Low Energy After Opioid Withdrawal: Expectations vs. Reality

About a week after Paul (name changed for privacy) finished his rapid opiate detox, he called us. He has a very physical job and is the father of a 4-month-old baby, Noah, who is also the reason he decided to finally stop his drug use once and for all. Paul has been using high dose opiates for over 20 years, with a few small sporadic periods of abstinence..

Paul did well through his detox; he was able to stay pretty comfortable getting off the equivalent of somewhere between 300-450 mg of mixed opiates. He was also using heroin but didn’t want his grandmother—who was his support person—to know about that. We never mentioned it to her. 

Paul called because he was frustrated with his lack of energy. Between his job installing granite counters, a newborn, not to mention the mother of this tiny baby who is desperate for his help, this man wants to feel energized. Now. Yesterday. He wants a magic pill and he is certain there is something I can prescribe for him to help.

If there is, I haven’t met it. This isn’t reality.

Fight Low Energy With Natural Dopamine

Dopamine, the neurotransmitter that allows us to feel pleasure is made in our brains so we can enjoy food, sex, laughing, a beautiful sunset, fishing, hunting—whatever it is that personally brings you pleasure. When the brain is constantly overloaded with exceedingly high levels of dopamine from an external source like opioids, it eventually stops making its own. It can’t compete.

Research shows that if external sources of dopamine are not introduced into the brain for about four months, the brain will begin to make it again. And that’s what we tell our patients.

One of the standard questions we track at Coleman Addiction Medicine when people return for their follow up Naltrexone implants specifically addresses what Paul was facing: What is your energy level on a 0-100% scale?

Most people don’t have their energy back 100% by four months, but almost invariably people are feeling better in 2 to 4 weeks. It is closer to 2 weeks for patients getting off short-acting opiates such as most painkillers and heroin; closer to 4 weeks for patients detoxing off methadone and Suboxone.

The Realistic and Right Way to Heal Low Energy

Part of my job is to help people manage their expectations around this reality. Some patients say they have used various amino acid supplements that seem to help with a quicker recovery. Others say exercising, working hard, and avoiding naps during the day help. I believe the body wants to heal and it will. I think it’s important to put the best ‘fuel’ into our bodies we can, but I haven’t met a patient yet who doesn’t eventually feel and look better within a few months, even if the only change they make is stopping opiates.

So I have great faith that Noah’s dad will regain his energy, hopefully, sooner than later. And when that little guy looks up into his dad’s face and smiles and laughs, or when he takes his first few steps, I think some genuine dopamine will be coursing through this proud daddy’s brain.

Joan Shepherd, FNP

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