Low Energy After Opioids: What’s to Blame?

Low Energy After Opioids: What’s to Blame?

“Please,” my patient begged me, “please take out my naltrexone pellet. I don’t want it anymore…”

Jennifer is a 40-ish year-old teacher in New Jersey, and frankly, had a hellacious 2020. Although every teacher deserves a medal for the Adaptability and Creativity category in the Teaching-During-A-Pandemic contest, Jennifer’s job was even more challenging since she works with special needs children. Her students have learning disabilities, compounded by the fact that many also have limited internet access. Besides struggling to keep her students engaged, Jennifer was coping with personal grief. Her mother died from Covid-19 and she hadn’t been allowed to visit her in the hospital. 

A History With Opioids Became A Crutch

Like so many others across the country, Jennifer and her family were unable to celebrate her mother’s life with a traditional in-person funeral. Jennifer was plagued with anxiety that she was powerless to stop. 

In her 20s, Jennifer had briefly experimented with opiates. She snorted heroin a few times, got caught, and her parents stepped in.   Then last year, as she was swimming in emotional pain, an old and strikingly powerful memory of the effects of opioids returned to her and she started obsessing over finding that bliss again.

It was easier to find opioids than she expected. ‘Respectable’ people connected her with a dealer. She rationalized to herself that it was pills, not heroin. By purchasing them on the street, she was able to stay away from her physician’s office and any potential Covid-19 exposure there.

Dealing With Opioid Cravings and a Career

After a few months of using these pills, Jennifer had to be honest with herself: she started getting withdrawal symptoms if she didn’t have a pill within about 5 hours. Meanwhile, the stress from her career responsibilities and grief from her mom’s passing was now magnified by awareness of new addiction to street drugs.

Jennifer’s work life involved motivating young people, yet she felt like a failure when she struggled to lift herself to seek help. How could she expect her kids to do the right thing when she herself was caught in this quagmire? She thought of how disappointed her mom would be. As she tortured herself with these awful thoughts, her depression got worse.

Family Support To Strengthen Outpatient Detox Treatment

Jennifer has family who acted quickly when she reached out for their help. They helped her investigate treatment options and, after crossing out Methadone and Buprenorphine as her preferred form of Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD), she decided to come to the Coleman Network for Addiction Medicine and have an Outpatient Accelerated Opioid Detox.  The Coleman Method has focused on using this 3rd form of MAT to treat OUD for over 20 years: long-acting naltrexone.

When she arrived, her urine drug screen showed that what she had thought was oxycodone was actually fentanyl. She was surprised. (We were not. Fentanyl is in basically everything purchased on the streets these days.)

Naltrexone Therapy for Recovery Support

Jennifer faced some of the typical side effects during withdrawal, especially when coming off of fentanyl, but with a few comfort medications and around-the-clock support from our knowledgeable staff and her family, she completed her detox in 5 days. We inserted a naltrexone implant, and she went back home for a few days before going back to teaching.

A few days after her detox, Jennifer called our office. She planned to return to work in two days, but she hardly felt like getting out of bed. She had low energy, no appetite, and she still felt a little queasy. She had some other unusual issues that we rarely see after a detox.  Jennifer was certain that all these symptoms were the side effects of naltrexone.

Any medication has side effects, and naltrexone is not an exception. The things she felt might have been linked to naltrexone and she was desperate to feel normal—at least normal enough to get back to her job. 

“I need you to take the implant out,” she told me.

Low Energy Following an Opioid Detox

Since opiates soak our brain with more dopamine than it was meant to have, many people who stop opioids–whether prescribed by a physician or just bought on the street–will feel a sudden loss of energy, especially in the initial phase of their brain’s healing. 

How Long Does Low Energy Last After Quitting Opiates?

I get asked this question a lot, and I honestly don’t have a universal answer. I always tell my patients to expect lower energy following their opioid detox. When our patients return for follow up appointments, it’s one of the first questions I ask. How is your energy? How are you sleeping? Are you feeling normal again? What is your appetite like?  How about your ability to concentrate?

The responses I get are all over the place.

One person who had been on a combination of prescribed pain medicine and street fentanyl said he felt better at exactly “three weeks and two days”. I just talked with a successful small business owner who had started taking pills for energy. She was back to normal in the time it took to remove her sutures around twelve days after her detox. Others experience a more complex path to normality—they suddenly realize one day that they haven’t had the thought, “I sure feel tired today.”  The most common experience is the ‘wave pattern.’ Patients have a ‘wave’ of Post-Acute Withdrawal Symptoms (PAWS) and then a wave of feeling good. Then another tough interval, followed by a better one, and so on. Over time the waves calm down and the time periods between PAWS gets longer and longer.

Do The Side Effects of Naltrexone Mimic Opioid Withdrawal?

Jennifer had a much tougher time than most of our patients. She stayed away from her job for more than a week. She believed that her symptoms were coming from naltrexone. She did online research in support of her theory. Listening carefully to her concerns, I suggested that she check in with her primary care physician rather than just assuming that all her unpleasant symptoms were caused by PAWS or naltrexone. Some things just didn’t add up.

Because of this, it wasn’t surprising when Jennifer called me last week to say that her physician had diagnosed her with an iron deficiency and a thyroid problem, and both were now being addressed.  She felt good again. She was meeting regularly with a therapist. She had started attending regular support group meetings via Zoom. And then she asked me, “Do I need to schedule my next implant, or is someone going to call me?”

I stopped myself mid-reply. “Jennifer, did you hear yourself? Do you remember when you begged me to remove your naltrexone implant? Now you’re asking about scheduling your next one!!!” She laughed; it was the first time I’d heard her laugh and it was a glorious sound.

Removing Opioids From Your Brain is a Process

Getting off opioids is difficult but it’s not impossible. The Coleman Network for Addiction Medicine can get you safely started by removing the opioids from your brain’s receptors and replacing them with the non-addictive opiate blocker called naltrexone. Lower energy and mild side effects are likely for a brief period afterward, but our patients agree that the reward of getting into recovery safely is well 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

Recovery Starts With Finding The Right Detox Option For You.

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