The agony of opioid withdrawal

Someone shared this video several weeks ago and it really resonated with me.

I’ve been an addiction professional for 27 years, so I’ve learned a lot about the effects of opioids and the experience of opioid withdrawal from doctors, counselors, clients, recovering people with a history of opioid addiction, and other experts. However, there’s something very powerful about his detailed description of his withdrawal experience. For me, it was made more powerful by the fact that he is not someone with the disease of addiction.

Here are some of the things that stuck with me:

  • He descibes his experience as “medical trauma.”
  • Early withdrawal was like the flu, but that was only the beginning.
  • The persistent, deep-seated restlessness was probably the second worst withdrawal symptom.
  • The emotional experience was the worst part of it.
  • He had a powerful desire and commitment to be free of opioids.
  • 3 weeks into the taper was the worst, particularly the emotional experience with depression.
  • The experience of being a medical hot potato that no one had a solution for or felt responsible for.

This man was physically dependant, but not addicted, and he still experienced this excruciating, extended suffering that he described as trauma.

Let’s think for a moment about all of the elements of addiction that this man did not experience.

Brian Coon recently explored the disappearing concepts of physical and psychological dependence. The absence of psychological dependence is one frame for thinking about how his experience differs from a person with addiction.

We can also use the 2011 ASAM definition of addiction to explore what he did not have to confront during his ordeal (emphasis mine):

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

ASAM

That this man experienced such trauma and difficulty without the craving, impaired control, diminished insight, or the psychological, social and spiritual manifestations of addiction speaks to the heroic ordeal undertaken by people with addiction seeking recovery.

We shouldn’t need a non-addict to validate the experience of people with addiction, but I found these take-aways very important:

  • It very effectivly challenged the notion that people with opioid addiction have a low tolerance for suffering and exaggerate a withdrawal experience that it really just like a nasty case of the flu.
  • It reinforced the emotional experience of withdrawal. I’ve known people who are tapering off opioids and are dropping from very low doses to zero and describe profound emotional difficulties. They see it pretty clearly and describe it as feeling foreign or external, and found it overwhelming and baffling.
  • The common, strong, personal preference to be opioid-free.
  • If the experience of physical withdrawl alone qualifies as trauma, should we assume the experience of addiction itself is traumatizing?

It also speaks to the harm that can be caused by abandonment of chronic pain patients and the importance of not pitting the problems of pain patients and people with addiction against each other.

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