Guide to Withdrawals

In order to experience the symptoms of withdrawal, one must have first developed a physical or mental dependence or addiction. The route of administration, whether intravenous, intramuscular, oral or otherwise, can also play a role in determining the severity of withdrawal symptoms. Symptoms of withdrawal may include, but are not limited to: anxiety, irritability, intense cravings, nausea, hallucinations, headaches, cold sweats and tremors - these will differ depending on substance from which one is withdrawing. Depending on the length of time a drug takes to leave the bloodstream (elimination half-life), withdrawal symptoms can appear within a few hours to several days after discontinuation and may also occur in the form of cravings. Addiction is a psychological compulsion to use a drug despite harm that often persists long after all physical withdrawal symptoms have abated. On the other hand, the mere presence of even profound physical dependence does not necessarily denote addiction, e.g., in a patient using large doses of opioids to control chronic pain under medical supervision.

Mental/Psychological Dependence - A “need” for a particular substance because it causes an enjoyable mental reaction.

Physical Dependence - A craving for one or multiple substance(s).

Opioids

Length

Physical Symptoms

Worst is usually over within 3-5 days (except for long half life such as Methadone/Suboxone, which can last much much longer)

PAWS (Post-acute withdrawal symptoms)

Can last anywhere from a month to years after last dosing.

Symptoms

Mental Symptoms

Anxiety, Panic Attacks, Cravings, Depression (that could escalate to suicide ideation), Dysphoria, Agitated, Irritability, Memory problems, Mood Swings, Paranoia.

Physical Symptoms

Deep bone/Joint/Muscle pain, Chills, Cramps, Diarrhea, Insomnia, Dizziness, Flu-Like Symptoms, Headaches, Nausea, Sweating, Tachycardia, Tremors, Vomiting, Weakness.

Treatment

OTC Medications

Loperimide (Immodium)

A rather powerful opioid that doesn't pass the BBB by itself. Only acts on your peripheral nervous system and not on CNS activity. Extremely helpful in limiting Diarrhea and related problems.

Naproxen (Aleve)

Is a NSAID that works as a pain killer which can help treat muscle tension caused by withdrawal. Ibuprofin and Asprin are other drugs in this category which could be used instead. These substances should not be used beyond the recommended dosage as they can cause intestinal bleeding and the likes.

Dextromethorphan (DXM)

Has light opioid action and can help reduce symptoms but is not active enough to fully taper with. More commonly used to potentiate other opiates and preventing tolerance (Like most NMDA antagonists) In higher doses acts as a dissociative that people can experience in it's own recreational use and some may find that it helps.

Diphenhydramine (Benedryl)

Is an antihistamine that is used to treat allergies, also used off label as a sleeping aid, and up to about 100mg’s will help you get to sleep. Taking too much acts as a deliriant and there is nearly no reason to go much beyond the recommended dosage. Some other antihistamines, including Promethazine and Diphenhydrate, will also help.

Prescription Medications

The OTC drugs listed above indeed help with some symptoms, but there are much more potent prescription drugs which are considered preferable; if you can get them.

Benzodiazepines (Diazepam, Alprazolam, Triazolam etc.)

Benzodiazepines the most strived out of these. Which could focus on/be a combination of sedative, hypnotic, anxiolytic (anti-anxiety) and muscle relaxant. Can help with a lot of mental aspect on the withdrawal. But are addicting in their own right, so take with caution.

Muscle Relaxants (Carisoprodol, Cyclbenaprine)

Muscle tension and stress.

Alpha Blockers (Clonidine)

Lowers blood pressure and limits hot/cold flashes, and seems to eliminate some if not most of the mental withdrawals.

Beta Blockers (Propranolol)

Lowers heart rate and blood pressure.

Caffeine and Nicotine

Just stop. You'll live.