I am often told by opiate addicts that they would kill themselves rather than go through withdrawal again.  I assume  that the comments are  exaggerations to make a point.   But a recent nightmare helped me realize that the comments are not hyperbole– but rather are serious attempts by addicts to describe just how horrible their experiences were.  I remember my own detox only when I force myself to remember it (0r after the occasional bad dream);  I have a tendency to repress the memory, perhaps as people do with traumatic memories.  But when I really think about my experience during those 5-7 days at the end of that horrible hall in that horrible ward, I cannot imagine going through the experience again, for any reason.  I hate to say it as a psychiatrist who knows the damage done to the survivors of suicide, but I understand the logic of choosing death instead. 

The loneliness is the worst part

When I discuss addiction and detox with other doctors, one frustration is that there are no words to express the horror of severe withdrawal.  (The other frustration, by the way, is that few doctors seem interested in knowing about the experience– but I’m not going to fix that problem with my blog!)  Opiate withdrawal is not a matter of physical pain, although physical pain is surely a part of the experience.  The term  ‘depression’ likewise do not capture the experience.  Nobody has the energy or wherewithall to write during the experience, and so it is unlikely that we will read a great description recorded in ‘real time’.  But when I meditate on the experience in order to improve my memory, I am struck by the utter despair, the self loathing, the hopelessness, and the complete isolation that I felt during detox.  I remember thoughts of being ‘cursed’, or of being possessed by demons of death– I felt as if the world I had known was long gone, and I was left alone with demons.  I had no vision of hope for the future.  I remember trying to take my mind off of the horrible thoughts by directing my attention on the clock, which seemed to move backwards, it was going so slow.
I am writing this somewhat self-effacing description of the experience because of a thread in SuboxForum earlier today, from a woman who was trying to make it through 24 hours in order to get induced with buprenorphine.  She was asking whether she could use anything to help her make it, such as tylenol, ibuprofen, or the Xanax that she has been prescribed for the past year.  For the record, yes– you CAN take all of those things.  In fact, ideally a person going through the 24 hours of hell will be given sedatives, clonidine, anti-emetics, and anti-diarrheals to make the process a little more bearable. 
For any doctors who are reading this and thinking that doing so is a waste of time, or who takes refuge in saying ‘I don’t know the person well enough to prescribe those things,’ shame on you– because withdrawal really, really stinks.   To the writer on the forum this morning, I hope you made it.  If not, don’t give up.  It is hard to see in the middle of all that horror, but it will be worth it.


skelley · May 11, 2010 at 11:47 pm

So as a beginner on suboxone I should get tough out of the gate, or is there a reason to get your celing levels right initially? 2 weeks plus a couple of days now from 4 yrs of 30-40 mg of methadone a day. Is there any one out there that had a reasonably withdrawal from the suboxone? That is why I opted to take it. I’m only taking 8 mgs a day. I feel rough, & doing life is a struggle. Am I just prolonging the inevitable? Oh & if I don’t take more will my celing level lower & if so how long could it take? I just want help through the transition. I’m not looking to get on another long term medication. I’m cool with those that are.

johnbeatingopioids · June 14, 2010 at 3:26 am

Dear SuboxDoc, I`ll make it to the point.Im bipolar from birth.Both parents alcoholics n drug addicts.I was abused in sick ways.I had many EXCUSES to numb up with any n all drugs.Which I did w/no regard to my life.When i found heroin i soon injected n i found what i always wanted.A longlasting buzz.It killed my pain n made me feel invincible.I had a shoulder repair n got dilaudid take home.Years later im hopelessly hooked(for14yrs).When i had no real medical reason for a script i cut my skin open and put foriegn bodies inside resultin in over 9 mrsa infections,vre, and worst septic and flesh eatin disease.But i had my pills.I recently found suboxone and clean now for 5 weeks w/no desire to use ANY drugs.My life reflects a new man.If all docs cant get on board with treatment modalities (yes even med assisted) rather than intolerance and ignorance Sad! What about hippocratic oaths? My last dr wouldnt even refer me to treatment after asking many times.My faith was lost in dr`s.How can i help to educate dr`s?

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