Heroin Withdrawal: How to Beat the Itch
There's heroin withdrawal, and then there's heroin withdrawal.
When it comes to drying out, everyone's experience is different. Varying metabolisms, pain tolerances, underlying health conditions, and of course, the amount and length of time an addict has been using, can lead to drastic fluctuations when comparing one withdrawal process with another. There is no right or wrong way of how to feel when drying out, no set in stone formula to follow, and, other than avoiding the drug altogether, there is definitely no rules or guidelines to abide by. It's an improvisational process; trial and error, until you get to know your body's capabilities of handling extreme punishment.
And that's exactly what it is; punishment. No reward worth capturing is earned for free, one must run an intense gauntlet of pain, endurance, sacrifice, and in the end, only then may he or she lay claim to the ultimate prize. Successfully making it through the withdrawal process intact and clean and sober, to me, is absolutely the ultimate prize. And like any sport or conquest, success rarely comes with the first try. My victory came on lucky attempt number thirteen. Talk about practice makes perfect.
People often talk about rock bottom, and depending on who you are, the bottom can mean anything. It's indefinable, intangible in its present tense, only given purpose and meaning in hindsight. Rock bottom has turned over many new leaves; it's almost as if one must headbutt the burning coals of hell before one can start living and breathing without society's toxicities poisoning the soul. My rock bottom wasn't a prolonged length of time like so many are, and for that I guess I'm grateful. Rather, it was a compressed incident, highly acute and with twenty years of drug abuse, dead emotion, denial and self-loathing, all boiling over within a ten minute period in the most intense concentration of negativity imaginable.
I had decided to make the jump from the Methadone program to another source of harm reduction that my doctor described as a more pleasant, gentler and less addictive experience; Suboxone. Methadone just wasn't working; all it did was add a warm glow to my opiate addiction. Suboxone, supposedly, would be different; better.
After so many agonising withdrawals, each bout more intense than the last, I had had enough. I was beaten. Heroin had won. But to jump from one program to the other, meant that for my own benefit, I needed a gap of 48 hours between my final Methadone dose, and my initial hit of Suboxone. That meant 24 hours of onset withdrawal. Fuck that! So, I lied to my doctor. The day I saw him to pick up my first Suboxone script, I told him that I had skipped my Methadone dose for the past two days and had not used any heroin for 36 hours, and therefore could go straight onto the Suboxone program. What an idiotic move that was.
My doctor was a great guy. He was one of those rare breeds of doctors that would always go the extra mile for his patients. I trusted him, and in turn, he trusted me. That trust made it very easy for me to lie to him. As long as I looked semi-decent, acted lucid and coherent, and wasn't sickly pale, he would believe me. Prior to seeing him, I splashed my face with cold water to fire me up, pinched my cheeks until they were a flushed rosy red, and took half a dozen pseudoephedrine tablets to enlarge my pinprick pupils. I had the act down; this was Academy Award winning stuff.
Of course, ten minutes before all of this, I had shot up behind the commission high-rises across the road from the surgery. But that mattered little. I had every base covered, and in his office, I turned it on. I sat restlessly, even though internally, I was perfectly calm. I fidgeted, twitched my legs, blinked excessively when he wasn't looking so my eyes would water, fake yawned, coughed; every single early onset of withdrawal symptom I could think of, I acted on. I even rushed off to the toilet twice during the consultation, pretending I had diarrhoea. He was convinced; hook, line and sinker.
In the back of my mind, I knew that jumping straight onto Suboxone was a serious risk. Doing so would put me into immediate withdrawal if I wasn't careful. Even though I still had some smack on me, I had to stop using there and then. Yeah, right.
Unable to sleep that night, I used several more times. After so many years of abuse, by now, the heroin wasn't even touching the sides. Vein after vein had collapsed over recent months, the money was drying up, I'd left my job and was fast running out of options. In my mind, I was determined; after tonight, I would never use again.
The next morning, I took that long uphill walk to the chemist, feeling shitty, but still determined not to use. The Suboxone should take the edge off. I thought I'd be fine. I was kind of relieved, as the sublingual tablet was supposed to be the best of both worlds; as it's an opioid, the daily high is still assured, but, it also contains Naloxone, which is a partial agonist. This means that the Naloxone, in part, latches onto the brain's opioid receptors, blocking out the potential to receive large amounts of any opioid based drug, other than the one it's mixed with. The problem is, in the process, the agonist kicks any residual traces of opioid off the receptors, hence the recommended cautious approach and necessary slight withdrawal. The delivery system is both amazing and complicated.
Science is great, and scientists are brilliantly-minded people. But usually, they tend to lack the reckless abandon and street smarts that makes a heroin user tick. In their analytical minds, Suboxone's design is perfect; used properly, it's the magic cure for addiction. However, there's one crucial aspect that science hasn't realised; heroin users don't have a cautious bone in their bodies. I was no exception.
I hit the chemist at 9am; opening time. Frantically pushing past the pharmacy assistant as she opened up for the day, I raced in making sure I'd be first served, and took my seat in the usual segregation from the normal customers. The Hole, as junky visitors of that chemist liked to call it, was a tiny, soul-sucking room that was tucked away in the back corner of the chemist, out of view, with a permanently flickering fluorescent light and four walls littered with rules; Do not steal medication; Do not write on the walls; Do not abuse other customers or staff; Do not, do not do not... Basically, stereotypical propaganda designed to corral the addict into the bullring of Paraiahville. Why would I write on the walls?
With the night before's heroin still streaming through my system, I slammed down my first dose of Suboxone, and began the very short walk back to the train station to go home. With Methadone, I could always tell within seconds what sort of buzz I would get; speedy, mellow, or otherwise. But with that deep-seeded instinct, also comes the knack of knowing immediately when something is about to go horribly wrong. My worst fears were coming to fruition and there wasn't a single damn thing that I could do about it.
By the time I arrived at the train station platform, I was sweating profusely in the morning heat. I had quickly become delirious and was disoriented to the point of very nearly falling off the platform and onto the tracks. Despite the summer sun and the excessive sweating, my entire body was shivering as if I were standing naked in a blizzard. This was in Seaford; a rather horrible outer suburb of Melbourne. By the time I hit Frankston, only two stations later, I was gone. In the eyes of other commuters, I must have looked like a possessed zombie in the dramatic dying process. I staggered off the train and through the thickening crowd, staring at nothing and clutching my stomach like I had been shot. Luckily, fantastically, a dealer that I knew was standing across the road from Frankston station dishing out the last of his supply. The universe giveth.
Frenzied, I sprinted across the road into oncoming traffic and pushed past a crowd of teenagers to score whatever amount my dwindling money pile would allow. The thought of the police beat control that almost permanently pounded those pavements never even entered my mind.
My man became my god; he had a medium sized rock left with my name on it. I raced back to the train station toilets, and with shaking hands, mixed up and eventually found a vein to successfully inject into. There was absolutely no high, but the gear had just enough potency to alleviate the worst of my symptoms. From here on in, I'd be fine.
Or so I thought.
What I was suffering from is called Precipitated Withdrawals. It fucking sucks. Basically, precipitated withdrawal is when an opioid dependent person with a prolonged build-up, ingests an agonist (Naloxone), or partial agonist (Suboxone) too early, and is forced into immediate withdrawal. Usually, opiate withdrawal is a drawn-out process that comes on slowly after a few days, peaks between the one and two week mark, and gradually trickles away over the coming weeks or, depending on the person, months. Precipitated withdrawal hits within a minute and renders the addict completely unprepared and helpless.
With the brain's opioid receptors drowning in a build up of opiates, and primed for more business, the partial agonist invades the receptors and kicks the living shit out of what's built-up over the years of addiction. In my case, the heroin was completely displaced, and within minutes, Suboxone became king. I swear that I could actually feel the agonist white-knuckling my receptors, but I've been assured that that's impossible. Regardless, Suboxone latches on to your receptors like there's no tomorrow and will not let go without a serious fight. With any form of agonist in the system, heroin's wicked powers become useless. The genius of science.
But I know better than a bunch of white-coats and a highly educated pharmacology specialist with a viewing gallery of diplomas and certificates behind his desk. Right? I went home feeling slightly better after using and grinned internally at my victory over the scientific community. I'd beaten the system.
Once home, I tried to get some sleep. Sleep cures all. And sleep I did, until I was rudely awoken by a horrific pain in all my joints. I sat bolt upright and noticed that I was shivering and twitching uncontrollably in a swimming pool of my own sweat. Fuck the system, it always wins; precipitated withdrawal was here to stay. It's akin to housing an evil spirit in your soul; a hyperactive, demonic spirit that pinballs through the body in desperate search of an exit portal that simply does not exist. The sort of evil spirit that no exorcist in his or her right mind would dare challenge.
I'm a weak person; heroin made me that way. I don't tolerate pain the way that I used to. Stoicism is dead to me. I knew that there was a quick fix out there, so why put up with any discomfort? I just needed to drag myself back to life for the scoring mission and go out and get it. So I did.
As I'd deliberately deleted all of my contact's phone numbers, and was dead certain that my Frankston connection would be long gone from the train station, I had no choice but to trudge all the way to Richmond and buy from the street. Without a car, I needed to brace myself for a couple more hours of shameful agony and illness; a twenty-five minute wait for the bus, a twenty minute bus ride, a five minute wait for the train, a one hour long train ride, and finally, a fifteen minute walk up from Richmond train station up Lennox Street to the Victoria Street hotspot. In my condition, that was a marathon.
On the train, as I made my way towards what I'd hoped would be bliss, my condition worsened to the point where concerned passengers came to my aid to see if they could assist. As nicely as I possibly could, I told them all to please leave me alone and that there was nothing that they could do. They respected my request, but one lady sat behind me just in case something were to go wrong. Faith in humanity restored.
The never-ending uphill walk on Lennox Street from the station is a killer at the best of times, especially when all you want to do is shoot up. On this day, in the mid-afternoon blazing summer sun, it was brutal. I have no idea how I made it to the top. Incentive, I guess.
Scoring from Victoria street was easy enough; a couple of close calls with law enforcement, but that's nothing new. With my last fifty bucks, I got my hands on a nice, juicy, brown-tinged rock. As always, once the deal was done, I hot-footed out of the dead zone and immediately jumped on a train that was heading to Flinders Street station. I couldn't risk trying to inject in the hot spot and have the police bust me and confiscate my gear. That would end me. The Flinders Street station toilets would have to do.
On the carriage, sat opposite me, was a group of stunning looking women all dressed up for some Saturday night revelry. They were all staring at me and whispering; not in a good way, but as if I were an absolute freak. I squinted, and studied my reflection in the window with what little concentration I had left. What I saw scared me. That reflection was not me. That thing in the window was hideous! Ugly, pale to the point of transparent, and with dilated, black hole pupils. Blood squirmed under the bridge of my nose and the relentless sweat had created dozens of tiny pimples all over my face. My clothes were soaked through and I was shaking incessantly. It was gross. The days of occasionally catching the eye of a beautiful lady seemed long gone. Just a distant dream.
At Flinders Street, I barged my way up the sardine-packed escalators and desperately lunged into the men's toilets. Every single stall was occupied, so I waited. And waited. Even the drunk hobos pissing in the disgusting urinals were shaking their heads at me. Finally, a fat, equally sweaty man, exited a cubicle and I all but dove in.
As I locked the door, I slid to the floor and shook like a Parkinson's patient. As usual, but this time even more pertinent, it seemed to take an eternity to complete the mixing process. When I did, I just blindly slammed the needle into my arm, hoping to strike anything that might resemble a vein. It took six attempts. The frustration was palpable. When I finally did draw some blood, the excitement that had built up inside of me was almost uncontainable. As I pushed down on the plunger, I knew that this was it; in a few seconds, severe illness would become a euphoric ecstasy. The ultimate cure. But nothing happened. Zero.
That point of zero, that for me was rock bottom. Nothing in my life could possibly get worse than that freeze-frame of time. I felt no improvement and, if anything, I felt worse. This is no exaggeration; that feeling of zero, that point of saturation where the body reacts to nothing, that is what it feels like to be void of soul and spirit. That is what the Devil yearns for. That is death.
Immediate suicide flashed through my mind on a repeat loop, but to be honest, I just didn't have the energy. Instead, there and then, on the floor of a disgusting toilet cubicle, with a crusty needle hanging out of my scabby arm, with no soul or purpose in life whatsoever, I had a nervous breakdown and cried hysterically.
It ain't ever getting worse than that.
My narcissistic and laboured point is this:
If you are opioid dependent, and would dearly love to get clean, listen to your damn doctor. Transition properly; slowly. Patiently. Sure, it's gonna suck; you will suffer through some sickening withdrawals, but short of a full blood transfusion, there simply is no other way to do it. Do it tough; without attempting to mask the symptoms with other drugs or alcohol, trust me, you'll just end up with a list of dependencies otherwise. Besides, that won't work anyway.
If you do want to kick heroin and sign up for the Methadone or Suboxone program, that's great! Eventually, Suboxone became my friend, and it was the one and only substance that helped me clean up. Just remember, completing the program successfully takes great dedication on your part. Should you wish to remove yourself from the localised entrapment that walks hand in hand with the program, you will have to go through the withdrawal process for those drugs too. Just stick it out, do it! A few days of pain and suffering sure beats a lifetime of heroin abuse. Stand tough, face the thing head on. Heroin withdrawal won't kill you, and from the experience, you will become a much wiser and headstrong person than ever before. You'll have money again! You can wander the globe, go wherever you want! You'll be healthy! You can fuck again!
Don't let the table put you off. The half-life is only stronger in Methadone and Suboxone because that's how they are designed; to stick in your system. Without that characteristic, they would be useless. I'm living proof that at least one of them works, and despite my own personal dislike of the Methadone program, others have proven to me that it can help you get clean too. Your own personal health aside, just think of the money you'll save. In Australia, either program costs only $30 per week. Peanuts. What do you have to lose by simply giving it a trial run?
There are several things that can be put in place to help deal with the withdrawal process a little easier. A natural negativity in mindset will fight you all the way, but if you can force yourself to checklist these tasks, the time will pass quicker and you will be much better for it.
- You will suffer a serious loss of appetite, but if your body does allow you to hold down food, be sure to continue eating three meals a day. It will be difficult, but go slow, and keep your portions small so not to appear too daunting.
- Green leafy vegetables that are high in iron are an absolute must when withdrawing. Spinach, silver beet, bok choy, broccoli, brussel sprouts etc. will strengthen your immune system and help prevent any foreign illnesses from entering your bloodstream.
- Home made soups and herbal teas are a fantastic way to flush the system; the quicker you flush, the quicker you'll heal. Green tea is a great energiser, Chamomile tea is good for relaxation, and Peppermint or Lavender tea will mildly assist with joint and muscle pain. There are several herbal teas on the market that can help with insomnia; Damiana and Mugwort work okay, but if you can't get to sleep, they will at least help you to relax for a brief period.
- Take vitamin supplements in the lead up to, during, and after the withdrawal process. Vitamins B, B12, C, Iron, and an appropriate multi-vitamin are all necessities. If your bodies allows, Chlorophyll, Royal Jelly, and small amounts of Spirulina are great sources of energy and body cleansing. Remember, the vitamins and supplements must be built up in your system for when you hit withdrawal, so now is as good a time as any to start popping them. NB: If you are allergic to bees, Royal Jelly is an absolute no-no.
- Take lukewarm baths. Lots and lots of baths. The added heat and trying to lay still will drive you nuts, but your aching muscles and palpitating heart will thank you for it. Baths can help the chaos and inner turmoil of your system slow down enough to maybe allow you to sleep. Baths salts and Peppermint oil are a great additive to the bath water, and will help slow the muscle spasms and cramping for the duration of your time in the tub.
- It sounds ridiculous, but wherever you lay your head, elevate your legs and add some lavender oil to the underside of your pillow. Oils can be an amazing tool to help slow anxiety; for me, essential oils work far better than any anti-depressant I've ever had the displeasure of swallowing. The elevated legs will assist with blood flow, which in turn will speed up the metabolism. You'll want to take every possible opportunity to purge as much shit from your system, so this exercise is crucial.
- Please don't drink coffee or alcohol during the withdrawal process. Alcohol might be a temporary relief, but trust me, in a short amount of time you will feel even sicker. Coffee is worse, as it only serves to promote anxiety, and even though it does speed up the metabolism, it can do so to a dangerous point when going through withdrawals. Smoking weed can help with anxiety, and while it doesn't work for me, it does for others, and its gentle and non-addictive properties make it a perfectly legitimate tool to use when withdrawing.
- Above all else, be prepared. Set up your favourite section of the house as nurturing and comfortable as you can. Pillows, cushions, spare blankets, porn... whatever floats your boat. Set up some DVD's or Netflix so there's plenty to watch as you wile away the time. Keep a journal; it's amazing how therapeutic that can actually be. When withdrawing, distraction is your best friend; boredom only serves to add further focus on your symptoms. As your senses return, they will be extremely heightened, and for me, music was an incredibly spiritual uplifter. My favourite tunes danced with my soul like never before. Don't freak out about your overly emotional state as your senses begin returning, I'm not a cryer, but during one withdrawal period, I cried while watching Return of the Jedi!
- Finally, another big one, practicing mindfulness and meditation are wonderful methods of refocusing energies and strengthening the will and spirit. Above all else, it passes the bloody time!
A holistic viewpoint of treating opiate withdrawal is only going to benefit you in the long run. Using advice from your doctor, counsellor, NA sponsor and others who have had personal successes with their methods, is key. Pick and choose what is right for you, and create your own recipe for wellness. Good luck, and remember, if you really want it, you can do it.
You've got this!
*For additional home remedies for opiate withdrawal, The Thomas Recipe is a highly used and credible system for alleviating pain and other symptoms.