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12-17-2008, 05:12 PM
Despite what you may hear from the many people on YA...Tramadol is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain.Some controversy exists regarding the dependence liability of tramadol. The manufacturer has promoted it as an opioid with a lower risk of opioid dependence than that of traditional opioids, claiming little evidence of such dependence in clinical trials. Despite these claims, it is apparent in community practice, that dependence to this agent does occur. The prescribing information for Ultram warns that tramadol"may induce psychological and physical dependence of the morphine-type". In addition, there are widespread reports by consumers of extremely difficult withdrawal experiences.While I have never had to withdraw anyone from Tramadol, I have had to assist several patients with issues related to opiate withdrawal, including Methadone, and Morphine.Key medical problems are blood pressure and the possibility of seizures. While there is little that can be done about the seizure potential except to observe, it is good to understand that Tramadol is known to lower the seizure threshold in those prone to seizures. The other issue is blood pressure. Elevations in blood pressure could lead to cardiac issues and stroke. The blood pressure should be monitored during the withdrawal period and the patient taken to the A&E if it becomes significantly elevated. If your physician is available, he/she may be willing to monitor and prescribe a low dose antihypertensive during this period. Nausea and vomiting are not uncommon, and medications for this are helpful.Tapering usually is somewhat effective with Tramadol as it has a shorter half life, so decreasing to 50mg/day prior to stoping may help with withdrawal issues.The following nutritional guidance may be helpful during the withdrawal period.Oral nutrition: Increase the right proteins!!!! Proteins are the building blocks for neurotransmitters and neurotransmitter receptors…as well as the building blocks for your natural opiate receptors• For 3 weeks you must remove all red meats from your diet. Red meat has chemical components that increase inflammation and pain. Fish, chicken, eggs are good sources of protein. If you are having a hard time taking in solid foods go to a health food store and buy protein powders that can be made into smoothies or drinks. You absolutely must have increased protein intake…proteins are the building blocks for all enzymes, neurotransmitters, and enzyme receptors in the body. No chemical works in the body without receptors. Just like opioids have to have opioid receptors.• L-Methionine—a sulfur bearing amino acid…necessary for the production of S-Adenosyl-methionine (SAM-e)…SAM-e is a necessary cofactor in the production of the master neurotransmitters—serotonin, dopamine, adrenalin, and nor-adrenalin…this must be added to any amino acid therapy directed at rebuilding neurotransmitter production and function…500 mg—two twice per day• Increase your intake of raw fruits and vegetables…you get little or nothing from canned foods…fresh fruits and veggies are loaded with fiber which help bind and remove toxins from your body…they also normalize gut function• Stay off candy, and other sugar heavy foods• Drink lots of good water, green teas are good for the antioxidants and anti-inflammatory properties…no cokes or soda waters for three weeks• When capable you must start exercising…swimming is best because it is low impact exercise…yoga…tai chi…walking daily…detoxing or otherwise…exercise is a normal component of good health.Supplements: Some need less and some more…remember the efficacy of all nutrition and supplement use is ultimately guided by your genetics…and we are all different to some degree…Multivitamin with a strong mineral component: in gel caps only…an excellent quality multivitamin is absolutely necessary…remember that vitamins and minerals are cofactors/coenzymes for repair, healing, and normal function of the body…most times I have patients double up on multivitamins for the first 3-4 weeksMineral complex: see aboveFish oils, or flax seed oil.: necessary for repair and proper function of cellular membranes…anti-inflammatory…these need to be mixed omega 3, omega 6, omega 9 oils—4000 to 6000 mg per day in split doses…although some can be purchased as liquids and mixed with your smoothies.If you don’t do the drinks…get proteins as free amino acids…double upL-Glutamine 500mg caps…at least 2000-3000 mg per day…split the dose so that your doing it at least twice per day…helps heal the gut and the building block for GABA…the primary inhibitory neurotransmitter…helps slow things down…Do not take GABA as a supplement…GABA is make in the brain…when out side the brain the molecule is to large to cross the blood brain barrier…the building block for GABA is L-Glutamine or Glutamic acid…these building blocks readily cross the blood brain barrier.Valarian Root 450 mg: Botanical that reduces anxiety and helps one to sleep…Kava, Jamaican Dog Wood, Lemon Balm, Avena are all nervine botanicals which can be used together or by self…I find the doses for each individual varies but typically 1000 to 1500 mg every 4 hours.Melatonin…dosages vary…this is a hormone released from the pinal gland in the human body at night time for sleep…this is essential for those coming off opioids…in my experience as little as 1 mg to 30 mg has been effective…do what you have to do…I’ve had addicts coming off $100.00 a day habits sleep 4 hours the first night…start low and add 3-5 mg every half-hour till sleep…research on healthy volunteers using up to 100 mg of melatonin in a single dose shows little side effects…Melatonin is also known as a very strong antioxidant with 1000 times the potency as Vit E…Take only at night when you would be going to bed at the regular time…the room must be dark…that’s the way this hormone is released in the natural state…Full Spectrum antioxidants: relieves inflammation and helps normalize inflammatory pathways and reduces damaging molecules (free radicals) present in the system while detoxingVitamin C: 2000-3000 mg per day divided doses…Reduced L-Glutathione 300mg per day: Helps liver detox metabolites of methadone…Detoxing agents can be found in many products…most in combinations…Adrenal Support: Research has shown that methadone, and drug use in general, has profound effects on the adrenal glands. In fact, research shows that there is a profound negative effect by methadone on the hypothalamic-pituitary-adrenal axis. This is why those that withdraw from methadone have protracted fatigue and problems with anxiety and insomnia. I often use freeze dried adrenal extracts in treatment with fairly good results. You’ll find these products listed under names such as Adrenal Plus, or Adrenplus…the starting dose is around 1000 mg per day in split doses.Milk Thistle with alpha-Lipoic Acid is one combination that I use extensively---for liver repair and detoxification…1200 to 1500 mg of milk thistle and 400 mg of lipoic acid per day in split dosesThis is the basics. There is absolutely no way to eliminate all the problems associated with withdrawal from opiates...one must have a supportive environment and sometimes with daily visits from a compassionate health care provider…This will not kill you…it will be a miserable event… In fact, cold turkey deaths coming off opioids are rare and usually associated with other health problems, or overdosing on prescription medications…withdrawal from opioids is much less of a risk than total withdrawal from alcohol. I wish you all luck on this endeavor…My compassion and empathy goes out to you…Ultimately, I know that you can do this…after all…it has to be done.
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