Opiate Withdrawal Survival Guide

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A brief note to our readers.

This guide, its content, and recommendations are for reference only. This guide is not written by a licensed clinician. Please be mindful of any current medical conditions that you have and any medications that you are currently taking before taking any of the medications or following any recommendations listed in this guide. If you have any concerns of possible allergic or adverse reactions, please consult your physician before taking any medications or following any of the recommendations in this guide. If you have any concerns, questions or other medical problems while going through withdrawals, please consult with your doctor or another licensed clinician immediately.
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Overview of opiate withdrawal and detox: What is it, why is it happening, and how did I get here?
This guide, its content and recommendations are for reference only. This guide is not written by a licensed clinician. Please be mindful of any current medical conditions that you have and any medications that you are currently taking before taking any of the medications or following any recommendations listed in this guide. If you have any concerns of possible allergic or adverse reactions please consult your physician before taking any medications or following any of the recommendations in this guide. If you have any concerns, questions or other medical problems while going through withdrawals, please consult with your doctor or another licensed clinician immediately.
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Withdrawal from opiates or any derivatives of narcotic painkillers can be a terribly uncomfortable experience, and although its not life threatening, it can be one of the most unpleasant experiences you will ever have to go through! Withdrawal Ease has searched every corner of the addiction and clinical community to develop the denitive guide to help you go through your withdrawal with safety and comfort as the key goals. Included in this guide is information on what to expect from your withdrawals based on your prior consumption of opiates, a list of essentials that youll need to have on hand to help with your symptoms, and some words of encouragement for when times get tough. This guide does not include information on the use or substitution of other opiates or narcotics in order to alleviate your withdrawal symptoms as we feel that can promote cross-addiction and will only transfer your dependence from one drug to another. Ultimately, we hope that you nd this survival guide a useful tool as you take your rst step in getting your life and happiness back. Congratulations on taking the rst step!
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Chapter 1
First of all, its important to keep in mind that everyone is unique. We have tried to address the typical persons opiate addiction (if there is such a thing!) and the most common withdrawal process. However, we recognize that theres a very wide spectrum when it comes to the intensity and duration of opiate addiction. Some of you may have been on opiates for years and some of you only for weeks or months. Some of you may take up to 80 pills a day and some may just take 5 a day (whether it be Vicodin, Norco, Dilaudid, Oxycotin etc.). We have done our best to take these varying factors into account, but please be aware that not everybody will react the same way to the withdrawal process.
Please take into account all aspects of your medical history, current medical conditions, and medications as you review our recommendations. Also, please use common sense at all times and if you have any medical conditions or if you feel as though you are in physical or psychological danger please seek out a licensed physician or psychiatrist immediately. Ultimately, all we ask is that you use your best judgment and seek help if you think you may become a harm to either yourself or others.
Chapter 2
Some Commonly Used Natural and Synthetic Opiates with Brand Name Equivalents
BuprenorphineBuprenex, Subutex, and Suboxone ButorphanolStadol Codeine FentanylActiq and Duragesic Heroin HydrocodoneAnexia, Lorcet, Lortab, Norco, Vicodin, Vicoprofen, and Zydone HydromorphoneDilaudid MeperidineDemerol MethadoneDolophine and Methadose MorphineKadian, MS Contin, and Oramorph Opium OxycodoneCombunox, Oxyfast, Percocet, Percodan, Roxicet, Roxicodone, and Tylox PentazocineTalwin PropoxypheneDarvocet and Darvon Time-Release OxycodoneOxyContin
Chapter 3
Opiates in very general terms stimulate the reward/pleasure centers (nucleus accumbens) of our brains and release a neurotransmitter called Dopamine which can create analgesia (resistance to pain) and feelings of euphoria or a sense of well-being. Nearly every drug either stimulates dopamine release or enhances its activity, directly or indirectly. In the graphic below you can see a representation of an opiate (in this case heroin) stimulating the opiate receptors in the brain which in-turn releases dopamine. When you take opiates for an extended period of time (10 days or longer), your brain begins to build a tolerance to the drug and subsequently alters the pleasure pathways which become more accustomed to higher levels of dopamine. What does all of this mean? There are many theories about addiction still being debated, but for our purposes lets just say that your brain becomes used to being stimulated by the opiates and steadily needs more drugs for you to feel that sense of well-being. When you take away the substance that produces these euphoric feelings, your brain begins to rebel. That rebellion is the beginning of the withdrawal process. Its obvious to you by now that the withdrawal process in your brain is a complicated series of events, but ultimately it just makes you very ill. Your body is craving more of the medicine that you were feeding it, and now that it doesnt have it, you have (or will) become sick.
Chapter 4
The intensity and duration of your withdrawal depends on a number of factors. Many people have a poly-pharmacy addiction which means they take a variety of different pills based on availability or personal preference. Due to this wide spectrum of use patterns, its extremely difcult to precisely predict exact withdrawal duration times. What we can do, however, is discuss what will contribute to your personal withdrawal experience and then give you some common statistics based on what we know. If youre not interested in the hows and whys of how long it takes for your body to begin to feel the effects of withdrawal, feel free to skip to our summary page which will give you the average time it takes for a person addicted to painkillers to begin feeling the effects of withdrawal.
Chapter 4: When will my withdrawals begin and how long will they last (cont.)
The Five Ts that contribute to the intensity and duration of opiate withdrawals:
1. Type: The brand and strength of the particular drug that you were addicted to. 2. Tenure: The amount of time that you were taking the drug. 3. Total Daily Intake: The amount of the particular drug that you were taking most consistently. Some people may take whatever comes their way. If you were taking many different kinds of opiates, take the strongest drug from the list on the next page that you were taking and use that as the reference. 4. Tolerance: The extent to which your body and brain become used to opiates and develop the ability to process higher doses of the drug. People have to take more and more as time goes by to get the same effect. Its similar to alcohol tolerance but much more profound and shorter acting. i.e. It takes years and years for an alcoholic to develop higher tolerances for booze. It only takes weeks for an opiate addict to develop tolerance for a certain amount of the drug. 5. Time of Half-Life: The amount of time it takes for 50% of a particular type of opiate to leave your body (From 3 hours in some cases to 3 days or longer in other cases). This a complicated process and we will spare you the technical details.
The Five Ts dened
1. Type
The following is a partial list of some of the most popular opiates (with their brand names) and their relative strength, from most potent to least potent per dose: **** Extremely Potent * Mildly Potent
****! Heroin (IV, snorted, smoked) **** ! Hydromorphone (Dilaudid) *** ! Fentanyl (Actiq and Duragesic) *** ! Morphine (Kadian, MS Contin, and Oramorph) *** ! Methadone (Dolophine and Methadose) *** ! Meperedine (Demerol) *** ! Oxycodone (Combunox, Oxyfast, Percocet, Percodan, Roxicet, Roxicodone, and Tylox) *** ! Time-Release Oxycodone (OxyContin When crushed and taken intra-nasaly) *** ! Hydrocodone 10mg (Lortab, Norco, Vicodin ES) ** ! Hydrocodone 5mg (Lorcet, Vicodin) * ! Propoxypene (Darvocet and Darvon) * ! Tylenol 3
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The Five Ts dened
2. Tenure
Your withdrawal will also depend on how long you have been addicted to opiates. The length of time that you have been addicted is a major factor not only in the determination of your withdrawal symptoms but also in gauging your psychological dependence. If addiction to pills has been a major part of your life for a long period of time, the ritual of maintaining your drug habit will be much more ingrained in your mind than it would be for someone taking opiates for just a few months. This why a distinction is made between Physical Dependency and Psychological Dependency
Different Classications For Tenure:

Using for 5 Years or longer:! ! Using for 1-5 years:!! ! ! Using for 6-12 months: ! ! ! Using for 2 weeks to 6 months: ! Chronic Dependency Long-Term Dependency Prolonged Dependency Short-Term Dependency
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The Five Ts dened
3. Total Daily Intake

This factor is very difcult to classify due to the wide spectrum of use patterns and different drugs that fall within the classication of opiates. The most consistent and linear classication structure for daily intake is a multiplier of common dosages as prescribed by a physician.
Using a common prescription for Vicodin as an example:

1-2 pills every 4-6 hours (Max 8 pills per day):! 2-3 pills every 4-6 hours (Max 12 pills per day):! 3-4 pills every 4 hours (Max 15 pills per day):!! 4+ pills every 4 hours (Max 15+ pills per day):! As Prescribed/Normal Intake Slightly Above Normal Intake Above Normal Intake High Intake
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The Five Ts dened
4. Tolerance
This factor is very difcult to classify due to the wide spectrum of use patterns and different drugs that fall within the classication of opiates. The most consistent and linear classication structure for daily intake is a multiplier of common dosages as prescribed by a physician.
The Five Ts dened
5. Time of Half-Life
The half-life of a particular drug is a widely used method of determining how long a particular drug will stay in your system after you have stopped taking it. When a drug reaches its half-life in your body, withdrawal is not far behind. So a prescription painkillers half-life is a pretty good indication of when you will start to feel the effects of withdrawal from a particular drug. Half-Life of Some Popular Opiate Painkillers Oxycontin:! 4-6 hours (If crushed before ingesting) Percocet:!! 4-10 hours Heroin:! ! 3-10 hours Hydrocodone:! 9-16 hours Suboxone:! 48-72 hours
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Okay, so youve gone through all of the 5Ts of your particular addiction what do you do now? Well, even though there are all of those factors involved: Most people will start to feel the effects of withdrawal between 12-24 hours after they have taken their last dose. People who use heroin may start feeling sick within 2 hours while other people may not start feeling sick for 12-24 hours. However, regardless of your drug of preference, the average person will start to experience withdrawals within 24 hours after taking the last dose. Most of your physical and psychological symptoms of withdrawal will last 5-7 days
You will not feel 100% after 5-7 days but you should probably be able to go back to work. Weve provided an intensity scale by day that will give you a good idea of how bad the withdrawals will be on specic days in a typical week of withdrawal.
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Intensity of symptoms
Duration of symptoms
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Chapter 5
Although you may feel deathly ill, opiate withdrawal is not considered life threatening. As always, use sound judgement and if you feel you need to see a doctor, please do what you feel is best for you and your body! The following list comprises some of the most common symptoms of opiate withdrawals with brief excerpts on each one. There are two lists: one for Daytime and one for Nighttime. We think this makes sense due to the fact that during the day, you are trying to get things done and be a productive person; and during the night, you are trying to get to sleep and stay asleep. Therefore, different symptoms of withdrawal will affect you in different ways depending on whether its day or night. Thats why the Withdrawal Ease Opiate Withdrawal Natural Supplement System has a Daytime Formulation and a Nighttime Formulation. During your withdrawal period you may suffer from all of these symptoms or maybe just a few. We have also attached a somewhat subjective scale that rates the symptoms from simply annoying to absolutely agonizing. There are obviously overlaps when it comes to symptoms in each list, but we have adjusted the Comfort Scale depending on how the symptom might affect you as you are trying to work as opposed to if you are trying to sleep. Please remember that we are not trying to scare you with this list or with the severity ratings; we want you to be prepared. When/if you do experience these symptoms, at least you will not be surprised. Its much easier to cope with something if you know how and when it will happen. And that is the strategy for much of this guide.
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Chapter 5: What are the common symptoms of withdrawal (cont.)
The following Comfort Scale is based on experiences of myself and other people who have gone through withdrawals. It is subjective and can vary from person to person.
* Annoying: One star is given to a specic symptom that you will most likely notice but will not be physically uncomfortable. It will mostly be a nuisance. ** Uncomfortable: Two stars indicate that a particular symptom may be uncomfortable but it will usually be bearable and not likely to cause great alarm or intense cravings to relapse. *** Very Uncomfortable: Three stars indicate that this a symptom that may either take you by surprise, cause you signicant physical discomfort, or make you seriously crave your drugs. These are symptoms that can either be physical or psychological and they can cause a person to want to give up. **** Agonizing: Four-star symptoms are those that break most people who try to go through withdrawals. They are ones that will cause you the most discomfort either psychologically or physically. These are the symptoms that you must prepare yourself to face and overcome if you are going to be successful in completing your withdrawal. The fourstar symptoms are the hallmarks of opiate withdrawal and therefore make it one of the most challenging things a person will ever have to face.
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* ** *** ****
Annoying Uncomfortable Very Uncomfortable Agonizing
Common Physical Symptoms of Opiate Withdrawal: Daytime
* * * * ** ** ** ** **
Pupil Dilation (large pupils): Pretty self explanatory. When your body is in withdrawal, your pupils get pretty large and as a result, your eyes can become a bit more sensitive to sunlight. Tremors (hands and feet): The tremors are mostly in your hands but can also be evident in other parts of the body. Just think of your body as a tree: when the wind blows the smallest branches shake the most. The same can be said for these tremors. Watery Eyes and Nose (not related to allergies): No itchiness, just tears running down your cheeks. Racing Heart Beat: Not much to say here. Your heart will feel like you have just exercised or had an anxiety attack. Excessive Sweating: The sweating can be in sudden bursts or over an extended period of time and can include the hands and feet. Goose-Flesh (goosebumps): Goosebumps are the by-product of the shivering that youll have during withdrawals. Although not terribly uncomfortable, they are prevalent throughout the withdrawal process and will probably rival any prior goosebumps youve had, both in size and quantity. Lack of Appetite: You will not feel any urge to eat at all either due to an upset stomach or lack of appetite. However, as we discuss later in the guide, your body needs fuel to ght this withdrawal process so you need to make a conscious effort to keep yourself wellhydrated and well nourished. Bone or Joint Aches: Your knees, shoulders and hips may hurt along with other joints; especially in the extremities. Sudden Muscle Jerks: The sudden muscle jerks can be somewhat alarming to a lot of people but they are nothing to worry about. They are all part of the withdrawal process and will dissipate, then go away altogether. These muscle jerks are sudden and random and can happen anywhere in your body. Most people nd that the common areas are the legs and the head; then occasionally, the whole body will suddenly just twitch. The best way to describe them is when you nod off to sleep and you suddenly wake up. It feels as if your body just involuntarily twitches or gets an electrical shock. They are very unnerving but not terribly uncomfortable.
**
Muscle Aches: This is part of the u-like syndrome but your muscles can ache as though youve had a really hard work-out.
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Chapter 5: What are the common symptoms of withdrawal (cont)
* ** *** ****
Common Physical Symptoms of Opiate Withdrawal: Daytime (cont.)
*** *** *** *** **** **** **** ****
Back pain: Usually lower back pain but sometimes it can also be in the thoracic region (middle back). Shivering: Throughout your withdrawal process, youll either be shivering and cold, or hot and sweaty. It will be rare that youre ever totally comfortable from a body temperature standpoint and it will become a constant battle to keep either cool or warm enough. Hot Flashes: See above. You will get hot ashes where your body will feel as though a wave of warmth has overtaken you and may begin to sweat. Again, its a constant battle to keep comfortable and will be one of the more consistent issues during your withdrawal process. Restlessness (Restless Leg Syndrome): Restlessness is one of the most frustrating symptoms of withdrawal. You feel as though your bones itch and have the urge to constantly move your legs and sometimes your whole body. This especially acute at night when youre trying to go to sleep. Flu-like Symptoms: This can be a combination of symptoms but u-like symptoms feel as though your body is ghting something off...and losing. Upset Stomach (diarrhea, cramping and nausea): This also a very common symptom and one that can be a primary source of discomfort and inability to function. Most people going through withdrawals will have nausea, vomiting, diarrhea or all three. Thus, it is important to stay hydrated. Lethargy/Low energy: This a major one. You will not have ANY energy. Youll feel as though even going to the bathroom is a chore both physically and psychologically. Depression: Perhaps the most insidious and cruel part of withdrawal is the depression you will most likely experience. Depression is very common for most people in withdrawal and it can be quite acute. If you are feeling so depressed that you want to harm yourself or others, please seek professional help immediately. The depression that most people feel is centered around the guilt and shame of their predicament. Many people have feelings of worthlessness and dread as well as feelings that their situation will never get better. Throughout this guide we will try to give you encouragement and other mental tips to help you keep a rational perspective and positive attitude.
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* ** *** ****
Common Physical Symptoms of Opiate Withdrawal: Nighttime
* ** ** ** ** ** *** ***
Watery Eyes and Nose (not related to allergies): No itchiness, just tears running down your cheeks...and onto your pillows. Goose-Flesh (goosebumps): Youll still have the goosebumps and they will be more noticeable at night due to your sensitivity as described in the muscle jerks section below. Youll feel that tingly, goose esh sensation and it can be more bothersome at night. Flu-like Symptoms: Youll still have u-like symptoms at night but since your rst thought when you have the u is to lie in bed, were only giving it 2 stars for nighttime. Back pain: Usually lower back pain but sometimes it can also be in the thoracic region (middle back). It can be particularly bad at night when lying down or when you wake up. Upset Stomach (diarrhea, cramping and nausea): If you have any intestinal issues during the day, hopefully your natural slower motility will help calm things down. Its still a major issue to deal with at night since youll be nauseous and may need to visit the bathroom several times which will further impede your ability to sleep. Shivering/Heat Flashes: The body temperature issue will continue at nights and will be more uncomfortable because you will constantly have to be throwing your sheets or blankets on and off. Excessive Sweating: The sweating can be in sudden bursts or over an extended period of time and can extend to the hands and feet. We add an extra star here for all of the sheets and pillow cases youll need to wash. Sudden Muscle Jerks: Random muscle jerks seem to be more prevalent at night. We believe thats because youre lying still and hence, more aware of subtleties in muscle movement as opposed to when you are up and about. The legs seem to be particularly annoying and jerky and can keep you awake, too. Combined with the restless leg syndrome, the muscle jerks make you a horrible bed partner (making this symptom worthy of 3 stars!).
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* ** *** ****
Common Physical Symptoms of Opiate Withdrawal: Nighttime (cont.)
***
Hypnic or Hypnagogic Jerk: One of the most surprising and dramatic symptoms of opiate withdrawal that occurs when you try and fall asleep is what some people call Hypnic Jerks. Although the origins of this syndrome are not fully known, the actual event can be terrifying if youre not expecting it. Just before you fall asleep (if youre lucky enough to get this far!) your brains sympathetic nervous system can activate your ght-or-ight response. You will suddenly wake up and feel as though youve had an electric shock or the sensation that you are falling and have just hit the ground. Some people even think theyve just had a stroke. Not to worry though. Its not dangerous and its most likely a result of sleep deprivation or that your sleep rhythms are a bit off. Were giving it 3 stars here because they dont happen to everybody but if they do and youre not expecting it, its a four-star symptom. Depression: Although you would hope to be asleep, depression is a signicant factor at night when you are alone with your thoughts. You will have a tendency to dwell on things and obsess a lot lying in bed so we believe that this is just as much of an issue at night as it is during the day, if not more. Restless Leg Syndrome (RLS): This is especially acute at night when youre trying to go to sleep. You feel as though your bones itch and have the urge to constantly move your legs and sometimes your whole body. It will cause you to toss and turn because it will seem as though theres no comfortable position. You may even nd yourself walking around the house or rubbing your thighs in order to relieve the RLS. Insomnia: Not being able to get to sleep when you are going through withdrawals is another very common and very upsetting symptom of withdrawals. The insomnia is a combination of regular sleeplessness that is only exacerbated by other common symptoms of withdrawal. Two of the main offenders that make it difcult to sleep are the muscle jerks and restless leg syndrome which both seem to be amplied when you try to sleep. The other factor of insomnia is the hypnic or hypnagogic jerks that are described above.
**** ****
****
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Want To Rate The Severity of Your Withdrawals?: The Clinical Opiate Withdrawal Scale (C.O.W.S.)
This chart is primarily used for initiating Buprenorphine therapy. However, it is also a useful tool to also gauge the severity of your withdrawal symptoms.
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How can Withdrawal Ease help?
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Chapter 6
The Withdrawal Ease Opiate Withdrawal Natural Supplement System Withdrawal Ease Opiate Withdrawal Natural Supplement System is the only natural supplement that has been specically formulated for opiate (painkiller) withdrawal symptoms. The complete system is a combination of 29 herbs, vitamins and essential amino acids designed to help the entire spectrum of withdrawal symptoms. Although we will suggest several other tactics to help reduce your withdrawal symptoms, The Withdrawal Ease product contains all that you will need from a nutritional supplement standpoint for the withdrawal process. Just take two (2) Daytime Formulation capsules in the morning and two (2) Nighttime Formulation Capsules in the evening!
Daytime Formula: Serving size: 2 Capsules Servings Per Container: 30 Passion Flower Lemon Balm Guar Gum Pomegranate Arabic gum Elm Bark Horse Radish ext 4:1 Mucuna Prureins Ext 20% Echinacea angustifolia ext 4% Magnesium Peppermint Leaves Green Tea Ext 50% Panax Ginseng ext 4% Anise Seed Powder Cayenne Pepper Ginger ext 4:1 Tumeric ext 95% L-Tyrosine Zinc Copper
Nighttime Formula: Serving size: 2 Capsules Servings Per Container: 30 Gaba Melatonin Milk Thistle Ext Alpha Lipoic Acid Reduced Glutathione Valerian Root Ext 0.8% Methionine
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Chapter 6: What is Withdrawal Ease?
How does it work?

Withdrawal Ease is specically formulated to help relieve the common symptoms of opiate withdrawal and opiate detox. The following content describes in detail why certain ingredients were included in the Withdrawal Ease System and the corresponding symptoms that they help relieve. It is also a powerful detox that can help restore normal organ function and cleanse the body of toxins and free-radicals. We have even provided some excerpts to relevant clinical study abstracts listed with the NIH (National Institutes of Health) when we cite the efcacy of a certain ingredient. Its our hope that you come away from this with a strong understanding of how Withdrawal Ease does what it says it does.
Withdrawal Ease Targets Withdrawal Symptoms At Their Source:

The Brain Major Internal Organs The Sympathetic Nervous System
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Chapter 6: What is Withdrawal Ease?
The Brain
The brain is where many of your withdrawal symptoms originate. Withdrawal Ease targets specic brain functions in order to help reboot your brains natural chemical balance and function.
Symptoms and solutions
Symptom: Depression Withdrawal Ease Solution: Lemon Balm, L-Tyrosine Symptom: Anxiety and Irritability Withdrawal Ease Solution: Passionower, Valerian, Ginseng Symptom: Lethargy or Lack of Energy Withdrawal Ease Solution: L-Tyrosine, Magnesium, Ginseng and Zinc Symptom: Insomnia Withdrawal Ease Solution: Melatonin, Valerian Root, Passion ower Symptom: Headache Withdrawal Ease Solution: Peppermint, Cayenne, Alpha Lipoic Acid Symptom: Lack of Appetite Withdrawal Ease Solution: Ginger, Ginseng
*Proof of Efcacy: How Do We Know It Can Help? Clinical Study Abstracts From The National Institutes of Health (NIH)
Passionower: Can be as effective in the treatment of Opiate Withdrawal as traditional care [Clonidine and Benzodiazepines] Tyrosine: Helps stimulate the reward centers of the brain and can help ease depression and increase energy Melatonin: Can be as effective as Sleeping Pills *Study Links and excerpts on Pub-Med (The Ofcial Website For Published Clinical Data on The National Institutes of Health website) are available upon request
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Chapter 6: What is Withdrawal Ease? (cont.)
The Internal Organs

Its no surprise that opiate addiction and consequent withdrawal wreak havoc on many internal organs in your body. Withdrawal Ease is engineered to provide a comprehensive detox to rid the body of toxins and free-radicals as well as help treat many of the withdrawal symptoms that originate in the digestive system, liver and musculature.
Symptom: Nausea, Diarrhea and Indigestion Withdrawal Ease Solutions: Nausea: Ginger, Peppermint, Lemon Balm Diarrhea: Iron, Ginger, Cayenne Irritable Bowel/Indigestion: Lemon Balm, Passionower, Peppermint Symptom: Liver Toxicity/Restoring Liver Function Withdrawal Ease Solution: Milk Thistle, Reduced Glutathione, Methionine, Tumeric Symptom: Elevated Heart Rate Withdrawal Ease Solution: Lemon Balm, Magnesium Symptom: Muscle Aches and Pains Withdrawal Ease Solution: Cayenne, Alpha Lipoic Acid
Milk Thistle: A Powerful Liver Detoxier Tumeric (Curcumin): An Anti-Inammatory Tool For The Digestive System Peppermint: An Effective Natural Aid For Abdominal Distress Ginger: Can Reduce Nausea and Help Increase Appetite *Study Links and excerpts on Pub-Med (The Ofcial Website For Published Clinical Data on The National Institutes of Health website) are available upon request
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Chapter 6: What is Withdrawal Ease? (cont.)
The Nervous System

The Central Nervous System is Ground Zero for opiate withdrawal. Although the brain is a part of the central nervous system, its important to note that much of the science and formulation behind Withdrawal Ease was dedicated to restoring normal sympathetic nervous system function.
Symptom: Restless Leg Syndrome Withdrawal Ease Solution: Valerian, Gaba, Mucuna Prureins Symptom: Dizziness/Fuzzy Brain Withdrawal Ease Solution: Alpha Lipoic Acid, Pomegranate, L-Tyrosine Symptom: Muscle Twitches or Tics Withdrawal Ease Solution: Gaba, Mucuna Prureins Symptom: Shakiness in Extremities Withdrawal Ease Solution: Methionine, Valerian Symptom: Decreased Dopamine and Serotonin production (Reward Center/Pleasure Pathway activity) Withdrawal Ease Solution: Mucuna Prureins, Gaba, L-Tyrosine, Magnesium
Valerian Root: Valerian Could Be The Answer For Restless Legs Syndrome and Muscle Twitches Mucuna Prureins: Mucuna Prureins Can Help Reinvigorate Sympathetic Nervous System Gaba: Can Help Calm Irritability and Regulate Neural Excitability
*Study Links and excerpts on Pub-Med (The Ofcial Website For Published Clinical Data on The National Institutes of Health website) are available upon request
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The importance of tapering
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Chapter 7
Introduction: Why taper?

The general goal of tapering your medications is to lower the amount of opiates or medication in your bloodstream so that you can lessen the impact of your withdrawal symptoms when you nally quit all together. Furthermore, immediately stopping some drugs can be potentially harmful. As a general rule, its never wise to completely stop any medication abruptly unless you are advised to do so by a physician. If you reduce the amount of narcotics in your system, your withdrawal will hopefully be less severe and possibly shorter. Thats the goal. If you plan to detox, most physicians (and the data that Ive read) suggest that tapering is an effective way to lower the acuity of your withdrawal symptoms. Like anything, sometimes this works and sometimes it doesnt. One very important consideration when planning your taper is...are you going to cheat? If you cheat and take more than your taper schedule calls for then youre just cheating yourself. Its not really worth it if you do not stick to your schedule. Many people say to me, I never try to taper because I know I will not be able to keep on-schedule. This not an excuse and it has nothing to do with whether you are a good person or moral or responsible...it is what it is. Be honest with yourself about this. If you feel as though you might have trouble sticking with your schedule, try our recommendation on page 23 and try to nd your pharmacist. Note to Withdrawal Ease Customers: If you are using Withdrawal Ease, we have seen the best outcomes when our customers begin to take the Daytime and Nighttime formulations approximately a 3-5 days before you begin your detox. This will allow the various ingredients in the system to get into your bloodstream and begin to work. Although it is not essential to follow this strategy, this where we have seen the best results. Many people have started their Withdrawal Ease upon detox (Detox in this case meaning the complete cessation of opiates) or even when they are in withdrawal and they have seen benets. However, we recommend starting Withdrawal Ease prior to your withdrawal if possible. This means that you can start Withdrawal Ease while you are still taking the last of your opiates.
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Chapter 7: The art of opiate tapering (cont.)
The Strategy
The strategy for a successful taper is one that depends largely on the Half-Life of the drug that you are taking and your own bodys reaction to reduced amounts of opiates/narcotics. In general terms, the half-life is the amount of time it takes for the opiate/narcotic levels in your blood to reach 50% of their original blood concentration. The half-life of your drug can vary from a few hours in the case of a drug like Heroin, to ve days for a drug like Suboxone. The half-life of a drug usually coincides with the onset of withdrawal. So if you are taking Heroin intravenously, one can reasonably presume that with a half life of say: 4 hours, that one will begin to feel withdrawal symptoms after 4 or 5 hours. For a person taking Suboxone, which has a very long half-life, it can take up to a week to feel withdrawal symptoms. As I mentioned, this can all vary from person to person based on your physical make-up, but the half-life of a drug is a very good indicator of how long it will take for withdrawals to start after stopping or signicantly reducing the intake of your medication. Ok, so Ive beaten that one to death. Back to the strategy. In my judgment, a successful taper is like walking on a razors edge. Youre trying to keep two opposing forces at bay. On one side, you are trying to reduce the amount of opiates (or narcotics) in your bloodstream, and on the other side you are trying to keep withdrawal from setting in. I cannot tell you how many people email me and say, Ive been tapering and going down from this to that etc. etc. and I feel awful. My response to that is Why? The goal of tapering is to eventually reduce the symptoms of withdrawal. The reason why you are lowering your dose is to help you feel better, not worse. Clearly, these people in my mind are not tapering their dose correctly. Either they are waiting too long between doses or they have reduced their doses too much too soon. Some people may disagree with me (for reasons I know not) but if you are tapering and you are acutely symptomatic then you arent doing it correctly. Of course there may be some very slight symptoms but one shouldnt be in full-blown, goose-esh withdrawal while tapering. Why prolong the agony? You are going to go through some sort of withdrawal/detox regardless.
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Chapter 7: The art of opiate tapering (cont.) Withdrawal Ease Tip: The Mountaineering Memory Management Device
Ultimately, tapering is a useful strategy to help reduce the discomfort of your detox/withdrawal but it has to be done correctly or it can make matters worse. A good analogy would be high-altitude mountaineering. All climbers have to acclimate themselves to the altitude or they can get sick and possibly even die from pulmonary edema or other nasty things that happen suddenly and kill you. If you have ever read anything on climbing Mount Everest or any tall mountains, youll recall that typically climbers have base camps at several altitudes on the mountain. When they arrive at base camp #1, they may ascend up to Camp #2 and then come back down for a day or so. Then they gradually move up to each base camp going back and forth as needed so that their body and get used to the lack of oxygen at those higher altitudes. Tapering is essentially the same process. But mountain climbers dont wait until they have a brain hemorrhage or pulmonary edema to go back down the mountain unless they have made a grave mistake and have acclimatized too fast. I think that this a great example albeit less grave of what your strategy should be for tapering. Take it slowly and let your body get used to not being on as much medication; if you start to feel sick then maybe you need to slow down or maybe youve cut your dose by too much. The strategy should be to lower your dose as much as you can yet still remain reasonably comfortable so that your eventual withdrawal is as painless as possible. This may take some trial and error but the secret is patience and also a willingness to adjust your taper schedule if necessary. If you are sticking to a schedule and you feel sick then you may need to shorten the time between doses or possibly raise your individual dose just a bit so that you do not cause withdrawal symptoms. Its a delicate balance for sure.
All good climbers know when to slow down and let their body adjust to the elements. Keep this in mind as you taper and slow down your taper if you start to have acute withdrawal symptoms.
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Chapter 8
Some people do not feel comfortable tapering because they either dont trust themselves to keep on-schedule or they think its a hassle. These are NOT good excuses for not tapering. Thats why we often recommend that people enlist the help of a trusted and responsible friend or family member to act as your pharmacist. We do not actually suggest that you ask your pharmacist to help you taper (although that would be delicious irony). What you are looking for is a person whom you can count on that will be able to hand out your scheduled doses dispassionately and on schedule according to your taper schedule. It could be your spouse, a friend or another family member. Bearing in mind how profound a tapering schedule can help you reduce the discomfort of your withdrawal, its worth it to approach someone close to you and simply tell them the truth. ! Something like: Hi Sally, I need to share something with you and perhaps get some help. Im going to be stopping some pain medication and the best way to do that is to slowly ween off of them. Can you help me take them on time and regularly according to my schedule? My doctor recommended that I do this and if I dont I could get sick. Can you help me? Id owe you one! And indeed you may perhaps owe them a dinner or something but it will be well worth it! If they agree then all you have to do is jot down your proposed schedule and hand over your pills to them. If they care for you, they will help you. I know that it may be uncomfortable entrusting someone with this information
A suspiciously attractive pharmacist is not needed; just someone you trust!
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Chapter 9
Before we get started, this for demonstration purposes only. This not a document written by doctors of addictionology; it is just an example of how a typical taper might work. There are all sorts of variables that need to be considered when you decide to taper your medications. Ultimately, you should always consult with your doctor before tapering any prescribed medications. Scenario: Lets say youre currently taking 10 Vicodin per day (2 at 4-6 hour intervals). You and your doctor have decided its time for you to discontinue the pain meds. So you both put a schedule together and it goes something like this:
Week One
Week 1: Lower your dose to 8 pills per day but instead of skipping an entire dose, just take one pill at two of your scheduled intervals (see below). This should always be the strategy. You want to make sure in the beginning of your taper that your body/brain get medication at the same times that they are accustomed tojust less of it. ! 8am: ! ! Noon: ! ! 4pm:!! ! 8pm:! ! Before Bed: ! 2 pills 1 pill 2 pills 1 pill 2 pills
A pill dispenser like this one is perfect for your taper.
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Chapter 9: Example of a typical taper (cont.)
Weeks 2-3
Week 2: Lower your dose to 6 pills per day and keep a close eye on how you feel. Is your energy ok? Are you eating and sleeping well? Are you down or depressed? If you have any symptoms of withdrawal, you may consider raising your intake to 7 per day for the rst half of the week. Remember, same intervals, reduce the dose. Week 3: Lower your dose to 4-5 per day and cut out one interval. This will be a bit difcult but I have found that it easiest to take out one of the intervals in the middle of the day as opposed to the morning or nighttime doses. As always, inform your doctor if you are experiencing any acute symptoms. ! 8am: ! ! Noon: ! ! 4pm: ! ! 8pm: ! Before Bed: ! Take 2 pills Take 1 pill Skip interval Take 1 pill (If you are feeling ok at this point, you can try and quit this interval too) 1 pill
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Chapter 9: Example of a typical taper (cont.)
Week 4
Week 4: Reduce Dose to 2-3 per day. This the point where you take out another interval and begin to lengthen the time between doses. As always, if you feel sick or start to go into withdrawal, you will want to consider taking a pill as needed to relieve the withdrawal symptoms. Remember, the goal is to not feel acute withdrawalsbut its not to get high either! Those days are long gone. ! 8am:! ! ! 2pm: ! Before bed: ! Take 1 pill Take 1 pill Take 1 pill
For our Withdrawal Ease customers, we would typically recommend that you start taking Withdrawal Ease along with your remaining opiates about 3-5 days before detox. It will give your body time to assimilate the various nutrients in the system.
If you plan on using Withdrawal Ease, begin taking the product as directed 3-5 days before you begin your detox. If you would like to start taking the product sooner, thats okay too!
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Chapter 9: Example of a typical taper (cont.) Week 5

Week 5: Remain at 2 pills per day for 3-5 Days. Take one of your pills in the evening and one at night until the end of the week preferably Thursday. Thursday mid-day should be your last dose. Thursday is a good day to quit if you are on a regular work week because your acute detox process can be dealt with mostly on the weekendor at least the worst part of it. This the time we all dread but has to happen. Its DETOX TIME! With any luck, your tapering program went very well, you stuck to your schedule, and your withdrawal symptoms will hopefully be mild. However, this will be the rst time your body and your brain will truly be without opiates. The vast majority of people who have been on pain medications for an extended period of time (more than 6-8 weeks) will go through some sort of withdrawal or detox. You will feel like you have the u and you may have many of the symptoms that we describe on our symptoms page. Hopefully you have been able to taper successfully and your symptoms are mild. If you have been on opiates for a long time, the detox may still be uncomfortable. At this point you should also refer to our Withdrawal Survival Guide: Chapters 10 and 11 to help you manage the acute phase of your withdrawal which will still be uncomfortable but if you have been able to taper, youve just spared yourself a lot of misery!
Note From George: Although this may be the start of a difcult part of your detox, it should also be met with a certain amount of excitement. I know that this sounds crazy but its the beginning of the end...the detox will not be easy but it will be easier than you imagine and youve done everything that you could to prepare. Its truly when all of the dread, angst and fear will subside and your determination must take over. Its the beginning of your new life without opiates, pills, methadone or whatever it is you are a slave to right now. If you can get through the next few days, you will soon begin to have more energy, less depression and a brighter future. Just get it done and youll wonder why you didnt start sooner! Once you succeed, it will truly be one of the most profoundly rewarding and life-changing gifts that you could ever give to yourself and those that love you. I promise. - G
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Detox: Your door to a better life
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Chapter 10
Before we get started with your detox, there are some tactics that can help you reduce the impact that your detox will have on your life over the next few days. In addition to tapering and The Withdrawal Ease Product, there are many other things that you can do to help relieve your withdrawal symptoms. Weve done extensive research on the best ways to treat withdrawal symptoms and have consolidated that information here. The following tips have been distilled from our own personal experiences, audits of the medical journals, exhaustive searches on reputable addiction web sites, conversations with other people who have experienced withdrawals and many other resources. This list certainly does not include ALL of the remedies, only the ones that have been widely reported to be efcacious and safe. Remedies For Common Withdrawal Symptoms
Exercise: We recommend light to moderate exercise (anything to get your blood pumping) on a daily basis to alleviate a variety of symptoms of withdrawal. Even walking around the block at your normal pace can do wonders for many of the physical and psychological symptoms of withdrawal. I truly believe that exercise is one of the most important things you can do to help relieve your symptoms! Oh, and its also good for you. Energy: Exercise will increase your energy level and the fresh air will help you get out of the normal funk that comes with most withdrawal episodes. Appetite: In order to increase your appetite and get the nutrients and fuel that you need to get through withdrawal, you need to raise your metabolism and theres no better way to do that than exercise. Sore Muscles/achy joints: Walking is especially good for sore muscles, back pain due to muscle spasms and even joint pain. If you can warm up and stretch your muscles, it can relieve a lot of the pain that youll feel and really help you reduce those achy joints in the knees and the lower back. Restless Leg Syndrome (RLS): Warming and stretching your muscles will help relieve your RLS. Depression: Moderate exercise will also help you get your mind off of things and elevate your mood. This extremely important since depression will likely be one of the most acute symptoms that you will experience. Getting fresh air and your blood owing will just make you feel a lot more hopeful and energetic.
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Chapter 10: The tricks of the trade - The best ways to alleviate withdrawal symptoms (cont.)
Hot Showers: Taking multiple hot showers daily will make your withdrawal process go a lot smoother and should always be a part of your overall withdrawal daily routine. Sore Muscles/Joints: Helps sore muscles and joints and eases back pain due to muscle spasms. Mood: Feeling clean will elevate your mood and help you feel a lot better physically, especially if you are sweating a lot. Its also part of a normal daily routine and will help you feel like you are active and accomplishing something thats good for your body. This may sound funny but its true; the more things that you can successfully achieve, the better you will feel. Tremors/RLS/Jerkiness: A shower will also help soothe your nervous system and alleviate the tremors, jerkiness and restless legs.
Clothing: The right clothing can help you regulate your body temperature and keep you comfortable as you experience hot-ashes and shivering. Were not going for fashion here... just optimal comfort. Light workout clothes: Clothes that are made for working out will breathe well and help your body and skin get the oxygen it needs. The other benet of workout clothes is that they wick away moisture if you are sweating. By keeping the moisture off of your skin, youll be able to alleviate the chills. ! ! ! We recommend brands such as Under Armour and Nike Dri-Fit clothes that are specically ! engineered to help regulate body temperature.
Jogging socks: Again, workout clothes are meant to help regulate your body heat so wear jogging socks to help wick away moisture and enable your feet to breathe.
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Chapter 10: The tricks of the trade - The best ways To alleviate withdrawal symptoms (cont.)
Helpful Over The Counter Remedies: We try not to overload you with suggestions for over the counter (OTC) remedies since taking too many may make you feel worse and there are possible interactions between drugs. Ultimately, you want to give your body and your mind a chance to heal without assaulting it with an assortment of different medicines. Trying to knock yourself out with OTC medications (such as nighttime cold remedies) is not the best way to go through your withdrawal nor is it safe to take any medication contrary to its intended purpose. During the daytime, the key strategy is to calm down your central nervous system and ease your anxiety while also giving you energy. At night, the key goal is to help you get a restful nights sleep. Please take all medications below as directed on their labels.
Imodium AD: Imodium is the gold-standard of OTC medications for opiate withdrawals. Why? Well, for one thing the active ingredient in Imodium is Loperamide which has a chemical make-up that is very similar to opiates although it has none of the narcotic effects. Imodium will help with your upset stomach and slow down your motility as it targets the same receptors in the GI tract that opiates do. This will help slow down any diarrhea and abdominal cramping you have. Due to its similarities to opiates, Imodium also helps generally ease the withdrawal process in its totality which will reduce the severity of a lot of the central nervous system, muscular and psychological effects of withdrawal. Advil, Aleve, Tylenol or Aspirin: OTC pain relievers will help with muscle pain and joint pain. Just take whichever is easiest on your stomach and does not interfere with any of your medications. Ben-Gay: Ben-Gay (or generic equivalent) can help with joint pain and muscle aches. Ben-Gay is a critical part of the famous Towel Trick for restless legs at night so get a good sized tube. Vitamin B-12 or B-Complex Vitamin: Vitamin B-12 will help with energy and will also help calm an overactive nervous system activity like twitching and the shakes. Withdrawal Ease does contain some Vitamin B6 but other Vitamin B variants such Vitamin B-12 are recommended for energy during the day.
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Dietary Tips: Even though you will not have much of an appetite, you must discipline yourself to get nourishment so that your body has fuel to ght through your withdrawals. There are several ways to get the caloric intake and nutrition that you need in order to not only feel better, but to ease withdrawal symptoms: Eat Small Meals More Frequently: Youre certainly not going to want to eat a big steak dinner and if you feel nauseous, youre probably not going to feel like eating anything. Thats why we suggest breaking up your meals from 3 per day to 5 per day and decreasing the portion size. Try Lean Cuisine Frozen Meals: Lean Cuisine frozen lunches are pretty small so they are a good portion size and they will be just enough to ll you up but not enough to overload your stomach. They are also very easy to prepare. Green Vegetables: Good sources of vitamin K and also ber which will help digestion and give you energy. Fruits: Bananas have lots of potassium for energy. Blueberries have antioxidants for liver cleansing. And fruits such as oranges and apples are great sources of vitamin C. Mini Carrots: They are good for you of course, but weve found that they are good things to snack on and they ll you up so you dont have to eat too many of them. Dark Chocolate: High-quality dark chocolate has ingredients that will stimulate the pleasure/reward centers in your brain and also help with nervous system activity. Soup: Its easy to ingest if youre nauseous and its not too lling. Light Crackers: Something like Saltines will ll you up but wont be too harsh on your stomach. Anything With Vitamin C or Calcium: A great way to kill two birds with one stone is to drink Tropicana Orange Juice with Calcium (if you can nd it). This vitamin combination will help you raise energy levels and also help calm nervous system activity. However, dont take too much as a lot of orange juice and Vitamin C can lead to nausea. Just take a six ounce glass in the morning and one at night.
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Chapter 10: The tricks of the trade - The best ways to alleviate withdrawal symptoms (cont.)
Other Detox Essentials: Heating pad: For sore muscles and the shivers. Ice packs: If you have any type of nerve related pain then you might actually want to stay away from heat and try something cold like an ice pack. For muscle pain, heat seems to work best but heat also has a tendency to iname and expand tissues which will put more pressure on your nerves or the surrounding tissues which can create nerve pain. So if your pain is any type of nerve pain or if you have pain that radiates down your leg or arms, an ice-pack will probably work best for you (You should probably have that shooting pain looked at by a doctor while youre at it). Muscle Pain? Use Heat. Nerve Pain? Use Cold. Plenty of Gatorade: For hydration. Throw blanket: Having a blanket that you can easily take on and off will help with the sudden perceived temperature changes. A quiet place to rest during the day: Make sure your bedroom or wherever you are going to rest during the day is as quiet as possible and away from any busy spots or high trafc areas. You wont want to have any distractions or a lot of people around. It doesnt have to be a sensory deprivation chamber... just a quiet place if possible. Audiobooks: If you have an iPod try getting a subscription to audible.com. I cant say enough about how valuable audiobooks are in passing the time and getting your thoughts away from WDs. Note: Dont get any books having to do with illness, addiction, drugs or anything complicated. Youre looking for mind candy. Anything deep or reective will annoy you. Movies and/or video games: Conversely, anything funny or senseless will help you pass the time.
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Other tips worthy of consideration: Even though some of these may seem like common sense, weve found that the tips below can make a big difference in your comfort level during withdrawals. At night when you go to sleep, rub some Ben-Gay on your legs and then wrap each leg with a soft bath towel. This will help with RLS. Keep the heating pad and the ice packs handy for chills and hot ashes. The neck is the best place to put them on your body. Wrap a soft terry-cloth towel over your pillow at night to soak up any sweat so that you dont have to keep turning the pillow around. Its actually pretty comfortable if you get the right towel. No phone calls for the rst 48 hours! You need to concentrate on yourself. No whining on message boards about your withdrawals. It wont help and you will get some really dangerous advice and a lot of I told ya sooos. Misery loves company so stay away from the boards. Keep the pets around. They are soothing and they dont judge. A big, dumb dog is perfect! If youre not listening to an audiobook or watching TV, have some calming music playing. Again, no self-help or meditation tapes...they will annoy you to no end. Dont talk to anyone at work for the rst 48 hours. You might say something that you shouldnt or make an un-wise decision due to your depression. Stretching. There are several, specically targeted stretching exercises that will help loosen the muscles if you have a muscular type of back pain. A good resource for these exercises is a web site called SpineUniverse.com. Stay Busy. Engage yourself in a hobby or a household project that is simple and that can be nished. This will get your mind off of things also also give you a feeling of accomplishment which will boost your mood and your energy. This sort of related to the previous bullet on work. You WILL be very depressed. Even if you have had experience with depression before, you may be surprised at how down you will feel. Please be careful! Dont make any nancial decisions, career changes, rash purchases or any other type of major commitments one way or another during this time. Dont be stupid. When depressed, you could do something that you will regret later so just make sure that you hold off on Telling your boss to shove it until you get your right mind back. And most importantly, make sure you dont do anything that might injure yourself or others. If you feel like you are a danger to yourself or others please seek professional help immediately! If you need to talk to someone, call 1-800-273-TALK, its a national hotline open 24/7. The sadness will go away; I promise you on that one.
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Chapter 11
Day One The rst 24 hours after your last dose.

Try to take your last dose of opiates 12 hours before you plan to go to sleep that day (refer to The Art of Opiate Tapering at the end of this section for more details on tapering). Hopefully by the time you go to sleep youll be feeling only a twinge of sickness but you will be able to get to sleep. The key strategy here is to fall asleep just as your withdrawal is kicking in so that you can at least negate 8 or so hours of discomfort. If you wake up on Day 1 and it has been 24 hours since your last dose, you will probably be in withdrawal by that time. Prepare for these symptoms to intensify as the day goes on. Some people dont experience the stomach issues until later in the withdrawal period but for the most part, youll feel...not well. In The Morning: Try to get something in your stomach like cereal or toast. Then take your Withdrawal Ease Day Time formulation (2 capsules), a dose of Imodium AD and some Aleve or Advil as needed. Take a shower. Go back to bed and sleep as much as you can. As the next few days progress, sleep will become a precious commodity so try and get as much rest as you can in the beginning of the process. In The Afternoon: Try and eat little snacks and drink plenty of uids. Take more Imodium or other OTC medications as needed and as directed. Exercise! Walk one mile as briskly as you can or do some stretching exercises. Take a Shower. Complete either a small chore or listen to an audio book. Watch a movie. Sleep if you can. Things to think about: Congratulations, youve gotten through your rst day and youre getting a feel for what real withdrawal symptoms are going to be like. Youre 1/3 of the way through the really tough part and a lot closer to getting your life back from pills than you were 24 hours ago. The rst day is when a lot of the people quit because they have just not prepared themselves for being uncomfortable. You have made it this far in the guide so you know all about how youre going to feel. The guilt and shame of being addicted will only get worse if you turn back now and take more pills. Remind yourself of all the reasons why you quit: the depression, the moodiness, the lack of energy and the absence of joy in your life were largely due to pills. Now all you have to do is get through a few days of being sick and all of that can be behind you. In The Evening Take your Withdrawal Ease Night Time Formulation (2 capsules), a dose of Imodium and and some Aleve or Advil as needed. Take a shower. Eat a small meal like a Lean Cuisine frozen meal. If youre sick to your stomach, try to eat some crackers and soup. Drink water or Gatorade. Watch a movie or listen to an audio book.
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Chapter 11: Withdrawal planner Day Two

By now you have most likely experienced abdominal cramping or diarrhea if you hadnt already and the withdrawal symptoms are getting quite acute. You will be shivering a lot and clammy. Your energy will be pretty low and youll have a hard time getting out of bed. Youll be depressed. This when you will really have to make an effort to stick to your schedule and keep getting things done.
In The Morning: Try to get something in your stomach like cereal or toast. Drink some orange juice or eat some fruit for vitamin C and to increase your blood sugar levels to give your energy a boost. A cup of strong coffee or tea is ne as well. Then take your Withdrawal Ease medication, a dose of Imodium AD and some Aleve or Advil as needed. Take a shower. Try and exercise a little earlier this morning in order to get your energy level up. In The Afternoon: Try and take a nap. Take more Imodium or other OTC medications as needed. Complete either a small chore or listen to an audio book. Take a shower or a bath to soothe your muscles. Keep drinking lots of uids and always have a cup of water or Gatorade by you to sip on. Force yourself to have a snack of mini carrots or some crackers. If youre nauseous, try munching on them while watching a movie or listening to an audio book since the distraction will help you get the food down. Watch a movie.
In The Evening Take your Withdrawal Ease Night Time Formulation capsules, a dose of Imodium and some Aleve or Advil as needed. Use your heat pads and ice packs for sore muscles and either chills or hot ashes since they will become more intense now. Remember: when trying to regulate your body temperature, the neck is a very effective place to put an ice pack or heat pad. Take a shower. Eat a small meal like a Lean Cuisine frozen meal. If youre sick to your stomach, try to eat some crackers and soup. Drink water or Gatorade. Watch a movie or listen to an audio book.
Things to think about: Youve gotten over the shock of all the symptoms by now and you probably havent slept very well so theres a good chance that from here on out there arent going to be many surprises. Its just going to get a bit more intense on Day 3. The good news is that you will probably peak on Day 3 or 4 so we are only talking a matter of HOURS and you will be on the path to feeling better! If youve made it this far, youve come too far to quit! You have to do it! At least give yourself the chance to feel what its like being without the pills; give your mind a chance to not feel so depressed all of the time. After all that you have been through with these pills and all the anguish, it doesnt make sense to turn back now! If youre reading this at the end of Day 2, congratulations; youve made it farther than most!
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Chapter 11: Withdrawal planner Day Three & Four

Days 3-4 will probably be the hardest days. Typically, withdrawal symptoms will peak around Day 3 so you need to be physically and mentally prepared for what lies ahead. The good news is that youve gotten used to the schedule and you know what the different symptoms feel like. The only thing that will be different is that the symptoms will have gained a bit of strength.
In The Morning: Get yourself out of bed as soon as you can. Your back will feel better standing up and you need to get your mind off of the symptoms. Try to get something in your stomach and stay away from anything highly acidic or anything that could further upset your stomach. Take your Withdrawal Ease Daytime formula, Imodium and any OTC medications as needed. Take a shower and get completely dressed like you would on a normal weekend. This includes, shaving, brushing teeth...everything. Go on a eld trip. Although we generally recommend that you stay at home, this one day when you need to get out of your surroundings and interact with the general public. We know that this the last thing you want to do but you have probably been cooped up in your house for a couple days and it will be good to get out. Go to a mall or big store, or even a movie. This will help make you feel as though you havent been living on another planet. In The Afternoon: Try and take a nap after you get back from your eld trip. Take Imodium or other recommended OTC medications as needed. Complete either a small chore or listen to an audio book. Take a shower or a bath to soothe your muscles. Keep drinking lots of uids and always have a cup of water or Gatorade by you to sip on. Force yourself to have a snack with fruit or some crackers. If youre nauseous, try munching on them while watching a movie or listening to an audio book. Watch a movie. Do some stretching paying particular attention to the legs and lower back. Then go and exercise.
In The Evening Take your Withdrawal Ease Nighttime Formulation capsules, a dose of Imodium and some Aleve or Advil as needed. Use your heat pads and ice packs for sore muscles and either chills or hot ashes. Take a shower. Eat a small meal like a Lean Cuisine frozen meal. If youre sick to your stomach, try to eat some crackers and soup. Drink water or Gatorade. Watch a movie or listen to an audio book.
Things to think about: If you get to Day 3 youve gotten to the mountain top and now all you have to do is slide down. No, the symptoms are not going to go away completely all of a sudden, but you have most likely gotten to the most intense part of the withdrawal and will slowly but surely start to get your energy back. Even though you may feel the sickest today, tell yourself that youre beyond the point of turning back now. We know its agony but it WILL get better and you WILL feel normal again. In fact, at the end of all this youll feel a lot better and have a lot more energy than you had when you were on opiates.
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Chapter 11: Withdrawal planner What to expect going forward

The most intense part of your withdrawal process should last about 5 days but it could continue on for a couple more days depending on your personal history. If you dont start to see improvement immediately after 5 days, dont get discouraged! The withdrawal symptoms will subside. When your symptoms start to taper down it will be subtle but youll feel a bit more energy and your depression may start to get better little by little. Just remember, these symptoms will go away in time but its a step by step process so you have to be patient and trust the fact that all withdrawals eventually get better. Some Other Things To Keep in Mind As You Start to Feel Better: Be patient and keep reminding yourself that your symptoms will slowly start to get better in little steps. Your depression may hang around for a bit longer. Even when you feel much better physically, you can still have some bad days once and a while so be prepared for a few bumps in the road. i.e. Life The shakes and the twitches sometimes take a bit longer to go away. These symptoms take a while to totally subside but they will happen with less frequency and then they will stop. Keep taking the Withdrawal Ease product after your symptoms have calmed down. It will help with energy and depression, so keep taking them even after your acute withdrawal is over. The Withdrawal Ease product has a months supply and you should not need any more after they are depleted. Keep doing the things like exercise and and eating well. They cant hurt and they will help you keep your energy up and also help replace the time you spent on your addiction with something positive and good for you.
Things to think about: The name of the game in your recovery period is patience. Many people say to themselves, I thought it would be over by now, why am I not feeling better?! Well dont worry, you will feel better but your body has just gone through quite an ordeal and it will take time to get back to 100%. You really have to keep telling yourself that Tomorrow I will feel better and try to have a positive and rational outlook. Over the next few days, you will start to notice that the lights are coming on and that you have a bit more energy and you are not in such a foul mood all of the time. We cannot overstate how important your state of mind is in the process of recovery. A positive outlook really will help you immensely. Your body and your mind are taking little steps each day whether you notice them or not so you have to keep contributing to your healing process by giving yourself a lot of credit for going through withdrawal. Youve been through a lot and theres nothing to be embarrassed or ashamed about; youve done something extremely good for yourself and you should be proud. Again, if youre patient and have a positive outlook, you will start to notice changes in your mood and your body and then it actually gets fun. It gets fun when you start to feel better than you did when you were on pills and when you notice how much more energy and drive you have. Thats when youll know for sure that quitting painkillers may have been one of the best decisions of your life.
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Suboxone
xlviii
Chapter 12
Opening Remarks on Suboxone and the Following Information: This page contains most of the basics about the drug Suboxone as well as some Pros and Cons. Although it may seem like an obsession, Suboxone keeps coming up. I can sense the panic in peoples emails and theres a lot of information ying around out there; some of it sensational and bogus. All of the following information and opinions are, of course, mine. I have read all of the abstracts, articles, clinical trial data and even the submission for approval to the FDA as well as the nal approval letter granting Suboxone marketing rights here in the US. Along with the published data, I have spoken to literally hundreds of Suboxone users, ex-users and prescribing physicians. Furthermore, I have personally been on Suboxone. Im not a doctor or a pharmacist so the technical bits are generalized because people just want to know the basics. Suboxone can be a useful therapy for many people or as a short term detox solution but some people who are on it right now probably should never have gotten on it in the rst place. This my opinion and many people in the clinical and pharma world may not share my views, but since this my Survival Guide Im going to call it like I see it. Suboxone What is it?
Suboxone is a combination of Buprenorphine and Naloxone that is prescribed for opiate addiction. It is called a Partial-Agonist opiate because it occupies the opiate receptors in your brain but does not cause acute, narcotic effects. An example of a Full-Agonist opiate would be Hydrocodone. Suboxone tablets come in 2 strengths; 8mg and 2mg.
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Chapter 12: What is Suboxone?, cont.
Illustration provided by The NAABT This guide, its content and recommendations are for reference only. This guide is not written by a licensed clinician. Please be mindful of any current medical conditions that you have and any medications that you are currently taking before taking any of the medications or following any recommendations listed in this guide. If you have any concerns of possible allergic or adverse reactions please consult your physician before taking any medications or following any of the recommendations in this guide. If you have any concerns, questions or other medical problems while going through withdrawals, please consult with your doctor or another licensed clinician immediately.
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Chapter 13
Who Should Be Taking Suboxone?: In my opinion

1. ! 2. ! 3. ! Patients/addicts with a history of long-term/chronic, heavy opiate addiction and abuse. People who repeatedly commit drug-related felonies and/or are a danger to society in order to feed their drug habits. People who are in the care of a doctor who will help them detox with Suboxone and then get them off of it within a couple weeks at the MOST.
As I have written in some recent posts on our website (To Sub Or Not To SubSuboxone That Is & Suboxone: Is A Storm Looming?), I equate Suboxone to a rich-mans, high-tech methadone since it is a good replacement therapy for heavy opiate abuse and addiction. From a mass societal perspective, Suboxone can help reduce drug-related crime, homelessness and overdoses so there are plenty of very worthwhile applications for Suboxone. Thats why the majority of study participants in Suboxone clinical trials are comprised of heroin users and heavy, heavy abusers of potent opiates such as Dilaudid. This a very important distinction that is sometimes blurred by marketers and distributors of Suboxone. Suboxone therapy is for people who simply cannot discontinue their use of heroin or powerful opiates even if they were not faced with the looming specter of withdrawal. It should be considered a long-term (perhaps even life-long) therapy for people whose addictions are so acute that they are literally left with two choices: Jail or Death. These addicts continue to use because they are chronically addicted to the high; not simply afraid of withdrawal. Suboxones primary clinical benet is that it signicantly reduces cravings for opiates. Its effective because it takes away addictive impulses. Many of the opiate addicts that I come in contact with here at Withdrawal Ease do not t that description. They would give their left arm to get off of opiates; yet they are afraid of the WITHDRAWAL.
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Chapter 14
Beginning Suboxone: When Do You Take It? In order for Suboxone to work, the opiate receptors in your brain must be totally free (empty). Opiate receptors free-up when drugs are no longer being delivered to the brain. Your rst dose of Suboxone must be taken when your opiate receptors are clear. However, theres a catch. This freeing-up of the brains opiate receptors is what causes withdrawal symptoms. (See the graphic below) The red dots are Suboxone occupying clear opiate receptors and the yellow dots are drugs/opiates leaving the receptors. During this transition those receptors are not being stimulated therefore the withdrawal process begins. An opiate addict must not take their rst dose of Suboxone until they have stopped their intake and are experiencing full withdrawal symptoms. You cant park a car in an occupied space.
In order for Suboxone to work, it must occupy EMPTY opiate receptors or you could suffer from precipitated withdrawal. You Do Not Want That.
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Chapter 14: How does Suboxone work? (cont.)

How Long Do You Have To Wait to Take Suboxone? What Happens if You Dont Wait Long Enough? As we have discussed, the onset of withdrawal is dependent upon the half-life of the drug that has been in your system. Heroin, for instance, has a short half-life so it will take only about 4-8 hours for opiate receptors to free-up and full withdrawals to take effect. For a person on Hydrocodone, which has a longer half-life, acute withdrawal might not start for 24-36 hours. In any case, you basically have to be pretty sick before you take your rst dose of Suboxone OR you will go into what is called precipitated withdrawals. Precipitated withdrawals can be caused by taking the Suboxone too early and not letting those opiate receptors clear out, thereby causing withdrawal. You do NOT want this to happen. To make sure that you are in full withdrawal, your prescribing doctor will rate your withdrawal symptoms on a certain scale called the C.O.W.S. (Clinical Opiate Withdrawal Sale). That way, you both can make sure that you avoid precipitated withdrawals. After your opiate receptors have cleared and you are in full withdrawal, you can then take your rst dose of Suboxone. This will trick your opiate receptors into thinking its being fed opiates and will also block any other real opiates that try to occupy those receptors.
Suboxone stimulates opiate receptors and blocks other opiates
53
Chapter 14: How does Suboxone work? (cont.)
Suboxone comes in two forms: sublingual pills or strips with doses ranging from 2mg to 8mg. Sublingual means under the tongue. You place a pill/strip under your tongue and let it dissolve for about 10 minutes.
The pills taste a bit like burnt Tang with a sort of bitter orange-peel taste. For me, the taste is not too unpleasant but some people hate it. If the taste is bad, try the strips. It can take up to an hour for you to feel any effects which are very minimal. Contrary to popular belief and marketing claims however, you WILL feel a very mild calming/euphoric effect when you take your dose and the intensity of this effect can vary from person to person. Some people actually get a bit euphoric when they take their dose (I did) but it is nothing like taking a handful of Hydrocodone and guzzling 3 glasses of wine. Make no mistake however, theres a reason why people have a hard time reducing their dose and its the same reason why we have a hard time reducing or titrating down regular opiatesSuboxone gives many people a little bit of narcotic nostalgia. Anybody that says differently is either lying or hasnt taken it.
54
Chapter 15
The pros of Suboxone: 1. If administered under the care of a licensed physician who has undergone additional training and accreditation for prescribing Suboxone, it can be helpful for some. 2. Does not have intense narcotic effects and provides a stable means to permanently quit your opiate cravings. 3. Its very hard to overdose on (unless taken intravenously or with Benzodiazepines) and helps block other opiates from having any effect on your brain. 4. Can be tapered with your doctor in a controlled manner. Tapering is a lot easier for most people to accomplish due to the fact that it has a very mild narcotic effect so you wont be tempted to take more. 5. Provides a way to partially avoid full-term acute withdrawal from the drugs you were taking previously. 6. Is accepted by most major insurance carriers. 7. Its relatively easy and painless to take other than the bad taste.
55
Chapter 14: The pros and cons of Suboxone (cont.)

The cons of Suboxone: 1. It is very, very expensive. Even if your insurance covers it, they are going to make you pay a lot more for it than your normal co-pay, expect to pay about 300 bucks a month with insurance and about 300 bucks a week without insurance. Thats not including the cost of your monthly doctors visit. Ouch! 2. Its addictive. I know, I said that it doesnt have the same narcotic effects that other opiates have but it does have a calming and slightlyumnostalgic opiate euphoric effects. This my personal experience and others may be different but I got a little bit of a high from it. I have met others that have gotten really really hooked on it. 3. You are substituting one drug for another and you have to ask yourself if you are getting closer to your goal by doing so. The clinical strategy with Suboxone is virtually the same as methadone which is essentially to stabilize and then sustain the patient until he or she is ready to get off of it. 4. There ARE withdrawals from Suboxone. Since Suboxone is a relatively new drug (Buprenorphine is not a new drug but Suboxone is), theres not much data on the long-term effects of the drug or the withdrawals. The common wisdom is that Suboxone withdrawal is very similar to opiate withdrawal except that it is a bit milder and lasts up to a month as opposed to 5-7 days like Vicodin. There is a syndrome called P.A.W.S. (Post Acute Withdrawal Syndrome) that is commonly associated with Suboxone and it consists of prolonged lethargy, depression and insomnia. There are entire websites dedicated to Suboxone withdrawal so it is not a small issue. 5. Many people who have used Suboxone will nd it too expensive and then transfer to methadone treatment since its cheaper. Trust me, you do not want to be on Methadone! You have to go to a clinic every day (gag) to pick up your dose and the withdrawals are horrible. In my opinion, you might as well go back to Vicodin if youre thinking about Methadone. 6. Suboxone doesnt have many side effects but the ones that it does have are acute. Industrial strength constipation that will make you want to drink Drano (for Gods sake this a joke! Dont drink Drano!). It gives you munchies for sweets and whatever weight you are now just tack on 10% after you get on Suboxone. It can also make you very very sleepy and when I was on it, I drank about 4 cups of coffee and 5 cokes a day to stay awake which causedinsomnia. 7. Did I mention its very expensive? You also need to nd a doctor that will administer it to you every month so factor in the ofce visit copay or out-of-pocket costs into the total cost of the treatment.
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Chapter 16
Ive been on Suboxone for a while and want to get off. So what do I do now? Let me just say that there are many people in the addiction community that dont have a very solid answer for this question. Ive heard a lot of different theories and I will share them with you but heres the deal: Im not a doctor and Im not YOUR doctor. So if you try any of this stuff, you do so at your own risk or more preferably with your prescribing physician so that he or she can monitor your progress. If you do not work with your doctor on this you could get hurt or die. Suboxone Detox Option #1: The Glacial Taper Process (Explained in Further Detail in the Next Chapter!) The Standard of Care for Suboxone detox is to slowly taper over a long period of time. When I say long I mean up to 6 months. You and your doctor can gure out how to titrate your dose but the key here is to have a disciplined taper that does not cause withdrawal symptoms. Ive heard of people even cutting their 2mg pills with razor blades to get to the lowest possible dose before nally quitting. This will give you an idea of the increments that you will be looking to titrate at as you detox. Your doctor can also prescribe some other medications if you have any symptoms but frankly I think Withdrawal Ease does a better job. For now, I believe that this still the best way to detox from Suboxone. We have an article on Withdrawal Ease.com called How To Detox From Suboxone using this taper method. The following URL will get you to the proper page on the website to nd out more: http://www.Withdrawal Ease.com/how-to-detox-from-suboxone-at-home/
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Chapter 16: How do I stop taking Suboxone (cont.)
Suboxone Detox Option#2 (Experimental and Potentially Dangerous): Go back to What Brung Ya I have heard from a couple of doctors and a few customers that they believe the easiest way to detox is really to start all over and start taking a full-agonist opiate of some sort. Most people have tried Vicodin, Lortab and other Hydrocodone variants. The people that I have talked to have sworn by it. Essentially what they did was to wait for approximately a week so that their opiate receptors are free of Suboxone and then they began low doses of opiates. They would stay on the opiates for a month and then go through detox. It makes sense I suppose but there are a few things that concern me about this theory. Obviously, theres a serious risk of overdose if you start taking opiates and the Suboxone is still in your system. Secondly, youre back to square one with your drugs and this whole exercise has been a waste of time and money. Thirdly, are you just going to go back and start using again? If you consider this option, you MUST do so under the supervision of a doctor. There is a real risk of overdose because of the Suboxone in your system and your tolerance has lowered considerably since you last took opiates. You need to have a disciplined plan to initiate the opiates as well as taper off of them and detox. I do not recommend this option unless you have a doctor who is participating fully in this plan.
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Chapter 17
I truly hope that this Guide provides some hope and help for whoever may be reading it. Perhaps its you. Or maybe someone you love. For those that are struggling with opiate dependency, the detox and withdrawal process can be a daunting challenge, but we believe strongly that it can be done in a more comfortable and affordable manner. We want to help those who nd withdrawal too much to bear both physically and emotionally and end up becoming slaves to these drugs due to the fear of withdrawal. There are millions of you out there who started taking opiates for all of the right reasons and who cannot stop for all of the wrong ones. A more comfortable opiate withdrawal process can lead to early intervention and perhaps prevention from opiate addiction, overdose and even death. I did not have a product like Withdrawal Ease when I was taking opiates and perhaps if I had, I wouldnt have let it get so far. Its for this very reason that I believe Withdrawal Ease helps to ll a signicant gap in care for those that are currently dependent on opiates, afraid of withdrawal and who feel as though they have no viable options. The epidemic of opiate dependency is growing, and within the realm of substance abuse, its like nothing weve ever seen. There are no absolutes with opiates and the data suggests strongly that current treatment options are not addressing the issue soon enough or with enough focus to help the millions who are waiting for something or someone to address their needs. Im hopeful that we can do our part by providing lucid education, encouragement and the tools to help people take their rst step towards recovery by helping to reduce the agony of withdrawal. Withdrawal Ease is certainly not a cure for addiction or the only solution for withdrawal but I hope that by giving people another choice, we can save some lives in the process both guratively and literally. Withdrawal Ease will continue to strive to provide people with a more comfortable opiate withdrawal process with new products and services as well as improving our existing ones. Were off to a good start but were not nished by any stretch of the imagination. If you have any questions or concerns about Withdrawal Ease, or any information contained in this Guide, please do not hesitate to contact me at info@Withdrawal Ease.com. Thanks. And good luck! George Catlin
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Opiate Withdrawal Survival Guide

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How to navigate this iBook.

This guide has been created as an Apple iBook to be viewed on an iPad.

Swipe to turn pages.

Portrait mode is not supported on all pages.

A brief note to our readers.

The Five Ts dened

The Five Ts dened

Different Classications For Tenure:

The Five Ts dened

3. Total Daily Intake

Using a common prescription for Vicodin as an example:

The Five Ts dened

Chapter 5: What are the common symptoms of withdrawal (cont.)

Chapter 5: What are the common symptoms of withdrawal (cont.)

Annoying Uncomfortable Very Uncomfortable Agonizing

Common Physical Symptoms of Opiate Withdrawal: Daytime

Chapter 5: What are the common symptoms of withdrawal (cont)

Annoying Uncomfortable Very Uncomfortable Agonizing

Common Physical Symptoms of Opiate Withdrawal: Daytime (cont.)

*** *** *** *** **** **** **** ****

Chapter 5: What are the common symptoms of withdrawal (cont.)

Annoying Uncomfortable Very Uncomfortable Agonizing

Common Physical Symptoms of Opiate Withdrawal: Nighttime

Chapter 5: What are the common symptoms of withdrawal (cont.)

Annoying Uncomfortable Very Uncomfortable Agonizing

Common Physical Symptoms of Opiate Withdrawal: Nighttime (cont.)

How can Withdrawal Ease help?

Chapter 6: What is Withdrawal Ease?

How does it work?

Withdrawal Ease Targets Withdrawal Symptoms At Their Source:

Chapter 6: What is Withdrawal Ease?

Chapter 6: What is Withdrawal Ease? (cont.)

The Internal Organs

Chapter 6: What is Withdrawal Ease? (cont.)

The Nervous System

The importance of tapering

Introduction: Why taper?

Chapter 7: The art of opiate tapering (cont.)

A suspiciously attractive pharmacist is not needed; just someone you trust!

A pill dispenser like this one is perfect for your taper.

Chapter 9: Example of a typical taper (cont.)

Chapter 9: Example of a typical taper (cont.)

Chapter 9: Example of a typical taper (cont.) Week 5

Detox: Your door to a better life

Day One The rst 24 hours after your last dose.

Chapter 11: Withdrawal planner Day Two

Chapter 11: Withdrawal planner Day Three & Four

Chapter 11: Withdrawal planner What to expect going forward

Chapter 12: What is Suboxone?, cont.

Who Should Be Taking Suboxone?: In my opinion

Chapter 14: How does Suboxone work? (cont.)

Suboxone stimulates opiate receptors and blocks other opiates

Chapter 14: How does Suboxone work? (cont.)

Chapter 14: The pros and cons of Suboxone (cont.)

Chapter 16: How do I stop taking Suboxone (cont.)

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