When a person suffering from opiate use disorder (OUD) stops using opioids, that person goes through acute withdrawal symptoms from about seven days to two weeks. After that period, lingering symptoms become Post-Acute Withdrawal Syndrome (PAWS). PAWS symptoms can be physical, psychological or social and can last as long as two years or even indefinitely.
Post-Acute Withdrawal Symptoms
There is no specific agreed-upon cause of PAWS. In general, it stem either from disturbances in the nervous system or deteriorated brain function from opioid use or the stress of living without opiates causes these symptoms to occur.
Unfortunately, PAWS can come and go unexpectedly. That’s why it’s often the best course of action to enlist the help of professionals to identify post-acute withdrawal symptoms and then gain the medication or coping skills necessary to heal from them.
Some post-acute withdrawal symptoms include:
- Irritability and hostility
- Depression
- Low energy and fatigue
- Withdrawal insomnia
- Fatigue
- Fatigue
- Memory lapses
- Emotional numbness
- Anxiety
- Increased susceptibility to emotional and physical pain
- Intense cravings to use opiates
- Lack of focus
- Lack of sexual desire or the ability to experience pleasure
- Inexplicable chronic pain
Others may experience different withdrawal symptoms, but these are the most common. People can experience PAWs whether the opioid was a prescription pain pill, heroin or even more potent opioids like fentanyl or ISO drug.
(See also How long does opiate withdrawal last?)
Tips For Living With PAWS
Recovery is an ongoing process even for those who complete a medication-assisted treatment program. Keeping up the healthy habits help a person work through about with PAWS safely and successfully. These include:
- Surround yourself with stable people who love you: An effective support system provides a solid base of encouragement, motivation, and feedback.
- Maintain a busy routine: Focus your thoughts and actions on work, family, friends, activities and hobbies. Keep a journal of your thoughts, fears, desires, and things you are grateful for.
- Eat nutritiously: A healthy diet is a great way to ward off or even reverse PAWS. Everyone is different, so there is no prescribed diet, but healthful foods promote wellness.
- Exercise: Being physically active can have a significant positive effect. Exercise can help produce endorphins that ease pain and make you feel better physically and emotionally. It can reverse depression, increase your energy, improve how you look physically and boost your confidence. Choose something you like and stay with it regularly.
- Be active in your community: Being a positive force in your community can take the focus off yourself and put it on others.
- Commit to personal growth: Learning new skills, developing personal strengths, and improving your knowledge can not only keep you busy but give you a good sense of self-esteem.
"PAWS can be frustrating, but by being able to relax and enjoy the good parts of life will get you through the difficult days. Believing in yourself and your ability to overcome detox is the biggest part of getting to the other side."
Medication Options for PAWS
If you or a loved one are experiencing post-acute withdrawal symptoms, the medication Suboxone may help. (See How Does Suboxone Work?).
Comfort medicines can also be prescribed as-needed. For example:
- Clonidine: can help with sweating, diarrhea, restlessness and anxiety
- Ondansetron (Zofran): can help with nausea and vomiting
- Trazodone: can help with anxiety and sleep
These medications also come with side effects and some can be habit-forming. Addiction doctors help you weigh the benefits of any medications against your symptoms and adjust until you feel your best.
If PAWS symptoms are impacting your function or quality of life, consider involving an addiction doctor to start feeling better.
Get Help with Post-Acute Withdrawals
12 Comments
What are the alternatives to using Suboxone or other medication for relief from opiate PAWS?
Comfort Medications are prescribed based on patients’ withdrawal symptoms such as clonidine, Zofran, Trazadone, benzyl, and in some cases, a muscle relaxer.
How can I keep my nerves calm while going thru withdrawals from fentanyl? I’m going to be starting soon because I want off. I know not to quit cold turkey. A hospital put me on Suboxone but I didn’t wait the full 72hrs and the Suboxone mixed wrong with what I still had in my system and I lost my mind for a bit, but that only lasted 5 days but I relapsed shortly after. Can I taper myself off of opioids? I keep having the fear it’s going to end up bad like the first time.
The best way to manage anxiety and restlessness while going through withdrawal from Fentanyl is with a combination of comfort medications consisting of either Clonidine or Lucemyra, AND either Hydroxyzine or Benadryl. Benadryl is available over the counter, but the others require a prescription. Tapering yourself off Fentanyl without medical treatment is very difficult to do. I understand your fear of trying Suboxone again since it sounds like you’ve experienced precipitated opioid withdrawal due to taking the Suboxone too soon after your last use of Fentanyl. The most successful way of stopping Fentanyl use is to do so under medical treatment and supervision because they will be able to medically assess that you are in enough opioid withdrawal before starting you on Suboxone (so you don’t experience precipitated withdrawal again). This can be done as an outpatient through an Opioid Treatment Program (OTP) such as Symetria Recovery, or in a residential / inpatient detox and treatment program.
My BF has been off heroin for 40 days but he’s still experiencing extreme pain in his limbs with muscle and bone pain why and what can we do
If he stopped using heroin 40 days ago, it would be very rare for him to still experience muscle aches and pains due to opioid withdrawal. The physical opioid withdrawal effects should last no longer than 2 weeks from the last use. Therefore, I recommend he seek medical evaluation because there may be another medical issue causing his pain. Taking over-the-counter Acetaminophen or Ibuprofen as labeled can help reduce muscle aches and pains.
Can I get help with the symptoms of PAWS If I’ve already been clean for over a year? I’m still suffering quiet a bit.
Yes, it is possible to treat PAWS even if it has been a year since last use. Your medical provider can prescribe comfort medications such as Lucemyra, clonidine, trazodone, and other medications depending on your specific symptoms. Chronic PAWS symptoms can also be treated with the assistance of a counselor/therapist and a psychiatrist. The psychiatrist may be able to evaluate if there is in underlying psychiatric issue (i.e. undiagnosed depression, anxiety disorder, sleep disorder) that is contributing to your symptoms, or if it is truly just PAWS. Either way, a psychiatrist can further help by prescribing medication.
I’ve been off Percocet for 16 months and my PAWS is so bad I can’t function. I have maybe 2 good hours a day and that’s only with Lyrica to help. I can’t find anyone who deals with this.
Primary Care / Family Medicine Practitioners, Addiction Medicine Specialists, and Psychiatrists are able to further evaluate and treat your condition.