Opiate/Opioid Recovery Protocol

SIDE NOTE: Even if you don't try to implement this protocol and decide to continue using street opiates/opioids until you're ready to quit, PLEASE keep Narcan on hand (can be acquired for free/cheap at most pharmacies nationwide or find local harm reduction communities that also give them away for free) and fentanyl test strips (can be ordered here). Ensure you have someone watching over you any time you pick up off the street regardless of how much you trust your dealer/friend, especially if you are an IV user. Ensure they are not afraid to call the ambulance if necessary in case of overdose or insufficient Narcan. Your life is not a game and you are loved. This protocol will be here when you are ready.

"This same crucial factor will apply to every single one of these substance addiction/dependency protocols. To quote me from 2019, "Addiction recovery really comes down to the willpower and discipline of the individual and the extent that they've suffered during their addiction.  I can give you the car, but you need to be able to turn the keys to the ignition on your own."

To put it simply, to overcome any addiction regardless of the substance, food, sex, gambling, etc. included, one must have suffered enough to decide on their own that there is no other choice but to get sober and off their drug(s) of choice. This applies across the board regardless of who you are. I can make the quitting and recovery process easier for you, but I can't decide to get sober for you. You must decide that for yourself after taking a serious and critical inventory of yourself and your life.

As with all substance addictions or dependencies, the severity of withdrawal will be dependent on three factors: duration of use, dosage, and how you treated your body and mind during your period of chronic/acute use."

This recovery protocol will review how to taper off opiates (morphine, codeine, heroin) and opioids (oxycodone/morphone, hydrocodone/morphone, fentanyl, buprenorphine, methadone, tramadol, tianeptine, kratom), and everything else between. The approach is all relatively similar, which I'll detail further below, aside from tramadol, tianeptine, and kratom which still share the same main correlating factors, but tramadol and tianeptine introduce a serotonergic factor, while kratom's full alkaloid profile is quite extensive, but primarily extends further on into dopaminergic AND serotonergic factors. With that said, kratom plain leaf in isolation (without any other drugs/medications in combination) largely lacks any respiratory depression. Kratom extracts may as well be a heavy opioid considering their addiction potential and extent of withdrawal severity.

Entering borderline conspiracy here, but the opioid crisis began shortly after the United States invaded and remained posted in Afghanistan, then around 2010 to the present day, pain doctors began taking long-term patients off their pain medications, leaving them in severe withdrawal. Many people had no other choice but to look towards the black market to remain well. Enter fentanyl and its even more potent analogs flooding the streets around this same time. The primary problem issues with lacing opiates/opioids come with heroin (now largely ALL fentanyl/analogs), and oxycodone pills, and I've even seen reports of laced hydrocodone pills as well. Over all these years since the opioid crisis began and more recently, the fentanyl crisis, I've had no exaggeration at least a dozen friends and people I grew up with in high school died from a fentanyl overdose, including my best friend. It's really not a game and I highly urge anyone using fentanyl or what they think is heroin/oxycodone to either taper down to quality tested kratom plain leaf depending on the extent of your addiction/dependency or buprenorphine/methadone, and maintain at the bare minimum dosage you require to stay functional. I will go further into tapering properly below as well.

I just wanted to put it to you straight, the black market/street market is NOT a game anymore. Opiate/opioid addiction is quite literally life or death, you're playing Russian roulette anytime you pick up, regardless of how well you know or trust your dealer. Your life is worth so much more than a drug. It's not going to be an easy journey, but I'm going to outline everything I've learned throughout my own journey to help you to the greatest extent possible to overcome this obstacle, then it's up to you to decide what to do with your life. I highly recommend making amends with your family and loved ones, beginning to process your trauma, and taking care of yourself with all of the advice I've shared over the years. Pick your hobbies back up, go outside and enjoy the weather without being totally numb to your emotions and environment. Life is as beautiful as you make it.

If you feel like you don't have the self-control to taper yourself off, do not have any shame in asking for help and checking yourself into inpatient or outpatient rehab. There is no shame in seeking help. Cold turkey works too if you don't want to go the rehab route, yet still can't find yourself maintaining a taper without increasing dosage/relapsing. My main advice here is to mentally prepare yourself and think of it as severe flu. You will be down and out for a few weeks, but the acute withdrawal phase can be managed quite successfully without pharmaceutical helper meds which may run the risk of addiction in themselves (common ones I see are benzodiazepines, gabapentin, pregabalin, and phenibut, clonidine is fine). Post-acute withdrawal symptoms, otherwise known as PAWS, are where it can get tricky, but everything I'll be outlining below will help to manage those as well. With that said, AA and NA meetings did help me initially with gaining a new mindset and perspective on my life, past, and addiction after 10 years of opiate/opioid addiction myself from age 13 to 23. The last two opiates/opioids I quit myself were extremely high doses of poppy seed tea (morphine and codeine/opium), extremely high doses of kratom plain leaf and extracts, and small doses of buprenorphine here and there. This was back in 2018 and I took the taper route, having already started everything I'm about to share with you below, then figuring everything else out along the way during my experience. It was not fun, but I had decided I had inflicted enough self-harm and got fed up with suffering every single day, waking up sick as a dog.

So you've suffered enough with your current lifestyle and want to quit, huh? Let's detail the biochemistry we need to address with intelligent manipulation.

Opiates/opioids are all very similar in pharmacology with variation in binding affinity and potency at the three opioid receptors. Mu is the opioid receptor that mediates the feel-good beta-endorphin/endorphin, this is the receptor that is primarily activated by all opiates/opioids. This is the receptor site that gets you high and can cause respiratory depression and reduced consciousness ("nodding"), but it can also cause overdose and death in sufficient dosages/potency. It's one of the main receptors that mediate analgesia or antinociception specifically for acute pain (pain relief), but chronic activation will result in hyperalgesia and hypernociception (severely exaggerated rebound pain that mediates much of withdrawal). The delta opioid receptor is also responsible for analgesia/antinociception specifically for chronic pain, while also potentiating the effects of mu-opioid receptor activation. Low-level activation of delta opioid receptors typically decreases respiratory depression from mu opioid activation, while high level potentiates it significantly. The third primary opioid receptor is called the kappa opioid receptor, which mediates consciousness (think Salvinorin A in Salvia divinorum), pain, mood, and motor control, and is one of the primary mediating factors for all drug/substance addictions via the mu/kappa opioid-endorphin or enkephalin/dynorphin axis. While it can acutely potentiate the effects of mu-opioid receptor activation and even downregulate mu-opioid receptors with chronic agonism in isolation, chronic mu-opioid receptor activation vastly upregulates dynorphin expression. Dynorphin mediates the "feels bad man" effect of drug cessation/withdrawal, or so I've described it in the past. The anhedonia, lack of emotion, lack of drive/motivation, fatigue, increased pain perception, low mood/depression and anxiety, and many of the other effects of opiate/opioid withdrawal. This extends to alcohol, nicotine/tobacco, stimulants, high THC cannabis, and even benzodiazepines/gabapentenoids. The only exceptions to this rule are psychedelics, ibogaine, salvia, and ketamine, which actually downregulate kappa opioid/dynorphin expression via serotonergic and kappa opioid agonism properties respectively.

The mu and kappa opioid receptor systems are the factors we will be targeting in this protocol specifically, delta opioid receptors come back online with the other two in more optimal balance. Aside from that, we will also be targeting the following:

• DeltaFosB upregulation (applies to all addictions, drives cravings/compulsions)
• Dynorphin upregulation/endorphin or enkephalin downregulation (chronic mu-opioid receptor activation upregulates KOPr/dynorphin expression, high dynorphin/KOPr expression crashes the function of GABA, endorphin/enkephalin/MOPr, dopamine, serotonin, and norepinephrine)
• Neuroinflammation and cell death (apoptosis)
• NMDA receptor upregulation/GABA receptor downregulation (mediates inflammation and apoptosis)
• BDNF expression with simultaneous mu-opioid receptor activation (responsible for hyperalgesia/increasing pain response, the nuance here is that BDNF and other neurotrophic factors (NGF, GDNF, etc.) are also necessary to create epigenetic changes to break someone out of their addiction)

The three pillars of diet, exercise, and sleep/light environment play a major role in opiate/opioid cessation here as well. See the Stimulant Recovery Protocol for more details on this. UVB light exposure and vitamin D3 synthesis from midday sun is crucial to stimulating beta-endorphin function via POMC production while also downregulating both KOPr/dynorphin expression and DeltaFosB. Just the same, multiform magnesium saturation is essential to not only your mu-opioid receptors functioning properly altogether, especially during cessation/sobriety, but also massively attenuates almost all withdrawal symptoms via KOPr/dynorphin downregulation, NMDA receptor inhibition/downregulation, and GABA receptor upregulation, stimulating BDNF and other beneficial neurotrophic factors, and mitigating neuroinflammation and apoptosis. The major focus should be on full nutritional repletion across the board, as like stimulants many neglect eating or opt for their drug of choice over food if the financial situation is tight, and remaining disciplined with the zero-tolerance dietary framework. The only exception being possibly coffee if you need energy during the daytime, just keep in mind stimulants can sometimes exacerbate some withdrawal symptoms. Rhodiola rosea, Catuaba bark, Muira puama, Panax ginseng, Sabroxy, Schisandra chinensis, Cordyceps, Cistanche, and Shilajit would likely be better options, along with repleting thiamine, riboflavin, niacin, B5, and biotin to support energy metabolism/production.

In addition to this, heat (sauna/ambient heat in hot latitudes) and cold (ice bath/cold shower/ambient cold in cold latitudes) therapy can help immensely. Spend as much time as you can outside in the sun and/or in nature (the beach is an awesome way to combine both), spend time with someone who can help keep you accountable or someone you simply enjoy spending time with that cares for you if you have this option available (friends work too), EXERCISE regardless of whether or not you feel like it. Sprinting, walking, lifting, swimming, anything you can manage to get your body moving and the natural dopamine and endorphin/enkephalins flowing back again. I know you'll be hurting but these pillars will seriously make all the difference in your recovery process.

Unlike the Stimulant Recovery Protocol, I do prefer tapering over cold turkey for opiates/opioids as the PAWS can last quite some time jumping off high doses directly into withdrawal. After 10 years of opiate/opioid addiction, I simply could not quit cold turkey due to the severe upregulation of withdrawal symptoms I experienced during my last and final quit. First things first, if you're consuming fentanyl or one of its analogs (impossible to tell which one you're taking without extensive scientific testing after sending in a sample, immediately instate a preferably short-acting opiate such as morphine or a long-acting opioid such as buprenorphine or methadone. You can also instate kratom plain leaf, but depending on the severity of your addiction and financial situation, the buprenorphine may be most optimal in your situation as you could be pounding down literally ounces of dried leaf powder. Whatever works best for you in your own individual context. But seriously, unregulated fentanyl and analogs being laced into opiates/opioids improperly can end in your last day on this Earth. All it takes is one hot spot in the powder or pill for you to no longer exist. (Many police officers have been arrested for producing and distributing fentanyl or cut heroin/pills across the entire state, I can't imagine their intention being anything other than malicious, it may even be other countries distributing these chemicals into the US, but that's the least of concern in this context.) I genuinely insist you come off fentanyl/analogs whatever it takes for you to do so. Kratom is easiest to come off of for most people as withdrawal isn't quite as protracted as buprenorphine or methadone. For buprenorphine and methadone, try not to keep increasing your dosage as extended intake withdrawal can be just as nasty as other opiates/opioids, sometimes even worse. Take the lowest dosage you can to stay well and stable, and do not increase it. You will make this recovery process harder on yourself if you go up to 8-16mg most Suboxone clinic doctors will prescribe you, as an example. With any taper process, it is wise to drop say 5-10% of your total dosage per 3-14 days until you stabilize on that lower dosage. For most people who are taking the opiate/opioid to get high, you could likely cut down to 25% or even 50% in some cases as you're likely consuming far more of the drug than you require to simply stay well. You could even take your taper process slower than this if you'd prefer, just keep the stabilization period in mind. If you slip up at all, return back to your stable dosage and stay the course. Don't beat yourself up and end up relapsing, tapering is a work in progress and your health and life is more than worth it. Get to as low of dosage as you feel comfortable jumping from.

If you prefer to quit cold turkey, read on ahead.

This process is not going to be without pain, but you need to use that pain to never return back to this point in your life. Use the pain and discomfort as motivation. The pain is your brain and body returning back to homeostasis, it is part of the healing process, use it as a reminder of all the pain you've self-inflicted during your addiction period.

For pharmaceutical medications other than buprenorphine and methadone, you may speak to your doctor about quitting and they will likely prescribe something like gabapentin and clonidine. Some have also had success with memantine, which you may still be able to find online. Gabapentin is not recommended to take longer than 1-2 weeks max to avoid dependence and keep the dosage as low as you can to stay semi-comfortable.

For supplements, I highly recommend including multiform magnesium saturation (5-10mg/lb elemental Mg oral and topical as needed, a bowel flush is often much better than any variation of drug withdrawal, just ensure you're repleting the liquids you're excreting during this period, with topical SOAK entire back of head, full neck, and full upper body or get in a warm bath), l-theanine oral and sublingual (200-2000+mg range is safe as needed, but especially for sleep), taurine (1000-6000mg range is safe as needed, but especially for sleep), inositol (up to 6 tbsp is safe as needed, can be taken any time but does support sleep), agmatine (begin during your taper process, 100-2000mg either split between morning and evening, or with each redose, can safely increase beyond this for short periods if tolerated, will help to reduce tolerance and upregulate dopamine receptors/MOPr while antagonizing NMDA receptor hyperactivation), vitamin C (preferably in liposomal form, see this Reddit thread for dosage and schedule), DLPA (100-2000mg, can be helpful to support dopamine and endorphin/enkephalin status and mood/energy in general, NAC/N-acetylcysteine (100-2000+mg per day, can inhibit cravings/compulsions and may help mitigate some aspects of withdrawal), palmitoylethanolamide (up to 2000mg), black seed oil and lots of it (up to 3 tbsp per day can be extremely helpful not only to manage withdrawal symptoms, but also to mitigate inflammation, and heal GABA/glutamate and Mu/Kappa opioid balance), blue lotus, magnolia bark, oat straw (1 tbsp as needed), bacopa monnieri, gotu kola, polygala tenuifolia, lion's mane extract (start with 1/2-1 tsp and increase as needed), astragalus, holy basil - throw all of these into a pot/french press and let steep in boiled water for 10-20 minutes, drink 1-3 times a day or as needed (targets all factors that contribute to opiate/opioid withdrawal and addiction, repairs the brain, organs, and CNS, and helps to mitigate withdrawal symptoms (blue lotus, magnolia bark, oat straw, bacopa being most important). Ultra Low Dose Naltrexone in the range of 1-5mcg (dissolve the tablet in ml to mg equivalent of pill content) can be extremely helpful in reducing tolerance and withdrawal symptoms via MOPr upregulation and KOPr antagonism, along with TLR4 antagonism (mediates MOPr downregulate via inflammation). PRECAUTION: DO NOT exceed more than 100-1000mcg as this enters the Low Dose Naltrexone range which can and will induce precipitated withdrawals, extremely painful, and to put it simply, it is the opiates/opioids immediately being ripped off the receptors they were binding to, sending you into immediate withdrawal. Start as low as you possibly can with ULDN and you will be fine. Skullcap, Gastrodia elata, Ku shen, Jujube date, Mulungu bark, Banisteropsis caapi/Peganum harmala microdose, turmeric/curcumin with black pepper/piperine, lavender, chamomile, Panax ginseng, milk thistle, Andrographis paniculatus, saffron, Kava, wood betony, cacao or dark chocolate, and Chinese cat's claw (Uncaria rhyncophylla, similar pharmacology to kratom without the opioid activity) are also excellent additions to mitigate withdrawal and speed up the recovery process, helping to get sleep and mitigate depression/anxiety. Most of these supplements and herbs will work best in combination/formulation so don't just use one or the other and decide none of it works. Include what you can afford.

Cannabis, specifically higher CBD, or preferably oral consumption to mitigate inflammation from smoke inhalation can be helpful to mitigate withdrawal symptoms to some extent and is much easier to quit than opiates/opioids. I used edibles and cannabis oil personally.

HDAC inhibitors: butyrate from endogenous production in the gut microbiome or supplement, thymoquinone in black seed oil, bromantane, acetyl-l-carnitine/l-carnitine, curcumin in turmeric, skullcap, niacin, acetate from endogenous production in the gut microbiome or diluted apple cider vinegar

C-FOS upregulation > DeltaFosB downregulation: UV light, exercise, socialization, stress management, psychedelics, Schisandra chinensis

Side notes: Bromantane (tyrosine hydroxylase/dopamine synthesis and GABA upregulation + resets DeltaFosB + HDAC inhibitor + upregulates BDNF, NGF, GDNF), Acetyl-l-Carnitine (D1 dopamine receptor upregulation + indirect HDAC inhibitor via Acetyl donor and cholinergic via same mechanism donating Acetyl group to choline for acetylcholine), Aspirin may be helpful to upregulate tyrosine hydroxylase expression (dopamine synthesis) and reduce systemic inflammation, careful with higher intake of Omega 3s and anything else with potential to thin blood.

Chronic stress and social isolation upregulate DeltaFosB and dynorphin expression directly which drives drug cravings/compulsions, so active stress management via minimizing stressors and factors like sunlight during the daytime, darkness during nighttime, GABA support, adrenal support, etc, and community/spending time with friends and family will reset this factor in the whole equation.

When you finally make the jump after your taper or even better, when you start the taper, begin supporting your liver detox pathways. This is covered in past articles if you search liver or detox on the search bar at the top of my Patreon page. Aside from achieving biochemical homeostasis, much of the drug withdrawal of all types of drugs is the elimination of numerous accumulated toxins that built up throughout your addiction all at once as your liver becomes no longer inhibited by the CYP enzyme pathways your drug intake either occupies or inhibits altogether. Liver detox will make a major difference in how you feel, but the three major pillars also support liver detox via optimizing redox status and mitochondrial function.

END NOTE: I do genuinely encourage seeking therapy if you are unable to delve into and process your trauma on your own, especially in your sensitive emotional/mental state, although I will say correcting GABA/glutamate imbalance, malnutrition, circadian dysregulation, and inflammation make this process infinitely more simple without breaking down, lashing out, relapsing, etc. I’ve heard excellent reviews on CBT and EMDR specifically. Psychedelics and ketamine helped me through this process on my own personally, as I had never responded well to one-on-one therapy in the past, but I do understand this will not apply to everyone. Among malnutrition, circadian dysregulation, inflammation, and GABA/glutamate imbalance, one factor we all share is trauma and lack of community/social support that drove us to our addictions in the first place.

From my notepad when I tapered myself off opiates and opioids:

"We'll first start to hamper the tolerance, neural apoptosis (brain cell death) and hyperalgesia (increasing pain/sensitivity) associated with opioid. The tolerance info applies to all opioids.

Tolerance and hyperalgesia (increased pain sensitivity) from opioid use hinges on several linked factors; AKA targets for inhibition: (1) Ceramide is induced by (2) Nitric oxide, which (along with neural apoptosis - cell death) has also been linked to (3) glial cell activation and (4) inflammatory cytokine production during opioid use. The Microglial anti-opioid mechanism is (5) BDNF release (responsible for hyperalgesia- increasing pain responce) and (6) NMDA expression/upregulation (that causes cell death/apoptosis). These factors can be inhibited or antagtonized to stop/reverse tolerance, apoptosis and hyperalgesia. 

Striking at the Root: Pl3k/Akt is the pathway leading from mu opioid to microglial activation. Potential Pl3k inhibitors include: Thymoquinone, Wogonin - Skullcap, Scutellaria lateriflora, Fentretinide, Isoliquiritigenin, Ascofuranone, Quercetin - capers, onion, apple skin, bee pollen, Apigenin - Bacopa monnieri, Chamomile, Dandelion root, Damiana, Honokiol - magnolia bark, enhances GABA, Naringenin - rosemary, grapefruit concentrate, Berberine - Barberry, Goldenseal, Phellodendron amurense, Huang bo (anti-anxiety painiller), Corydalis (strong painkiller) also has "berberine type alkaloids".

Limiting N.O. production: "One method of limiting NO production is to coadminister an opioid with an NMDA receptor antagonist or a NOS inhibitor". Quercetin inhibits Nitric oxide; as do melatonin, agmatine, NAC, and Nigella sativa and it's oil, thus reversing dependence and preventing Ceramide induction (avoid the NO precursor L-Arginine or L-Citrulline before dosing). Combining with NMDA antagonists and NO synthase inhibitors improves effects. "The inhibitory effect of the (Nigella sativa) oil on morphine-induced tolerance and dependence and on naloxone-induced biochemical alterations in morphine-dependent mice was enhanced by concurrent i.p. administration of the NMDA receptor antagonist(...) Similarly, concurrent i.p. administration of the NO synthase inhibitors; L-N (G)-nitroarginine methyl ester (10 mg/kg), aminoguanidine (20 mg/kg) and 7-nitroindazole (25 mg/kg) or the antioxidant, N-acetylcysteine (50 mg/kg) enhanced this inhibitory effect of the oil. On the other hand, this effect was antagonized by concurrent i.p. administration of the nitric oxide precursor, L-arginine (300 mg/kg). These results provide evidence that Nigella sativa oil, through inhibition of morphine-induced NO overproduction and oxidative stress, appears to have a therapeutic potential in opioid tolerance and dependence." (Emphasis added) To follow up, assuming some microglial activation is still occurring, BDNF (brain cell death) could be stopped[ by curcumin (w/ black pepper) and NMDA antagonists such as a therapeutic dose of DXM/O (Delsym) or memantine can be utilized. NMDA antagonists include: Chelated Magnesium glycinate/taurate/citrate, L-Theanine (B6 boosts absorption), Taurine, Agmantine, Magnolia (Honokiol), Cat's Claw, Delsym, Memantine.

CCK blockers, such as Proglumide, Gotu kola, or possibly Neem (Cyp3A4 inhibitor synergist) can reverse tolerance and enhance analgesia and prevent cytokine inflammation. Kappa opioids agonism and subsequent downregulation down-regulate inflammatory cytokine expression (Salvia divinorum, Erinacine E in Lion's mane, Menthol, Ibogaine, Psychedelics including Psilocybin, Ayahuasca, LSD, mescaline, Ketamine, DXM, Matrine of Sophora flavescens) - and also reset the opioid system. Fun Fact: Kappa agonists also potentiate dopamine response when taken an hour before many drugs.

Ceramide is reduced by: Myriocin (from Cordyceps), L-Carnitine/ALCAR (the latter may enhance absorbtion), Lysine, Silymarin, Resveratrol. So these are great supplements especially after heavy use. Additional Notes: Turmeric/Curcumin w/ black pepper to enable absorbtion may remove some of the rewarding effect but: "(...)a health food product, curcumin, might reduce morphine analgesic tolerance(...) Salvia divinorum on days off to reset opioid system by kappa agonism, like Iboga."

Next up will be a protocol for benzodiazepines, alcohol, gabapentenoids (including phenibut and baclofen), and dissociatives (physical withdrawal isn't common but can be possible in some individuals and the underlying biochemistry is similar, hence being grouped together). I just need to find a solid copy of the Ashton Protocol to briefly summarize that can be reviewed on your own or shown to a competent doctor and catch back up on sleep as these articles have taken a long time to write up.

Good night, friends. Sleep deeply.
- Grimhood aka Daniel