Withdrawal is not a psychological longing, it is a physical demand.
Tracey Duncan; Jonathan Perez/Unsplash
If you’ve never gone through withdrawal, you don’t know shit about it. You think you know because you saw some movie from the 90s with a dead baby in it, but you don’t. You think you know because you quit smoking or stopped eating meat or you gave up Instagram for like a whole fucking week. Congratulations on quitting smoking, but I’ve done that, too, and while it truly sucked, it never made me want to die.
Opioid withdrawal is not, I wish I could have that, but I can’t. Or, I wish that I could have that, but I shouldn’t. It’s not even, I want that so bad it hurts. Opioid withdrawal is, I am going to fucking die right now. I actually really want to die right now, but if I could just have that one thing, I wouldn’t want to die anymore. It’s everything hurts and there is only one thing in the world that will make it okay. Withdrawal is not a psychological longing, it is a physical demand.
You want to know what it feels like? It feels like the worst flu you ever had, the sickest you’ve ever been, times suicidal thoughts and complete and total confidence that you are never, ever, ever going to feel better. It feels like the day your wife left and your kitten died and there were no more rainbows anywhere and never will be again.
Like most people, I didn’t mean to become an addict. I was originally prescribed Tramadol, a synthetic opioid, for endometriosis pain. For almost a decade, that was fine. Every so often, I would call my doc for a script. No big deal. And then I went to Mexico, where you can buy Tramadol in heavier doses and higher amounts. And it just seemed like a good thing to have on hand.
No, I’m not kidding, I really thought that.
Fast forward two months later and I was totally strung out. I went through all my Mexican stash and my doctor, suspicious of my sudden biweekly refill requests, flatly refused. I did some tricky things that got me flagged in the system the DEA uses to track pharmacies, but that’s a story for another time. The bottom line is I ran out of drugs.
And the truth was I didn’t want to take them anymore anyway. Sure, they made me feel like a fucking superhero for a few hours, but then totally not. And I didn’t want the Vicodin or Oxy or H that my neighbors sell. I have watched that slippery slope to overdose up close and personal and I knew that I wanted off the slide.
So I quit. Cold turkey.
To cope with withdrawal, I smoked weed. A lot of weed. But it wasn’t enough. I couldn’t get high enough. So I got drunk. I stayed drunk and high for a month a half. And then I woke up with a raging six-day hangover and an acute sense that my whole life was going to collapse if I didn’t get my shit together. I went to a Refuge Recovery (think of them as the Buddhist 12 steps) meeting and I have been sober since. It was the hardest thing I’ve ever done.
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But did it have to be? What started as a tiny doubt has become a big question: Is quitting opioids cold turkey really the only way? Because for me, quitting cold led to a whole host of other behaviors that were—in many ways—more debilitating than opioid addiction. It’s easier to teach yoga high on Tramadol than hungover. It’s way easier to meditate. It’s also easier to be a kind human. Opioids turned me into an addict, but opioid withdrawal turned me into an asshole. My wife left me because our relationship was “too hard” and I was too self-absorbed. Yeah. That’s what happens to a body in withdrawal. It’s a dick.
There are a lot better ways to do withdrawal than the way I did it. But also, I wasn’t totally off track. Some addiction counselors think that cannabinoids may offer a kinder, less pharmaceutical recovery process. “Cannabinoids share several similar pharmacological properties to opioids. As the side effects and cost of cannabis are negligible in comparison—to traditional medical approaches—more research should be conducted to explore cannabis treatment for opiate withdrawal,” says Laura Braby, a New Orleans-based substance abuse counselor. In other words, medical weed could be a cheaper, kinder way to soothe the savage (addict).
Other doctors and researchers don’t necessarily recommend cannabis, but no expert that I spoke with recommends quitting opioids cold turkey. “It’s rare that people can spontaneously get through withdrawal. Most people begin using opioids again,” says Joshua D. Lee, an associate professor at the department of population health at the NYU School of Medicine. “Opioid withdrawal can be treated humanely with medications.” Some examples that have been deemed particularly successful are buprenorphine and naltrexone.
‘Humane’ is not usually a word that people struggling with addiction associate with recovery. Lee’s emphasis on helping those in recovery as people who have a problem instead of people who are a problem importantly differentiates his point of view (and that of other highly qualified addiction experts) from the layperson’s pejorative perception of addiction.
“Quitting opioids makes you so sick that you desperately want relief. Most people find it intolerable. Medical detox makes it easier to withdraw and lessens the risk of relapse,” says Sherry Benton, chief science officer of TAO Connect, a digital that platform gives people easy access to recovery treatments, and professor emeritus of psychology from University of Florida. When Benton speaks of the intolerability of withdrawal, she does so with concern and compassion. She recognizes that the symptoms are so intense that they almost always lead to relapse.
And while opioid withdrawal probably won’t kill you unless you have some other pretty serious shit (like heart disease) going on, relapse definitely can. "People tend to go back to the level of the drug they were taking when they used, but they no longer have the tolerance, and now it’s enough to kill you,” Benton explains. We’ve all heard the story about the "junkie" who was "clean" for months and then suddenly ODs, but it’s a story no less sad for its ubiquity.
Benton also addresses the use of cannabis as an alternative to opioids for pain management—something she said she never would have recommended until recently. “When you give people a choice between opioids and medical cannabis, medical cannabis is better for pain reduction,” she says. And while some doctors are concerned about cannabis dependence, Benton says that cannabinoid dependence can be managed more easily than opioid dependence. "There are no dire physical symptoms of withdrawal and it’s an easier detox.” Win-win-win. Perhaps if I'd had access to this kind of pain relief, I wouldn’t have ended up strung out and divorced.
Plus, as Benton tells me, “There was a 25 percent drop in death by opioid overdose in places where cannabis has been legalized.” Because another issue at play here is that misuse or abuse of pharmaceutical opioids could lead to heroin use. This is another trope we all know: the chic housewife on heroin. But it’s actually terrifying. Arwen Podesta, a psychiatrist in New Orleans who specializes in addiction recovery, says that “80 percent of people who start heroin come from opioids.”
Podesta used to run a clinic in New Orleans that was focused on people like me: people who'd gotten addicted to pain meds but who didn’t exhibit what she described as “extremely aberrant” behavior. The clinic was meant to keep people away from street opioids by using medical detox and clinical and holistic therapies. Here in New Orleans (and in many other cities), opioids that you buy on the street are sometimes laced with fentanyl, a synthetic opioid so strong that it’s extremely easy to OD on. Podesta wanted a safer, kinder alternative.
But guess what, y’all? The clinic lost its funding in September. Thanks 45.
In a country where more than 1 in 3 people have been or will be prescribed opioids for pain relief, the risk for increase in opioid addiction is palpable. Because the junkie stereotype is so strongly embedded in our cultural memory, the friends and families of those addicted often don’t know how (or don’t want) to help them. They are portrayed as parasitic. For many, the only respite is 12-step programs, which some of us find alienating and archaic, and where addiction is often seen as a personal identity trait instead of a socially and culturally contextualized issue.
The addict is often cooly written off by most of us as a pariah or a victim of genetics or as someone who simply lacks self control. But this is too easy. I am not just a junkie. I’m your yoga teacher. I’m your neighbor, your friend, maybe your (soon-to-be-ex) wife. And in order to heal from addiction, I will need to be treated with hopefulness and compassion. Cold turkey is the withered flesh of a beast raised for slaughter. It is not compassion. There are better ways. Let’s know about them.
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