Why fentanyl withdrawal is so unbearable

the reality is people do die from opioid withdrawal they die from the consequences of dehydration which gives you a sense of just how bad the symptoms can be that people can have such profound diarrhea and vomiting that they can actually get dehydrated to the point that they die from [Music] it when you think about someone using opioids whatever reason they start using opioids which could be for pain relief it could be for fun or experimentation it could be for emotional pain relief what happens early on is that people experience really pleasurable effects generally from using

opioids and so that can be a sense of calmness of euphoria again of relief of any sort of pain both emotional relief of anxiety and depression and physical pain but what happens is the body is amazingly capable at relatively quickly re-calibrating when there are changes going on in the body and so over time the body and the brain gets used to having opioids around and we see this shift from using to feel good to needing to use just to feel normal and then needing to use just to not feel sick and people get trapped in

this terrible cycle where they don't feel normal they can't function they feel horribly ill unless they're finding a using opioids often multiple times a day opioids bind to opioid receptors in the brain which are receptors that get activated when you have opioids in your body that activation leads to a Cascade of effects so opioids block neurotransmitters that communicate pain so they block the sense of experiencing pain um they increase dopamine which is a Feelgood hormone that allows you to feel um happy and have a great mood they increase serotonin another sort of feel-good hormone they

block the stress response that sort of adrenaline fight ORF flight response that we get and that's what leads to the calmness the anxiety relief the pain relief that people get when they're acutely using opioids and the reason it matters to understand that because withdrawal is the exact opposite so if you think of a seesaw or trying to balance a scale if you're loading in weight on one side and you're trying to keep balance you're going to load weight on the other side and that's essentially what the brain does so over time you actually have lower

dopamine levels lower serotonin levels higher stress hormone levels because you're trying to balance out the changes that opioids have caused now if you all of a sudden remove that counterweight on the scale you're going to flip yourself into the opposite effect and so when withrawal you see this flooding of stress hormones so all of those things that come with opioids like calmness and feeling happy and not depressed and warm and safe and having pain relief is exactly the opposite in withdrawal so for a short acting opioid like heroin are now fentanyl opio withdrawal often kicks

in sometimes as soon as 8 hours certainly by 12 hours after the last time that people use and it Peaks around 2 to 3 days but it can last for 5 6 seven eight or even 10 days first they get intense drug Cravings which is an urge to want to use the drug that you know will make you feel better so that's not being able to think about anything else people start feeling restless anxious agitated they start sweating they might notice that their nose is running their eyes start tearing they start yawning they get belly

cramps they get muscle aches it starts feeling like really a terrible terrible flu if the person doesn't get opioids or use opioids that gets worse and worse and worse to the point that people get severe diarrhea severe vomiting terrible anxiety depression they can't sleep they feel like they're crawling out of their skin they get goosebumps they can feel like they have chills just this terrible um sense of sort of dread Doom in your body I think we all can identify with sort of basic Primal urges so thirst or hunger where if you ever were completely

starved of food or didn't have access to water you would do extreme things to relieve that sort of physical drive and so there are these innate drives for survival that are Beyond conscious thinking so you may rationally you know think you would never drink out of a toilet bowl I guarantee you if we put you in a room with just a toilet and deprived you of water you would drink out of a toilet bowl and so I think of withdrawal as that it is this Primal Instinct that people will forego other basic Primal needs like

connection and sex and food just to relieve their withdrawal symptoms that's how powerful it is so there's um there's a lot of stigma about medications for opiod use disorder like methadon and borine and I think that stigma is rooted in a couple different things one is a misunderstanding between the difference of physical dependence and addiction so if you get prescribed opioids for a painful condition and are on opioids for months or longer even if you never develop addiction you will have dependence and you'll experience withdrawal in contrast addiction is defined by compulsively using and losing

control of your use despite bad things happening to you in your life so those two things are different and that's really important because the best treatments that we have for addiction actually maintain physical dependence so they continue to activate the receptors which allows a person to feel normal to function normally to not have craving to not have withdrawal and really importantly to not die from overdose which is one of the most important factors of treatment with medication Str opioid use disorder it's easy to think like oh it's just the flu someone can just get through

it or they should just tough it out and you layer that into the fact that our societal Notions about addiction and about drug use have generally been that people are doing something bad and immoral and illegal and therefore even if we start talking about this as an illness or a public health issue in the back of everyone's heads they sort of think someone's doing something bad and therefore we should kind of make it hard on them I think that reinforces this idea that one would draw must not be that bad but two even if it's

really terrible people should sort of have to endure this suffering and just pull themselves up by their bootstraps um and I think that lack of compassion for sort of the dignity and Humanity of people who use drugs but also empathy and understanding for the hell that people are experiencing when they're going through the draw and the fact that their R your rational mind when you're dealing with that sort of intense physical urge is not functioning you need to relieve your symptoms just like if you were deprived of water just like if you deprived of food

um and that we have to be treating withdrawal we have to be effectively treating people if we want to address opio use disorder and if we want to address this crisis this is a very treatable good prognosis health condition and I see that every day in my clinical practice and people do get better and we just need to make available the treatments that we know are going to help them [Music]