Suboxone withdrawal timeline and PAWS timeframe

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Suboxone withdrawal timeline and PAWS timeframe

Postby cheeps » Mon May 28, 2012 1:55 am

How long does this last? It's been weeks; I have no energy or motivation. Finally, a place that tells you why Sub Sucks!!

When a person takes mood-altering chemicals over a period of time,
neurotransmitters can become disregulated or depleted. Users can experience this
disregulation or depletion as a sour or dysphoric mood.

After the use of mood-altering chemicals is stopped, and the conditions for
healing are in place, the brain begins a period of physiological and biological
readjustment. This readjustment process is essentially a healing of neurochemical
disregulation produced by the drug and/or alcohol use. While this process is underway –
and until it is complete – the recovering person will likely experience their neurochemical
deficits as unpleasant moods and/or difficulties in thinking or focusing.

The withdrawal syndrome (a syndrome is a group of symptoms that usually occur
together) from any substance of abuse has two stages – Acute Withdrawal and Post-Acute
Withdrawal. Though the acute phase of withdrawal is usually over relatively quickly -
the post-acute phase, depending on the drug or drugs abused, and the severity and length
of the abuse, can last up to eighteen months.

Acute Withdrawal

During the first few days after substance use has stopped, the user can feel
distressing and uncomfortable withdrawal symptoms. With some substances (like
barbiturates and benzodiazepines – and, in extreme cases, alcohol) withdrawal actually
can be life threatening. Withdrawal symptoms can vary according to the amount,
frequency, length of use and type of substance that was used.

The pattern of using increasingly larger doses of opiates often continues until the
user either chooses or is forced to stop using opiate drugs. It is only then that they
experience the deficit in endorphin and enkephalin levels and the dearth of opioid
receptor sites as the classic opiate withdrawal syndrome. Symptoms include insomnia,
restlessness, depression, muscle cramps and diarrhea. The abrupt cessation of opiates in
dependent subjects results in overstimulation of a part of the brain called the locus
ceruleus (LC) which functions to evaluate and respond to pain, reward, panic and
anxiety. Overstimulation of the LC is believed to be responsible for the typical signs and
symptoms of opioid withdrawal, such as anxiety, hyperactivity and tachycardia. Other
opiate withdrawal symptoms are teary eyes, runny nose, yawning and gooseflesh.
Symptoms usually last 7-8 days for most opiates. Methadone and buprinophine,
synthetic opioids are the exception; possibly due to their long half-life in the body,
withdrawal symptomology for these drugs can last a month or longer.

Post-Acute Withdrawal

After the acute phase of withdrawal is over, the more-lengthy post-acute phase of
withdrawal begins. At the conclusion of the acute phase, levels of neurotransmitters
affected by substance use have rebounded to about 80% of their pre-use levels. And,
though the newly recovering person is feeling more comfortable and thinking more
clearly, a lingering sub-clinical dysphoria reminds them that the healing process is not yet

For opiate users, the post-acute period is characterized by gradual normalization
of sleep patterns and a lessening of anxiety. A slow, steady improvement in symptoms
can be expected for about a year or so. In cases of heavy and chronic opiate addictions,
however, it may take several months for normal sleep patterns to be re-established. Also,
in the post-acute withdrawal phase, the newly recovering opiate user will probably
experience a slightly elevated pain response and some heightened restlessness.

And best of all:

Speeding-Up the Process

Anyone experiencing post-acute withdrawal from any substance of abuse would
be well advised to cultivate and practice patience, acceptance and perseverance. As long
as the recovering person maintains the conditions of healing (total abstinence from all
mood-altering chemicals – except those prescribed by an informed physician) the
process is inexorable – it will go forward on its own.

However, if person wants to speed the process a bit, this is possible. The keys to
doing this are diet and exercise. To ensure that our bodies have the building-blocks
necessary to rebuild depleted neurotransmitters, it is important to eat foods that are rich in
the amino acids that are the chemical precursors of neurotransmitters such as dopamine,
norepinephrine, serotonin and endorphins.

The amino acids most helpful in the process of rebuilding depleted
neurotransmitters are tryptophan and tyrosine. Foods like turkey, other lean meats, green
leafy vegetables and dairy products are rich in these amino acids. The more often one
make the choice to eat healthy, fresh foods, the more quickly brain chemistry will attain
8pre-use levels – and the recovering person will feel better and think more clearly.

Moderate, regular exercise speeds the process even more. Now the major job is
guarding and maintaining the recovery process by continuing to access sober support and
not entertaining the attitudes and behavior that can eventually lead to relapse.

Maintaining good physical and emotional health allows a person to develop a lifestyle
conducive to supporting continued recovery. Although the most difficult “start-up”
period is now over, continued hard work is needed to maintain and further improve the
quality of life.
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Re: Acute and More PAWS timeframe

Postby runthemachine » Mon May 28, 2012 8:56 am

This is awesome information. Enlightening in so many ways.

Thanks for posting this, cheeps.
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Re: Acute and More PAWS timeframe

Postby AddictAJ » Mon May 28, 2012 9:33 am

Sweet. I needed to read this for sure. PAWS can seriously bring you down & I'm in the thick of it at 4 months sub-free. Info like this is so refreshing to read when you're going through it.

Thanks a ton cheeps!

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Re: Acute and More PAWS timeframe

Postby Justjules13 » Mon May 28, 2012 11:51 am

When I read this in another thread I was going to ask you to make it easier to find....and sure enough, you already did!
Even if you fall on your face, you're still moving forward.
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Re: Acute and More PAWS timeframe

Postby Sub zero » Thu May 31, 2012 6:29 pm

Yeah, good information and I agree with a lot of what is said. What I would like to know is who wrote it?
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Re: Acute and More PAWS timeframe

Postby cheeps » Sat Jun 02, 2012 2:08 am

Don't know who wrote it.... sub zero..

Here's more info...Arlene wrote it.

This is written specifically for those residents whose drug of choice (DOC) is an Opioid or Benzodiazepine. Be it heroin, Methadone, Subutex/Suboxone, Oxycontin, Oxycodone, Hydrocodone, Lortabs, Vicodin, Dilaudid, Morphine, Norco, Valium, Xanax, Klonopin, Ativan, etc., …the list is endlessly frightening.

In general artificial Opiates, known as Opioids, such as Methadone, Subutex/Suboxone have exceedingly long half-lives. This is also true of the Benzo family. Their “memory”; both physically and emotionally, can continue on far past the acute withdrawal phase.

• Inability to think clearly; Memory problems
• Emotional overreactions (anxiety/sensitivity) or numbness
• Depression
• Sleep disturbances
• Physical coordination problems/tremors

Post Acute Withdrawal Syndrome (PAWS) are those emotional and physical symptoms that appear following the acute detox from your DOC. These symptoms, side-effects, can sometimes blind-side the clean addict up to 6 months following actual physical detox.

Interestingly, there are particular plateaus for PAWS.

They can appear at 30 days, 60 days, 90 days, and 6 months.

Further, there are numerous anectdotal accounts of relapses at the 6 month mark. I suspect that may be the case for several reasons:

• Many addicts give the appearance of having their life back on track with employment, housing, regaining of material possession, family and friends re-enter their environment.
• We become distracted, at this juncture, from our “primary purpose”
• P.A.W.S. can lurk in the background waiting for our guard to go down
Although the physical toll of P.A.W.S. may not appear to be as exacerbated as they were in the first few months, the mental aspect is very much present. Our endorphin/serotonin levels are still not at their peak and depression can hit…and hit hard.

While this is NOT a medical treatise, there is significant research attached. I only seek to share with you what has been my personal learning curve…and most importantly, HOPE.

I arrived, as a new resident, having just kicked 15 years of Methadone Maintenance @250mg. per day. I was already one month clean when stumbling into the doors of treatment following a very lengthy stay in a detox facility.

I was also ill- prepared for the toll of PAWS. And it is the awareness that I hope to pass on to those of you reading this. The knowledge that one might encounter this syndrome will, I believe, allow you to understand it for what is; that is a natural and normal part of the process of early abstinence….

I was unable to hold a conversation as well as the inability to put two words together, no less a sentence. A problem when I was asked to share my “issues” in groups. I was unable to read or write .

I would suggest that one start by:
• Reading a paragraph at a time…then test your own sense of comprehension. You can increase a little at a time.
• Try highlighting concepts.
• Try to write down what you perceived you read.
• Writing, in general, seems to be an exceedingly effective tool in rebuilding the powers of concentration…to say nothing of working on recovery issues.
• Stay away from watching TV as much as possible. It’s all too easy to glaze over and not retrain your mental acuity.
• I think video games are different, however…in moderation. They can help to
re-create powers of concentration. Just don’t spend 24/7 in front of a monitor.

I also recall the absolute fear…terror…I encountered when, at four months clean, I was asked to function in an employment capacity. My lack of concentration was overwhelming. I couldn’t stay on task. I knew what I was supposed to do…however, I had great difficultly carrying it out. Although I never had any hint of Attention Deficit before my active addiction began, in early recovery, I encountered just that. An inability to focus. My mind went everywhere and anywhere…except to the task at hand.

• Tackle one thing at a time. Our tendency is to become “scattered” both in thought and deed. This can create frustration.
• When in groups, sit up straight. Don’t “lounge”. Lean forward to encourage alertness. If you physically take the stance of concentrating…it will take on a life of its own and lead to actual concentration. Faking until you make it? No doubt. And that’s more than okay.
• Post-ems…one of the great blessings for recovering addicts who have difficulty with memory and concentration. Use them.
• Be aware that while your short-term memory will vastly improve, there may continue to be gaps in long-term memory associated with active periods of addiction.. Perhaps this is the mind’s way of protecting itself from past unpleasantries. I don’t know. What I do know is that with each passing day, your mental acuity becomes stronger.
• Rebuilding of concentration and memory prowess requires practice like any re-learned skill.

The removal of opioids/benzo’s in turn removes the numbness that we’ve used to get through our daily lives. All of a sudden, everything becomes hyper-acute.

OUR ENTIRE BEING CAN BE DICTATED BY THE WAY WE PHYSICALLY FEEL…IF WE ALLOW IT• Hearing : Everything’s too loud. We startle easily.
• Smell : Things smell either really great or really bad.
• Taste : Things are too sweet or too acrid. Craving chocolate and salt, at
the same time, is not unusual
• Sight : Colors are too vivid. People move around us too fast….or too
slow. The sun is too bright. Your eyes may water. .
• Touch : Our skin prickles. Clothing hurts it. Wind hurts it. Our skin
feels like its on fire.

Is it any wonder, given the above, that we frequently don’t respond well to normal, every day situations? That we yell, cry, are deeply wounded by a perceived slight? Anger is a very normal outgrowth of PAWS. Did someone look at you crossed-eyed? Did someone say something mildly inappropriate? Okay….hold on….don’t take their head off. You may be in PAWS…and you need to PAUSE and breath…they’re not responsible for your feelings…you are responsible for your responses.

The alternative reaction during PAWS can be the “walking dead syndrome.” We’re abstinent…we’re clean…and we’re shell-shocked. We have sudden realizations of the
depth of our disease. We’re in rehab, aren’t we? We have sudden realizations of the wreckage we’ve caused in our life. Our emotions….on overload…sometimes can shut down as a means of survival. It’s all too much, we believe. So rather than react…or respond…we’re numb to it all.

I believe that one of the additional problems we encounter, as opioid/benzo addicts, unlike addicts who used other substances (with the exception, I suspect, of alcoholics) is that our using…certainly in the end…is very much solitary. We don’t “party” any longer when we use. We use, metaphorically speaking, to “stay well.” This behavior brings isolation and alienation from other human beings. So, when newly clean and surrounded by PEOPLE, we’re totally out of our element. Our social skills are minimal. We have difficulty with appropriate forms of interaction so that our initial reactions…as opposed to responses…may be that of anger or, failing that, no intereaction whatsoever (numbness).

My suggestion would be to
• Choose your close companions sparingly…discerningly.
• If you feel you fall into the category of “Off the Hook Reactions”, seek out those individuals who have calmness to them…who won’t or don’t engage in the behavior you are trying to change for yourself.
• Conversely, if are numb to everything around you, look to those who are more gregarious…have developed the ability to laugh and interact with others. Force yourself to put yourself forward…a little at a time…to have conversations.
• In other words, two “angries” don’t make for a calm environment and two “shut down’s” don’t make for light and joyful surroundings.

For many of us coming off of opioids/benzo’s, the ability to embrace joy, laughter or…at the other end of spectrum….sadness and tears is foreign. Not surprising. We caused a shut down of our endorphin/serotonin production level in our brains by over-supplying it with an artificial substitute. It takes time…again the dreaded word…for our own physiological systems to begin to reproduce without outside aid. Our brains, in effect, still sit in wait for the “instant fix” that we gave it every time we ingested a narcotic/benzo. Synapses misfire. Sans substance, it searches around looking for something it’s not receiving any longer externally. Amazingly, with the passage of time, internal, natural production of endorphins and serotonin begins…maddeningly slowly at first…and then far more quickly.

Until this time however….and it is a process….we may either be so blocked to the ability to cry or laugh…to feel any joy whatsoever…that it becomes disheartening.

One of my clearest memories, during early PAWS was sitting in the common area at 6AM. A fellow female resident said something funny. And all of a sudden a sound came out of me that I didn’t recognize. It was hysterical laughter. Laughter from the bottom of my toes to the top of my head. I didn’t recognize the sound because I hadn’t laughed in almost 15 years. From that point on…everything became very funny or tragically sad. I carried a box of tissues with my everywhere I went…for months.
And, eventually, your reactions will level out...with time.

Depression can rear its ugly head. A feeling of being in a black hole…or is this ever going to end.

Some might suggest that the depression they feel following opioid/benzo withdrawal requires the use of psychotropics or anti-depressants. And I would proffer that this usually is not the case.

I would also suggest that a psychiatric diagnosis to determine the actual need for these types of medications should be made following a significant period of abstinence. Several months of abstinence is prudently required for the brain to readopt to its natural state.

Making a psychiatric diagnosis when one is either using or in the midst of PAWS, I believe, is bound to be a faulty one.

If, however, one comes into abstinent recovery having had a pre-using diagnosis, then this may indeed change the entire picture of the need for psychotropics and anti-depressants.

“NOBODY EVER DIED OF LACK OF SLEEP” So you either want to sleep forever…can’t get up…don’t want to get up. Or, more likely, with opioid PAWS, you can’t sleep more than 2 hours at a time. Or if you do manage to sleep for 5 or 6 hours, you are wakeful…fitful…during the night. You don’t get a full, uninterrupted night’s sleep. Your eyes fly wide open. You look like a deer caught in head lights. Your mornings are the worst. What’s up with that? What’s up with that is the fact that we’ve used narcotics/benzo’s for years and it’s altered our sleep/REM patterns. We find we can’t sleep unless we have them.

Sleep deprivation, particularly for opioid users, is probably the longest-lasting of all PAWS side-effects…and probably the most frustrating. You stare at the ceiling…looking at the clock every 15 or 20 minutes. You fall asleep…awake…to find just a few minutes have elapsed.

My suggestions would be:
• Warm showers or baths…frequently. They are very soothing emotionally as well as helping to relax the muscle cramps that might be one of the causes of wakefulness.
• Also, don’t hesitate to ask for Melatonin before retiring. It’s natural, non-addicting and can be very efficacious.
• Don’t nap during the day…as much as you may be tempted. Stay on your feet. Don’t lie down on your bed during the day. Keep that for the time when you’re going to retire at night.
• Exercise can be of tremendous aid. Whether it’s light walking in the beginning, jogging, basketball after a time. It tires you out…naturally. It also produces endorphins…naturally. This greatly aids in counter-acting depression.
• Keep yourself well hydrated. Drink lots of water or Gatorade. Gatorade will replace lost electrolytes experienced during acute opioid withdrawal.
• Steer clear of caffeine and sodas with caffeine…as much as you may want the energy boost. Caffeine will only serve to increase your anxiety level…and that ain’t pretty in PAWS. Water and Gatorade also help to flush any remaining toxins out of your system…they are wonderful cleansers.
• If you find your skin dry…that you are itching, hydration is crucial.

The danger of sleep deprivation, given its long-lasting effects, is the frustration level that occurs. It engenders a feeling of helplessness. And we, as addicts, intrinsically know what will “fix” that feeling. A note of caution: the inability to sleep and awake rested is one of the biggest factors in early relapse. Is it pleasant? No. Just wait it out.

That being said, I will pass on to what was told me….


So, you drop everything you pick up…or it seems that way. Your hands shake. Your body gyrates out of control. Your legs feel like lead. Your back hurts. Your shoulders ache. You can’t take the stairs and opt for the easier softer way…taking the elevator. You can barely move your body it hurts so badly. Feel like you’ve been in a fight? You have been. The fight of your life…getting off of opioids/benzo’s…and now staying clean.

So, what worked for me?
• Again, showers…until I was a prune.
• Light exercise. Stretching…slowly. Be cautious not to pull a muscle.
• Force yourself to take the stairs.
• And don’t laugh…your house job. I pushed myself to do it. …vacuuming halls for months in my case. And so what that the vacuum held me up…and not the other way around…I was moving…I was doing my house job…and it engendered feeling good about myself.
• Esteemable acts build self-esteem. A win-win.

And because lack of physical acuity can be a benchmark of PAWS, it is important to note that long-term use of certain opioids can impact on bone integrity. Therefore, fractures can easily happen. Older females are particularly susceptible to this. Check into using a Calcium supplement.

I also found, for those mornings I could barely move, that I had to mentally “walk” myself through the process with a mantra:
• Now I’m getting out of bed
• Now I’m walking to the bathroom
• Now I’m brushing my teeth.
• Now I’m getting into a shower
• Now I’m getting dressed and putting on my makeup
• Now I’m going to group/work
• Now I’m not going to the Methadone clinic (or to cop dope)

And it’s okay if you’re so exhausted that you have to sit down between each goal. The important thing, I believe, is to:
• Set the goal itself…and then do it.
• It’s slow…it’s tedious.
• And in the end, it is so gratifying. The simplest of acts become huge and the rewards are giant sized as well.
Look…everyone encounters these symptoms differently. And some will not experience them at all. We all bring to the table different circumstances when we get clean.

PAWS experience can be dependent upon:
• Age
• Length of use
• Amount of use
• Other pre-existing physical and emotional issues.

Our bodies take time (there’s that word again) to heal. We did damage. And the body is an amazing piece of equipment…and has remarkable recuperative powers…as long as we allow that process by staying clean.


Mental attitude is pivotal to recovery…particularly early recovery…and counter-acting PAWS. I would suggest that while it takes effort to maintain a positive mental stance, that effort has rewards and gifts that are unsurpassed.
• Learning to walk through physical and emotional aspects in early abstinence provides a sense of accomplishment…of self-validation.
• Old behavior dies hard.
• Old behavior landed us on our behinds.
• New behavior and new responses, while difficult to embrace, because they are just that…new…is self-empowering.
Last edited by cheeps on Tue Jul 24, 2012 9:33 pm, edited 1 time in total.
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Re: Acute and More PAWS timeframe

Postby Sub zero » Sat Jun 02, 2012 8:32 am

More good stuff. I especially like the time-frames given and the comment that PAWS can blindside a clean person at the 6 month mark. I too experienced sudden PAWS at around 6 must be the magic number for a lot of peeps. What bugs me is that the medical literature makes no references to PAWS at all...they don't acknowledge its existence. I remember visiting my doctor once and telling him about some symptoms I'd been having...he said "that sounds a lot like withdrawal...when was the last time you used?" I said over a year ago - and he's like "Oh no, it can't be that then"....and I'm thinking to myself MY ASS!!!!
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Re: Acute and More PAWS timeframe

Postby Owen » Sat Jun 02, 2012 5:06 pm

I did not feel some of the PAWS symptoms mentioned here. However I did take a SAO for couple of months, some I boga root back (small doses) and did taper down for several months up to a year. I held on to a small dose for several months, this must have helped me when I stopped bup.

I am at the 7 month mark now and I feel well. The turning point for me was about 4 weeks after I stopped everything including clondine and valium. Somehow I do actually feel the SAO, long tapering and Iboga root bark micro-dosing limited my PAWS. I have felt the same for the last 5 or 6 months which I did not really expect but sometimes you cannot tell. The valium helped a lot for sleep as did Ropinirole/Requip.

I wasn't depressed or anxious, however I did taper every med I took. You need to be very positive and look for successful stories. Am sure the low dose tapering of bup contributed in making me feel stable upon this point. I look back on it and tell myself I had done cold turkey and never took a SAO I may be in the midst of PAWS r ight now, if I never held on a low dose of bup for many months I may still be on bup now or struggling. Am sure what I did ands took must have helped. I did a lot of research into PAWS and what can help, I was advised to take a SAO for couple of months to limit PAWS, and it did actually work. The acute withdrawals I held off by taking SAO's and after stepping off DFs, after that I took clonidine and after that I took Iboga root back in small caps (micro dosing), I also took root back with DFs along the way, so am sure that must have helped to hold down bup withdrawals..

I wasnt taking hig doses of DFs so I thought why not take small Iboga too. When I stopped everything I did feel a little tired and some symptoms of PAWS that I mentioned here but it was doable..The brain gets back slowly, I could feel it when I was on 0.1/0.2 of Subutex, I felt very clear about a 1 month into taking DFs, psychically I could feel a lot but could handle it..I personally do not find psychical symptoms just so long as I can handle things mentally.

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Re: Acute and More PAWS timeframe

Postby Owen » Sat Jun 02, 2012 5:08 pm

I didnt feel inclined to post as I felt I might be an outcast, being clean from everything just makes you feel you do not need to go on drug forums,. its selfish I know but I have to punch myself to remind myself that I was on bup for a very long time, everything seemed a blur when I think about it but not so shocking because I got to this stage slowly. The slower you do things the less shocked you become and the more use to clear feelings you can take in, this in turn can make you handle PAWS a bit better, but hey this is my experience and the experiment I did.

I wouldn't ever recommend SAO as a protocol but I was advised this by someone here and it did work, you got to tell yourself your only using them to hold off the bup symptoms. All I had in my mind was to get much of bup out of me as possible, the thought of being addicted to SAO just scared me, I was on a low dose of DF's and a family member helped me there...This is something I dont want to go through again..There is hope and your brain does come back.

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Re: Acute and More PAWS timeframe

Postby subster58 » Sun Jun 03, 2012 5:30 am

Outstanding post. Helped me so much as I thought I was going crazy. Thanks for the great post
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Re: Acute and More PAWS timeframe

Postby abacus23 » Sat Jun 23, 2012 6:46 pm

Owen wrote:I didnt feel inclined to post as I felt I might be an outcast, being clean from everything just makes you feel you do not need to go on drug forums,. its selfish I know but I have to punch myself to remind myself that I was on bup for a very long time, everything seemed a blur when I think about it but not so shocking because I got to this stage slowly. The slower you do things the less shocked you become and the more use to clear feelings you can take in, this in turn can make you handle PAWS a bit better, but hey this is my experience and the experiment I did.

I wouldn't ever recommend SAO as a protocol but I was advised this by someone here and it did work, you got to tell yourself your only using them to hold off the bup symptoms. All I had in my mind was to get much of bup out of me as possible, the thought of being addicted to SAO just scared me, I was on a low dose of DF's and a family member helped me there...This is something I dont want to go through again..There is hope and your brain does come back.

What are "df's"? Tapering off of DF's... thanks.
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Re: Acute and More PAWS timeframe

Postby Justjules13 » Tue Jul 24, 2012 10:35 am there a way to make this info easier to find? Isn't there another mega thread with this kind of info too? It would be great to have a "frequently asked questions" and general info(comfort meds, time frames, that sort of thing...)at the top of the board so it's easy to find...
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Re: Acute and More PAWS timeframe

Postby cheeps » Tue Jul 24, 2012 9:28 pm

Yeah....we don't do much stickie shit here....PM ratch about it...maybe pick out some threads that have info in them if you have time to look.... or start a thread and ask the other taperer/jumpers which ones helped them.... :shrug: 8-)
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Re: Acute and More PAWS timeframe

Postby Special K » Wed Jul 25, 2012 6:59 am

I am at 20 weeks - 4 days off heroin, and 12 weeks - 1 day off Sub, and for the past 10 days I have felt dope sick - sans the dope. I saw this thread when I logged on this morning, and I am going to re-read it and print it off for hubby. Sounds exactly like what's going on w/ me. I have puked so much I had to go to the ER for a I.V. :sick: and just last last night after 9 days sick, I ate a decent meal (grilled chic, rice, spinach and dark greens salad, baked potato, several glasses ice water) and slept in my bed from 11 pm until 5:15 am when the alarm went off. :zzz: I feel much much better. It's so hard to know if I am actually "sick" or just suffering from PAWS. Your post helped clear it up for me, and give me tools on how to deal w/ it.

Thanks for posting this. :kiss:

Much love,

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Re: Acute and More PAWS timeframe

Postby cheeps » Tue Jul 31, 2012 1:42 pm

PAWS help...R. Smoker

The reality of Recovering from Opiate addiction is that there is an initial "HELL" period (immediate withdrawal) that is followed by a much longer, much milder period of time while the body is fine-tuning the nervous system, and while the body's own endogenous opiate system (endorphin) is recuperating.

There are 2 basic stages of opiate withdrawal.
1. The Short-lived, Acute, intense, immediate withdrawal which occurs directly after stopping all opiates. "clucking", shakes, profuse sweating, chills, gooseflesh, body temperature instability, autonomic instability, "revved-up," diarrhea, cramping, bone pain, mental anguish, etc. (takes ~3 to 10 days depending on the half-life of the drug)
2. PAWS or "Post Acute Withdrawal Syndrome." This is the more drawn-out phase of the body learns to cope without the drugs. includes boredom, insomnia, self-doubt, 'restless legs,' depression.

I believe from my own experience, combined with reports from recovering opiate addicts and the physiology involved that the initial withdrawal is the big, feared MONSTER associated with feelings of sickness and delirium, whereas PAWS can be extremely different for different people. PAWS seems to be more akin to a "waiting game" with fears of overwhelming boredom than an acute sickness. The most important thing to remember during PAWS is AWARENESS that PAWS IS ONLY TEMPORARY!

With time, PAWS will go away!! In fact, with few exceptions, it seems that with every passing week, PAWS symptoms can be demonstrated as improving--sometimes DRAMATICALLY compared to the weeks prior.

Some Reasons why PAWS takes several months to get over:
1. Behavioral changes are necessary in order to learn new and solid pathways for the brain's reward circuit, and
2. It takes MUCH LONGER for your effective neurotransmitter levels and nerve conduction parameters to return to normal, pre-addiction levels.
And depending on your expectations and how you approach these critical 're-building' and 're-organizing' phases, will go far in how well you'll feel during and after withdrawal.

What can be done to HELP your nerve conduction while re-equilibrating to life without opiates? (or--"How to Maximize Your Neuronal Signaling During Post Acute Withdrawal Syndrome.")
• Boost the deficient neurotransmitters.
• Maximize electrical conduction ALONG the nerve.

First, let's talk about boosting the neurotransmitters. For the opiate addict, this means SPECIFICALLY "ENDORPHIN"---short for "Endogenously Produced Morphine" aka "Endomorphine" aka "ENDORPHIN."

There are some things you should know about endorphins. They are the body's natural opiate. Endorphin is released naturally in response to pain, orgasm, exercise, laughter, positive thoughts, secondary messengers responsible for fevers & immune responses, and there are other potential triggers including prayer.

These tips may not seem like earth-shattering phenomena by themselves, but believe me, when these steps are clustered and performed regularly, THEY REALLY DO HELP!!!

Common activities known to boost endorphin levels/satisfy cravings:
• Chocolate. Chocolate has a mild effect on endorphins.
• Candy. Actually any kind of sugary candy boosts natural endorphin levels. Candy helps most with early stages of withdrawal. Lab mice experiments have shown sugary sweets appease craving after abruptly cessation of morphine. Swim practically LIVED on Reese's Pieces, sour candies, M&M's, and those 'tiny' Hershey Kisses for 8 TO 10 WEEKS! Note: he did not gain or lose weight during this time.
• Exercise. This is #1. Force yourself to walk out the front door. FORCE YOURSELF to walk 2-3 blocks from your front door…then you turn around and get 2-3 additional blocks in for good measure. I CANNOT STRESS THIS ENOUGH!!! The best exercise is running/jogging/spinning/anything aerobic. Second best is walking or yoga. Somewhere in-between the two is weight lifting. Weight lifting or resistance-training can be done in a fraction of the time and there is evidence to show that this kind of exercise might benefit the MOST at the late stages of withdrawal (i.e. insomnia from 'restless legs').
some medical professionals believe the positive feeling you get when you meet a physical challenge, rather than the exertion itself, is what stimulates the endorphin release....(how much endorphin-release you get) is all about intensity and duration.
• Accomplishment. That's right. Any kind of accomplishments. Small ones, big ones. Just be sure you're PLANNING and EXECUTING daily. Anything that fosters a feeling of self-accomplishment and PRIDE will cause your brain to squirt out some Endogenous Morphine.
• Sex. Orgasms release endorphins. You've probably already figured this one out… OR--more likely, you've noticed that your sex drive has gone down to almost NOTHING while on opiates. This is normal. I can explain the hormones of it later if you're interested. The point is, you've replaced the endorphin-rush of sex with one that requires no build-up, no mess, and no chance of rejection. Do not feel embarrassed if you become a masturbation machine. This is also a normal part of recovery. Eventually, the sex act itself will be overshadowed by the LOVE aspect.
• Love. Love is a complicated emotion. It's the fuel for poets, playwrights since recorded history and the need for it traces all the way back to the first man and woman. HOWEVER!! SEXUAL LOVE IS *NOT* WHAT I'M TALKING ABOUT HERE!!!! Ultimately, your most long-lasting, gratifying experiences outside of drugs will come from the experience of giving AND RECEIVING love. Get creative with this. Love your enemies. Remember people's names. Start remembering birthdays. Surprise someone with your generosity. Next time you mow the lawn, cut your neighbor's grass…and take his trash out to the street. Donate time to feeding the homeless. There's literally TENS OF THOUSANDS of small things you can do to put forth love out into the world. *THIS* is the true secret to learning how to live without opiates! And believe it or not, the rewards are MUCH GREATER than even the best heroin you'll ever do!!! But you've got to get up and DO SOMETHING!
• Sleep. Eventually---like in 4-6 months from now--your body's autonomic nervous system will stop being 'revved-up' all the time. Eventually, you will be able to sleep again without having to knock yourself in the head with a sledgehammer! When this day comes, BE PREPARED! Start going to bed as early as possible, to allow yourself a good 7 or 8 hours of restful sleep. Your endorphin levels will naturally increase from the circadian rhythm, plus you'll allow yourself the luxury of copious dreaming--not only endorphin-releasing, but overall will make your days more relaxing and give your psyche plenty of time to play.

• Eat a hot Chili Pepper. *
The rush you get after holding one on your tongue is likely due to your body's protective response. "Chewing a hot pepper can release endorphins centrally and on the tongue," says Dr. Hirsch. Why? To reduce pain, of course.
• Think Positive Thoughts.* Placebos, prayer and positive thinking all trigger endorphin release according to Dr. Slotnick.

• Get Emotionally Moved *

Dr. Fuhrman says that viewing beautiful art, watching a touching dramatic scene or even listening to an inspiring piece of music can produce endorphins. "A person who gets pleasure in life, from whatever source, will keep endorphins at a healthy level," he says.
• Undergo Acupuncture.*
"Putting needles into the body is a release," says Dr. Fuhrman, "and it may trigger endorphin production." Also, acupuncture patients benefit from a placebo effect -- they believe that the process is working, so it really does, says Dr. Fuhrman. Talk about the brain's power.
Endorphin factor: 3 (NOTE: HIGHEST LEVEL). People who use acupuncture tend to be positive thinkers, which adds to the effects.
• Be Afraid.*
Whether you're watching a horror movie... or feeling a rush of wind in your hair as you plummet down a steep incline on a roller coaster, fear causes endorphin release. Why do you think extreme sports are so popular? No one wants to get hurt; it's just fun (in a twisted kind of way) to cheat death. "The thrill of a high-speed ride induces a positive mood state that can leave you giddy," says Dr. Hirsch. And Freddy Krueger can do it for you too. Who knew he was such a heartthrob?
• Watch a Funny Movie or TV Show. More specifically, research has proven that simply the expectation of watching one's favorite funny movie releases Beta-endorphin and human growth hormone.** Go ahead and buy the Seinfeld Box DVD.
2. MAXIMIZING NERVE CONDUCTION. or How to Increase Electrical Conductivity WITHIN Neurons.

The portion of your body that is re-learning its own equilibrium WITHOUT OPIATES is essentially an aquatic salt-water ecosystem that runs almost entirely off electrolytes (+ and - particles called "ions" dissolved in solution) and VERY THIN membranes. These membranes are "semi-permeable" which means that with some assistance from various proteins, these membranes allow your body to separate and partition off positively-charged & negatively-charged ions. This creates VOLTAGE--the difference in charges across a membrane or "potential energy."

You can imagine the separated + and - ions as being like a battery. As long as the membranes are intact and your body is able to separate positives from negatives, then your batteries are "charged." But, if you punch a hole in one of the membranes or stop actively separating out positives from negatives, you end up with a lifeless or DEAD battery. ions from

Anytime you 'fire' off a neuron, an "ON" signal is propagated from somewhere deep inside the brain, along a LOOOONG axon, that ends by terminating into either another neuron (inside the brain) or somewhere else outside the brain (like a muscle or a salivary gland, for example).

If you were to tell yourself, "I am now Lifting my right fore-finger," then a neuron in your brain's motor cortex will first "fire" using a neurotransmitter. But the signal actually travels all the way down on a single neuron from the brain to your right arm. All the way down a discrete "wire" found in a bundle of other wires (your spinal cord) until the single nerve cell finally ends on muscles in your forearm where ANOTHER neurotransmitter is released, cause you to LIFT YOUR RIGHT FOREFINGER.

Why the description? well, the FIRST step involved in this example involves a neurotransmitter. In this case, the neurotransmitter is called acetyl-choline... but there are plenty of other neurotransmitters whose functions are to transmit various ideas, emotions, reactions, reflexes, memories, etc.

The SPECIFIC neurotransmitter you're missing is ENDORPHIN. Earlier in this post, I listed suggestions to help you SHOWER your brain with endorphin--and these will make you feel much better. If you can assimilate some or all of these activities into your daily routine, then you'll not only be back to normal very soon, BUT (swear to GOD) you'll actually FEEL MUCH BETTER THAN YOU DID ON OPIATES!!!

The reason I went thru the whole explanation of the + and - ions, the function of cell membranes to partition off these charged particles, and how that nerves & thus your entire brain FUNCTIONS by using a continuous flow of ions in and out of various partitions is because I want you to really REALLY UNDERSTAND something about how our bodies work.

You see, all this fine detail about nerve transmission can ONLY take place under ONE condition. And this is one of the most convincing arguments for evolution that I've ever heard… The ONLY PERFECT ENVIRONMENT for the proper flow of electricity and nerve conduction is found---IN THE OCEAN!

Fortunately, our body's have a "waxy coat" of skin that traps the ocean INSIDE US!

So, whenever you hear someone say "SALT IS BAD FOR YOU", you can tell them they would be DEAD if it weren't for the salt they eat!

Without getting too involved in this, just know that your body has exquisite mechanisms for hanging onto precious minerals and filtering out 'excess' ions. This is mostly done by the kidneys. HOWEVER, your body has NO WAY of either DILUTING or CREATING electrolytes. (i.e. sodium, potassium, calcium, magnesium, & trace minerals)


Simple. Drink plenty of water. Plain water. Not colas, not coffee, not beer. Your body will utilize pure water to form the MOST PERFECT, EXACT ion levels in the various partitioned areas. Unlike what many people believe, drinking extra water does NOT go straight into your piss!! Rather, the water goes from your GI tract, into your bloodstream where it is then dispersed EVENLY throughout every single cell in your body!

That's right…when you drink a glass of pure water, that water becomes almost instantly available to EACH AND EVERY CELL IN YOUR BODY, in order beginning with those cells which NEED WATER THE MOST! So, those cells which urgently need this pure water will get 'first dibs', and so on until the water has been evenly dispersed.

What do the cells DO WITH this pure water??
• Rejuvenate Cell Processes/Restore Cellular Health. First off, the new water allows overly-concentrated, sluggish, toxic (dehydrated) cells to return to their original healthy size, shape, & texture. You may recall from biology that a single water (H2O) molecule is generated in cellular energy generation (called respiration). Glucose and Oxygen are transformed into energy, releasing CO2, and H2O. Well, if your teachers were like mine, they neglected to teach how important pre-EXISTING H2O was for this energy to be produced in the first place! Without a surplus of pure H2O, NONE of this energy can be produced!!
• Eliminate Toxins. This pure water is necessary for your muscles (and other cells) to mobilize their toxic byproducts for excretion in to the urine. Plus, the additional water will optimize sub-cellular activities that have become erratic or sub-optimal from dehydration, built-up waste materials, and are living in an overall unbalanced, unhealthy state. These molecular-level processes will be cleansed by way of excessive hydration, dilution of toxins, and toxic elimination when these toxins are absorbed along with excess water into the bloodstream and almost immediately filtered into the urine. This 'flooding' leads to a "clean slate" on a sub-cellular level, which then allows the cell's energy production to normalize, which translates into higher energy, more energy efficiency on the tissue & organ level which affects the energy and health that we "FEEL" as organisms!!
• Enhance Normal Nerve Conduction Velocity. Remember all that talk about positive and negative ions being separated by membranes to form a 'biological battery'?? Well, one of the most vitally important pieces of the nerve-conduction puzzle is adequate hydration! Adequate hydration allows nerves to conduct their signals FASTER and also allows each nerve to 'reset itself' FASTER as well! So, in essence, adding pure water into your body will make your brain and muscles faster and more efficient--as though your neurotransmitter levels were actually HIGHER--when in reality, you haven't done anything to change your neurotransmitter levels!
When your urine has any yellow coloration or smells, this signifies waste products and toxins that your body must ELIMINATE in order to create this perfect aqueous environment for your nerve cells, muscles, and every tissue.

HOW MUCH WATER SHOULD YOU DRINK? honestly, everyone is different. People going through drug withdrawal require more water than someone whose tissues are already in equilibrium. Your need for 'extra' water during times of stress or drug detoxification will be obvious by the color and smell of your urine.

RULE OF THUMB REGARDING PURE WATER CONSUMPTION: Your urine should be clear and have no smell. This signifies optimal hydration.

Vitamins and Minerals. For fastest re-equalization, you should take ONE daily vitamin with minerals. These days, most every daily vitamin includes minerals as well as folate (aka folic acid). Don't waste your money on expensive vitamins or supplements. All you need are the basic RDA. The *REAL* secret to maximizing the absorption of vitamins is to simply take them WITH FOOD. Taking excess or "mega-dose" vitamins is just a waste of vitamins. 250mg to 500mg of Vitamin C per day is also encouraged, especially in the first few months of withdrawal.

The basic message is to take care of the things that you probably never even THOUGHT ABOUT while on the junk. Things like making sure to take vitamins, eat balanced meals to provide sustenance, exercising and drinking PLENTY OF WATER!

* Endorphins 101: Your Guide to Natural Euphoria, Slotnick, MD David & Walke, Melissa.

**Just Expectation Of A Mirthful Laughter Experience Boosts Endorphins. American Physiological Society session at Experimental Biology 2006, Lee S. Berk of Loma Linda University, 07 Apr 2006
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Re: Acute and More PAWS timeframe

Postby cheeps » Tue Jul 31, 2012 1:44 pm


Taurine is an amino acid which plays a major role in the brain as an "inhibitory" neurotransmitter & neuromodulator. It is similiar in structure to the amino acids GABA & L-Glycine, which are also neuroinhibitory. This means it helps to calm or stabilize an excited brain.

Taurine stabilizes nerve cell membranes thus depressing the firing of brain cells & dampening the nerve cell action of the excitatory amino acids, glutamate, aspartate, & quinolinate.

Taurine acts by regulating the sodium & potassium concentration in the cells & the magnesium level between the cells. This has everything to do with the electrical activity of the cells & subsequent communication between cells.

By this mechanism, it has anti-anxiety & anti-convulsant activity. It has also been found useful in some cases of migraine, insomnia, agitation, restlessness, irritability, alcoholism, obsessions, depression, hypomania/mania.

Dosage is from 500 mg twice daily to a total of 5000 mg daily in 3-4 divided doses, though I rarely recommend that high a dose. The total ideal body pool of taurine for adults is 12,000- 18,000 mg.

Since taurine also affects the hypothalamus to help regulate body temperature, a higher dose can decrease your temperature & give chilliness, so be aware of that.

Taurine also plays a role in memory & increases the level of a memory neurotransmitter, acetylcholine, in the brain (in animal studies).


Taurine is highly concentrated in animal & fish protein or organ meats. Strict vegetarians can be at risk for taurine deficiency. Your body can make taurine in the liver & brain from the amino acids, L-Cysteine, & L-Methionine. Three enzymes are involved in the conversion, all requiring the pyridoxal-5-phosphate form of Vitamin B6 for this conversion. A B6 deficiency can thus cause a taurine deficiency.

Some studies suggest humans are dependent upon dietary taurine to maintain "adequate" taurine reserves. Females tend toward lower taurine levels than males as their production pathways don't work as efficiently.

Taurine is closely bound to zinc & manganese so deficiencies of either of these can interfere with its' utilization. Likewise, zinc & manganese enhance the effects of taurine.

Taurine is the amino acid present in highest concentration of all amino acids in the fetal & newborn brain, which is the most dependent upon taurine & the least able to synthesize it.. The developing infant must derive taurine from the placenta, the newborn, from breast milk or taurine fortified formula. It is low in cow's milk. Taurine is essential for proper development of the central nervous system & the eyes. Nursing mothers especially need taurine as it stimulates prolactin to promote lactation, which is an interesting twist of nature, since infants need it so much. ( We could speculate that a mother unable to lactate may be taurine deficient, among other possibilites, & the infant is thus protected from receiving taurine deficient breast milk) Premature infants are especially prone to taurine deficiency.


MSG can decrease taurine. Trauma, surgery, radiation therapy, burns, muscle diseases, steroid use, intestinal dysfunction with bacterial overgrowth of the small bowel can all lead to excess loss of taurine in the urine & subsequent deficiency.

The medications Thorazine (a major tranquilizer) & Chloroquine (an antimalarial) can reduce taurine levels. Some depressed patients have decreased taurine.


EYES: It is in high concentration in the eyes where it has multiple functions to maintain normal retinal structure & function. Depletion leads to degeneration of the photoreceptor cells. Degenerative changes in the retinas of taurine deficient cats & dogs resemble retinitis pigmentosa. Taurine may be helpful in preventing cataracts. Age related macular degeneration has responded favorably to "injected" taurine as reported by American Biologics Mexico Hospital.

CARDIOVASCULAR: Taurine is the most abundant amino acid in the heart, a particularly electrically excitable tissue, as are the brain & eye. Since taurine participates in electrical stabilization of the cell membranes & the normal regulation of nerve-muscle interaction, it is useful in heart irregularities & mitral valve prolapse, acting similarly to a calcium channel blocker (a class of drugs used in CV Disease) Taurine also helps control high blood pressure & is useful in congestive heart failure.

DIABETES: Taurine affects carbohydrate metabolism. It potentiates the effect of insulin, enhances glucose utilization & glycogen (stored glucose) synthesis.

FAT METABOLISM: Taurine reduces cholesterol by forming bile acids which are the end products of cholesterol breakdown & are the only route for eliminating cholesterol from the body. This action requires a functioning gall bladder. Taurine has an inhibitory effect on the formation of cholesterol gall stones. It is required for efficient fat absorption & solubilization. It is helpful in states of fat malabsorption such as with cystic fibrosis & other pancreatic deficiency syndromes.

DETOXIFICATION: Taurine conjugates & detoxifies various internal & external toxic compounds & may help chemical sensitivities.

ANTIOXIDANT: Taurine plays a major role in protecting cell membranes from oxidative attack.

STRESS: It can inhibit the release of adrenalin & thus help with anxiety in this way, as well as protecting from other adverse effects of too much adrenalin.

MISC: Acts as an immune stimulant to increase Natural Killer Cell Activity & Interleukin 2. Controls cell volume & osmolality. Is involved in the regulation of iron metabolism. Modulates levels of serum copper.


Read more: ... z22E8tDNJP
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Re: Acute and More PAWS timeframe

Postby sublows » Tue Jul 31, 2012 2:01 pm

Brilliant Cheeps, love the detail though it did lead to a lot of re reading, sports med minor :smart: but this was definately enlightening, especially all the information about the neurotransmitors and the hydration. The water thing is a huge tip, I had been downing gatorade like crazy to try to make up for what I was not eating, but now that I am eating it seems like the best way to go about it. ty for the info.
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Re: Acute and More PAWS timeframe

Postby cheeps » Tue Jul 31, 2012 2:45 pm


I steal good posts from many sources. Most of them are based on experience...but many have scientific background.
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Re: Acute and More PAWS timeframe

Postby Justjules13 » Tue Jul 31, 2012 3:15 pm

Lol.....good one Cheeps..
As far as things to eat during WD..yorgurt is on the top of my list. Even the inside of my mouth hurts during WD and I just want to slurp down something fast with a lot of nutrients and calories. And I buy those coconut water drinks and really like those during WD too.
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Re: Acute and More PAWS timeframe

Postby subster58 » Tue Jul 31, 2012 7:41 pm

thanks for taking the time to research and post.
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