This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.

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Opiate withdrawal refers to the wide range of symptoms that occur after stopping or dramatically reducing opiate drugs after heavy and prolonged use (several weeks or more). Opiate drugs include heroin, morphine, codeine, Oxycontin, Dilaudid, methadone, and others. ¹

Charlie's shoulders are cast square, her form solid, known, enhanced by an oversized jacket. Or at least it used to be. Charlie's been on opiates for 25 years, last month marking the first time in remembrance that she's been off the drugs. For a while it was heroin, then, for years, methadone for maintenance. (Cocaine has always been more her thing, the sharp buzz of stimulants reaffirming the edge she needs on the streets.) She began snorting heroin as a teen in a rough neighborhood.

Charlie: Hunts Point. Courtesy of Chris Arnade.

Today, her face is gaunt, her skin paler than before. She moves slowly now, with more care, as if she doesn't want to dislocate or startle a piece of her body. It's a slowness that's more than a result of her prison environment* -- she's been there before, behind wrap-wire fences and thick walls.

The other times, though, one of her girls had snuck her drugs, ferrying opiates sewed into packages of clothes. A privilege of being a pimp, perhaps. This prison is further away from her usual city lockup, in Westchester County, about an hour drive from the city, and her girls don't have cars. And so, she's detoxing without medication, laying in bed day in and out, sleeping little out of discomfort, unable to concentrate on anything more than not getting sick. The first time in 25 years.

About 9% of the population is believed to misuse opiates over the course of their lifetime, including illegal drugs like heroin and prescription pain medications such as Oxycontin. These drugs can cause physical dependence. This means that a person relies on the drug to prevent symptoms of withdrawal. Over time, greater amounts of the drug become necessary to produce the same effect. The time it takes to become physically dependent varies with each individual. When the person stops taking the drugs, the body needs time to recover, and withdrawal symptoms result. Withdrawal from opiates can occur whenever any chronic use is discontinued or reduced.

Charlie just wants to sleep again.

Early symptoms of withdrawal include: * Agitation * Anxiety * Muscle aches * Increased tearing * Insomnia * Runny nose * Sweating * Yawning Late symptoms of withdrawal include: * Abdominal cramping * Diarrhea * Dilated pupils * Goose bumps * Nausea * Vomiting

It's more than her presence of notice that's diminished, crumbled under something. Her attention blinks in and out, better when talking about the streets, something that seems so far away. Wondering how her girl is, how her little brother, the one she haphazardly raised as a teen after the deaths of her parents, fares back in the South Bronx.

People withdrawing from methadone may be placed on long-term maintenance. This involves slowly decreasing the dosage of methadone over time. This helps reduce the intensity of withdrawal symptoms.

Michael after detox: Astoria. Courtesy of Chris Arnade.

Michael's been on heroin for five years straight, having detoxed himself during a prison stint. After a recent self-selected detox, a life-change attempt, he inched around my couch, the master of six pillows. Nothing soft enough to ease his body aches, Tylenol taken in excess. He, too, wanted to sleep, having been sent from detox with no follow-up medication. That's what eventually broke him, the pain and discomfort.

The biggest complication is return to drug use. Most opiate overdose deaths occur in people who have just withdrawn or detoxed. Because withdrawal reduces your tolerance to the drug, those who have just gone through withdrawal can overdose on a much smaller dose than they used to take.

He's overdosed in a Starbucks bathroom before, and in a McDonald's, too. He woke up later in the hospital, having fallen over after shooting and begun to twitch. But that was two times, and the damage from an OD was short lived. The pinpricks of withdrawal pain, however, last much longer.

It's almost not worth it to get off, they think, despite their bodies needing more and more to feel good.

Those withdrawing from opiates should be checked for depression and other mental illnesses. Appropriate treatment of such disorders can reduce the risk of relapse. Antidepressant medications should NOT be withheld under the assumption that the depression is only related to withdrawal, and not a pre-existing condition.

Michael's been diagnosed with a mood disorder, the heroin helping him to stay away from extreme upset and anger flashes.

For Charlie, it's a decades' old relic that lingers.

Both move forward, or backward, in flinches and spurts.

*Charlie was arrested while answering a court summons for 10-year-old nonviolent drug offenses. She's now serving two years in Bedford Hills Correctional Facility for Women, a maximum security prison.

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¹ Zieve, David, MD, David R. Eltz, and Eric Perez, MD. "Opiate Withdrawal: MedlinePlus Medical Encyclopedia." Medline Plus. U.S. National Library of Medicine, 23 Jan. 2012. Web. 04 Apr. 2013.

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