[Note: This essay dates from sometime in the period of 2009 to 2011, when I was in the last years of opioid addiction and raw from episodes of withdrawal. I repost it here just for for the historical record, so to speak.]
“Ah’m no sick yet, but it’s in the fuckin post, that’s fir sure. … The great decline is setting in. It starts as it generally does, with a slight nausea in the pit ay ma stomach and an irrational panic attack. A toothache starts tae spread fae ma teeth intae ma jaws and ma eye sockets, and aw through ma bones in a miserable, implacable, debilitating throb. The auld sweats arrive oan cue, and lets no forget the shivers, covering ma back like a thin layer ay autumn frost oan a car roof.”
-Trainspotting, Irvine Welsh
Cows assess this syndrome. OK, not cows cows; C.O.W.S. The Clinical Opiate Withdrawal Scale. An instrument that objectively assigns a numerical value from 0 (or, chilled-out) to 4 (or, yir fucked, mate!) to the externally observed level of intensity of eleven different opiate withdrawal symptoms. Sweating, pupil dilation, tremors, nausea, quickened pulse, aches, anxiety, chills, etc. Doesn’t really sound so bad, does it. Especially not when it’s in a nice tidy formatted list with accompanying point scale. Clinical. Sterile. Like the monotone voiceover of a prescription drug TV advert where the gent says, “Symptoms may include…”.
But those banal, familiar symptoms that we’ve all experienced at one time or another (usually in non-addiction contexts) become much greater than the sum of their own clinical descriptions, the further up that COWS ladder one climbs.
I know this. I’ve scaled that thing too many goddamn times.
“Here ah am in the junky’s limbo; too sick tae sleep, too tired tae stay awake. A twilight zone ay the senses where nothing’s real except the crushing, omnipresent misery n pain in your mind n body… Doctor Mathews sais that it’s jist really like a bad flu, this withdrawal… When wis the last time auld Mathews hud cauld turkey? Ah’d like tae lock that dangerous auld radge in a padded cell fir a fortnight, and gie um a couple ay injections ay diamorphine a day, then leave the cunt for a few days. He’d be beggin us fir it eftir that. Ah’d jist shake ma heid and say: Take it easy mate. What’s the fuckin problem? It’s jist like a bad flu.”
That’s the way a lot of doctors and therapists and counselors and clean lay folks describe opiate withdrawal: like a bad flu. And lexically, technically–matching up and comparing the words in both symptom lists–I guess it is. But they don’t know this from personal experience. Nor do they understand the severity of the psychological component, which is after all what addiction really is: a brain disorder. I don’t know of any strain of flu on this planet that precipitates soul-crushing anxiety, drives its victims mad with the craving-ridden knowledge that just one hit, one dose, will make it all go totally away, or denies them any and all rest for days and weeks at a time.
Why no rest, you might wonder? Well, opiate withdrawal, experientially and neurochemically, is a (seemingly endless!) sustained fight-or-flight reaction. Literally. During opiate addiction, the body’s ancient noradrenergic system, which is activated in times of great stress, fear, or pain, is suppressed. (Which is why opiates feel so good in the first place: they relieve all that.) In a brain soaked with opiates, the production and release of stimulating neurotransmitters like noradrenaline and norepinephrine is squelched. With continued use comes brain adaptation to this situation, so when opiate use is ceased, production of noradrenaline ramps up again, wildly, and the brain catches fire. A chemical fire, an internal “overdose” of the neurotransmitters behind our inherited fight-or-flight reaction: fear, panic, pain, excitement, restlessness, and all the attendant involuntary somatic manifestations of these. All acutely intense.
For me this extremely heightened arousal was always the worst. It denied me sleep for days on end, which is an experience horrific enough that no human should ever have to endure it. In the worst moments there wasn’t much I wouldn’t have done to get even one hour of the most restless, sweaty, feverish sleep. The closest I ever came to suicide–which at times was closer than I’ve ever told anyone–was in these days of complete deprivation of rest. It makes you fucking crazy. A few times I tried hitting myself in the head with my own fist, as hard as I could, hoping to knock myself out long enough to get some rest. Stupid and pathetic, but true.
“It’s still fourteen hours and n fifteen minutes until ah kin git ma new fix.”
No flu strain stops time, either. When you’re in the trough of that drug withdrawal roller coaster–those brutal, sometimes days-long, in-between times between taking your last dose and being dope-rich again–time slows to a standstill. Like those scenes in sci-fi movies where full-speed motion quickly slows to a frozen moment, a three-dimensional photograph. But your brain keeps frantically pumping out the noradrenaline, so you’re keen to everything…your senses are sped up, so everything else slows way down. Time passes, but not for you. You’re left embedded in misery, feeling hopeless and damned for eternity, because the one thing that you most need to happen–for time to pass ‘til either you get your next dose or ‘til the withdrawal abates naturally–won’t happen. At least it seems that way.
How many times I went through all this, how many times I counted the seconds…then the minutes…and then the hours…’til I could pick up my next dose, I shudder to recall. How many times I phoned my docs and the pharmacy for early refills, hoping that they’d let me slide just this once…how many times I showed up at the pharmacy the very second they opened, cold yet shirt soaked with sweat, trembling, aching, sad and humiliated, and trying my best to act casual and not at all desperate…how many times I waited “just ten or fifteen minutes” more, wandering around the pharmacy waiting for them to prepare and process the script or the refilll…I literally can’t count.
Then I would hurriedly pay and greedily slip away with the Rx bag, dope-rich again. I would dose before even leaving the pharmacy, and within minutes I was feeling warm and euphoric, like none of this had ever happened. And I’d keep using ‘til I ran out early, and the whole goddamn cycle started again.
If I’m ever tempted to relapse, I’m going to try to remember all this shit, because I don’t EVER want to have to go through it again. But for now I’m writing it down here, and then going to try to forget it. Fuck addiction.