin Today
Figure 36

After doing some research on the issue, I began to gain a better understanding of the procedure and started to see the concept behind it. Some within the addiction community see heroin assisted treatment as a means of treating addicts with a drug that is "cleaner" than what they would normally be getting on the street while also having the drug administered in a safer fashion and dosage than what they would otherwise normally be practicing. This method of treatment is somewhat similar to what doctors sometimes do to aid patients who have been prescribed opiates over an extended period of time get off opiates by tapering the patient's dosage over a period of time with the eventual goal of coming off opiates altogether.

Obviously there is a major difference between tapering prescription painkillers with tapering heroin but the overall concept remains, for the most part, quite similar. This method of treatment is without a doubt one of the more lesser preferred methods of treatments but is still nonetheless actively used in some countries. With the methods, beliefs, concepts, medications, and technology constantly changing within the addiction community, it is not that unrealistic to think that this kind of approach (or one similar) of treating those who struggle with opiate addiction reaching other countries or facilities over time. Thus, I would like to go into further detail about this matter by talking about the exact nature of heroin assisted treatment, its history, where it is used, its effectiveness, the risks and benefits, and finally, my opinion on the matter. To make things a little easier on myself and your eyes, I will be using the acronym HAT at times to refer to heroin assisted treatment.

 

What is Heroin Assisted Treatment and How Does It Work?

Heroin assisted treatment (HAT) is the "prescribing of a synthetic heroin, in an injectable or capsule form, to opiate addicts that do not benefit from or cannot tolerate treatment with one of the established drugs used in opiate replacement therapy such as Methadone or Buprenorphine (Suboxone)". Under this method of treatment, heroin is administered under the supervision of a doctor with the dose being gradually lowered over time. Similar to how doctors taper patients off of prescription painkillers, the goal of heroin assisted treatment is to eventually wean the patient off of the drug in an effort to minimize withdrawal. After gradually tapering down to a fairly low dose of heroin, patients will sometimes then be switched over from the heroin to a low dose of Suboxone or Methadone for a brief period of time before jumping off opiates altogether.

The method of treatment allows addicts to identify and learn about their addictions with the hope that these addicts can learn to cope with their addictions and eventually achieve sobriety. By having the heroin administered under medical supervision, the risk of overdose, disease, criminal activity, and costs are lowered or minimized. Heroin assisted treatment is available and practiced in Denmark, Germany, the Netherlands, Switzerland, and the United Kingdom while experimental trials are currently being conducted in Canada and Belgium. Meanwhile, the policy has been heavily criticized and opposed by many within the United States with Methadone, Buprenorphine, and total abstinence being the more preferred and favored methods of treatments for opiate addiction.

The history of heroin assisted treatment began in the United Kingdom during the early 1920s and was commonly referred to as heroin maintenance. The method of treatment was available to a select group of patients, with many ironically being doctors themselves. Due to the close relationship between the United States and the United Kingdom along with the United State's strong anti-drug stance in what would eventually be labeled as the War on Drugs, the use of HAT experienced a sharp decline beginning in the 1960s. However, the method of treatment begun to see somewhat of a resurgence beginning in the mid 1980s and has since found a niche within the addiction community today with the United Kingdom, Netherlands, and Switzerland notably maintaining an active role and voice in the policy today. Germany and the Netherlands actually include the treatment option as a component of their national health care systems.

Bayer Prescription Heroin in 1910

Figure 51

The way in which the heroin is prescribed and administered varies from not only country to country but from clinic to clinic as well. For most patients who are partaking within a treatment program offering heroin assisted therapy, the patients are usually given their dose of heroin under the supervision of a doctor or medical professional. This course of action is preferred as it can help reduce the chance of the heroin being abused or sold on the streets. However, the United Kingdom is unique in that it sometimes allows patients who have demonstrated a sense of trust and responsibility to take home their heroin prescription or to have to only show up to the clinic once a day rather than several times throughout the day due to heroin's short acting half life. It is important to note that while this may seem rather extreme as well as the fact that the United Kingdom is one of just a few countries where HAT is legal, less than 1% of all opiate replacement treatments for heroin in the United Kingdom are heroin assisted treatments.

Clinics in the Netherlands meanwhile often require patients to make at least two visits per day to obtain their doses of the heroin with the option of being able to take home a single dose of methadone each day. Switzerland handles their treatment programs by at first requiring patients to make daily (sometime multiple times per day) visits to obtain their doses with the possibility of patients being able to take home a pill form of heroin after the patient has demonstrated a sense of trust as well as being able to obtain employment.

Patients are sometimes prescribed Methadone in addition to the heroin to help provide relief for withdrawal if the heroin wears off before the patient is able to obtain their next dose. The use of heroin in treating addicts is seen as a way in combating what has been viewed by many as an epidemic that is growing in size and severity each day. Still, there is much fear that this method of treatment can be dangerous, contradicting, and ineffective with many fearing the possibility that the drug can make its way to the streets. Similar to the way in which concerns surrounding Suboxone and Methadone affected programs, this has resulted in tight regulation and supervision of the clinics and doctors who offer this option of treatment.

The Pros and Cons of Heroin Assisted Treatment

As you can probably already gather, there are several pros and cons of heroin assisted treatment. The method has been met with its fair share of intense criticism with many feeling that it is simply a means of providing addicts with their drug of choice, holding little to no value in actually treating their addictions. There is also the issue of the prescription heroin possibly getting out onto the streets. We have already seen just how easy it can be for prescription painkillers to make their way onto the streets and into the hands of addicts each and every day with little disturbance or interruption. With the heroin used for HAT programs most likely purer and with little to no additives (cuts) than most heroin found on the streets, there runs the possibility that drug dealers and addicts may see this as a means of making profits or getting high. Think about how often you hear about a corrupt doctor or pharmacist who wrongfully prescribes, steals, or sells prescription drugs for profits. Well, what would stop these same kinds of people from doing the same exact thing with heroin?

Another cause of concern involves the safety of the patients themselves who are partaking within an heroin assisted treatment. Heroin is a dangerous drug and is certainly one of the more common opiate culprits behind overdoses and opiate-related deaths. Doctors will have to use extreme caution in not only determining how much heroin is safe enough to administer but that there is enough administered to help provide relief from withdrawal. I ask myself, what happens when a patient with an extremely high tolerance to heroin enters treatment? The patient will most likely require a dose of heroin that could be considered dangerous in order to minimize withdrawal. Is the risk really worth it or would the patient be better served with a drug such as Methadone or Suboxone? I'm sure programs offering this type of treatment have thoroughly thought these concerns over but it begs to ask the question, how safe, supervised or not, can administering heroin really be?

The Success of Switzerland's Harm Reduction Programs

Figure 53

The benefits of heroin assisted treatment are a little more difficult to identify and support. A good comparison of HAT would be to the harm reduction programs that several cities across the world run. These programs are created and implemented with the hope that they can reduce and minimize the various risks and negative consequences so often associated with drug use. An example of a harm reduction program would be a needle exchange clinic in which IV users of heroin can drop off dirty or used needles in addition to being able to obtain new and clean needles. The program helps prevent needles from being carelessly tossed on the ground where they could be picked up by an innocent child or accidentally poking someone who unintentionally comes into contact with the  carelessly disregarded needle. Needle exchange programs also discourage needle sharing which can result in the spreading of diseases such as hepatitis or HIV/AIDS. This is critical as diseases such as these are very present within the world of drug and its inhabitants.

I mention the comparison of the needle exchange programs in relation to the heroin assisted treatment option because both concepts are meant to reduce the risks and harm that often come along with using a street drug such as heroin. Supporters of programs such as these see heroin use as a problem that is difficult to stop or even prevent and look to ways to help deal with the problem at hand through harm reduction rather than the difficult and, unfortunately, often unrealistic attempt to eliminate heroin use totally. To sum it up, supporters of these programs feel as through quitting heroin cold turkey or with drugs such as Methadone or Suboxone is too ineffective for some select addicts such that using heroin under a supervised tapering regimen is the next best option. A good saying for this particular scenario is that heroin assisted treatment is the lesser of two evil when compared to heroin use on the streets.

Sign for a Needle Exchange Program

Figure 54

Another benefit that is used to support HAT is that the method of treatment can reduce criminal behavior and costs. Addicts partaking in one of these programs would be obtaining their heroin legally (man that sounds crazy, doesn’t it?) through a doctor’s prescription rather than buying it off the streets from a drug dealer. Addicts will also not have to pay anywhere near as much as it would cost to maintain a habit of buying heroin off of the streets. This would, in theory, reduce the need to commit criminal acts such as theft, drug dealing, prostitution, and violent crimes to support one’s habit. Ultimately, this combination would result in fewer arrests and incarnations. Who would have ever thought that giving heroin to heroin addicts could reduce criminal behavior?

A final benefit that one could associate with HAT is that the method of treatment would be much safer for the addict than if they were purchasing and using heroin from the street. Because individuals within the program would have their doses overseen and administered by a medical professional rather than the addicts themselves, the risk of overdose is greatly decreased. More often than not, heroin is rarely pure, often containing a variety of additives. Occasionally these additives can result in serous illness or death due to the presence of harmful additives, allergic reaction, or the inclusion of more potent drugs (such as Fentanyl). Another factor to consider is the overall nature of the heroin underworld and drug game, which is often filled with dangerous places, acts, scenarios, and people. No one is going to get harmed or killed in a medical facility or treatment program over bag that was shorted or because someone didn’t pay back some money or drugs that they were loaned.

So, Just How Effective is Heroin Assisted Treatment?

Trying to determine the overall effectiveness of heroin assisted treatment in comparison to more traditional methods such as opiate replacement therapy, AA/NA, or total abstinence is, for the most part, quite difficult to determine.

In North America and Europe alone, there are an estimated 2-4 million heroin users with 1-2% of this population prematurely dying each year. The social, economic, and medical costs attributed to heroin use is believed to be in the billions of dollars in addition to the thousands of individuals serving sentences in prisons, jails, hospitals, and institutions each year. In other words, heroin has had a major impact on society and this holds true to not only the addicts themselves, but to everyday people as well. Every day, family members and friends lose loved ones to heroin addiction, be it from incarnation, destroyed relationships, or death. Heroin use is unfortunately a growing problem that looks like it is here to stay. This is all without mentioning the enormous impact prescription painkillers such as Oxycodone, Oxycontin, Dilaudid, and Fentanyl have had on society as well. 

There are a few studies out there that have been conducted over the last 25 years in regards to the effectiveness of heroin assisted treatment. It is a lot of information to digest in these studies to the point that it wouldn't really be appropriate to include all this information in this post. Rather than copying and pasting all this information into this post, I thought it might be a better idea to include the links to these studies below. I will also touch upon some of these findings in my own words below as well as providing you guys with some of the more important results of these studies. The following links below this paragraph will bring you to these studies. The first link is a detailed study conducted by the European Monitoring Centre for Drug and Drug Addiction (EMCDDA) that provides a great insight on the matter. I defiantly recommend checking it out if you have the time even through it unfortunately requires you to download the document after you click on the link (it is, however, free and on a secure site). The articles are as follows:

EMCDDA "New Heroin Assisted Treatment Findings"

Heroin Assisted Treatment, A Decade Later: A Brief Update on Science & Technology

Heroin Assisted Treatment/Heroin Maintenance

Heroin Assisted Treatment for Opiate Addicts: The Swiss Experiment

Heroin Assisted Treatment in Europe: A General Overview

Between 1994-1996 , a study involving the effectiveness of heroin assisted treatment was conducted by an independent research team consisting of members from the Addiction Research Institute and the Institute of Social and Preventive Medicine at the Swiss university, Zurich University. The study demonstrated several positive results in regards to the effectiveness of HAT. The link to the study is the 4th link above this paragraph and can also be accessed by clicking HERE. Some of the findings include (in blue font): 

"The safety of patients and staff could be evidenced (no fatal overdose from prescribed substances, no successful thefts or deviation to the illegal market, few cases of violent behavior). In contrast to expectations, the daily dosages of Diamorphine could not only be stabilized, but were slightly reduced over time. Many patients preferred to combine injectable Diamorphine with oral methadone, in order to have more freedom to resume school attendance or employment"

"The consumption of illegal / non-prescribed substances while being on the program was reduced significantly (especially the daily use of heroin and cocaine, to a lesser degree the regular use of Benzodiazepines). Cannabis use on the other hand remained essentially unchanged, but without noticeable effect on treatment outcome."

"Regarding social integration, it may be mentioned that homelessness was significantly reduced, while reintegration into the regular labor market proved to be more difficult. Most spectacular was the reduction of criminal activities according to self-report and police data (Killias & Rabasa 1998)."

"Retention in treatment was superior to what is observed in other forms of treatment (76% over a 12-month period). 60% of discharged patients could be transferred to a regular treatment program within 18 months (about half of those to drug-free programs)."

In 2000, a second systematic follow-up study was made (Güttinger, Gschwend et al, submitted). The study included 244 patients covering a period of 6 years. At that time in 2000, 46% of patients in the previous study were still in treatment while 48% of discharged patients had entered a regular program. The study also provided a comparison of those still in treatment with those who were discharged showing the following information (again, in blue font):  

 

- a significant reduction in illegal heroin, cocaine and Benzodiazepine use in both groups

- no reduction in cannabis use in both groups

- a significant reduction of homelessness in both groups

- no reduction in unemployment in both groups

- a highly significant reduction in living from illegal income and in new court cases.

The results of the Swiss study clearly illustrated mostly positive outcomes for patients involved in the heroin assisted treatment trials. Despite these results, the study stresses that it is not recommending heroin assisted treatment as a first line of defense in the battle against opiate addiction. Rather, the method of treatment should be reserved for a select few individuals, focusing on those who are 1) using heroin and 2) have been unsuccessful with other lines of treatment in the past such as Methadone or Suboxone. In other words, someone with an addiction to prescription painkillers shouldn't attempt to go this route as it geared more towards heroin addicts as a last resort. Using heroin, whether in a program or not, can at times be like playing a game of Russian roulette as the potential risks, addictive nature, and reputation of the drug are all well documented. Heroin assisted treatment should thus be reserved for those heroin addicts who have exhausted nearly all other possible options (with little to no success) such as abstinence, Methadone, or Suboxone before looking into a HAT program.

 

Now lets take a look at a study conducted in the Netherlands in which injectable Diamorphine (heroin) was administered to patients. The group receiving the injectable heroin was compared with a group receiving Methadone. The Dutch study showed that after twelve months, client retention rates were higher for the Methadone group compared to the heroin assisted treatment group. However, patients in the heroin assisted treatment group responded better than those in the Methadone group in regards to aspects such as comfort level, side effects/reactions, and overall cost effectiveness of program. The overall findings of this study demonstrated that the group receiving the heroin assisted treatment was usually nearly equal to or greater than (although not by substantial margins) in most factors of the study than the group in which members were administered Methadone.  

A quick summary, conveniently in the form of a table, of a few of the studies conducted that focused on the effectiveness of heroin assisted treatment can be found by clicking HERE.

 

A final aspect to look at when determining the effectiveness of heroin assisted treatment is the availability of the program. As I mentioned earlier in my post, HAT is quite limited in that it is only legal and available in a select few (five to be exact) countries and even in those countries, the number of heroin assisted treatment programs is small. I bring this issue up because what good is a treatment option when it is close to impossible to find or partake in. To demonstrate to you guys just how few HAT programs there are worldwide, take a look at the number of HAT programs in each of the five countries where the method of treatment is legally available.

Country                                   Number of HAT Programs

Denmark                                             3

Germany                                             7

Netherlands                                        17

Switzerland                                        23

United Kingdom                                3

 

 

My Final Thoughts and Opinion on Heroin Assisted Treatment

Over the past decade, the world (especially the United States) has seen what appears to be an epidemic in regards to the abuse of prescription painkillers and opiates. Thus, we must learn new ways to deal with this growing and demanding problem. Is heroin assisted treatment the perfect solution to this problem? Of course not, but neither are drugs such as Suboxone or Methadone. For some, these methods of treatment work wonders while for others they are ineffective. Rather than praise one method while bashing another, we should give each method a fair and efficient evaluation determining what works and what doesn’t. Would I consider HAT a solid solution to opiate abuse or something I would try myself? My answer is probably not, but I believe that if it truly works for some people, then it has its place within the addiction community.

What I’m trying to say is that if it works for some people, is proven to be relatively safe and effective, and is used the right way, then who am I to say it does or doesn’t have its place within the addiction community. For example, I am currently on less than 1 mg of Suboxone a day after being addicted to over 200 mg Oxycodone for roughly two years. I have been on the Suboxone for a little over a year and through a supervised taper regimen, have found the drug to be a total godsend. However, there are some people who feel Suboxone just doesn’t work well enough for them and would prefer other means such as Methadone maintenance, AA/NA meetings, or total abstinence to treat their addictions. If those routes work for you, than all the power to you with the most important thing at the end of the day being whether or not you are clean off of opiates or are, at the very least, heading into that direction through your method of treatment.

Typical Outpatient Clinic

Figure 55

I look at heroin assisted treatment as a more untraditional means of tapering just like how someone would be tapered off of a prescription painkiller. I think a lot of criticism surrounding HAT programs is due to the stigma that revolves around heroin. Most people, rightfully so at times, see heroin as an evil, dangerous drug that has no place in the medical community. Yet when you get down to the main ingredients in most prescription painkillers, they are almost the same ones usually found in heroin, often coming from the same kind of plant. Because these prescription painkillers are made in a factory or lab, there is often a sense of false security that comes with them. Well guess what, at the end of the day both heroin and prescription painkillers can cause addiction and both result in similar withdrawal. To provide you guys with a metaphorical example, think about marijuana. There is a difference between some high grade marijuana and some low grade mids. Yet, at the end of the day, they are both kinds of marijuana.

The best way that I can describe how I feel about HAT is to tell someone to try to look at the relationship and similarities between heroin and prescription painkillers in the big picture. By big picture, I am referring to looking at where both come from, the similarities in the highs between the two, the withdrawals that can accompany both, and the devastating consequences that both can have on people and those around them. Is it really that insane to think and see the similar nature between both beasts? Sadly, I think it is not that crazy to think and see such as thing.

To reiterate and summarize my final thoughts on heroin assisted treatment, I say that while it is something I would never consider partaking in myself (if it were legal in the U.S.), I think that the method of treatment is deserving of further attention. As of right now, I feel this method of treating addicts leaves far too much opportunity for it to be misused or abused. I admit that I could certainly use more information or firsthand accounts of the process that one undergoes when getting into one of these programs as well as more information as to how they usually operate.

Under the proper supervision and environment, I feel there is potential and promise for this concept. However, the idea of giving someone with an addiction to heroin the opportunity to take home doses of the drug seems a little absurd to me in that I feel the potential for abuse or misuse is too great to allow someone to take home and administer the drug themselves without the supervision of a medical professional. I have met and seen firsthand several addicts with prescriptions to Suboxone and Methadone who do not take their medications as prescribed or even sell them as a means of supporting their habits. Thus, I don’t believe it is too farfetched to see something like this occurring in a program that offers heroin assisted treatment.

Conclusion

Well, I think this post might take the icing on the cake for the longest post that I have written thus far. If you read it all, especially in one sitting, I would like to thank you for taking the time to do so. I hope you found this post interesting and if you are someone in a country where heroin assisted treatment is legal and are considering this method of treatment, that you found this post was helpful. I would love to hear what you guys think of this topic under the comment section so please don’t hesitate to drop a comment. If you have any firsthand experience with HAT, I would greatly appreciate your input on the matter.

As always, thanks for reading Guys. Don’t forget about the new section in my blog that allows readers the opportunity to view the various pictures, graphs, charts, figures, and tables used throughout my blog. I think this section will be especially helpful for referencing items as well as allowing readers the opportunity to look something up that they may have read in one of my previous posts. I can only hope that my next post is as exciting and interesting as this one as I must admit, it is at times getting more and more challenging to find and write about fresh and interesting topics. I guess that's part of the fun as well. I have certainly learned a lot since I wrote my first post roughly a year ago.

Well, my time is now up and I thank you for yours. Take care my friends and remember…in even the darkest places and times, there is always light so don't hesitate look around a little bit to keep seeing that light! It’s there somewhere, I promise.

Be safe, be healthy, and most importantly, be happy.

-Seeingthelight

Restless Legs During Opiate Withdrawal

Hi Folks and welcome to my blog about opiate addiction. When one quits opiates by going cold turkey or after a tapering process, they will most likely experience a variety of withdrawal symptoms. Some are worse than others while others are barely noticeable and simply a minor nuisance. Some of these withdrawals last for a few days while others can be felt for weeks. All and all, withdrawals from opiates can really make quitting opiates and staying clean an extremely difficult (yet possible) task.

If you were to ask me what withdrawal symptom I dread the most, I can say right off the bat and without a doubt that restless legs takes home the prize. Sure, the chills, sweats, aches/pains, stomach problems, and lack of sleep make for one hell of a week(s) but in my opinion, none of these symptoms come remotely close to how bad restless legs can feel. The awful feeling of having to constantly move one's legs while changing positions every 30 seconds is about as close to Hell as I can imagine. To make matters worse, I actually have the condition Restless Leg Syndrome, which makes the common opiate withdrawal symptom of restless legs feel like a million times worse when detoxing. Hell, even if I'm not withdrawing from opiates and am experiencing restless legs I feel so frustrated, defeated, and weak.

Therefore, I would like to use this post as an opportunity to provide you guys with some quick information about restless legs during opiate withdrawal along with some ways to help provide relief for such a nasty withdrawal symptom. While I will talk a little bit about the condition Restless Leg Syndrome (RLS), most of this post will concern restless legs as a symptom of opiate withdrawal rather than the actual medical condition of RLS.

 

What are Restless Legs and Why Do We Get Them

 

It is important to first identify and separate the medical condition known as Restless Leg Syndrome (RLS) and the symptom of restless legs that one would experience during opiate withdrawal. While both items carry with them near identical symptoms, RLS is usually a chronic condition meaning it is something one will have for quite some time and possibly for their entire life. On the other hand, restless legs as a symptom of opiate withdrawal is a result of the body undergoing a detoxification process and these symptoms will eventually disappear over time. To provide you guys with an example, pretend an individual takes part in an intensive exercise routine that results in their blood pressure increasing momentary. While this person did experience a bout of high blood pressure, it does not mean that the person suffers from the condition of having high blood pressure. Rather, the increase in blood pressure for this individual was a direct result of the exercise rather than an actual medical condition, illness, or disease. Thus, for this particular post, we will focus on restless legs occurring as a result and symptom of opiate withdrawal.

 

Restless legs can be described as having any of the following symptoms:

 

• Constant or frequent urges to move legs
• Itchy feeling in legs commonly described as "an itch you can't feel or itch"
• Crawling feeling within the legs
• Random jerks or reactions from legs
• Hot or cold flashes in the legs
• Pain or burning sensation in the legs

 

Common Symptoms of Restless Legs

Restless legs can truly be a nuisance and often limit or disturb one's sleep making detoxing off opiates that much harder. The condition also seems to worsen for many at night and/or when they are sitting or laying down. For many, this leads to numerous nights of tossing and turning in bed late at night in hopes of being able to find a comfortable position and achieve some level of sleep. Although less common, some people report having these feelings in their arms, neck, and shoulders as well.

The understanding of Restless Leg Syndrome and restless legs in general is pretty limited as of right now. Fortunately, the topic and area has been getting more attention over the last couple of years as the number of cases of patients experiencing restless legs or related symptoms continues to grow. In years past, many doctors and specialists thought restless legs were a symptom of a condition rather than an actual condition in itself. Today, the condition is actually labeled as an entirely separate beast and not simply as a symptom of something else. Some studies suggest that as many as 1 in every 10 people will develop Restless Leg Syndrome at some point in their lives, with those over 55 appearing most vulnerable.

Now, the restless legs episodes that most of us who are reading this blog experience are most likely a symptom resulting from opiate withdrawal rather than the actual condition of RLS. However, I mention the increase of attention in the condition RLS as it has led to numerous medications and treatments becoming available that can also be used to treat restless legs resulting from opiate withdrawal. Most of these medications are still in the early stages and as a result, there has been mixed reactions as far as how effective these medications are in treating restless legs.

According to the website Help Guide, scientists and doctors believe the cause of restless legs is as follows (in blue font):

"Experts believe that restless legs syndrome is caused by an imbalance of dopamine, a chemical that transmits signals between nerve cells in the brain. Restless legs syndrome is usually genetic, about 60% of people with restless legs have a family member with the condition. Although anyone can have restless legs syndrome, it is more common in older adults and women. In fact, about 40% of mothers experience temporary restless legs syndrome during pregnancy. Health conditions such as diabetes, iron deficiency, rheumatoid arthritis, and kidney failure can also trigger restless legs syndrome."

 

Web MD provides the following information (again, in blue font) in describing some of the potential causes or factors contributing to the presence of restless legs:

 

Chronic diseases. Certain chronic diseases and medical conditions, including iron deficiency, Parkinson’s disease, kidney failure, diabetes, and peripheral neuropathy often include symptoms of RLS. Treating these conditions often gives some relief from restless legs symptoms.

 

Medications. Some types of medications, including antinausea drugs, antipsychotic drugs, some antidepressants, and cold and allergy medications containing antihistamines may worsen symptoms.

 

Pregnancy. Some women experience RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.

Other factors, including alcohol use and sleep deprivation, may trigger symptoms or make them worse. Improving sleep or eliminating alcohol use in these cases may relieve symptoms.

 

Now, it doesn't take a rocket scientist to figure out that the reason most of us who are reading this blog experience restless legs is due to withdrawing from opiates. However, some people (myself included) may actually have Restless Leg Syndrome so it is important that one is able to differentiate between the two. You don't want to be experiencing restless legs 3 months after detoxing off opiates thinking that you are getting the restless legs due to no longer using opiates. You may in fact actually have the condition Restless Leg Syndrome so make sure you evaluate your situation and talk openly and honestly with your doctor. A simple physical and possible lab blood test can sometimes determine whether or not you have RLS as well as possibly identifying the cause of it. Having any conditions, problems, or issues taken care of and in control will only make your road to recovery easier in the long run. You don't want to end up one night feeling frustrated and uncomfortable because you can't sleep or that your legs are bothering so much that you end up turning to your drug of choice for relief. I have been there before... more than once unfortunately.

As I previously mentioned, restless legs can be a direct result of something else other than opiate withdrawal. This situation is referred to as Secondary Restless Leg Syndrome and can occur in situations such as pregnancy, disease, nutrient deficiency, or as a side effect from certain medications. Diphenhydramine, the main ingredient in Benadryl, is a perfect example of Secondary RLS. A common side effect of this over the counter medication, especially when taken in higher dosages, is restless legs. I use this medication as an example because I know it is a popular choice as a medication among addicts (as well as non-addicts) to use to provide relief for insomnia. The sedative effect of Diphenhydramine is appealing to many addicts who are struggling to sleep during detoxification. However, the medication can have the exact opposite effect on some leaving them with a sense of restlessness and feeling worse. This was something that I dealt with numerous times until I finally figured out the medication was doing more harm than good. Please not that I am not knocking Benadryl as it can be really effective for some. At the end of the day, know your body and what works and doesn't work. The chart below provides some common factors that can lead to Secondary RLS.

 

Possible Causes for Restless Legs

 

Remedies and Treatments to Help Relieve Restless Legs

 

As I have previously stated, the methods and treatments used for treating restless legs right now are somewhat limited. There are several tips, treatments, and medications out there that claim to help in providing relief for restless legs. Some work well for some people while providing little to no relief for someone else. In other words, these medications and treatments have different degrees of success. At the end of the day, like so many other things in life, everyone is different and their bodies will react differently to different treatments and medications. However, I would like to include some of these medications and treatments in hope that maybe you will find one that works well for you. As always, be sure to talk these items over with your doctor and to know what you are putting into your body. A little research can go a long way.

 

This information was provided by the website Help Guide. You can access this information and learn more about restless legs by clicking HERE.

 

Help Guide's Lifestyle treatments for restless legs syndrome (RLS):

There is a lot you can do to take care of restless legs syndrome yourself. Mild RLS can often be treated with lifestyle changes alone. The following daytime habits can help reduce the frequency and severity of your restless legs symptoms.

• Sleep better by sticking to a regular sleep schedule. Fatigue can worsen the symptoms of restless legs syndrome, so doing what it takes to get enough sleep is crucial. Try hitting the sack at the same time every night, (or try warm baths or reading in bed) allowing plenty of time for winding down.
• Exercise in moderation. Daily activity, including moderate aerobic exercise and lower-body resistance training, can significantly reduce the symptoms of restless legs syndrome. Swim, go for a walk, take the stairs, or spend a few minutes doing jumping jacks. Keep in mind that excessive exercise—like training for a marathon—can actually make restless legs syndrome worse.
• Cut back on caffeine. Caffeine often makes the symptoms of restless legs syndrome worse. Try reducing or eliminating your consumption of coffee, tea, soft drinks, and caffeinated foods such as chocolate.
• Avoid alcohol and cigarettes. Many people with restless legs syndrome find that their symptoms improve when they stop drinking and smoking.
• Consider dietary supplements. Check with a doctor or nutritionist to find out if you’re low on iron, vitamin B, folic acid, or magnesium. Deficiencies can bring on RLS.
• Lose weight. If you’re overweight, dropping the extra pounds can often relieve or lessen the symptoms of restless legs syndrome.
• Try practicing relaxation techniques such as yoga and meditation. Stress can make RLS symptoms worse. Daily stretching and meditation can promote relaxation and alleviate (RLS).

Help Guide's Self-help treatment for restless legs syndrome (RLS):

Living well with restless legs syndrome means knowing how to manage situations where you must be still. The following tips and tricks will help you control RLS so it doesn’t control you.

• Pressure can help relieve the discomfort of restless legs syndrome. Try wearing compression socks or stockings or wrap your legs in bandages (but not so tight you’ll cut off circulation).
• Try sleeping with a pillow between your legs. It may prevent nerves in your legs from compressing.
• Try to find or create a work setting where you can be active. If you work at an office, look into a desk that lets you stand and type.
• Tell friends, family, and coworkers why you have to move more than others. They’ll likely be accommodating and want to help you create a healthy environment.
• Choose an aisle seat at movies and on planes so that you can get up and move.
• Give yourself stretch breaks at work and during long car rides.

Help Guide's Stretches for restless legs syndrome (RLS):

Simple stretching can help stop the symptoms of restless legs syndrome in their tracks. Here’s a handful to help you get started.

• Calf stretch – Stretch out your arms so that your palms are flat against a wall and your elbows are nearly straight. Slightly bend your right knee and step your left leg back a foot or two, positioning its heel and foot flat on the floor. Hold for 20 to 30 seconds. Now bend your left knee while still keeping its heel and foot flat on the floor. For a deeper stretch, move your foot back a bit farther. Switch legs and repeat.
• Front thigh stretch – Standing parallel to a wall for balance, grab and pull one of your ankles toward your buttock while keeping the other leg straight. Hold for 20 to 30 seconds. Switch legs and repeat.
• Hip stretch – Place the back of a chair against the wall for support and stand facing the chair. Raise your left foot up and rest it flat on the chair, with your knee bent. (Or try placing your foot on a stair while holding the railing for balance.) Keeping your spine as neutral as possible, press your pelvis forward gently until you feel a stretch at the top of your right thigh. Your pelvis will move forward only a little. Hold for 20 to 30 seconds. Switch legs and repeat.

Help Guide's Treatment for restless legs syndrome (RLS):

If self-help doesn’t relieve your restless legs syndrome symptoms, you may benefit from visiting a doctor or a sleep specialist.

Diagnosing restless legs syndrome (RLS)

While there are no laboratory tests that can determine if you have restless legs syndrome, your doctor can diagnose it by reviewing your medical history and conducting a physical exam. To diagnose RLS, your doctor will request:

• A complete medical history
• A survey to see if anyone else in your family has similar symptoms
• A diagnostic interview, to rule out other medical conditions
• A blood test for low iron levels

Your doctor may also review the medications you’re taking as some prescription and over–the–counter drugs can make the symptoms of restless legs syndrome worse.

Help Guide's Medications that can make restless legs syndrome (RLS) worse:

• Over-the-counter sleeping pills
• Antihistamines (found in many cold and allergy pills such as Benadryl, NyQuil, and Dimetapp)
• Anti-nausea medications (such as Antivert, Compazine, and Dramamine)
• Calcium channel blockers (used for high blood pressure and heart problems)
• Antidepressants (such as Prozac, Effexor, and Lexapro)
• Antipsychotics (used for bipolar disorder and schizophrenia)

If a medical condition, such as iron deficiency, diabetes, or nerve damage is triggering your restless legs syndrome, treating the underlying problem may relieve your RLS symptoms. But if there is no underlying condition and lifestyle changes don’t bring enough relief, you may need medication to reduce the restlessness in your legs.

Help Guide's Medication as treatment for restless legs syndrome (RLS):

No single medication works for everyone with restless legs syndrome. In fact, a drug that relieves one person’s restless legs may actually make your symptoms worse. In addition, many people with restless legs syndrome find that medications that work initially become less effective over time.
It’s also important to be aware of potential side effects, such as nausea, headache, and daytime sleepiness. If you struggle with compulsive shopping, gambling, or binge eating there is also a risk that medication for RLS could make these problems worse.

Before using medication for the treatment of restless legs syndrome (RLS)

Have you…

• given self-help a fair shot with non-medication treatments?
• considered how medication side effects may impact your life?
• weighed the pros and cons of medication vs. lifestyle changes?
• talked to your doctor about existing health conditions and drugs you’re taking?

Parkinson’s medication for restless legs syndrome (RLS):

The US Food and Drug Administration (FDA) has approved three Parkinson's medications for the treatment of restless legs syndrome, with the latest addition, the dermal patch Neupro, approved in April, 2012. The three are:

•  Pramipexole (Mirapex)
•  Ropinirole (Requip)
•  Rotigotine Transdermal System (Neupro)

Medications Used to Treat Restless Legs

Other Parkinson’s drugs that are sometimes used to treat RLS include Sinemet (carbidopa/levodopa), cabergoline and pergolide. Side effects of Parkinson's medications for restless legs syndrome include nausea, lightheadedness, fatigue, and an increased risk of heart disease.

Help Guide's Other common medications for restless legs syndrome (RLS):

• Prescription painkillers (such as codeine, oxycodone, Vicodin, and Percocet) can provide relief in severe, unrelenting cases of restless legs syndrome. However, prescription painkillers can be addictive. Side effects include nausea, dizziness, and constipation.
• Sleep medications and muscle relaxants (such as Ambien, Sonata, and Klonopin) can help you sleep better if the symptoms of restless legs syndrome keep you up at night. However, these medications do not eliminate the uncomfortable leg sensations and can cause daytime drowsiness.
• Anti-seizure medications (such as Neurontin, Tegretol, and Epitol) can be effective for painful daytime symptoms of restless legs syndrome. Side effects include dizziness and drowsiness.

Conclusion

 

As you can see, there are several ways one can go about in treating restless legs. In my opinion, the most important step one should first take is to determine why they are getting restless legs. Ask yourself if you were experiencing restless legs before, during, and after your use of opiates or rather did they appear right after you began detoxing and withdrawing off opiates. One must determine whether it is the detoxing off of opiates that is causing the restless legs or is it perhaps an underlying condition or symptom of one?

 

It may also be a good idea to get a lab blood test done as deficiencies in certain vitamins or minerals such as Iron can also cause restless legs. The lab blood tests are pretty easy to get done and can tell you and your doctor a lot about what is going on inside your body.

 

In my experience, I have used hot baths, stretching, moderate exercise, and the medication Requip (Ropinirole) to treat bouts of restless legs. Overall, these have provided me with moderate relief but are defiantly not miracle drugs or techniques. I have yet to withdraw and experience withdrawal since being on Suboxone so I can't speak much about how effective the Requip medication is in treating restless legs from opiate withdrawal. As I stated earlier, I actually have Restless Leg Syndrome and can honestly say the Requip has been effective in treating the restless legs but as most of you, opiate withdrawal is an entirely different beast so its effectiveness for this kind of situation remains to be seen.

 

My best advice is to talk with your doctor about what your options are for treating this dreadful withdrawal symptom. Your doctor might be able to prescribe you with something or possibly recommend some things, such as a change in diet, that can help your particular situation and needs.

 

As always Guys, thanks for taking the time to read and participate in my blog. Feel free to leave any comments in the comment section about your experiences with restless legs and what helps/doesn't help in treating this symptom of opiate withdrawal. I look forward to hearing from you guys in the comment section and remember to keep seeing the light!

 

Take Care,

 

Seeingthelight

The Ultimate Surival Kite For Opiate Withdrawal

Introduction

Hi Guys, hope all is well on the other side of the computer screen. I welcome both new and returning visitors to my blog about opiate addiction. For this post,  I would like to provide you guys with a list of items that can help provide some relief for those experiencing opiate withdrawal. As most of you already know, opiate withdrawal can be a true pain in the ass and is for many, one of the hardest and most difficult times of one's life. I call this list the ultimate survival kit for opiate withdrawal and hope that it can help you guys during such a challenging time.

For this list, I will provide you guys with a list of over the counter medications, prescription medications, coping techniques, and other tips or activities that can help make withdrawal a little more bearable. With the exception of Loperamide, a relatively weak opioid, I will be excluding any opiates or opioids from my list as well as any drugs that can be used for opiate replacement therapy (ex. Suboxone or Methadone). In other words, the items on this list are things that will not simply mask or prolong opiate withdrawal but rather help provide relief for withdrawal without the aid of opiates through other means.

What Are Opiate Withdrawals and Why Do We Get Them?

 

Opiate withdrawal occurs when a person continues to use an opiate(s) over a prolonged period of time and than suddenly stops taking the opiate(s). The amount of time it takes for one to become addicted to or dependent upon an opiate varies from person to person and also depends on a variety of factors such as the amount of the drug taken, the length of time the drug is taken, the kind of drug being taken, along with other factors. These factors can also determine the severity of the withdrawals as well. Some people may become addicted to a drug after a few weeks of continued use while for others, it may take longer to develop a dependency or addiction. The general rule of thumb for most opiates is that anything over 2 weeks of continued use greatly increases the risk of developing a dependency or addiction to the drug. Everyone experiences their own set of withdrawal symptoms with some feeling worse than others. Misusing, taking more than prescribed, and abusing opiates in comparison to taking them as prescribed by a doctor under their supervision can also increase the chances of becoming addicted or dependent upon the opiate. 

 

It is also important to note the difference between being physically addicted to something and physiologically addicted to something. Being addicted physically means you will actually feel a variety of symptoms if you stop taking the drug after continued use. These symptoms include things such as aches, chills, cold sweats, restless legs, and such. The physiological aspects deals with the cravings and urges to use the drug you may begin to develop after continued use of the drug. While it may take several weeks to become physically addicted to something, becoming addicted to something physiologically may happen much quicker. Again this varies from person to person along with other factors so there really isn't a definite answer as to how much of or how long we must take something to become addicted to it.

 

Some common symptoms of opiate withdrawal include any of the following:

 

• Stomach Aches/Pains
• Diarrhea
• Restlessness
• Restless Legs/Limbs
• Cold Chills/Goosebumps
• Cold Sweats
• Joint and Muscle Aches/Pains
• Runny Nose
• Watery Eyes
• Difficulty Sleeping
• Anxiety
• Depression
• Frequent Yawning
• Agitation
• Lack of Appetite
• Tremors
• Flu-Like Symptoms

As you can see and may already know from experience, opiate withdrawal can be one hell of a time. Most people who experience opiate withdrawal will experience several of these symptoms while their bodies withdraw, detox, adjust, and heal from the continued use of a opiate(s). The length of time one experiences these symptoms also varies depending upon the drug, person, and other factors. Some drugs like Oxycodone and heroin usually result in about 7-10 days of physical withdrawal symptoms. Others like Suboxone and Methadone result in physical withdrawal symptoms lasting between 10-30 days, sometimes longer (especially in the case of Methadone withdrawal). These physical withdrawal symptoms are usually accompanied with and/or followed by physiological symptoms such as anxiety, depression, boredom, and dysphoria. A common term used to describe these physiological symptoms is the term PAWS, which stands for Post Acute Withdrawal Symptoms. PAWS can often be the most difficult part of opiate withdrawal and recovery as these symptoms can last several months or even years in some extreme cases. This is where the saying "Getting clean is easy. Staying clean is the hard part."

 

The body withdraws from opiates after continued use due to the fact that the brain and body eventually begins looking for and craving the drug. When we put opiates in our bodies, the reward system in our brains receive and send positive signals throughout the body. I have used this example before so please excuse me if you have already heard it before in my blog. Take for example, a dog owner trying to train his dog how to sit on command. The owner will command the dog to sit and will reward the animal with praise, encouragement, or treats each time it successfully sits on command. The dog eventually learns that each time it sits on command, it will be rewarded with something positive such as a treat or words of praise. This is the reward system in the dog's brain working, which we as humans have as well. Well, when we put opiates in our bodies, our brains over time begin to see these drugs as something that will lead to a positive reward. This results in the brain releasing endorphins, which are neurotransmitters in our bodies that lead to feelings of wellness, happiness, success, and the like. To make matters worse, opiates have a very powerful effect and impact on the human brain and its reward system, which can eventually result in the brain depending upon opiates to create and provide the body with endorphins instead of creating them naturally. Rather than creating natural endorphins through say, running or exercising (a "runner's high"), our brain sees opiates as a more powerful and easier means of creating endorphins, albeit unnatural ones.

 

When we use opiates for a long period of time and become dependent upon or addicted to them, our brain then struggles to know how to make its own endorphins naturally without the presence of opiates. Our minds and bodies now depend on the opiates to create endorphins that lead to a sense of wellbeing, enjoyment, happiness, and a feeling of being content and satisfied. Once we stop taking the opiates, our brains become confused as to why it is no longer being rewarding and struggles to remember how to make endorphins naturally, leading the mind and body to go into a state of confusion. Our bodies then react negatively ultimately resulting in opiate withdrawal. Learning how to once again create endorphins naturally is often one of the hardest parts of recovering from opiate addiction, which is why it is not uncommon for former addicts to feel depressed, tired, or anxious for a period of time after they stop taking opiates. This is where the saying "It gets better over time" comes into play and why many in the addiction community recommend finding new hobbies, exercising, and talking with people such as family, friends, counselors, doctors, psychologists, therapists, and other addicts in recovery.  

I have previously written a few posts that discuss these matters in a little more detail that some may find to be beneficial to read in addition to this article. For those who are interested in reading these posts, feel free to click on any of the links below to check them out.

Addiction and Our Bodies

Why We Got Addicted To Opiates

The Power of AA/NA Meetings

The Dreaded Withdrawals
 

The List

 

I have developed and created this list through my own personal experiences, talking with other opiate addicts along with my addiction counselor and doctor, and through researching the matter and talking with others about it online. There are a lot of helpful websites out there filled with hundreds of other opiate addicts and specialists helping one another. Try doing a quick Google search with a topic your interested in and you'll be surprised by how many results that will come up and how many others are in the same boat as yourself. Some of the items on this list actually come from the Thomas Recipe, which is list of items and tips that can help provide relief during opiate withdrawal. The link to the Thomas Recipe can be found by clicking Here.

 

 

Over the Counter (OTC) and Easily Accessible Products:

 



Benadryl, Unisom, Sominex, Tylenol PM (Diphenhydramine): Benadryl or any other OTC product containing Diphenhydramine can be helpful during opiate withdrawal as it can provide relief for a runny nose, teary eyes, and for some, sleep. Diphenhydramine is known for having a sedative effect which is why it can help some with sleep. However, beware that Diphenhydramine can cause restlessness in some people (myself included) possibly resulting in you tossing and turning all night from restless legs and an overall sense of restlessness rather than being able to fall asleep. I personally prefer Tylenol PM as it has a sedative effect and can also help with the sore joints and muscle aches. Be careful not to overdo it and take too much of any of these brands as too much can lead to restlessness, hallucinations, and even death.

 

Dramamine, Driminate, Gravol, Gravamin (Dimenhydrinate): Dramamine is a medication I prefer to use during opiate withdrawal as it helps with a few things. First, the Dimenhydrinate in Dramamine has a sedative effect similar to Diphenhydramine which can help with insomnia that so often accompanies opiate withdrawal. However beware that like Diphenhydramine, Dimenhydrinate can also cause a sense of restlessness for some and in larger doses can lead to hallucinations, illness, or death. This drug also helps with stomach cramps/pains and nausea although it provides little relief for diarrhea.

Dramamine Tablets

 

Tylenol (Acetaminophen), Aleve (Naproxen), Advil (Ibuprofen): These medications are useful for providing relief with the body and muscle aches/pains that are often present during opiate withdrawal. Some of these brand name medications can also reduce fevers that can sometimes occur during opiate withdrawal. Every person reacts differently to these drugs and have their own opinions/favorite so there really isn't a universal one to chose from this group. I have actually found Advil and Tylenol to be quite helpful with the muscle and body aches/pains during opiate withdrawal. Again use caution with dosing as too much can lead to organ damage or death and be sure to use only one of these products rather than a combination of them.

 

Imodium, Lopex, Fortasec, Lopedium, Pepto Diarrhea Control  (Loperamide): These medications will help with diarrhea and stomach cramping/pains. I have no experience with any of these medications but it appears Imodium is a favorite among opiate addicts as I have heard from others and read this numerous times. Loperamide is actually an opioid drug and some claim that when taken in higher doses, it can help with some of the other symptoms of opiate withdrawals due to it being an opioid. Please be cautious with this medication like any other and talk it over with your doctor as it can be just as dangerous as the others when taken in high enough doses. Because Loperamide is an opioid, there is also a risk for dependency and the drug can cause minor withdrawal symptoms when discontinued after being taken regularly for a period of time so please keep this in mind and to try to use this medication only when needed. It seems that this is a great medication to use during opiate withdrawal if used cautiously and correctly as it has garnered much praise and recommendation from other addicts and members of the addiction community.  

 

Imodium (Loperamide) Tablets

 

L-Tyrosine: L-Tyrosine is amino acid that is said to help provide relief for stress and for helping with mood swings during opiate withdrawal. I have no experience with this drug but it is commonly recommended by addicts with many saying it helps with mood and energy. This drug can be found at most pharmacies, food stores, and vitamin/supplement stores.

 

Vitamin B6: This vitamin is said to help with mood, fatigue, diarrhea, and stomach cramping. Once again, I have no experience with this vitamin but it is often recommended by other addicts or members of the addiction community for providing relief during opiate withdrawal.

 

Multivitamin: A multivitamin is important to take during opiate withdrawal for several reasons. The first reason being that most of us have little to no appetite during withdrawal so it is important we find some way to get our needed vitamins and nutrition. A multivitamin is something good to take not only during withdrawal but on an everyday basis before, during, and after withdrawal as well. In addition to providing nutritional value, some vitamins and minerals are said to help with a variety of symptoms during opiate withdrawal so it certainly can't hurt to take. It is important to remember that with vitamins and minerals, taking more does not result in better results as once the required amount is ingested by the body, the extra or leftover vitamins and minerals are simply passed through the body. In my experience, I have noticed virtually no difference from taking a multivitamin during withdrawal but I was also taking one daily before and after my experiences with withdrawal. I believe the benefits of taking a multivitamin can be difficult to physically see and determine despite doing the multivitamin doing its job. I prefer using the Men's One A Day multivitamin chewable tablets.

 

Valerian Root: Valerian Root is a herbal medicine that can be found at most pharmacies and vitamin/supplement stores. This herb can be found in capsules that can be taken orally or as powder-like substance that can be made into a tea. It is said to help with anxiety, restlessness and sleep as it has a sedative and calming effect on some. I have taken Valerian root capsules before and can say it did help a little bit but was nothing too dramatic or extreme. Everyone is different though so it might do wonders for some and absolutely nothing for others. These capsules can run on the expensive side as well and people with heart problems should use caution when taking Valerian Root. I decided to include this herbal medicine on my list as it is something that often comes up on several similar lists for dealing with opiate withdrawal but in my opinion, it is probably something you could get away with not taking.

Valerian Root Extract Capsules 

 

Supplemental Drinks such as Ensure: These drinks often provide a variety of vitamins, minerals, amino acids, proteins, fats, carbs, and calories that we usually struggle to obtain during opiate withdrawal. It is not uncommon for someone to lose some weight during opiate withdrawal so it is important we make sure we are getting good nutrition during this difficult time. Plus, providing your body with the right nutrients will only help with the recovery process as withdrawal can certainly take its toll on the mind and body. Your body will most likely feel weak and tired at times during withdrawal so it is important you are eating and drinking the right things during this time. The combination of a lack of appetite, ability to keep foods down, and possible bouts of  diarrhea can lead to weakness and dehydration.

Ensure Supplemental Drink

 

Melatonin: Melatonin is a naturally occurring compound in our bodies that help regulate sleep. It is hormone that regulates our sleep schedule and cycle. This compound also comes in the form of a supplement that is taken a few hours before bedtime each night. It is important to note that this supplement takes time to work and build up in the body (usually a couple of weeks) so it is important you begin taking it before you start your detox if you do decide to use a Melatonin supplement. I have tried Melatonin before and it did little to help with achieving sleep but there are many people, including my own family and friends, who swear by it. Melatonin is a relatively safe and cost effective supplement which is an added plus.

 

Melatonin Capsules

 

Kava/Kava-Kava: Kava, sometimes called Kava-Kava, is a plant that is said to have a sedative and calming effect that can help with anxiety. There are a lot of herbal supplements and such that are said to provide relief for insomnia and anxiety with varying degrees of success and effectiveness so keep in mind that what works for one person might not work for another. I have no experience with Kava myself.

 

St. Johns Wort: St. Johns Wort is a herbal medicine that is said to be helpful in treating insomnia, restlessness, anxiety, and depression. I have no experience with this herbal medicine but have seen it mentioned several times on online forums regarding medications or products that provide relief for opiate withdrawal. You'll most likely have to experiment a little bit with herbal medicines such as St. Johns Wort, Kava, and Valerian Root before you find one that works for you. It might be a good idea to give these herbal remedies a try before you actually go head to head with opiate withdrawal to see what works and what doesn't work. Be sure to talk with your doctor before trying any of these herbal medicines and make sure to not mix them with one another or other drugs without your doctor's approval. Remember, just because they are natural remedies doesn't necessary mean they are any safer or more effective than other medications.

St. John's Wort Extract Capsules

 

Hylands Restful Legs: Hylands Restful Legs is an over the counter medication that is said to provide relief for restless legs, tingling feelings in the legs, and minor aches/pains in the legs. It comes in two different forms of a pill; one that can be taken orally and another that is taken sublingually (dissolved under the tongue). I have tried this medication myself and found it to be ineffective but there are numerous positive reviews about the product online. So many in fact, that I was shocked by how ineffective it was for me. Like I always say, to each his own.

Hylands Restful Legs Sublingual Tablets

 

Potassium and Zinc Supplements: Potassium is a chemical element while Zinc is mineral. Both of these are said to help with restless legs, which for many is one of the worst symptoms imaginable of opiate withdrawal. I have used a Potassium supplement before and found it to be only moderately effective. Restless legs can sometimes be caused, among other things, by neurological damage or low potassium, zinc, or iron levels so if you are someone who regularly experiences bouts of restless legs regardless of whether you are in withdrawal or not, a visit to your doctor and a blood test at the lab might prove beneficial in determining the cause of the restless legs.

 

Caffeine/Energy Supplement: I have found that having a cup of coffee in the morning helps warm me up a little bit from the chills while providing me with a little jolt of energy to make it out of bed. Getting out of bed in the morning during opiate withdrawal can sadly be a painstakingly and difficult task so doing something simple yet motivating like making a cup of coffee and watching the news, surfing the web, or reading the newspaper can make getting up and out of bed a little easier. I wouldn't recommend drinking or ingesting any caffeine or energy drinks/supplements past noon and to try to take as little as possible as it may affect your sleep and lead to restlessness. Decaffeinated tea might be a good choice to drink throughout the day and night to help provide one with sense of warmth and something that is easy to get down.

 

Prescription Medications:

 

Clonidine: Clonidine is a medication that is used to treat high blood pressure but has also found its niche in the addiction community. This medication is used to help treat not only the high blood pressure that can appear during opiate withdrawal but also with other symptoms such as cold sweats, chills, anxiety, restlessness, and sleep. This medication can have a sedative effect so be careful driving on, working on, or taking it during the daytime. I have used this medication (.2 mg at night) and have found it to help with sleep, anxiety, and restlessness. It isn't a miracle drug but it does help in my opinion and there is a reason that it is often the first line of defense for a medication during detoxes and rehabs. It is usually pretty easy to obtain a prescription for Clonidine if you are honest with your doctor about your addiction or if you go to an ER explaining to them you are in opiate withdrawal. Clonidine should be tapered off of as it can lead to rebound hypertension (high blood pressure) when stopped suddenly after continued use. It is important that whomever is prescribing you this medication is aware of any health issues you may have, especially those concerning the heart.

 

Requip, Ropark, Adartrel (Ropinirole): Ropinirole is a dopamine agonist medication that was originally used to treat Parkinson's Disease. More recently, it has been used to treat Restless Leg Syndrome (RLS) and has been met with mostly positive reviews. I am currently using this medication for treatment of RLS and have experienced only moderate success. In my experience, it defiantly helps if you have RLS regardless of your addiction to opiates but when your going through RLS as a result of opiate withdrawal, it seems to only provide moderate relief. Experiencing restless legs is for many one of the most dreaded and uncomfortable symptoms of opiate withdrawal so having a prescription to Ropinirole isn't a bad idea.  

 

Man, I love Restless Legs...

 

Valium (Diazepam), Xanax (Alprazolam), Ativan (Lorazepam), Klonopin (Clonazepam): These drugs are all classified as Benzodiazepines. Benzodiazepines are used to help provide relief from insomnia, anxiety, restlessness, and muscle spasms/cramping. Benzodiazepines can be extremely helpful during opiate withdrawal but there are also several risks one must be aware of and consider before taking any of these medications. These medications can be dangerous if abused or used with any other medications/drugs that can result in illness or even death, so please be careful and talk with your doctor about your plan and any other medications, supplements, vitamins, or drugs you are using. Benzodiazepines can also be habit forming so it is important to plan on taking these medications for only a short period with the possibility of having to taper off them. Withdrawal from Benzodiazepines is said to be even worse and more dangerous than withdrawal from opiates so again, use caution. I  have no experience with Benzodiazepines but have talked with several addicts as well as reading online that Benzodiazepines can really make withdrawal more bearable especially with the anxiety and sleep issues. At the end of the day, remember these are a pretty powerful classification of drugs so it is critical you speak often and honestly with your doctor if you plan on using any kind of Benzodiazepine. Your best bet is probably to try to avoid these medications if possible but I know that is easier said than done when you have been up for 48 hours straight, freezing and sweating at the same time, and have been unable to sit, lay, or stand in a comfortable position for more than 30 seconds.

 

Trazodone: Trazodone is an antidepressant that can be helpful in providing relief for depression, anxiety, and insomnia from opiate withdrawal. This medication is usually safer in comparison to a Benzodiazepine as it is less habit forming and has less negative side effects. It is however weaker than most Benzodiazepines so don't expect to have anywhere near the same results. However, I currently take Trazodone and must say it does help with getting to sleep although I have never taken it during opiate withdrawal, instead taking it as needed for sleep during my time on Suboxone.

 

Ambien (Zolpidem): Ambien is a medication that is used to help treat insomnia. I have some experience with this medication and have found it to be effective in getting one to fall asleep, more so than Trazodone. While taking Ambien for a prolonged period of time won't lead to the same withdrawal symptoms one would normally feel from an opiate or Benzodiazepine, it does still carry the risk of dependency as some users have stated they experience anxiety, restlessness, and difficulty in falling or staying asleep after discontinuing Ambien suddenly, thus a taper may be necessary to come off this medication. Some people experience hallucinations, vivid dreams or nightmares, and sleepwalking on Ambien so it is important that you, if possible, have someone with you during your first couple of nights on this medication in addition to speaking with your doctor about the risks and benefits of Ambien.

 

Other Tips/Tools:

 

Hot Baths/Jacuzzi/Hot Tub

Reading Material

Movies or Video Games

Computer/Laptop with Internet

Heated Blanket

Comfy Bed or Couch

Comfy, Loose Clothing

Fan or Air Conditioner

Music

Time Off From School, Work, or Other Duties/Responsibilities If Possible

Strong Support Network of Doctors, Counselors, Friends, and Family

Go For Short Walks or Jogs
Exercise Lightly Whenever Possible

Drink Plenty of Fluids and Eat as Healthy as Possible

 

Conclusion

 

Alright Guys, that's everything I could think of for my list of things that can make opiate withdrawal a little more bearable. One thing that I cannot stress enough is to please talk openly and honestly with your doctor and support network before using or combing any of these medications (even the OTC ones). Some of these medications can have negative consequences when mixed with one another or with drugs. The Benzodiazepines can especially be habit forming or addicting so please use caution with these as you don't want to switch one addiction for another. Ask yourself if you think you can take a medication such as a Benzodiazepine responsibly for a short period of time without becoming addicted to it or abusing it. Benzodiazepines can be extremely dangerous to mix with other drugs, especially opiates so again, please, please, please talk all this over with your doctor. Better to be safe than sorry!

 

I also want to note that I am not encouraging you guys to use all these drugs. Some of these medications accomplish and provide relief for the same symptoms so you DO NOT need to use them all. I wanted to give you guys a few options as I know some medications work better than others for some people or that some may have allergies or bad reactions to certain medications. Once again, talk with your doctor(s) and support network in addition to doing your own research before putting any of these medications into your body.

 

 

At the end of the day, I think withdrawal for most will still suck to some degree with or without these medications. They may, however, be able to provide some relief or minimize some withdrawals. Just don't go into it expecting everything will be fine and dandy because this period of our lives will most likely be one of the most difficult. I'm not trying to scare anyone, I just want to be real with you guys. Some people feel worse during withdrawal than others while some feel as if they just have a nagging cold. If your like me, withdrawal feels like Hell on Earth. Its the price we must pay in the end for abusing these opiates to get high I guess. May god have mercy on us!

 

Based on what I have read and heard, a lot of people seem to say that it is important to remain active and busy during withdrawal. Now, I'm not suggesting you go out and work a 40 hour week or run a marathon. Rather, I'm saying you should do things such as going for walks/jogs, seeing a movie, doing some easy yard or house work, spending a day at the beach, and things like that. In other words, don't just sit in bed all day thinking about how bad you currently feel. It may seem like the easiest thing to do but in reality, it probably just makes things worse as all you will think about is how bad you feel and how easy it would be to use again to feel "normal". I would defiantly recommend taking some time off from work or school if possible as I think it will be really difficult to concentrate and have the energy during this difficult time but everyone is different. Some people may find school or work keeps them busy and their minds off withdrawal so you guys know your bodies and yourselves better than me.

 

How most of us feel during opiate withdrawal

 

As I mentioned in my previous posts, I will soon be coming face to face with Suboxone withdrawal in the near future. I am currently taking .75 mg a day and know I will one day have to experience life without Suboxone or any opiate for that matter. To be honest with you guys, it is something I am truly scared of. I absolutely hate and fear withdrawals! But that's just part of life and something I have to deal with and accept. I have experienced withdrawal several times going cold turkey from Oxycodone and know it isn't fun. Hopefully, the combination of some of these medications, the skills and coping mechanisms I have learned over the past year, and the help of my support network will be enough for me to reach my goal of sobriety and life without pills.

 

I would like to thank you guys for reading my post and I hope this list is helpful to some of you guys. If any of you guys have any questions, comments, or suggestions please feel free to put them in the comment section. I always enjoy and appreciate the advice of other opiate addicts.

 

Take Care Guys and remember to keep seeing that light.

 

-Seeingthelight