LDN and PAWS??

Hi Doc,
First, thank you for being here. I know you've taken some cheap shots on here, but I hope you can see through those and take satisfaction in the fact that your knowledge is a Godsend to some people on here. I just have a couple quick questions. First, I asked the other day about LDN which is Low Dose Naltrexone (4.5mg a day at bedtime I think). I know it's being tested as a helpful agent for MS and Crohn's disease, but can it help opiate addicts fresh off detox to alleviate or stop PAWS symptoms? Also, what are your views on PAWS? Is it real? How do we avoide it or reduce the symptoms? Again, Thanks Doc!!

[J T Junig, MD PhD]

Hi-- thanks much for the words of support-- I do appreciate it.

I really should know more about LDN-- after I answered your first post I looked up those letters and realized that you were referring to.  I have heard of it, but just barely--  It is a good example of something that I try to keep in mind about the brain and about the sciences in general:  we tend to see the brain organized a certain way, but that way may be completely different from reality. To elaborate, when we think about 'opiate receptors' we think of pain, analgesia, euphoria, addiction... and assume that everything related to opiate receptors should fit into one or all of those categories.  In reality, the 'opiate receptor' may be involved in neurotransmission in circuits that have nothing to do with analgesia.  For example, if we found that the opiate receptor can be found in the visual cortex, the first thought might be, 'what does pain have to do with vision?'  But in reality, the receptors were not set in place according to a human engineer;  they were selected through a procession of random events that were then subject to 'natural selection'.  So we shouldn't be real surprised when opiate receptors end up related to things other than addiction, such as MS and Crohn's.  In fact, we do know of opiate receptors throughout immune tissues including white blood cells.  Just a thought.

I read a comment somewhere about using LDN to 'increase endorphins' or to 'sensitize opiate receptors'-- As I remember, the person was talking about the fact that opiates have been studied for years in relation to their use to treat depression-- the writer wondered if LDN taken at night would make receptors more sensitive, so that endogenous opiates would be more effective during the day.  I remember a study that showed that in people taking significant doses of naltrexone (50 mg per day), endorphin levels in CSF were higher than in controls.  But my response is... so what?  What good do those endorphins do, if it takes blocking the opiate receptors to increase their levels?

I'm just musing here.  But your question about alleviating PAWS using LDN is sort of along the same line.

I do think that PAWS (post acute withdrawal syndrome) is a real phenomenon, but I don't know if it is 'chemical' or 'psychological', or both.  I guess it is the latter;  the body is still out of whack, and there is a great deal of unfinished business psychologically--  under the surface the patient is filled with hope, lingering despair, fear, shame, embarassment, pride...  then you have the messed up sleep cycle, altered stress hormones, newly-corrected nutritional deficiencies...  It is amazing that in those first few months of sobriety we can get anything accomplished!

I think that step-related recovery is good 'treatment' for PAWS;  there is some support in seeing others who understand what one is going through;  the focus on a 'higher power' helps achieve the right balance of humility and new-found pride;  the 4th and 5th step help deal with the shame issues...  Other important things include establishing a regular sleep cycle, getting good nutrition and some exercise, getting sunlight and fresh air-- the basics, essentially.

If I learn more about the LDN idea I will let you know-- thanks for bringing the issue to our collective attention!

JJ