For most drugs the withdrawals alone aren’t deadly. Someone going through heroin withdrawals may feel like their life may be in danger, but that is generally not the case. Successful treatment centers rely on the attention to both physical and emotional withdrawals of a patient’s drug abuse.
Physicians who treat opioid addiction have the option of utilizing ‘medication-assisted treatment,’ and the most common medications used in the treatment of opioid dependence today are methadone, buprenorphine (Suboxone), and naltrexone.
Methadone is a powerful opiate with a long half-life (how long it takes the body to eliminate half of what is in it) that ranges anywhere from 12 to 47 hours depending on numerous factors. The theory being that the long half life will help keep addicts from going into withdrawals and ease them down. Often what happens though is they just go from being heroin addicts to being methadone addicts, so this is often a last resort and not used in many treatment facilities.
Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is a unique opioid medication. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access.
Naltrexone is an opioid blocker that is also useful in the treatment of opioid addiction. Naltrexone blocks the euphoric and pain-relieving effects of heroin and most other opioids. It does not eliminate the withdrawal or cravings. Therefore, many patients are not able enough to take it on a regular basis. It cannot be started until a patient is off of all opioids for at least 14 days. Once patients have started on naltrexone the risk of overdose death is increased if relapse does occur.
Stimulants like methamphetamine are a little more difficult to simulate. With opiates it’s possible to take a small enough dose of say heroin, that someone accustomed to taking codeine wouldn’t be able to tell the difference because most opiates act on the same areas of the brain, whereas stimulants have a wider range of receptors to act on, stimulate, and inhibit. This makes it a little more difficult to make substitutions that will give the brain what it’s looking for. In those situations there are some medications that are used to help reduce the cravings, but it is largely behavioral therapy to deal with the withdrawals and depression.
For Benzodiazepines (Valium and Xanax being the most famous of them) the withdrawals alone are potentially fatal and addicts basically have to get given a daily dose that is slowly tapered down to nothing. Death by withdrawal isn’t common, but it’s common enough that benzos should be looked at with a certain amount of respect and caution that other pharmaceutical drugs aren’t.
There are two stages of withdrawal. The first stage is the acute stage, which usually lasts at most a few weeks. During this stage, you may experience physical withdrawal symptoms.
The second stage of withdrawal is called the Post Acute Withdrawal Syndrome (PAWS). During this stage you’ll have fewer physical symptoms, but more emotional and psychological withdrawal symptoms. PAW occurs because your brain chemistry is gradually returning to normal. As your brain improves the levels of your brain chemicals fluctuate as they approach the new equilibrium causing post-acute withdrawal symptoms.
The most common PAW are: -Mood swings -Anxiety -Irritability -Tiredness -Variable energy -Low enthusiasm -Variable concentration -Disturbed sleep
In the beginning, your symptoms will change minute to minute and hour to hour. Later as you recover further they will disappear for a few weeks or months only to return again. As you continue to recover the good stretches will get longer and longer. But the bad periods of PAW can be just as intense and last just as long.
Each PAW episode usually last for a few days. Once you’ve been in recovery for a while, you will find that each post-acute withdrawal episode usually lasts for a few days. There is no obvious trigger for most episodes. You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just as quickly as it started. After a while you’ll develop confidence that you can get through PAW, because you’ll know that each episode is time limited.
PAW usually lasts for 2 years. But if you think that post-acute withdrawal will only last for a few months, then you’ll get caught off guard, and when you’re disappointed you’re more likely to relapse. Committing to professional counseling and therapy is highly recommended to avoid relapse.