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Help with heroin withdrawal
July 21, 2007 9:49 AM   Subscribe

Please tell me everything you know about the first few days of heroin withdrawal, in particular, ways to ease the dope sickness.

This is for my boyfriend and yes, we'll be talking treatment and yes, he'll eventually be seeing a doctor and stuff, but right now it looks like I'm going to be driving 600 or so miles to pick him up and then turning around and driving him home. I just want to know is there anything, herbal or OTC or available, that he can take during this drive to make him more comfortable and less utterly miserable? Weed and clonopin are both possible options - would either help? And I need to know banal stuff, like, will drinking a whole lot of water help? Is he going to be able to hold anything down? I have a lot of demons but heroin, thank god, isn't one of them, so I have no direct experience with this. When we got together he was already through that part but he went back on and now he wants to get clean again and I am willing to do anything in my power to help. So please help me help him.
posted by anonymous to Health & Fitness (40 answers total) 6 users marked this as a favorite
 
imodium and xanax. Says my brother.
posted by Dreamghost at 10:14 AM on July 21, 2007


No personal experience, but the heroin page at Erowid might be a good start.
posted by trouserbat at 10:14 AM on July 21, 2007


Do not use cocaine! While this may seem obvious, I once had an interesting conversation with someone (you'd least expect to be having these problems, but that's how it always is), and apparently cocaine is a common path for heroin users trying to kick the habit.

That said, they also said the expectation of how bad it was going to be was worse than it actually was. Expect it to be a bad flu, but not the most horrible experience of your life. I wouldn't do anything but weed without a doctor's approval.
posted by geoff. at 10:16 AM on July 21, 2007


Starting treatment sooner might prevent him from having to go through the withdrawal feelings at all, if he can get on buprenorphine.
posted by xo at 10:18 AM on July 21, 2007


I've never undergone serious opiate withdrawal, but I've had to babysit a couple folks who did. Clonopin, and plenty of it, is a marvelous idea. Some folks need to smoke a ton of pot, but it makes others feel worse.

He's definitely gonna need to stay hydrated, because he'll probably be throwing up a whole lot. He probably wont want to eat a whole lot, but I'd suggest some nourishment in liquid form (like Ensure or PediaLyte).

Withdrawing for 600 miles in a car has got to be one of the least pleasant experiences imaginable, but at least it beats withdrawing in jail.

You're an awesome girlfriend to help your dude through this. Good luck.
posted by solipsophistocracy at 10:18 AM on July 21, 2007


The Harm Reduction Coalition's H for Heroin (pdf) booklet has advice on managing detox and withdrawal. Good luck to both of you.
posted by gingerbeer at 10:49 AM on July 21, 2007


Make sure you know where gas stations and decent bathrooms are (perhaps starbucks?) The constipation will end.
posted by filmgeek at 11:18 AM on July 21, 2007


detoxing + roadtrip = potential disaster IMO. Any possibility of doing the detox after you get him home?
posted by clh at 11:41 AM on July 21, 2007


You might see if there's a needle exchange program near him - I'd try to find one for you, but don't know where you are. They will have people who can give you good advice about withdrawal, but also let you know if there are any local resources for him that can help him out until you get there, maybe get him started on treatment now, dispose safely of any leftover works, and help you know what this experience is going to be like for you as well as for him.

Definitely hydration, frequent restroom stops, blankets, and a bucket or something he can throw up into in an emergency if you can't pull over. Since he's been through this before, he may have some sense already of what it's going to be like and what would be most helpful for you to do.

What you're doing is wonderful. But please don't forget to take care of yourself in all of this, too. This is going to be hard on you, and having you be safe, healthy, and stable during all of this is going to benefit both him and you.
posted by Stacey at 11:41 AM on July 21, 2007


Seconding the "you're an awesome gf for doing this." And the safe injection site advice.

Also, as a next step, find out if wherever you'll/he'll be living has a methadone maintenance program. I work with a doctor in Toronto who runs a program out of his family practice, and while YMMV, I've seen huge improvements in people over the 8 years or so I've been working with them.

Good luck!
posted by sarahkeebs at 11:42 AM on July 21, 2007


I had one acquaintance back in the day who used sugar, and PLENTY of it the first 48 hours.
posted by vito90 at 12:07 PM on July 21, 2007


anonymous, you rock. most people would just dash and run when confronted with such a problem.
posted by krautland at 12:26 PM on July 21, 2007


First off, everyone is different when it comes to withdraw.

I have, in the past, used different things to ween myself off of smack, and a few times have quit cold turkey.

Booze has worked for me. Booze and Valium or Xanax. That is, for the initial onset of withdraw. I have begun drinking after my last dose of Heroin and continued to drink for 24-48 hours afterwards. It does calm the withdraw.

I realize that the advice of mixing booze and pills isn't really sound advice, but 10mg of Valium or 20-25mg of Xanax plus booze isn't going to kill him. I'm just stating what has worked for me the best.

For the most part, weed usually isn't a good idea. But again, everyone is different.

Blankets, a puke bucket, water, and a few towels are essential for the drive if he is withdrawing while you travel.

I have found that oranges are nice to have, as well. Not to eat, but just to suck on for the juice and flavor.

Really, I would suggest bringing him home and then proceeding to quit. A long car ride is not what someone going through withdraw should endure. I don't know the exact situation, but one last small fix for the car ride home just to keep from getting sick would be ideal, to me.

It is indeed like having a really bad flu, but the feeling is ten times worse.

Another thought would be to see a doctor, explain the situation, and get a prescription for methadone. It is hard to find a sympathetic doctor sometimes, but they are out there.

A lot of it comes down to how big his habit is, and how long he has been strung out. If he is using 50-60 dollars worth a day or less, he can probably kick cold turkey. If he is using 100 dollars worth or more a day, I would seek professional help.

Again, I am not advising anything illegal, I am just sharing what has worked for me.


You are a trooper for wanting to help him and I wish the best of luck to you. I have been addicted for twenty years and have been clean for the last six. It is very nasty business, being addicted. If you have anymore questions, I would be glad to answer them.

Best of luck to you both.
posted by peewinkle at 12:56 PM on July 21, 2007 [1 favorite]


I have zero experience with heroin, or any illegal drugs, but I do have some experience with Klonopin.

It might help him to be manageable by sedating him, BUT depending on his anxiety level the effect may not be dramatic. I took prescribed Klonopin during a stressful time, and it barely took the edge off. Meanwhile, I had a friend who was prescribed a third of my dose as a sleep aid!

When it did relax me significantly, I had memory loss, especially if I took it within a couple hours of going to sleep. I would wake up not remembering going to bed, or conversations that I had the night before. So be prepared for that. Write down anything important he might need to know, so you can avoid the "I told you yesterday" arguments.
posted by The Deej at 1:06 PM on July 21, 2007


Methadone withdrawal can be fatal.
posted by hortense at 1:14 PM on July 21, 2007


Deej - the trick with Klonopin is to take it preventatively, when you face an anxiety-provoking situation, or when the anxiety first starts to ramp up. If you take it when the anxiety is on full throttle, the effect is almost nil.

Ditto on the memory loss, although this didn't seem to start occurring until I'd been taking it for six months (then again, how do you know what you don't remember?).
posted by desjardins at 1:35 PM on July 21, 2007


Good luck - you are an excellent partner to be helping him with this. When I had a stomach bug earlier this year and couldn't keep anything down at all, Gatorade with an Airborne vitamin tablet dissolved in it was sippable and kept me from feeling any worse.
posted by jtron at 1:46 PM on July 21, 2007


Deej - the trick with Klonopin is to take it preventatively, when you face an anxiety-provoking situation, or when the anxiety first starts to ramp up.

True. But in a state of constant stress, such as I was, and how I imagine withdrawal would be, it may not do much. Thankfully I haven't needed it for a couple years now. I would think it couldn't hurt, but he definitely needs to be under a doctor's care for anything like this.
posted by The Deej at 2:00 PM on July 21, 2007


Vitamin C. And a LOT of it. Every few hours. It will cause some stomach distress, but he will already have some of that going on. It helps with the detox. Godspeed. It's a long road.
posted by gingembre at 2:22 PM on July 21, 2007


comment from someone who would prefer to remain anonymous:

I would do everything in your power to avoid having him kicking on a 600 mile car ride. seriously. The w/ds will vary hugely depending on his habit but to give you an idea of how bad it CAN be... last time I kicked i was not able to get out of bed for 3 days. i was puking violently and constantly throughout that time. I did not sleep for 12 days...hopefully his habit isn't as bad as mine was, but just be aware that is a possibility. I was not able to do ANYTHING for myself besides crawl to the bathroom occasionally..and I didnt always make it. being in a car? cant imagine that at all. in fact i got chills just thinking of it. FWIW i had about a 2/3-1 gram of black tar a day IV habit at that time.
maybe he can get his hands on some kind of prescription painkillers one way or another. ideally it would be suboxone(aka buprenorphine-used to treat opiod dependence) and my rec for kicking once he gets to a dr) but some hydrocodone, oxycodone or even codeine could make this ride bearable without getting him high .
if you do this though and want to stick with OC stuff, lots of water lots and lots and lots, a bucket , immodium, and lots and lots of aleve(naproxen sodium) or ibuprofen. i have to say though-none of it will help too much if he has much of a habit.
he is also going to be extremely uncomfortable for him mentally and emotionally. and there is really very little you can do about that. please dont take anything negative he says or does during this period too personally(or even too seriously). kicking dope is pure unadulerated hell.
by the way you are awesome for not giving up on him. i would probably be dead if my boyfriend had given up on me. but he didnt and im pretty okay now and we are still together. so yeah you rock and there is hope.
posted by jessamyn at 2:57 PM on July 21, 2007


If you do decide to wait until he's home before he starts to kick the habit, then I don't just suggest you find a needle exchange, I really strongly urge it. Along with the other things I mentioned earlier, please talk to them about overdose symptoms and treatment, and ask them if they can provide you with Narcan (the overdose treatment drug used by paramedics) and instructions for administering it. A lot of exchanges now have programs where you can go through a brief training session and then get a legal prescription to have Narcan, and sometimes they can provide you with the Narcan itself.

If you can't find anyone to help you out with this, at least look over the overdose prevention materials at the Harm Reduction Coalition. If you haven't had experience with this kind of thing before, a lot of things you probably think you're supposed to do are dead wrong. Better to be prepared.
posted by Stacey at 3:54 PM on July 21, 2007


Look, I don't really know about this but I would beg you to have him do it in a rehab with doctors around. My oldest friend just died from detoxing (he was already on methadone but suddenly quit boozing and the lack of a controlled detox stopped his heart.) There are pros. Use them.
posted by CunningLinguist at 4:03 PM on July 21, 2007


Seconding CunningLinguist and others who have written that your BFs withdrawal is best managed in a clinical setting under the care of professionals and NOT by a well-meaning but under-informed and ill-prepared GF in a car driving down the highway.*

I am not an MD but a medical researcher in the field of the health of individuals who use injection drugs, primarily heroin. The common (and common-sensical) view that death from heroin results from taking too much is wrong. While dose and tolerance are predictive factors, instances of instability and changing circumstances have also been implicated in elevated likelihood of mortality and morbidity for people who use heroin, regardless if they're using or not. Withdrawal is unpleasant enough, if survived; using after a period of abstinence in an unusual setting has been identified as strong risk factor for fatal overdose.

Quite simply, your BF should get on methadone and cease heroin use before your trip.

Trying to kick cold turkey with street-based remedies, ie pot and/or diverted drugs, could kill him.

I am more than happy to offer any help or advice I can via email.

* I don't want to sound hurtful but I believe this situation must be looked at plainly.
posted by docgonzo at 4:29 PM on July 21, 2007


Benzos always helped me tremendously, with a good supply of Xanax I could keep myself real, real low so that the discomfort seemed distant and not so desperate. I would blackout for long spells which considering the scenario was a blessing.

A 600 mile drive with a kicking addict is going to be one hell of a grim ride. There's no way you could have gotten me in that car, I'll tell you that much. Really, I guess I'm saying that the whole scenario sounds half cocked and ill conceived but that's for another thread, I guess.

And Suboxone (buprenorphine) is a godsend but I at least still felt like I just stepped in front of a bus for a week after coming off it. I've heard similar stories regarding UROD (ultra rapid opiate detox) of being bed ridden for up to a month after the procedure. Your mileage may vary but the piper will always get paid. There's no quick and easy fix for opiate withdrawal.
posted by The Straightener at 5:51 PM on July 21, 2007


maybe he can get his hands on some kind of prescription painkillers...or even codeine

Do you know any Canadians? Tylenol #1 (8mg codeine) is OTC here.

Some years ago I watched a movie with a couple in a basement apartment trying to get off heroin (99% sure it was heroin, at least); wish I could remember the name of it now. It was a Canadian film, and there was a bit of fussing with ground-up Tylenol #1, a coffee filter, etc (to get the Tylenol out of the mix, I mean); clearly, it's been thought of and done. (Anybody know the name of the movie I'm talking about? Standard low-budget Cdn thing, possibly set in Montréal. Vaguely punk-ish couple. They black out the windows, ignore the angry dealer pounding on the door. 1990s.)
posted by kmennie at 6:52 PM on July 21, 2007


Yeah, cold water extraction on Tylenol/Codeine mix will remove the nasty acetaminophen. But if one is trying to kick an opiate habit, I'm not sure that using a different opiate is gonna help.
posted by Justinian at 7:01 PM on July 21, 2007


Let me reiterate what everyone else said about not trying to detox and drive at the same time. It's a bad idea, as is driving 600 miles with weed in the car. How are you going to help him if you're jail in bumfuck U.S.A?
posted by delmoi at 9:37 PM on July 21, 2007


One cold water extraction method; this works with Lortab, tylenol with codeine (they called it "Tylenol 3" when I was a teenager), vicodin, any opiate with acetaminophen.They also make opiates mixed with aspirin or ibuprophen; my mom used to take Fironal #3. Ultram a.k.a. tramadol might also work. These are common substances that ain't too hard to get that will keep him from getting too sick, though they won't be nearly as much fun as heroin. Valium or xanax might help too.

I say this because I think withdrawing from a physical addiction during a long car ride will be torture for the junky, literally, regardless of whose idea it is. It'd be much better to get him to a safe place and then let him withdraw. And immodium will be a good thing to have on hand: there's something really depressing about sloppily shitting oneself that makes any illness seem worse.

I'm not speaking from experience, I'm glad I never developed an opiate habit, but I was in the drug scene for decades and I've seen junkies get sick. No thanks. It most likely won't kill him, but still. Not on a long car trip.
posted by davy at 9:55 PM on July 21, 2007


Just picking up on the various suggestions of other drugs, legal or not: imagine that the bf has seizure, blacks out, or something else happens where you need help on this trip. How do you feel about going to the hospital or calling emergency services with a sick junkie and a car full of dodgy shit? I don't know much about drug laws where you live but the little I do know scares the pants off me. What you are contemplating is terribly impractical if anything goes wrong.

He's willing to do anything to get clean? Then "anything" includes getting help from someone who knows what their doing, in an appropriate setting, with the appropriately PRESCRIBED assistance.
posted by i_am_joe's_spleen at 11:35 PM on July 21, 2007


He should be in a rehab long enough that he can tolerate the ride, this is a ridiculous question.

And be realistic, and don't expect he will stay sober forever, this is going to be a long term problem so be ready for it and leave the relationship if you don't want that.
posted by furiousxgeorge at 12:00 AM on July 22, 2007


Here's a list of Alcohol and drug links:
http://qcpages.qc.cuny.edu/Health_Services/AA.htm

Note that there is a heroin hotline and web link which might offer more help/info/phone numbers.

If you can, look in the phone book in your city for drug treatment and explain the situation and ask for advice.

If none of that works, and you have a bit of time, go by emergency room and see if you can get advice from someone.
posted by Brandon Blatcher at 12:27 AM on July 22, 2007


Here's another link for an addiction hotline. Call it and ask for advice.

If any hotline and person can give you advice, be sure and ask about the next stage, i.e getting him into rehab. You don't want to be continually doing this.
posted by Brandon Blatcher at 12:30 AM on July 22, 2007


Methadone withdrawal can be fatal.

No it can't.

McDermott's Guide to DIY Detox
posted by PeterMcDermott at 6:29 AM on July 22, 2007


Or the hard copy.
posted by PeterMcDermott at 6:48 AM on July 22, 2007


Heroin addiction, as well as all opiate addictions, usually require medically monitored detox for the severe withdrawal symptoms the drugs produce. Heroin use causes a strong physical dependence and therefore opiate detox can result in serious complications when the use of the drug is stopped abruptly. Cold-turkey heroin detox and withdrawal symptoms can include seizures, heart irregularities, vomiting, insomnia and the sweats. Once the body has adapted to the presence of the drug, withdrawal symptoms may occur if heroin use is reduced or stopped. Opiate withdrawal, in regular abusers, may occur as early as a few hours after the last administration. It may also produce drug craving, restlessness, muscle and bone pain, diarrhea, cold flashes, goose bumps, leg kicking movements and various other physical symptoms. Most heroin detox and withdrawal symptoms peak between 48 and 72 hours after the last dose. Sudden withdrawal from some synthetic opiates such as methadone can be fatal.
posted by hortense at 11:14 AM on July 22, 2007


Ibogaine cures withdrawal
posted by hortense at 1:57 PM on July 22, 2007


Keeping fluids down: Small sips. Lots of ice, and no gulping, only sipping. Avoid room temperature liquids, especially water, because it will make vomiting worse. Cold Ginger Ale is good because it replaces electrolytes, and the Pedialyte mentioned above is excellent if you can find it. Nibbling on a cracker and sipping cold effervescent drinks is the best chance of staying nourished with minimal vomiting. Good luck.
posted by Blingo at 5:45 PM on July 22, 2007


From my old roommate, who works at a detox:

For heroin withdrawals, it’s tough to make any certain recommendations without know more details, specifically age, the average amount he was using, anything else he was taking, and any existing medical concerns or conditions. I would strongly recommend that they look into detox facilities in their area so that this can be handled professionally. If he lacks insurance, they can contact the county health department, who should be able to help, although since it sounds like he’s going to a new area.



In general, the expected withdrawal effects of any drug are the opposite of what the drug does. In the case of opiates, this will include general pain and discomfort, particularly aches in the backs and legs and an upset stomach, insomnia, diarrhea, and flu-like symptoms. Some of these will be short-lived; such as the upset stomach and flu-symptoms. Generally the pain and discomfort will start getting better about 48 hours after the last use (this is approximately the half life of heroin, and will be better about 4-5 days after last use. The insomnia can last for much longer, and seems to vary greatly with the individual, but probably will last a few weeks at least. He should know that opiate withdrawals, while very uncomfortable, are not in and of themselves dangerous or risky, and unless he is withdrawing from other drugs as well, or has complicating medical conditions, he is not at risk for long-term health concerns or death from withdrawals.



As far as what he can do to ease discomfort, I would definitely recommend lots of fluids, as long as he can keep them down. Imodium AD or some other anti-diarrheal can help with the diarrhea, but he should only take according to the directions on the package; since opiates make you constipated, taking medication to continue or increase his constipation can lead to an impacted bowel, which will add surgery to what already will be an ugly week. If he can eat or take in fluids, he should. I recommend broth or Ensure/Boost to start, so he can maintain some semblance of nutrition. He should carefully move on to solid food, as his stomach can take, and try to eat as healthily as possible. The exception to this is chocolate, which will release endorphins and very minor opioids into his brain, and ease his discomfort. Get him to eat as much chocolate as possible, I guarantee it will help. If he smokes, cigarettes will probably worsen his insomnia, and studies do show that quitting smoking at the same time as other drugs or alcohol increases the likelihood of success with both. Tell him this, but if he still wants to smoke, then let him. Not worth a battle over this one.



I would recommend against the Clonopin if it is not prescribed to him, as it is a rather powerful blood thinner and overuse can result in dangerously low blood pressure, which can lead to all sorts of nasty complications, including death and long term brain damage. If you want to go this route, take him to a doctor so that his use can be monitored.



As far as the weed goes, I would recommend against it, as well as Xanax or any other sedative, including alcohol, as some folks have already suggested. The reason for this is simple if you think about it. He’s an addict, and giving him other mood altering substances will be enabling him to continue his addictive behavior. Numerous recent studies have confirmed that the changes to the brain that occur in addiction will not begin to heal as long as any mood altering drug is being used. Studies also confirm that addicts typically have a drug (or class of drugs, such as opiates) that they prefer, but in the absence of that will use anything else available to change their mood. (Some of the data can be found through the US Center for Substance Abuse) This is in part because addiction is a behavioral disease, and the driving force behind the symptom of using is the need to change one’s mood to avoid negative feelings or thoughts. I guarantee that part of what he will be wrestling with is intense guilt and shame, and allowing him to continue to avoid this will not lead to him getting better. Don’t get me wrong, I am not advocating that he simply suffer, but replacing one addictive drug with another is not a recipe for success. My strongest recommendation is to try and take him to some AA or NA meetings, or arrange some 12 step visitors to cam and talk to him regularly. He needs to experience hope that he can get better, and the sense that his experience is shared by others and that he is not isolated. This will be the best method of dealing with guilt, shame, and other powerful emotions that come with withdrawals. Making connections with other addicts in recovery and creating a relationship with a recovering community is to date the only reliable indicator of success in staying abstinent for the long haul. AA or NA meetings should be easy to find through the web and the phone book.



Finally, some advice for the girlfriend: 1) Find some Alanon meetings in your area, go to them and find a sponsor. Learn from others who have been there what it means to be in relationship with an addict and how to help them without enabling addictive behavior for them and opening yourself up to harm.



2) Take his money. If he needs something, he can ask you for it. Keep money, credit cards, etc. on your person or at some other location. Make sure he isn’t left alone without supervision while he’s withdrawing or for a few days after he starts feeling better. Enlist help if necessary. These are the times he is most likely to relapse, and if he becomes obsessive about using, he will lie, cheat, steal, or just about anything else to get high. No matter how good your relationship is or how much he says he loves you, he still may lie or steal from you if it means he can get high. This is not because he’s a bad person and can’t be trusted, but because he has a behavioral disease. if he reaches a certain point where he wants to use, the desire to use will essentially become as strong as his drive for self-preservation, and he will basically be operating from a fight-or-flight reaction. Do not make the mistake of assuming that you or your relationship are the exception to this sort of thing. If you go to an Alanon meeting you will understand why I say this.



3) Talking about treatment eventually is not enough. If he’s serious about getting sober, there needs to be a plan about what he will be doing to stay sober. I can’t say that he needs treatment, but you should have an agreed upon plan including whether to go to treatment and including attending 12 step meetings. If possible, get this agreed upon before picking him up. If he is serious, this shouldn’t be a problem for him; if he isn’t than that should be clear when you talk to him. Hold him accountable to his plan. If it were me, I would only pick him up with a plan, and he would have to understand that staying with me and receiving help from me would be conditional on sticking to the plan or coming up with a new one we can agree to. He needs accountability and support from others in recovery to get sober, and anything that only helps halfway will not in the end be effective.



So there’s my advice. Feel free to include my email address if folks have questions. (It's akraemer@dawnfarm.org)
posted by klangklangston at 11:04 AM on July 23, 2007 [1 favorite]


Two nitpix:

Clonopin ... is a rather powerful blood thinner

Klonopin =! Coumadin.

replacing one addictive drug with another is not a recipe for success

Weed =! addictive.
posted by kmennie at 1:32 PM on July 23, 2007


He sent a followup, which I neglected to post: "I realized in my response I misread clonopin in the original post as Clonodine, which is the blood thinner I talked about, since it is frequently prescribed in small doses to ease opiate withdrawals. Klonopin is a benzodiazepine, like Xanax or Valium, is a powerful sedative, and my thoughts about it are in one of those paragraphs."

Weed can be addictive, and the chances go up if someone has already demonstrated an addictive personality.
posted by klangklangston at 2:08 PM on July 23, 2007


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