Monica Beattie (not her real name) a 39-year-old woman from Mesa, Arizona, began taking oxycodone more than five years ago to relieve pain from a herniated disc. "At first it had an amazing effect on my life," says Monica. "It gave me extra energy. It relieved my pain and helped me work longer hours so I could build my business."
Then it all came crashing down, she says, when she discovered that she was addicted to the drugs and couldn't stop taking them, even if she tried."I was not warned by the doctors about the possible ramifications of taking oxycodone until it was too late," she says.
For the next five years, she says she was "a slave to oxycodone," taking 15 mg every six hours. It wasn't until she almost died from a staph infection that she began to reflect on the quality of the life she was living and that her "real self was disappearing."
Diary of an epidemic
The opium poppy has been used around the world for thousands of years to treat patients for pain, agitation and anxiety. Hippocrates, considered the "father of modern medicine," used opium in his medical work, and the early Sumerians called the opium poppy Hul Gil, the 'Joy Plant.'
Of course, it is the euphoria and extreme relaxation people experience from taking opium and its derivatives that make the substance so dangerous and opioid addiction so prevalent in Western societies today.
In 1950, the US Food and Drug Administration approved oxycodone hydrochloride, a semisynthetic opioid derivative of opium, a depressant drug that slows down the signals traveling between the brain and the body. By the early 1960s, abuse of oxycodone medications such as Percodan had become a major problem.
Chronic pain is a global phenomenon, which has been increasing as Western populations age. Over 100 million American adults and over 43 percent of the UK population are estimated to suffer from chronic pain conditions, ranging from mild to severe to debilitating.1
In the face of this pain epidemic, particularly for chronic pain that isn't related to cancer, the availability of opioid derivatives and the development of synthetic opioids such as fentanyl have been seen by the medical community and millions of patients as little short of a godsend.
"Pill mills," pain management clinics centered on prescribing opioids for a wide variety of chronic pain conditions, have made the drugs increasingly available, not just to patients, but tangentially to the black market as well.
And all this enthusiasm was fueled by hundreds of millions of dollars in false advertising spread by the pharmaceutical industry, claiming that the new timed-release prescription opioids were not addictive.
For instance, after Purdue Pharma introduced and promoted OxyContin as "safe" for chronic pain, its sales grew from $48 million in 1996 to almost $1.1 billion in 2000 (see News Focus, page 20).
By compiling prescriber profiles for individual physicians according to zip code, county and state, pharmaceutical companies like Purdue were able to target doctors writing the highest number of prescriptions for opioids.
They promoted OxyContin by courting these doctors, giving them free vacations at resorts and sending them branded promotional items such as OxyContin stuffed toys, fishing hats and even music, with songs like "Get in the Swing With OxyContin."2
By 2004, OxyContin was infamous for its rampant abuse throughout the US. Today, more than 47,000 Americans die every year as a result of opioid overdose, and an estimated 1.7 million men and women in the US have been diagnosed with opioid use disorders. And part of the wave of death has been related to the production of ever-more-powerful synthetic opioids such as fentanyl.
Opiates do more than relieve pain. Aside from their feel-good impact, both opiates and opioids are well known for other side-effects, including dizziness, drowsiness, impairment of mental acuity, mood changes, constipation, loss of fine motor skills and, of course, addiction. With long-term use, they deplete the body, triggering a lack of energy, lack of motivation, extreme fatigue and depression.
Long-term use can also create severe nutritional deficiencies and contribute to erectile dysfunction in men as well as reduced libido in both sexes. HIV/AIDS, hepatitis C virus and staph infections may be contracted in cases of intravenous use, and they appear to trigger insulin resistance, leading to diabetes.3 Opioids also suppress the function of the hypothalamus and the pituitary glands and can lead to reduced bone mineral density.4
Paradoxically, taking opiates long-term can also increase a person's sensitivity to pain. "Opioids as a class cause what's called hyperalgesia," says Dr Ravi Chandirimani, ND, founder of Blue Door Therapeutics in Scottsdale, Arizona. "This means that the individual on opioids, which are meant to manage their pain, actually and counterintuitively develops a more acute perception of their own pain level than they would have if they were not on opioids.
"What we found, pretty universally, was that as we brought these individuals down on their opioids—and certainly once they were off of them completely—they quickly came to the realization that they were simply not in as much pain as they thought they were."
Getting off and staying off
Medication-assisted treatment (MAT) is the most common approach to treating opioid use disorder, combining a wide variety of medications to treat opiate addiction and withdrawal symptoms in combination with counseling, including cognitive behavioral therapy (CBT) and 12-step programs, which focus on acceptance that one is an addict, surrender to a higher power and active participation in 12-step meetings and programs.
CBT is an action-focused treatment approach that can take as few as 16 sessions to achieve behavioral changes in the patient. Cognitive behavioral therapists focus on helping addicts identify the negative 'automatic thoughts' that drive them to self-medicate. Patients learn to recognize the situations and feelings that trigger drug use, avoid those triggers and use techniques to mitigate the emotions and thoughts leading to drug use.
Unfortunately, all of the drugs used in the MAT protocol have side-effects. Methadone, buprenorphine and naltrexone are all slow-acting opioids called agonists, which are used to help wean addicts off of stronger opioids. But they are also addictive opioids themselves. The medications used to deal with the various uncomfortable withdrawal symptoms—methocarbamol (brand name Robaxin) for muscle aches and spasms; dicyclomine (brand name Bentyl) for abdominal cramping; clonidine, a centrally acting antihypertensive for agitation, anxiety and night sweats; hydroxyzine to reduce activity in the central nervous system and help with milder daytime anxiety; and trazodone, quetiapine (brand name Seroquel) or gabapentin for sleep disturbances—are problematic in different ways.
Each of these drugs can have numerous side-effects:
Buprenorphine: allergic reactions, swelling (edema), fever, headache, slow heart rate, amnesia, confusion, dizziness, seizures, blurred vision, nausea, vomiting and other problems.
Dicyclomine: constipation, diarrhea, headache, vomiting, heavy sweating and blurred vision.
Clonidine: drowsiness, constipation, irritability, insomnia and nightmares.
Hydroxyzine: hives, difficulty breathing, rashes, headache and swelling of the face, lips, tongue or throat.
Trazodone: headache, muscle aches, constipation, diarrhea, numbness, nausea and vomiting.
Quetiapine: most of the above, along with mood changes, trouble speaking, hostility and jerky movements.
And there is no way of knowing what side-effects result from mixing and ingesting such a potent pharmaceutical cocktail while a patient is detoxing from strong opioids.
Another problem is length of treatment. As Dr Mark Willenbring, former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, put it in a New York Times interview, "You don't treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it."5
The holistic approach
To meet this need, holistic clinics are springing up to deliver individualized treatment plans combining MAT with everything from equine therapy to meditation, yoga, acupuncture, neurofeedback (real-time feedback from a client's brain activity), psychodrama (acting out events from their past), reiki (a hands-on energy healing treatment), somatic experiencing (a therapy that addresses symptoms of post-traumatic stress disorder), massage therapy, outdoor activities and much more. Programs are also providing individual and group treatment tailored to men, women, families, the LGBTQ community and specific ethnicities.
Although there are currently no studies conclusively proving that the holistic approach to addiction recovery is more effective than traditional 'standard of care' MAT-based approaches, it doesn't take much to see
that they must.
In controlled trials, subjects who receive training in mindfulness meditation practices along with standard pharmaceutical treatments do as well or better than those receiving pharmacotherapy alone.6
Yoga has been proven to reduce cravings associated with addiction by activating the parasympathetic nervous system, which relaxes the body—as opposed to the sympathetic nervous system which prepares the body for fight or flight.7
Massage has been proven to decrease the stress hormone cortisol while stimulating the production of the "feel good" neurotransmitters dopamine and serotonin, which is especially critical in the early stages of addiction recovery when a person's dopamine levels usually drop significantly.8
Acupuncture is a well-known positive adjunct to addiction treatment. Numerous studies show that acupuncture can relieve opioid-associated depression and anxiety.9 Especially effective for addiction recovery is an auricular-based treatment (acupuncture of the ear) called the NADA protocol.
"The main function of the NADA protocol is optimizing the detoxification process in the body and also releasing the body's endorphins serotonin and dopamine, which help ease the discomfort of the withdrawal symptoms," says Dr Eva Ross.
A former addiction practitioner at a major treatment center in Malibu, California, Ross holds a PhD in traditional Chinese medicine and now runs the Maui Healing Center in Kula, Hawaii. She says the other major effect acupuncture has during withdrawal and recovery from opioid addiction is a very rapid detoxification of the liver, helping the body dump the toxins from the drugs.
Another highly effective newcomer to drug addiction recovery programs is medical marijuana. Dr Ravi Chandiramani, ND, is a pioneer in the field of integrative addiction medicine and medical director of Blue Door Therapeutics in Scottsdale, Arizona. There, CBT is expanded to include individual, group and family therapy, and MAT to include naturopathic resources such as hormonal analysis, specialty laboratory testing and evidence-based supplementation based on nutritional testing.
In addition to these approaches, his integrative protocol includes mindfulness meditation, acupuncture and body work such as Rolfing and reflexology. But it is the addition of cannabis-supported treatment that he says has made the biggest difference in patients' recovery.
"Historically we'd have to use a variety of prescription medicines from the medication-assisted treatment protocol to cover all of the withdrawal effects," he says. "But we found that the cannabis strategy handles over 80 percent of all of those effects really, really well."
Especially effective for patients who have been on opioids for a long time or have been taking them at high doses, medical marijuana is "remarkable," he says, as patients have to deal with only one substance versus having to take seven different medications.
"It's had a startling impact on our recovery success rate," he says. "With the cannabis strategy, my success rates one year out of treatment are significantly improved over the national average, which is around 11 to 13 percent. I've always experienced a success rate one year out of treatment that was over 30 percent."
Unlike most 30-day in-house addiction programs, patients at Blue Door are all outpatients. Treatment is highly individualized and usually lasts a year, with six to nine months spent in a highly structured program and another three to six months coming in for 'tune-ups.'
If you are already dealing with opiate dependence, the hardest and most important part, says Dr Chandiramani, is finding "other things to motivate you that are more powerful than the addiction—your commitment to your family, valuing the job that you don't want to lose, living a long, healthy life ... there has to be something that has more meaning for you than what the addiction holds."
How to get hooked on opioids
Opiates and opioids are Schedule II drugs, meaning they are legal medical drugs that have a high potential for abuse. Their painkilling effects (also known as their half-life) can range from one to nine hours, depending on which type of drug you take and what quantity.
Opiates such as codeine and morphine are made from the natural alkaloids found in the sap of opium poppies. Opiates can be manipulated synthetically, and these man-made opiates are called opioids.
Both opiates and opioids work the same way on the central nervous system, binding to and activating receptors in the brain called mu-opioid receptors.
When these receptors are activated, they trigger the release of signals that muffle our perception of pain while stimulating the release of the neurotransmitter dopamine, creating a sense of deep relaxation and boosting our feelings of pleasure and euphoria, thus causing an immediate reinforcement for the drug-taking behavior.
The most common culprits
The following are some of the most common opiates and opioids found on the market today:
Codeine: a natural substance and less powerful opiate used primarily as a cough suppressant
Morphine: a natural substance and highly addictive opiate
Hydrocodone: a popular, highly addictive, semi-synthetic opioid with brand names including Lortab and Vicodin.
Oxycodone: a highly addictive, semisynthetic opioid with the common brand names Oxycontin and Percocet
Fentanyl: a highly addictive synthetic opioid that can be up to 100 times stronger than heroin, often prescribed as a transdermal patch for the terminally ill.
Slow-acting opioids: Methadone and buprenorphine, both synthetic opioids used in opioid addiction treatment—and both addictive themselves.
Killing pain without opioids
Even the US Centers for Disease Control and Prevention (CDC) now recommends nondrug approaches such as physical therapy over the long-term use of addictive prescription painkillers.
Acupuncture is widely known to be effective for mitigating chronic pain.1 Chiropractic care has been shown to improve acute and chronic neck pain, one of the most prevalent reasons patients seek prescription pain medication.2
Studies show that therapeutic exercise programs can reduce pain and improve physical movement in people experiencing everything from osteoarthritis to hip and joint pain.3
And massage therapy has shown effectiveness for reducing nonspecific low back pain as well as shoulder pain, carpel tunnel syndrome and pain from headaches.4
How I beat my addiction
Monica Beattie, the 39-year-old woman from Mesa, Arizona, who started taking opioid pain medication when she herniated a disc in her spine (see main story, page 57) and then after a cesarean delivery, says the drugs weren't even working.
"My pain started getting worse. I was having nightmares every night. I was so hot all the time, my joints would swell up, and I couldn't poop. I gained a lot of weight, and worst of all, I wasn't enjoying any part of my life anymore."
She decided to stop taking oxycodone, but tried to quit on her own many times with no success. Eventually she found Dr Ravi Chandirimani and Blue Door Therapeutics in Scottsdale, AZ.
She chose to use intravenous vitamins, massage, acupuncture, several forms of psychological therapy, medical assessments, dietary advice and, most cutting-edge of all, medical marijuana in her treatment process. Now, after years of struggle with oxycodone addiction, she has been completely off all prescription medications for almost two years.
"Medical marijuana played a huge role in my staying off of oxycodone," she says. "Now I use CBD [CBD, or cannabidiol, is extracted from the flowers and buds of marijuana without the psychoactive component] two or three times daily, and on most nights, right before I go to sleep, I use medical marijuana. It keeps my pain under control and helps me rest.
"Today I am a salon owner, hairstylist, singer, swimsuit designer and, most importantly, a wife and mom to three super-amazing children. I'm doing such a better job at life since being freed from my addiction."
Quitting opioids on your own
It is possible to get through opioid withdrawal on your own, but it's tough. On average, people who go it alone take between eight to 12 attempts to finally get clean. And if you have a preexisting heart condition or diabetes, you should not try to go through an opiate withdrawal process at home.
If you do decide to quit on your own, try to slowly taper off your opiate medication(s) before you cut them out completely. The intensity of the withdrawal symptoms will be less than if you go cold turkey. However, there is a downside to doing it slowly. The very nature of addiction doesn't lend itself to moderation, and most people who try to taper off unsupervised often relapse back into full addiction.
Here are some tips for a natural DIY withdrawal program. Plan for a minimum of four weeks on this program, but understand this: real success (a life without opioids) is measured in years, not days.
Get professional support. Find a cognitive behavioral therapist to provide active counseling and be prepared to stick with counseling for as long as it takes.
Get support from friends and family. Tell them what you're doing and ask them to be there for you. You will need their help and encouragement.
Look to the East. Find an acupuncturist who uses the NADA protocol to mitigate addiction symptoms and go as often as needed—ideally, first thing in the morning every day for at the very least five days in a row, says Dr Eva Ross, a doctor of traditional Chinese medicine in Hawaii.
A Chinese medical doctor can also provide herbs that are specific for treating withdrawal symptoms, such as Evergreen Shine DS to alleviate depression and anxiety. Also ask about using Tai-Kang-Ning, a Chinese herbal medicine formula used to assist in acute heroin withdrawal symptoms.
Hydrate. Many people end up in the hospital because the vomiting and diarrhea of withdrawal deplete them of water and electrolytes. Stock up on electrolyte solutions, such as Pedialyte or Dioralyte, and drink lots of additional water. Symptoms of dehydration include extreme thirst, dry mouth, little or no urination, fever, irritability, rapid heartbeat and rapid breathing.
Try passionflower for treating anxiety, restlessness and agitation. Passionflower (Passiflora incarnata) as a homeopathic or herbal remedy has long been used for its calming properties and may help with withdrawal symptoms. WARNING: Do not combine passionflower with any sort of sedative such as pentobarbital (Nembutal), phenobarbital (Luminal), secobarbital (Seconal), clonazepam (Klonopin), lorazepam (Ativan), zolpidem (Ambien) or any others.
Suggested dosage: Take one 400 mg capsule of passionflower extract twice daily for up to eight weeks or 45 drops of liquid passionflower extract once daily for up to one month
For nausea and vomiting, take ginger or the homeopathic remedy Nux vomica, in addition to standard approaches like Dramamine (dimenhydrinate) and Pepto-Bismol (bismuth subcarbonate).
Also try acupressure: apply finger pressure to the acupuncture point Pericardium 6 (P6) on your inner wrists. Place the three middle fingers of one hand onto your opposite wrist, with the top of the upper finger just on the wrist crease, and hold until the nausea lessens. Then switch hands and repeat on the other wrist. You can also buy motion sickness wristbands and bracelets online that stimulate these points. For temporary diarrhea use over-the-counter medications such as Imodium or charcoal made from coconut shells.
Get plenty of rest. Treat aches and pain temporarily with homoepathic arnica, the supplement bromelain, acupuncture or, as a last resort, aspirin or another over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen.
Exercise. Movement is a great therapy, and exercise can trigger the release of endorphins and other 'feel-good' chemicals in the body such as serotonin, dopamine and testosterone.
Get massages to help relieve body aches and pains and to soothe agitation. Take hot baths and showers to soothe body aches and anxiety.
Eliminate caffeine from your diet while detoxing. You don't need to stimulate agitation. Switch to decaf coffee and teas for a month.
Drink soothing teas like chamomile and bland soups like bone broth.
Drink smoothies with veggies, fruits and protein powder.
Eat several small meals per day and eat bland foods such as rice, oatmeal, crackers, bread, bananas, applesauce, avocados, well-cooked vegetables, potatoes and pasta.
Eat some dark chocolate. Chocolate triggers the production of the calming neurotransmitter serotonin as well as stimulating your brain to release dopamine and serving as a much-needed reward.
Supplement your diet with:
St. John's wort: This herb has been shown to reduce opiate withdrawal shaking and diarrhea in rats, acts as a mood enhancer and helps with insomnia. WARNING: Do not use this herb if taking HIV medications, antidepressants, birth control pills, heart medications such as digoxin, or the blood thinner warfarin.
Suggested daily dosage: St. John's wort extract standardized to 5% hyperforin content, take 300 mg three times daily
Calcium/magnesium: Opioids deplete calcium and magnesium in the body, contributing to body aches and pains during withdrawal.
Suggested daily dosage: Take 1,200 mg calcium and 350 mg magnesium. Since these two minerals can compete for absorption in the body, take them at different times of day
GABA: A neurotransmitter, GABA (gamma-aminobutyric acid) can reduce anxiety and cause relaxation.
Suggested daily dosage: 3,000 mg
Suggested daily dosage: 1.3 mg
Suggested daily dosage: 2.4 mcg
Omega-3 fatty acids
Suggested daily dosage: 2,000 mg/day for depression and anxiety
Prebiotics (like sauerkraut and kefir and probiotics to help restore gut health)