Post-acute withdrawal syndrome & EDS: a PAWS for thought

When one hears vanilla horror stories about opiate addiction, the talk usually targets abrupt withdrawal following a tolerance level developed over time; this is a nasty state immediately following cold-turkey that lasts from a few days to, uncommonly, many weeks depending on the opiate involved and the person kicking (age, length of addiction, tolerance and amount, etc). However, most don’t realise that kicking is the easy part; who but the experienced has heard of post-acute withdrawal syndrome? Who but the experienced understands that PAWS, not the initial painful kick, is the reason why the ex-user becomes a re-user? Hell, even the oft-referenced and usually quite accurate Wikipedia when perused doesn’t really get into it until specifically unearthed, as a kind of aside, or curiosity.

PAWS has implications for the EDS depressed. Because depression during PAWS is increased to levels not experienced pre-opiated, one must make a difficult and informed decision. I can understand that it is better to be judged by twelve than to be carried out by six if antidepressants just don’t do it and existential despair is the only road ahead; but a possible lifetime of dependence is a frightening investment because, though the brain usually goes back to its pre-opiate state subsequent to kicking after some time… there is evidence that a somewhat unretracted state is possible…

…do you wanna roll the dice?

I suppose if I was a sixty year old man the decision to become dependent would be a no-brainer, provided I had permanent access to product. But a young person has more to think about… looking at a future married with kids and a lifetime of potential difficulties because of opiates, even if small non-abusive doses are taken. As well as PAWS, complications like hypogonadism and adrenal dysfunction, though usually reversible, are possible, and enough to scare any young person away from potential refractory depression relief via opiates (but that’s another post).

~The crux of the issue is that EDS depression can be controlled or eliminated with rational opiate therapy; but… a lifetime of opiate use will probably be necessary and, who knows, might in the long run make depression worse with decades of use or when one is forced by circumstances to quit dosing… and the future is filled with circumstances…

…but then again, what about decades of “legitimate” antidepressant use?

No one said making this choice would be easy.