textfiles/drugs/withdrwl.drg

Date: Sun, 17 Apr 1994 21:37:39 -0400
From: Victor Borras <latin@PANIX.COM>
Subject: Re: controlled drinkers?
Sender: "Academic & Scholarly discussion of addiction related topics."
 <ADDICT-L@KENTVM.BITNET>
Message-id: <01HBAJJB5G7M8WY3Q0@ymir.claremont.edu>

I've been on both ends of withdrawals, heroin and methadone, every patient
of methadone will always tell you the same, as I do; I can kick heroin
anytime, but methadonde that is something else.  In 15 yrs of heroin
addiction, I've kicked 3 times, 'cold-turkey'.  In 10 years on methadone
I've never kicked methadone. Once I landed in jail, you have to do 72hrs.
of jail time before you see the judge, called 'due' process.
I was literally on the floor screaming my guts out.  About 12hrs. before I
was to see the judge, I demanded to be taken to the hospital, I just
couldn't take it.  I was cuffed, and looking like a 'chair' was glued to
my back, I limped to the ambulence, since I couldn't lift my leg to climb
into the back, the police grabbed me on both sides and shoved me in like a
sack of potatoes, I fell flat on my face.
The doctor realizing my condition and that it was severe, gave me a shot
of morphine or methadone,(I had ID# and she called my Doctor).  The cops
were very angry.  When they saw that I was ok, walking straight without
pain or slouching, they cuffed me to a chair, called another unit to
return me to the court building.  The new transport was ok with me, when I
got to the court building the cops wrote a message on my sheet.
"This is the addict that cried and was give dope, don't let him go to see
the judge, RETURN him to precinct jail to start new 72 hrs."  I was
returned to the precinct and 2 days later I was in the same condition!

Never did I go through such hell in all my days, I finally saw the judge,
I was able to stand and talk because, lucky for me, another inmate had
some heroin, I gave him my food for the 'dope'!

THE INTENSITY OF METHADONE WITHDRAWAL IS JUST TOO MUCH!  I COULD NEVER DO IT,
BTW ABOUT 5 YEARS AGO ONE INMATE WENT INTO CONVULSION AND UPON FALLING, HE
HIT THE METAL BARS, HE DIED!

=============================================================================

Eli-
  I objected to the idea that heroin, "did not cause any direct
health problems," because of two things, those being addiction and
withdrawl.  However; I was under the impression that withdrawl could
be fatal, which is not usually the case.

  If anyone is interested in learning more about this drug, I would
like to recommend the following book:

  Heroin, Myths and Reality
  by: Jara A. Krivanek     pub. 1988, Allen & Unwin

  Our discussion originally stemmed from the question: How bad is
heroin withdrawl?  Then it led to flames about "health problems",
tobacco withdrawl, etc...  Here is a section from _Heroin, Myths and
Reality_ that discribes addicts and withdrawl:

  "The development of physical dependence depends as much on
regularity of use as on the ammount actually used.  In pratice, the
vast majority of addicts fo not use heroin consistently on an
ongoing basis.  Less than half of the addicts who have been on the
streets for more than a year will have used daily for that period
(Johnson, 1978).  They may voluntarily withdraw to reduce their
tolerance, or the scene may be temporarily too much of a hassle, or
they may have an important engagement such as a trial, at which an
appearance of addiction would be undesirable.  Or they may simply
need a rest.  During such times, physical dependence may virtually
disappear, yet they will still think of themselves and describe
themselves as addicts.  In other cases, the users may never use
enough drug to develop significant physical dependence.  Senay
(1986) estimates that between 25 per cent and 40 per cent of street
addicts are not physically dependent.  Nevertheless, such 'chippers'
may wish to see themselves as addicts for reasons of their own, and
will so describe themselves.

  The withdrawl syndrome we have been discussing is what is termed
'primary' or 'early' abstinance.  A substantial portion of the
physical symptoms of this stage seem to depend on the activity of a
part of the brainstem called the locus coeruleus.  Opiates depress
this area and it would therefore be expected to become hyperactive
during withdrawl.  The locus coeruleus is an important centre in the
brain's fear-alarm system, and such hyperactivity would be
consistent with the marked anxiety and agitation withdrawing addicts
report.  Fortunately for withdrawing addicts, other drugs beside the
opiates can depress this region and one of them is clonidine.
Clonidine is generally used as an anti-hypertensive agent, but in
1978 Gold and his colleagues reported that it could supress or
reverse the symptoms of opiate withdrawl.  Subsequent work has shown
that this reversal is by no means complete, but there seems no doubt
that clonidine can make opiate withdrawl much more comfortable.

  Even if clonidine is not used, medical detoxification is usually
accomplished by giving decreasing doses of a long-acting opiate like
methadone.  Aftr a few weeks of this, the patient is usually
opiate-free without having suffered any appreciable physical
discomfort.  Since a percentage of the methadone marketed for
medical use finds its way into the streets, many addicts also detox
themselves this way without formal medical help.  Still others detox
'cold turkey'--without any pharmacological help at all.  They simply
tell their friends they have the flu, go to bed, and suffer in
relative silence.

  Medical supervision and assistance is certainly not essential for
successful withdrawl."  --pages 88 and 89

  That was immediate withdrawl.  The author goes on to say, "the
duration of early abstinence depends on the drug's rate of
elimination and in the case of heroin most major symptoms should be
gone within seven to ten days."

  He then describes, "A protracted abstinence syndrome follows
withdrawl from both heroin and methadone and...
lasts at least 31 weeks after withdrawl, and perhaps longer.  Blood
pressure, pulse rate, body temperature and pupil diameter seem to be
the main physiological variables affected.  Behaviourally, the
subject shows an increased propensity to sleep and there are
negative changes in mood and feeling state."

--Ahren