Low Energy After Opioids: What’s to Blame?

Low Energy After Opioids: What’s to Blame?

“Please,” my patient pleaded, “please take out my naltrexone implant. I don’t like it anymore…”

Jackie is a 40-something year-old teacher in New Jersey, who had an especially brutal 2020. While all teachers deserve a medal for Adaptability and Creativity in the Teaching-In The Middle Of-A-Pandemic sweepstakes, Jackie’s job was even tougher because she works with special needs kids. Her students have learning disabilities, further complicated by the reality that many also have poor internet access. In addition to struggling to keep her students engaged, Jackie was confronting massive personal grief. Her mom died from the coronavirus and (like many others) she and her siblings hadn’t been able visit her mom in the final days of her illness. 

Jackie and her family were also not able to celebrate her mom’s life with a traditional in-person funeral. Jackie was weighed down with pain and worries that she could not push aside. 

A History With Opioids Became A Crutch

In her 20s, Jackie briefly tried some heroin. She snorted it a few times, was caught, and her parents intervened.  Last year, as she was drowning in emotional pain, an old and unusually powerful recollection of the effects of opiates came back to her and she started obsessing about finding that feeling again.

It was way easier to find opioids than she had expected. ‘Respectable’ people hooked her with a supplier. She reasoned with herself that it was pills, not heroin. By buying them on the street, she was able to stay out of her doctor’s office and any Covid-19 exposure there.

Dealing With Opioid Cravings and a Career

After a few months with these pills, Jackie had to be level with herself: she was hooked and faced withdrawal symptoms if she didn’t take a pill every 4-5 hours. At the same time, the stress from her job and sadness about her mom’s passing was now amplified by the burden of a fresh addiction to street drugs.

Jackie’s career involved inspiring young people, but she felt helpless as she struggled to act and seek help herself. How could she possibly expect her students to do the right thing when she herself was trapped in this rut? She imagined how disappointed her mother would be. While she tortured herself with these awful thoughts, her depression deepened.

Family Support To Strengthen Outpatient Detox Treatment

Jackie’s family acted rapidly as soon she reached out for their help. They helped her find treatment providers and, after removing Methadone and Buprenorphine as her preferred form of Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD), she opted to get an outpatient Accelerated Opioid Detox using the Coleman Method.  Dr. Coleman has focused on using the 3rd type of evidence-based MAT to treat opioid dependent patients for over 20 years: long-acting naltrexone.

When she came into the office, Jackie’s urine drug screen revealed that what she had believed was oxycodone was actually fentanyl. She was shocked. (We weren’t. Fentanyl is in pretty much everything bought on the streets these days.)

Naltrexone Therapy for Recovery Support

Jackie experienced some typical side effects during withdrawal from fentanyl, but a few comfort medications and constant support from our experience team and her family, she wrapped up her detox within 5 days. We inserted a naltrexone pellet, and she returned home for a few days before she planned to go back to her teaching job.

Soon after her detox, Jackie called me. She hoped to go back to work in 2 days, but she scarcely had the energy to get out of bed. She had little appetite, low energy, and she sometimes felt a little queasy. She had a few other issues that were unusual after a detox.  Jackie was firm in her belief that all these symptoms were the result of the non-addictive opiate blocker, naltrexone.

Any medication has side effects, and naltrexone is no exception. The things she was feeling could have related to naltrexone and she was desperate to feel good again—at least good enough to get back to her normal routine. 

“You have to take the implant out,” she told me.

Low Energy Following an Opiate Detox

Since opioids flood the brain with more dopamine than it was intended to have, most folks who stop opioids–whether prescribed by a doctor or just bought on the street–will experience a loss of energy, especially in the first phase of their brain’s healing process. 

How Long Does Low Energy Last After Stopping Opiates?

I hear this question a lot, and I don’t have a one-size-fits-all answer. I always tell my patients to expect lower energy after an opioid detox. When patients return for their follow up appointments, it’s among the first questions I ask. How is your energy? What is your appetite like?  How are you sleeping? Are you feeling normal again? How about your ability to concentrate?

The responses I hear vary widely.

One person who had been on a combo of prescribed pain medicine and street fentanyl said he felt better at exactly “4 weeks and 3 days.” I just talked to a CEO who had started taking pills for energy. Her energy returned to normal in the time it took to remove her sutures around 12 days after her detox. Others experience a more amorphous path to normality—they suddenly realize one day that they haven’t had the thought, “Boy, do I feel tired today.”  The most common experience is a ‘wave pattern.’ Patients have a ‘wave’ of Post-Acute Withdrawal Symptoms (PAWS) and then an interval of feeling good. Then another tough wave, followed by a better interval, and so on. Over time the waves get smaller in amplitude and the time periods between PAWS symptoms gets longer and longer until they disappear.

Are The Side Effects of Naltrexone Similar to Those of Opioid Withdrawal?

Jackie had a more difficult time than most  patients. She stayed away from her job for more than a week. She was firmly convinced that her symptoms were due to naltrexone. She did online research to support her theory. After listening carefully to her concerns, I suggested that she schedule an appointment with her primary care physician instead of just asserting that her unpleasant symptoms were caused by PAWS or by naltrexone. A few things just didn’t add up.

Because of this, I wasn’t surprised when Jackie called me to say that her doctor had diagnosed her with an iron deficiency and a thyroid problem, and both were now being addressed.  She felt great again. She was meeting regularly with a therapist and also attending support group meetings via Zoom. She asked me, “Do I need to schedule my next implant appointment, or will someone call me to do that?”

I had to stop myself mid-reply. “Jackie, did you hear what you just said? Do you remember when you were begging me to take out your naltrexone pellet? Now you’re asking about scheduling your next one!” We both laughed; it was the first time I had heard her laugh and it was a most wonderful sound.

Removing Opioids From Your Brain is a Process

The reality is that getting off opioids is difficult, but not impossible. Coleman Addiction Medicine can get you safely started by knocking the opioids off your brain’s receptors and replacing them with the non-addictive opiate blocker naltrexone. Lower energy and mild side effects are possible for a brief period afterwards, but our patients agree that the rewards of getting into recovery safely is worth it.

If you have any questions, please schedule a callback with one of our Care Advocates. We are here to help.

Joan R. Shepherd, FNP

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