First Person: Opioid Withdrawal
Hello, I’m Quinn, and I’m documenting my experience of opioid withdrawal to help others who are facing the same process. It’s just one person’s experience, but I hope it can help others out there get through withdrawal safely and successfully, and put physical dependency behind them.
I am physically dependent on opioids after being prescribed three-day patches for post-operative pain. My surgery was no trifle: it was between three and four hours, and involved my cervical spine. I also require a great deal of physical therapy to get back on my feet, as well as good sleep, and none of that was possible without controlling my post-operative pain.
Pain control doesn’t seem as fine grained in Europe as it is in America. After getting no relief from Tramadol/Paracetamol, my doctor went to a 21 day supply of 25 mcg/hr Fentanyl. That was a lot of opioid, more than I wanted, but at least I could do physical therapy and sleep.
I used my last patch on Tuesday for a trip to Paris to follow up with my surgeon. I had to save it for the occasion, which means I got a few days’ preview of this process when I stopped the Fentanyl the week before. But it’s more than a month since I was released from the hospital, and it’s time to kick for good.
I should define a few terms out of the gate: I am physically dependent, not addicted. The drug my body is depending on is the Fentanyl, which is an opioid. That means it’s in the same class of drugs with Heroin, Oxycontin, and Morphine, but Fentanyl is much stronger than any of those.
It’s easy to get physical dependency on opioid drugs, but physical dependence is not addiction. Addiction is a complicated illness with physical, emotional, and psycho-social elements. What’s happening to me is much simpler: the Fentanyl took over various functions of my body, like releasing endorphins to manage pain, and my body stopped doing these things for itself. The body always seeks equilibrium, and that means if something else is supplying a lot of signaling via neurotransmitters or hormones, your body will stop releasing them, or stop accepting them, or both. Once the substance is taken away, your body has to fire up the systems it turned down when the drug was there. The time it takes for that to happen is what we call withdrawal, and it is no fun at all. Sometimes withdrawal can be dangerous, when the body isn’t ready to compensate fast enough, and the withdrawal of the drug itself can kill a person. That’s not the case with opioids — the only danger with them is secondary to withdrawal. The body can take over the functions the opioids were doing fine, except the time while it’s doing that is a terrible experience. Unpleasant, but not in and of itself dangerous.
Addiction is different than withdrawal. Kicking an addiction often has an element of withdrawal, but it has a lot of other moving parts too. Craving, drug seeking, emotional and psychological instability and more can come along with kicking an addiction. Opioid withdrawal alone is like getting very sick, but for many people withdrawal with addiction feels like getting very sick during the end of the world.
Which brings me to why I want to document this. Physical dependency can be the beginning of addiction, especially for people like me: people with no history of addiction who are given an potentially addictive drug in the medical system and then left to handle the aftermath on their own. I’m happy to report I’m not at very high risk for addiction myself, but not because I am a special addiction-proof surgical patient. It’s because I’ve studied addiction, and I know what to watch out for and what not to do, and I’m well supported by friends and family with whom I have talked about the process I’m about to go through. That’s what I’m hoping to pass on through my experience, a record to help other people who might be coping with opioid dependency not let withdrawal turn into addiction.
Day 1: I’m exhausted. I had enough sleep, so my guess is this is how withdrawal is beginning this time.
This will be a no shame account of physical withdrawal. It will be as ugly as the experience is, but also, it will be over in about a week. Opioid withdrawal is nasty, but blissfully short compared to many other addictive substances. I have often wondered how many people could have avoided becoming addicted if they’d know that they’d only have to feel this way for about a week.
I have some help on this project: I have a partner who is physically with me much of the time. My mother is my spirit guide in this. She was a heroin addict, and we’ll be talking through the process of kicking. I have a doctor friend who works in addiction medicine. I won’t be getting my medical advice from him (I have my own doctor for that) but he will be checking my facts about addiction and physical dependency, so that I don’t steer you wrong. I have a group of friends in a chat room to talk to, and who are cheering me on. This is the ideal way to kick, if you have to kick and can’t just taper down on medication. (It’s often possible with certain medical interventions to avoid withdrawal altogether, but those interventions are not currently available to me) Strong social support isn’t available to everyone, but any part of it can make the process more tolerable.
Last time, I started with sniffles, this time, it’s tiredness.
You can follow my day one twitter thread: https://twitter.com/quinnnorton/status/982714344495558657
Day 2: 5 hours of sleep
The worst part right now is just being so uncomfortable in my own skin. I toss and I fidget, I can’t stand my legs touching each other. It makes me angry and panicky when they do. The pain is coming through my shoulders and left arm, but also my skin just crawls all over my body. My nose is stuffed up, and I’m coughing all the times. I’m sucking on menthol and lidocaine lozenges in order to not keep my partner (and myself) up with coughing. My mom has told me it’s like having the flu, and that’s definitely true, but for me at least it doesn’t have any of the lethargy of the flu. It’s like the flu, except I’m twitchy and awake too much.
I kept fighting with my watchband last night, it was always in the wrong place, always too tight, or if I loosened it, scraping along my skin intolerably. I only slept maybe three hours.
I fell asleep again later in the morning, and woke up again. My skin still felt uncomfortable and my stomach was turning. I spent a good amount of time on the toilet, cramping, as my digestive system stared back up. Opioid drugs cause constipation, but my impression of this is that they just make everything in my guts slow and sluggish. Now that it’s starting to move again, I’m glued to the toilet for a long, painful, and boring time. I thought about the worst case scenarios I’ve read about in withdrawal, all them about mental state. I had read in one person’s account: “I had to go get something or I was going to kill myself.” I don’t feel that way, I’m grateful to say.
Waiting in the bathroom, bored and uncomfortable, my memory went back to a low point in my life, almost two decades ago, where’s I’d come close to hanging myself. I remember the feel of the cord in my hands, and how disappointed I was with my life then. I sat there, lost in that memory for a moment. And then I looked around me, back here, on a toilet in 2018. I yelled “you sneaky bastard!” to no one in particular.
Last time I’d had a few days of withdrawal to deal with, about a week ago, I’d watched a violent TV show right before bed. I’d crawled into bed with my partner to sleep, but then I was just assaulted by images of me murdering him with a knife in the kitchen. They were out of nowhere, imagination gone haywire. I laid there, tensely, stressed, trying to get the images to pass. They morphed into him murdering me. They were intensely emotion, and they felt almost like premonitions, but I knew intellectually that that were just out-of-control imaginings. Eventually I got my iPod and put on a podcast about chemistry while I lay in bed. It gave my mind something to chew on, just difficult enough to keep it from wandering. I relaxed, and was able to sleep a little while later.
Knowing that theses are meaningless mental fragments, like a spilled file cabinet in brain, it helps. But it doesn’t make this fun. The point is, I can walk away from the thoughts and memories, they don’t have to have power over me even if I don’t have control over them. And I’m not feeling them because they are any truer than they were last time, I’m feeling them because I’m withdrawing from Fentanyl.
Tonight I’ll go back on my normal sleep medication, 50 mg of Trazodone. I have a lifelong sleep disorder and have used Trazodone on and off for over 20 years. It’s a good helper for me, and I’m looking forward to getting some good sleep.
You can follow my day two twitter thread: https://twitter.com/quinnnorton/status/983013738939854849
Day 3: 7.5 hours of sleep
It took a lot of tossing and turning to get to sleep, and I was still uncomfortable, but the Trazodone seems to have done its job eventually.
I had vivid dreams about spending time with and pleading with an ex, and woke up confused about why I hadn’t talked to him, before realizing he’s been dead for years. It left me shaken and sad.
I coughed more today than I had before, not just at night, but through the day. My nose remains very stuffed. I still have my fake flu.
Everything smells far too strong today, which is unfortunate in a house full of fermenting foods. We have kimchi maturing and fermented pepper paste and whatnot, which is normally lovely, but all a bit too much right now. Yesterday I didn’t want to eat any challenging foods, favoring slightly bland and sweet things, which is unusual for me. Bread and cookies and nothing with any strong flavor.
By midday I was feeling better, and I went in the afternoon to a tattoo appointment I’d made a while ago. The tattoo work was surprisingly soothing. I forgot to eat most of the day. When I eventually had some bread and soup, I filled up very quickly and had a stomach ache. Shortly after I started yawning a lot, which seemed strange. My partner looked up the yawning and aversion to strong smells and cheerfully confirmed both of them were withdrawal symptoms. I grunted my annoyance at him, and complained a bit about it all while he poked fun at me. I’m so glad he’s here for this.
I was tired enough to go to bed by 8pm, and yawning several times a minute, which made my shoulder and arm ache. I’m dealing with a lot more post-op pain now, and physical therapy is both vital and unpleasant.
You can follow my day three twitter thread: https://twitter.com/quinnnorton/status/983419182275493889
Day 4: 4 hours of sleep
I get a bit of vertigo when I lie down or get up quickly. I’m grateful it’s just that, last time I would nearly faint and be nauseous from the room spinning every time I changed between laying down and getting upright. At first I was worried about my blood pressure, and felt unstable when I walked, but all my vitals checked out fine. I cannot easily convey how unpleasant it was feeling like I was falling, fainting, and about to throw up every time I changed positions. I’m glad it hasn’t been anywhere near as bad so far this time. It’s still destabilizing and makes me worry about falling and damaging my brand new neck.
Mostly I’ve been just tired today, and unenthusiastic about food. I’d still been periodically constipated, which just comes with the territory where any kind of opioids are concerned. That’s starting to let up, thankfully. But it’s also letting up in the form of many painful bowel movements all day.
It’s quite hard to sleep, because I’m so uncomfortable when I lie down. I’m chewing gum all the time because I keep clenching my jaw, though I don’t know if that’ the re-emergence of the underlying condition of my neck or the withdrawal.
Today felt tired and normal, but also it’s the first day I’ve been in a down mood. Once again, I don’t know if this is withdrawal or just me, or what that distinction really means in this circumstance. I’d hoped to get some writing done today, but I spent the day retreated into a philosophy podcast that made me feel better, and doing house cleaning. Moving helps, even if it’s sometimes hard to get started.
My partner says I’m being unusually quiet.
You can follow my day four twitter thread: https://twitter.com/quinnnorton/status/983787255365070848
Day 5: 6.5 hours of sleep
Most of my physical symptoms have diminished, except the vertigo, which has gotten stronger. I’m relieved to say I didn’t feel as depressed today as yesterday. I was quiet though, outwardly and inwardly. I went spent most of today in reading and a history of philosophy podcast. I like having my mind far away, on very large and distant ideas.
I read more about Opioid Withdrawal Syndrome, but I’m not impressed with the literature out there, or the documentary support I’ve found thus far. It’s very dry, vague, and clinically correct, and I don’t think anything I’ve seen prepares people for the lived experience of withdrawal. If I didn’t have my mother, my friends, and years of studying drugs, I might have panicked by now. I went and read accounts on Bluelight for a while, which I’ve always appreciated for the candor and realness you find there. Most people talking about withdrawal on Bluelight are also dealing with addiction, and they often provide a dramatic window on that experiences. As with everything, you can take what you like and leave the rest, and that’s what I did for the evening.
I wish there was more explicit and plain spoken descriptions of this process in the medical world, and I wish more doctors talked to their patients about withdrawal and managing withdrawal. This is getting better, but there’s still a long way to go.
You can follow my day five twitter thread: https://twitter.com/quinnnorton/status/984179678561873922
Day 6: 7 hours of sleep
I don’t seem to have much left of physical symptoms. Psychologically, I’m withdrawn. I feel fragile, and burst into tears a lot. To be honest, I’m the kind of person that bursts into tears at a well produced 30-second commercial, but I was reading a few webpages this morning and just sobbing. I burst into tears after looking at an infographic on European trade. I’ve been a raw nerve all day.
My partner lured me out to a cafe, but other people feel overwhelming and loud right now. My biggest fear is that withdrawal could kick me into a cycle of depression, which I haven’t seriously had to face since 2016, when it brought my life to a standstill. My spinal problems kept my life at a standstill after the depression lifted, and in my emotional state I’m even more sad and frustrated at all the time and life I’ve lost. But now, with any luck, the spinal problems are being unwound by the surgery. Remember the surgery? that’s where all of this started, getting surgery. I’ve had to remind myself this was all for a good reason.
The thing about my mood sinking is that it all feels reasonable. It feels like how I’m reacting to reality, how I just am, and will be, because of what my life is. Intellectually I know that this isn’t something I can really know about the world right now, so I’m just trying to manage my feelings. Some days you just have to let time pass.
You can follow my day six twitter thread: https://twitter.com/quinnnorton/status/984568013931405312
Day 7: 6 hours of sleep
I’m pretty much ok. My dizziness, coughing, runny nose, and muscle aches are all gone. I’m still fidgety and uncomfortable when I lie down to sleep, but I can listen to a podcast or audiobook and calm down quickly. I don’t feel depressed anymore, just mildly apprehensive about the world. (I was feeling apprehensive before withdrawal, but maybe I’m feeling it more now.) I have no urge to use opioids. As a matter of fact, given the unpleasantness of withdrawal, I’ll probably try to insist on something else if I’m ever prescribed Fentanyl outside of a hospital again.
In my seven days of withdrawal I dealt with a lot of symptoms, but few of them lasted for very long. Just knowing that all I had to do was wait, and my problems would go away on their own, made the whole thing much less scary. Knowing that I was physically dependent, and not an addict, gave a healthy context to what I was going through. I never felt the need to panic, or take what my brain was telling me too seriously, because I knew that this was withdrawal, and it passes. If you find yourself in my shoes one day, I hope you can take this to heart, wait it out, and go on with your life. “Just one more” never makes it better in the long run.
You got this.
You can follow my day seven twitter thread: https://twitter.com/quinnnorton/status/984912900572827648
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A note from two weeks post withdrawal. I’m exercising regularly now, and trying to get up to my pre-op fitness (and hopefully beyond with time). I’m still dealing with a lot of dizziness and a few other neurological oddities, which I plan to follow up with my doctor about. But I’m happy to say I’m free and clear of painkillers now, except for the occasional ibuprofen. I still do a lot of pain management, but I use heat, massage, physical therapy exercises and breathing to manage that. Life isn’t all kittens and flowers, but it’s ok, and getting better.
If you need to kick, either physical dependency, or the full addiction package, don’t be afraid to ask for help. Don’t be afraid to go get it, and don’t feel like you don’t need it or deserve it. We all need and deserve help. Get medical help if you can, and be forthright about what you’re dealing with and what you’re afraid of with your doctor. But if professional help isn’t available, friends and family along with a good amount of water and gentle foods can get you through this. And even with a doctor’s help, a few friends keeping you company and cheering you can go a long way. It’s about a week, and you can do a week.
See you on the other side.