Common PAWS Symptoms

PAWS can affect your mood, sleep, energy, and ability to think clearly.

Mood and Emotional Changes

You might notice:

• Anxiety and panic attacks — Feeling constantly worried, on edge, or suddenly overwhelmed by fear
• Depression — Feeling sad, hopeless, or unable to enjoy things that once made you happy
• Mood swings — Going from feeling fine to upset, angry, or tearful without much warning
• Irritability — Getting frustrated or angry over things that wouldn’t normally bother you
• Emotional numbness — Feeling disconnected, unmotivated, or as though you’re just going through the motions

Some people find that even minor situations can trigger strong emotions. As one MyOpioidRecoveryTeam member put it, “PAWS gave me a pretty bang of anxiety. Really, really minor things can cause me ludicrous levels of anxiety.”

Sleep, Energy, Concentration, and Cravings

Other reported symptoms include:

• Insomnia — Difficulty falling or staying asleep
• Fatigue — Feeling exhausted or drained, even after resting
• Brain fog — Difficulty concentrating, remembering things, or thinking clearly
• Low motivation — Struggling to find energy or interest to do everyday activities
• Cravings — Feeling a strong urge to use opioids again, sometimes after a period without cravings

Getting Support During Recovery

There’s no single treatment proven to resolve PAWS, but that doesn’t mean you have to put up with every symptom. Small changes, practical coping strategies, and medical support may help you feel better.

Medical Options for PAWS Symptoms

There’s no medication specifically approved to treat PAWS. However, some symptoms may respond to individualized treatment.

For example, your healthcare provider may recommend therapy or appropriate medication for persistent depression, anxiety, or insomnia. Cognitive behavioral therapy (CBT) may help you manage distressing thoughts, emotional changes, and sleep difficulties.

If you’re already taking medications such as buprenorphine (Brixadi) or methadone (Methadose) for opioid use disorder, continue following your prescribed treatment plan. If you think you have PAWS, talk to your doctor before stopping your medication or changing how you take it.

Lifestyle Tips for Managing PAWS

Simple self-care strategies may help you manage fatigue, brain fog, and sleep problems.

• Keep a consistent sleep schedule — Try going to bed and waking up at the same time each day, even after a restless night.
• Exercise regularly — A short walk, stretching, or gentle exercise may help ease stress and improve sleep.
• Work around brain fog — Use reminders, write things down, and tackle demanding tasks when you feel most alert.
• Make room for rest — Break larger tasks into smaller steps rather than pushing through exhaustion.
• Try mindfulness — Breathing exercises, meditation, or journaling may help you manage difficult emotions.

You don’t have to do everything perfectly. Even one small change that makes your day easier is worth keeping.

Managing Cravings When They Return

Cravings can catch you off guard, even after a period without them. Having a plan can help you respond before an urge becomes overwhelming.

• Know your triggers — Stress, seeing your old dealer or a friend who’s using, certain places, or difficult emotions may bring cravings to the surface.
• Give yourself some distance — Leave situations that make the urge harder to manage.
• Distract yourself — Try a walk, music, or another activity that keeps you occupied.
• Talk to someone — Reach out to a trusted person, counselor, or support group rather than dealing with the craving alone.

If cravings are becoming harder to manage on your own, let your treatment team know. You may need additional support or an adjustment to your care plan.