The Withdrawal

If you were asked to think about someone experiencing drug withdrawal symptoms, what first comes to mind? I personally used to believe this was essentially “jakey shakes” coming from the cliché kind of misfortunate drug addict. I was wrong.

It took the best part of a year to completely wean myself off tramadol. I found it extremely challenging to reduce my dosage because I was always in such a debilitating amount of pain. I started by trying to take one less tablet at a single point of the day, taking me from eight (400mg) to seven (350mg) tramadol over 24 hours. After a month or so, I increased the length of the intervals between doses, and decided to try 2x50mg three times per day. It was at this stage where I became a bit stuck and remained on the same dosage for many months.

While in third year at university, we were learning about the physiological effects of opiates (e.g. tramadol and heroin) as part of a pharmacology module. I was absolutely horrified. Without confusing matters with scientific jargon, opiates depress your central nervous system by acting on receptors in the brain to inhibit the release of noradrenaline. This results in a slowed heart rate, reduced blood pressure and suppressed respiratory functions, i.e. your ability to breathe. Wow, what a treat. They also impair your cognition and reduce levels of consciousness, leading to extreme drowsiness. This all made sense with regards to the side effects I had experienced, but had dismissed as not being a big deal. I had believed this was simply my new normal.

I also learned that opiates impair gut motility - causing reduced bowel movements - by depressing muscle contractions in the intestines. This movement (peristalsis) is normally required to move digested food through the intestine. Dysfunction of this process therefore leads to abdominal cramps and constipation. A delightful topic, I know, but it's real life. Opioid-induced IBS? Check! I left the lecture hall and all that was swirling around my head was ‘I need to get off this medication ASAP.’

A few people had previously suggested that I try medicinal cannabis to help relieve my pain. I was extremely anti-drugs at this point in my life for reasons I won’t get into, so in all honesty, I thought it was a total sham. Oh yeah, medicinal cannabis, you say? For your glaucoma? No bother mate. It's hilarious looking back how naive and narrow-minded I was about it. I could not have been more wrong!

Due to the legalities around cannabis (and my profession) I'm not sure how much information I can reveal without provoking some trouble. However, I quickly changed my opinion and became a massive advocate for medicinal cannabis. Even CBD oil - which you can buy legally in the UK – has enormous pain-relieving and anti-inflammatory properties. No bullshit; read some peer-reviewed journals on clinical studies around it if you are a sceptic like I once was.

I made the decision to give it a try following one of my more intense flare ups. I remember being unable to move from the couch and had NHS-24 on speaker phone. Once things had settled, I surrendered to my curiosity and decided to try medicinal cannabis after doing some research. When your quality of life is so poor and you are constantly in excruciating pain, you will do anything to help.

I didn’t at any point experience a ‘high' with the oil, which was administered by placing a few drops underneath the tongue. This method (sublingual) is preferable as it enables quick absorption of the drug directly into the systemic circulation. There is consequently a quicker onset of action and faster pain relief. I took a few drops three times daily, and very quickly noticed a massive reduction in my muscle spasms and overall pain levels.This is what gave me enough relief to reduce my tramadol dosage from eight to six tablets per day.

As I mentioned earlier, this is where I became a bit stuck. If I'm honest, maybe I stopped here as I was actually simply in fear of my pain becoming intolerable. What if I was unable to obtain the oil and had no prescription for tramadol, then I ended up stranded with no method of pain relief? Not taking any medication at all seemed unthinkable back then.

While in my final semester of university, I obviously believed there wasn’t enough stress in my life at that time. No, let’s add some more insomnia-inducing challenges into the mix! I enrolled in a new rehabilitation programme with “The Fibro Guy” who offers both 1:1 coaching and an online programme. Because the team were based in Newcastle at the time, and I was in the middle of my Honours year, I opted for the online version. I will discuss the details of this programme in a later post, but the benefits of it were incredible. It was throughout this programme that I finally felt well enough to reduce my tramadol dosage further.

It is absolutely crucial with this type of drug to taper the dose very slowly and under the supervision of a medical doctor. Even doing this at a very slow pace can still result in withdrawal symptoms: something I once had a very unpleasant experience with. Withdrawal symptoms occur because your brain chemistry has adapted to the constant presence of a drug. With tramadol, neurons adjust by increasing their level of activity to counteract the suppression of noradrenaline I mentioned earlier. When the drug is suddenly removed, the brain essentially goes into overdrive trying to function without it.

Although I had been carefully tapering my dosage, when I was at the stage of reducing the dose from two (100mg) to one (50mg), and then from one to zero, this is where the problems arose. I recently discovered a page on the notes section of my phone from two years ago. I used this to record what I was taking and when, and any symptoms I encountered. The first entry was on 20th May 2020 and reads:

“no meds in morning or afternoon; pain became much worse and started to feel ill (hot and cold, sweats, shivering, sore throat,shaking, anxious, lack of energy); took 50mg tramadol at approx. 6pm, had a quick sleep then woke up feeling fine.”

The following day’s entry states:

“no meds all day; felt unwell again (same as yesterday but sorer throat & dodgy stomach); took 10mg CBD at approx. 5pm; symptoms of nausea and temperature fluctuations worsened at night; was sick around 1am; pain worsened and couldn’t sleep; took 50mg tramadol at 2am – fell asleep, woke up at 3.30am feeling much better”.

I can recall feeling absolutely dreadful while this was ongoing. I can also remember feeling some sort of shame and embarrassment that my body was responding in this way. This went on for a few days until eventually the symptoms subsided and I could handle what became only excessive sweating throughout the night. I was then able to take one tramadol every second day, then every third day until the symptoms came to a stop. As of Wednesday 5th June 2020, I have been completely tramadol-free.

Although I had told my doctor I was planning on coming off tramadol, I can only remember them providing very generic advice. There was no real plan in place for what to take and when. However, you should absolutely never go “cold turkey” as the side effects would be a hell of a lot more severe than the ones I experienced. It is extremely dangerous and potentially life threatening.

Most people living with chronic pain will continually use strong pain medication to allow them to function and get through each day. I’ve been there; it is completely understandable. The issue is when you start heavily relying on it both physically and mentally, and it becomes a crutch. However, although the effects may not be apparent right now, you are likely doing more damage than good. Do you want to be in control of your own body, or do you want to be a slave to your painkillers?

Thank you for reading :)

Much love, Kirsten xox