Monday, 13 December 2010

Dealing With Post Acute Withdrawal Syndrome PAWS




Unfortunately PAWS is a major cause of relapse after opiate detoxification.

Heroin and opiates attach themselves to various brain receptors, serotonin, dopamine, mu/kappa etc

They interrupt and replace the brains natural production of these hormones which provides the lovely, warm, happy feeling you can only get from opiates.

This is where the length of abuse comes into play, someone with a short term (less than a year) habit will hardly suffer at all, the brain will quite quickly recover and start naturally producing the hormones again, usually within six months. Whereas a heavy long term users brain can take years to recover!

PAWS is long term, low grade withdrawals, sneezing, sweating and chills, restless legs, goosebumps, stomach cramps and general anxiety.

Because opiate withdrawal is in my opinion quite largely psychosomatic these low grade withdrawals can quite easily in your head be turned into unbearable pain... and knowing that a tiny bit of heroin will not only take it all away but also give that lovely warm feeling is sometimes too much to deal with!

Some OTC remedies and medications that can help with PAWS and  acute withdrawal symptoms include...

Quinine - For cramps and RLS
Imodium - Cramps and diorreah
Paracetamol/acetaminophen - For keeping temperature regulated and aches and pains



Herbal supplements that can help (especially when recovering from ibogaine) are...

High Dose Vitamin C - 1000mg Plus Daily
Vitamin D
Vitamin B complex
Omega 3-6-9 Complex  

Fish oils help the body repair the synapses in the bran damaged by opiate abuse, zinc will also aid cell renewal

Also:

St John's Wort for depression, although be aware there are some contra-inications with SSRI's
And Rhodelia Rosea is really good for fatigue and lethargy post detox/ibogaine

Valerian can aid sleep (better than benzo's where possible)

When I was really struggling with 'kicky' and achey legs I would walk up and down the stairs in my flat..
I would take a bath whenever it got unbearable, this often meant 5-6 hot baths a day! Adding Epsom Salts helps too!
After that I'd rub deep heat all over my legs and use a hot water bottle...

If you have an understanding friend that will massage your legs its orgasmic :)
I had an acupressure treatment on my feet in rehab once and it was bloody fantastic!

It's really all about nursing your body back to health, eating well, meaning plenty of green vegetables, nuts, pulses, fruit, oily fish etc...


As I've mentioned before, a small daily dose of Ibogaine is great for PAWS and cravings.. start with 600mg (root bark) and work up if more is required, it's best to take it in the morning as it can cause insomnia.
If your using TA or HCL use titrate the dose up from 200mg and 100mg respectively.
A lot of people grind it down and mix it with a chocolate milkshake or something similar every morning.

Other than medication, post ibogaine therapies that have been shown to be beneficial include, talking therapies, acupuncture, exercise and sex (always good for an endorphin release after opiate WD, plus exercise will help with RLS and cramps)

If you are really worried about relapsing then a Naltrexone implant could be a good idea, although quite expensive and only available privately, Naltrexone is a full opiate antagonist, it completely blocks any opiates ingested rendering the drug useless..

As mentioned above, counselling has been shown to be an important part of recovery and most people that achieve long term abstinence employ some kind of talking therapy.

Saying all this though, the daily battle with your brain and body screaming out for heroin is one of the hardest things anyone can go through, and anyone that does has my full respect.

Ibogaine can definately help,  the liver converts it into noribogaine whichis stored in fat cells and slowly releases, this in most people, stave's off cravings for up to six months!
So my best advice for PAWS would be to micro-dose with Iboga rootbark.
The trick is to find how much you can take before you notice any psychoactive effects.
For me this is around the 1000mg a day mark.
Get some gel caps and weigh (with mini scales) 300mg Iboga rootbark into each of them.
You need to always take any Iboga in the mornings as its a stimulant in low doses.
Start with 300mg (1cap) one day and titrate up by one more cap daily, until you reach a level where you can feel any psychoactive effect. This is your limit.
Usually between 600-1500mg first thing in the morning is enough.

You want to take enough to relieve any withdrawal symptoms but not trip or notice any stimulating effect.
For the large majority of people, rootbark will relieve PAWS almost completely or entirely.
It really is the best thing for it.
Rootbark in low doses isnt dangerous and has some really beneficial effects.
You can buy it ready powdered or as actual bark.
I buy the 20 gram sachets from Iboga World and it costs around £75-80 usually.
This is enough for about a month though.

Ignore any rumours of it being addictive or habit forming. Trust me, Iboga is not something you would want to take daily if you didn't need to. Iboga wouldn't let you get addicted to it!

A lot of ex-ibogainers still use weekly or monthly top up (boosters) of rootbark.
A common and effective dosing regieme seems to be: a quarter teaspoon weekly and a half teaspoon monthly.
You can also put the powder into a smoothie of you prefer.

People have said things like 'I've heard of people becoming dependant on bark' or 'I don't want to swap one thing for another and still depend on taking something every day' ....
Well, as far as I'm concerned, I'd much rather take some Iboga when I need to than be dependant on heroin or methadone!

I think Iboga is safer and better al round than an opiate addiction! 

5 comments:

BMelonsLemonade said...

Sid, I am going to agree with you...the daily battle in your brain, as you get clean, is one of the worst things. My mind used to wander like this, "Dope, dope, fucking dope. Oxycontin. Dilaudid. Dope. Some girl, some where...I know she has the dope. I know the guy with the percocets is at the bar. The bar. The liquor. The percs. The dope. The fucking dope. Brown. Boy...and back to dope again." That fucking tape running over and over in my head. When I felt tired, I thought about using. When I felt sick, I wanted to get high. I was tired, and grouchy, and I SWEAR the sky was grey for several months. A year went by, and I still thought about it. I still did not feel great. A lot of times in that first year, I didn't even feel good.

But, it gets better. I promise. And its kind of weird because it creeps up on...just like addiction did at first. One day, you wake up and get out of bed, and all the way downstairs for a drink before you think about dope. And then, you may make it to lunch without thinking about dope. After a while, you go stretches of several hours without thinking about dope. And those hours turn to days. One day, you lie in bed, and realize, "Hey, I didn't think about dope all day." (Then, that night you can't fall asleep because you are thinking about dope..haha.) Pretty soon, you will go a whole day without thinking about dope. And that day turns to a week...I am not sure if I have ever gone a week, without thinking about dope at least once. But, now when I think about it, I do not also crave it. The cravings really began to fade when I had broken that cycle.

When I got up, and dope was not the first thing I thought about...the cycle began its break. When enough time passes that you are no longer bouncing between sick and well in both mind and body...the cycle is broken. The screaming has long since been quieted, and even your muscles have begun to relax again. Your mind is no longer obbsessed, and you sleep soundly once more. It does happen eventually.

Another thing...Immodium is similar in chemical structure to methadone. That is part of why it can ease the pain a little. Something that worked wonders for me was clonidine. It is a blood pressure medicine that a doctor must prescribe, but it is an easy script to get if you are dope sick. Withdrawl raises your blood pressure, and lowering it can alleviate a lot of the symptoms. Almost all of my symptoms were alleviated with clonidine. I stayed on it for a year after I got clean, and it also helped me sleep. A lot of people getting off methadone are given clonidine.

Gledwood said...

I would love to be able to take Ibogaine, but I suspect in my position it would be just about the worst thing I could do. Isn't there some contraindication to do with "psychosis"..? Considering I went off the planet just switching from weird gear to methadone I'm not sure Ibogaine would be at all suitable for me. Which is annoying, considering all the wonderful things I've heard about it.

Sid said...

Gleds,

Ill look into it but I actually don't think there is anything saying you can't take it with psychosis. It's quite a gentle hallucinogen, If you read accounts people say the visions are humorous and not scary... it's nothing like LSD/Shrooms/DMT ..
It's nothing like anything i've ever taken before so difficult to explain,.

I was thinking though, rather than using a full flood dose to get off high dose heroin/meth you can also use it in small non hallucinogenic doses for PAWS and cravings, if you were worried about taking the full psycho-spiritual dose..

The thing is as well, opiates stop your mind being open, they dull your emotions and senses..

It is scary taking such a powerful drug when your used to living in a cushion.. I totally understand..

I would never push it on anyone but I think it's worth you doing some research on, if you email the guys at ibogaworld.com they will answer any questions and make sure you know what your doing before they post it to you..
They're affiliated with Sara Glatt from Sara's house in Holland, the best ibogaine treatment centre in Europe.
Hope that helps..

Anonymous said...

Caught this site last night. I'm just 2-3 days into PAWS, had never heard of it before. I'd quit high doses of morphine 365/24/7 (everyday since 1998)just a few days ago. I was on 120 mg Avinza (24hr timed-release morphine)+ 30mg MSIR instant release PRN for 'breakthough' pain. I've got bad pain in areas that seem to have nothing to do with my 1998 anterior lumbar fusion L1-L2, with pain radiating really bad down the backs of my legs, and the skin on my arms, hands and face feeling as though they were scalded or sunburned. Then I caught this: http://www.sciencedaily.com/releases/2013/01/130106145747.htm , talking about how opiates can actually have a paradoxical effect, actually intensifying - and even CREATING - pain in areas where there was none, or where it was more of a minimal pain. So, I got out old prescriptions of ms-contin from 3+ years ago, when the Dr switched me to Avinza. I had 15 mg ms-contin tabs, so I could "gradually" (pretty fast, actually, in less than a week) bring the daily dosage down from 120 mg/day, to 0 mg/day. I need to find out just how much of my pain is real, and how much of it is "Memorex", created by the OIH of the morphine.

So, back to PAWS. It started a few days ago, just when I thought that the withdrawl was over. My backs of my legs have had this queer ache, especially behind the knees and in my ankles, and my legs had started the RLS really bad. I hadn't had much of any sleep in 2 days or more. Then, last night, it the RLS started in my arms, as well. I had dug out my pharmacy of old prescriptions, and after reading around on the net, took Gabapentin 100 mg and Lyrica 50 mg. Finally, after I'd gone to bed (but still awake with my limbs just out of control), the Dr returned my message, and told me to take 200 mg more of the Gabapentin, and 100 more of the Lyrica, which I did. Still had the RLS, the Lyrica made me tired, but I just couldn't get to sleep with my limbs going crazy. I finally dozed off and got about 3 hours sleep or less, only to awaken to the same madness. I tried wrapping a heating pad on high around my knee joint (where the worst of it seemed to be coming from, and around my rt-elbow joint. No relief. I was really getting despondent, not wanting to raid my of morphine, methadone, or tramadol.

I'd noticed thatwhen I'd wrap the heating pad around my knee joint (on high), the other limbs would calm down, as though my brain couldn't process more than one thing at a time. I also found that if I exhaled and held my breath, the RLS would stop, until I started to breathe again.

A lightbulb suddenly went off in my head. The pain radiating down my legs seemed to originate from just above the 'crack' of my butt, and that was the same place that the pain dr had done 'procedures' on me in the past at the hospital (outpatient), burning the nerves to alleviate the pain in my legs. I remembered the TENS unit that I'd not used in years and years that was in the bathroom cabinet. I got it out, and carefully positioned its 4 leads, centered around that spot, at the base of my spine. I turned the unit on, and MIRACLE OF MIRACLES, it worked!!

I'm typing this with the TENS unit running (in my shirt pocket - it runs on a 9 volt battery). All of the RLS in all 4 of my limbs just stopped altogether, as soon as I turned the unit on. I've still got a little bit of a queer ache down the backs of my legs; my arms are just fine now; but no RLS whatsoever.

You need a doctor's prescription in order to get a TENS unit, but at this point, I'd highly recommend it!!

Good luck, all!

...the difference between a street 'junkie' or addict, and a patient on prescribed opiate pain medication is a mere slip of paper, that allows him to get the drugs legally; but otherwise, there's not much difference...

Sid said...

Hey 'Anon'

Sorry to hear you're going through it right now, it will slowly start to get better though. It just takes time, there's really not much you can do to speed the process up.
Just treat the symptoms using some of the things I suggested above.

Microdosing ibogaine rootbark is the best thing I've found for withdrawal and PAWS.

Tapering your dose of morphine as slowly as you possibly can will help too.
You're already only using morphine which has a short half life (even slow release) and is, relatively, one of the easier opiates to stop using. (If you have ever experienced the hell that is methadone withdrawal you will understand what I'm saying!)

Interesting about the TENS machine, there was a treatment pioneered years ago that was very similar.
I found a link here:
http://www.wired.com/bodyhack/2007/03/neuroelectric_t/

Also, here are some other links to how to aid PAWS:

http://www.drugs-forum.com/forum/showthread.php?t=93270

www.drugs.com/forum/featured-conditions/thomas-recipe-opiate-withdrawal-35169.html


I'd also suggest that if you are really struggling then there is nothing wrong with using a small dose of morphine and tapering the dose down over a few days.
There is no point pushing it too hard and relapsing, then getting all the feelings of guilt and feeling useless that comes with this.
If you are struggling then work out a small and fast taper. Something like 30mg daily down to 0mg over 5 days.
Also some people find that rather than a traditional taper, dropping the dose down for a few days and then going back up a tiny bit, maybe a quarter of the total amount dropped, just for a day or two, then back to the original drop can help smooth things out.
I used to do it with methadone.
For example. If I was on 30mg say, I'd drop to 28mg for two days, 25mg for two days, 23mg for two days, then back up tp 25mg for a day, then back to 23mg...
the little rise at the end can help..

I hope you are feeling batter anyhow

Sid