- Generic Name or Active Ingridient: Diphenoxylate
Doctors prescribe diphenoxylate to curb diarrhea. Diphenoxylate is a mild opioid drug. Along with easing diarrhea, opioids relieve pain, cause sedation and produce a pleasant sense of euphoria.
Anyone who takes diphenoxylate or other opioids regularly for more than a few weeks can become physically dependent on opioids. The Institute of Addiction Medicine estimates there are almost 2 million opioid-dependent Americans. The opioid-dependent body becomes accustomed to having a certain amount of diphenoxylate present to feel “normal.” When diphenoxylate levels fall drastically, the body struggles to regain chemical stability. Doctors refer to this as the detoxification process. The patient experiences detoxification through uncomfortable and demoralizing withdrawal symptoms.
Without intervention, withdrawal symptoms associated with diphenoxylate detoxification last for five or more days before fading away at the end of the detoxification process. Withdrawal symptoms do not return unless the patient returns to an opioid-dependent state. The patient may use a variety of drugs to reduce individual withdrawal symptoms without stopping the detoxification process. He may stop withdrawal symptoms completely and immediately by taking more diphenoxylate but relapse halts the detoxification process, leaving the individual in an opioid-dependent state.
Detoxification also refers to the medical process of lowering opioid levels and easing withdrawal symptoms. Detoxification happens naturally or with the aid of medicine. Medical detoxification improves the chances of recovery by reducing the intensity of withdrawal symptoms.
Diphenoxylate detoxification is an important step in the patient’s quest to live a drug-free life, especially when followed up with rehabilitation to help the patient learn how to live without drugs. Detoxification removes the constant distraction of withdrawal symptoms, making it easier for the patient to participate in rehabilitation that further improves his chances of recovery. Diphenoxylate detoxification helps patients remain in treatment long enough to make meaningful changes that promote abstinence and reduce drug use. Complete detoxification reduces the frequency and severity of drug use episodes.
Types of Detox
More than 23 million people in the United States needed treatment for drug and alcohol abuse problems in 2010. Of those that needed treatment, only about 11 percent got it in a specialty facility staffed with medical professionals who receive advanced training in detoxification procedures. Everyone else went to a general hospital or psychiatric unit without trained staff or attempted diphenoxylate detoxification at home.
Everyone experiences opioid dependence in a slightly different way, so no single treatment plan is right for everyone. Furthermore, an individual’s needs change as she progresses through the recovery experience - it is common for people to engage in several types of detoxification before finding one that works for them.
Many people attempt diphenoxylate detoxification at home, without the help of medicine to ease withdrawal symptoms or professional guidance to predict and address dangerous complications.
Quitting “cold turkey” is probably the oldest form of detoxification. When someone quits cold turkey, he stops using diphenoxylate abruptly in hopes he has enough self-discipline to endure uncontrolled withdrawal symptoms long enough to complete the detoxification process.
Cold turkey refers to the appearance of his skin during diphenoxylate detoxification: cold, pale and clammy with goose bumps, much like a frozen turkey. Quitting cold turkey also causes stomach cramps, vomiting, diarrhea and other unpleasant symptoms.
Some people use natural remedies to help their bodies through the detoxification experience, participating in meditation, yoga, massage or acupuncture. Others use a nutritional approach to help the body detoxify naturally. Chamomile and cayenne slow diarrhea, for example, while ginger and peppermint calm an upset stomach.
Others create homemade treatment plans that include a variety of medications to address withdrawal symptoms. One such remedy is The Thomas Recipe, which calls for a benzodiazepine such as Valium or Xanax to help the patient relax and fall asleep. Imodium eases diarrhea, L-Tyrosine gives a burst of energy while vitamin B6 and supplements soothe muscle aches.
Most patients benefit from medical detoxification that utilizes professional guidance and advanced medicines. These procedures usually include medications and procedures that stabilize a drug habit, initiate the detoxification process, reduce withdrawal symptoms, and reduce the incidence and severity of complications.
Outpatient care is appropriate for those patients that have been dependent on diphenoxylate for more than a year and who require little supervision. Outpatient care usually includes maintenance programs rather than detoxification procedures.
Many outpatient clinics offer drug replacement therapy, or DRT. These replacement drugs are weak opioids that act similar to diphenoxylate but do not produce a strong euphoria. Methadone, buprenorphine, Suboxone and Subutex are common DRT drugs.
DRT allows the patient to participate in rehabilitation and behavior modification before attempting detoxification. Once the patient acquires the tools he needs to live a drug-free life, he weans himself from the replacement drug by taking smaller doses each day.
The FDA approved methadone for use in the treatment of opioid dependence in 1972. About 100,000 Americans currently use a methadone maintenance program to control their dependence on opioids. Methadone patients come to the clinic every two to three days to consume a beverage containing methadone.
Buprenorphine affords patients a little more flexibility. Specially trained healthcare providers can now prescribe buprenorphine for home use.
Early rules restricted buprenorphine to a one-week supply available only to patients who had been in treatment for at least nine months. These restrictions were because someone could abuse buprenorphine by dissolving and injecting it into a vein. The Department of Health and Human Services eased restrictions in 2013 so that even new patients could take home enough buprenorphine to last a week or more. This relaxation of the rules allows buprenorphine patients to lead a more normal life.
Suboxone and Subutex
To reduce the risk for improper administration and abuse, drug makers added naloxone to buprenorphine in the brand name preparations, Suboxone and Subutex. When take as directed under the tongue, naloxone has little or no effect. When injected, naloxone neutralizes the effects of buprenorphine, reducing its euphoric effects and causing withdrawal symptoms in opioid-dependent people.
Inpatient diphenoxylate detoxification offers the highest level of patient support. Inpatient care typically offers complete detoxification, not just maintenance, to bring the patient to a drug-free state. Inpatient detoxification usually incorporates a handful of medications to treat the variety of withdrawal symptoms. The detoxification specialist may administer one non-opioid drug for anxiety, for example, and another for diarrhea along with a third medication for nausea.
Inpatient care is appropriate for those who cannot receive treatment safely in an outpatient setting because of overdose, pre-existing conditions that increase the risk for complications, or have a documented history of not engaging in or benefiting from less restrictive programs. Patients who are at high risk for severe or prolonged withdrawal symptoms or complications should participate in inpatient treatment.
Individuals with psychiatric problems, including acute psychosis or depression along with suicidal thoughts, should consider inpatient care especially if they exhibit behaviors that may cause a danger to themselves or to others.
Rapid Opiate Detox
Rapid detox offers patients a safe, effective and humane approach to diphenoxylate detoxification. During rapid detox, patients receive sedatives and anesthesia prior to the standard detoxification and anti-withdrawal drugs. Rapid detox patients rest in a comfortable “twilight sleep,” unaware of the uncomfortable detoxification process. Rapid detox patients awaken a few hours later, refreshed and ready for aftercare.
Our detox center: Who we are and what we do
We are a fully accredited hospital staffed with board-certified anesthesiologists and other medical professionals. We have delivered compassionate and cutting-edge care to thousands of patients over the course of more than a decade. We treat patients as people, not drug addicts, and design an individualized care plan according to personal need.
We provide pre-screening to identify any pre-existing conditions that might undermine the patient’s success. We create a care plan according to the patient’s condition and administer the appropriate rapid detox medications to ease his transition into a drug-free state. Once we stabilize the patient’s condition, he may choose to enhance his chances for success in our aftercare facility.
As compared to outpatient and inpatient care, self-detoxification is the least expensive and affords the highest level of privacy. It is possible to achieve a drug-free state through self-detoxification, although uncontrolled withdrawal symptoms increase the risk for complications and diminish the chances for success.
Outpatient care is better than self-detoxification in that it addresses withdrawal symptoms and provides professional guidance. Outpatient care reduces the risk for complications associated with diphenoxylate detoxification. Outpatient care does not bring the patient to a drug-free state and patients could remain in treatment for months or years.
Inpatient care may be better than outpatient or self-care for some because it provides the greatest levels of professional guidance and advanced medical knowhow. Inpatient care usually offers complete detoxification, bringing the patient to a drug-free state before discharging him to an aftercare facility for rehabilitation.
Rapid detox is the most humane and efficient approach to diphenoxylate detoxification. Rapid detox offers fast and complete detoxification, putting the patient on the fast track to aftercare. Rapid detox brings the patient to a drug-free state in hours, not days or months. Rapid detox frees the inpatient from the uncomfortable and demoralizing withdrawal symptoms that could interfere with his recovery.
Detox Possible Complications
All medical procedures pose some risk for complications, including diphenoxylate detoxification. While diphenoxylate detoxification is not normally life threatening, severe and prolonged withdrawal symptoms can cause complications. Pre-existing medical conditions and co-existing drug and alcohol problems increase the risk for complications, as does pregnancy and long-term or severe diphenoxylate abuse.
Self Detox Possible Complications
Without a treatment plan or medications, self-detoxification leaves the patient vulnerable to complications resulting from uncontrolled withdrawal symptoms. Self-detoxification can worsen previously undetected illnesses to produce unexpected complications. Left untreated, these complications may become serious.
Severe and prolonged vomiting or diarrhea can result in dehydration and imbalances in potassium, sodium and other electrolyte levels. The patient may vomit then inhale the stomach contents, a condition known as aspiration that can cause fluid in the lungs and lung infections.
Relapse is the primary complication associated with diphenoxylate detoxification. Without medication to reduce the intensity of withdrawal symptoms, many people who attempt self-detoxification take more diphenoxylate in an effort to end the discomfort.
Relapse increases the risk for toxic overdose and death. The detoxification process lowers the individual’s tolerance to opioid drugs, making him more sensitive to the effects of diphenoxylate. Because detoxification lowers tolerance, it is possible for someone to overdose on a smaller amount of diphenoxylate than he used to take before experiencing even moderate withdrawal symptoms.
Outpatient Care Possible Complications
Because it offers some measure of supervision and uses medications to prevent withdrawal symptoms that could lead to complications, outpatient care is associated with a lowered risk for complications such as dehydration, aspiration and relapse. An outpatient may still experience complications stemming from the medications used in DRT. For example, methadone may slow heartbeat and breathing. Other DRT drugs may cause stomach pain or seizures. There is a risk for buprenorphine abuse through improper intravenous administration.
Many people have trouble quitting the replacement drug. About a quarter of all methadone patients quit using drugs altogether while another 25 percent never kick the habit. Approximately half of all methadone patients go on and off medication for the rest of their lives.
Methadone is causing an increasing number of deaths. This replacement drug accounts for about a third of opioid pain reliever deaths, up six fold in ten years.
Inpatient Detox Possible Complications
Inpatient care provides the greatest protection from complications because it typically includes effective medications and close patient monitoring. It is still possible to suffer complications during inpatient diphenoxylate detoxification, especially if the patient has pre-existing conditions. A co-existing alcohol or substance abuse problem increases the risk for complications, especially withdrawal from alcohol, benzodiazepines, sedatives and anti-anxiety drugs.
Patients may rarely become physically or psychologically dependent on the drugs used for inpatient treatment. Close patient supervision and appropriate aftercare reduces the risk for this complication.
Rapid Detox Possible Complications
Someone may suffer complications associated with the drugs used during the rapid detox procedure, especially the anesthesia and sedatives. High doses of sedatives can cause breathing problems, high blood pressure and changes in heart rate. Complications associated with anesthesia include infection, bruising or swelling at the injection site.
Despite decades of medical research and clinical experience, myths surrounding diphenoxylate detoxification prevent countless individuals from seeking qualified medical treatment.
Self Detox Myths
Myth: Detoxification is simply a matter of self-discipline.
Fact: Detoxification is an intense physiological process that is more than “mind over matter.” Without anti-withdrawal drugs and professional supervision, uncontrolled withdrawal symptoms can cause serious medical complications.
Myth: Self-detoxification plans like The Thomas Recipe are safe because they include drugs to reduce withdrawal symptoms.
Fact: While The Thomas Recipe can reduce symptoms, it does not account for any pre-existing medical conditions or co-existing substance abuse problems that could cause complications. Furthermore, the drugs used in The Thomas Recipe or other home remedies can interact with other medications the individual might be taking to cause unexpected and adverse drugs.
Outpatient Detox Myths
Myth: It is cheaper to throw opioid-dependent people in jail than to provide treatment.
Fact: A year of methadone costs approximately $4,700 per patient, whereas it takes about $24,000 to imprison that person for a year.
Myth: Methadone is a fast cure.
Fact: Methadone does not cure dependence on diphenoxylate - methadone is a replacement for opioids. A patient typically spends 12 months on methadone before attempting detoxification from this replacement drug.
Inpatient Detox Myths
Myth: Diphenoxylate detoxification is not worth the effort because drug addicts always relapse. Relapse rates for drug addiction are similar to those of other chronic diseases. In fact, drug addiction has a lower relapse rate than high blood pressure and asthma.
Myth: Drug treatment costs society more money than it saves.
Fact: Each dollar spent on drug treatment programs saves and estimated $4 to $7 in drug-related crime rates and criminal justice costs. Add in drug-related healthcare costs and these savings leap to a gain of $12 for every dollar spent.
Rapid Detox Myths
Myth: Suffering is an important part of the diphenoxylate detoxification process - the painful experience acts as a deterrent to drug abuse.
Fact: Pain and suffering are never therapeutic. Rapid detox is a humane approach to diphenoxylate detoxification in that it spares the patient from an uncomfortable and demoralizing experience. Rapid detox patients enjoy a pleasant twilight sleep instead of enduring endless days of detoxification and are therefore more agreeable to rehabilitation.
Myth: Diphenoxylate detoxification is a lengthy procedure that takes days.
Fact: It takes a reputable expert one to two hours to perform rapid detox.
Detox and Pregnancy
Diphenoxylate detoxification is unsafe for pregnant women. At this time, methadone is the only approved approach to treating opioid dependence in pregnant women.
Opioid dependence increases the risk of certain medical disorders in women, including anemia, blood infections, depression and other mental health issue, hepatitis, heart disease, and pneumonia. Dependence on diphenoxylate and other opioids is associated with an increased risk for contracting and spreading infectious diseases, such as sexually transmitted diseases, tuberculosis and HIV/AIDS. An opioid-dependent woman can experience wildly fluctuating blood sugar levels during pregnancy, a condition known as gestational diabetes.
Someone struggling with substance abuse issues is likely to live an unhealthy lifestyle. Drug dependence interferes with her ability to work, so an opioid-dependent person frequently faces financial difficulties that force her to make difficult decisions. Diphenoxylate detoxification is dangerous during pregnancy; if a pregnant woman has only enough money to buy food or drugs, she might forgo the meal to avoid causing harm to herself or her unborn baby. Financial hardships may also cause poor prenatal care, inadequate housing and other issues that diminish the health and well-being of the mother and child.
An opioid-dependent woman faces a higher risk for complications during pregnancy, labor and delivery. She may hemorrhage and bleed uncontrollably, suffer inflammation of the membrane surrounding the baby or separation of the tissue between the mother and her baby. Her unborn baby may suffer slowed fetal growth, spontaneous abortion, premature labor and delivery or fetal death. Methadone reduces these complications.
A baby born to a mother who uses diphenoxylate or other opioids regularly during pregnancy can suffer NAS, or neonatal abstinence syndrome. A baby with NAS suffers withdrawal symptoms in the first weeks of life, including fever, increased stools, feeding problems, irritability and hyperactive reflexes. NAS is associated with low birth weight, seizures, breathing problems, feeding difficulties and death.
Self Detox and Pregnancy
Diphenoxylate detoxification is never safe during pregnancy; this is especially true with self-detoxification. A pregnant woman may suffer serious complications that may cause harm to herself or her unborn baby.
Outpatient and Pregnancy
Methadone is currently the only approved treatment for opioid dependence during pregnancy. A rehabilitation specialist will prescribe a methadone dose based on the pregnant woman’s response to treatment. On the first morning of treatment, the patient will come to the clinic to drink a beverage containing 10 - 20 mg of methadone. She will return to the clinic that evening for assessment. Her healthcare provider may increase her next morning’s dosage another 5 - 10 mg, depending on how well she tolerates methadone. This will go on until she finds an effective and safe dosage, usually 48 to 72 hours from the first dose.
Women taking methadone sometimes experience withdrawal symptoms late in pregnancy and require stronger doses to manage symptoms.
Inpatient and Pregnancy
Inpatient diphenoxylate detoxification is not safe for pregnant women but these individuals may start methadone treatments as inpatients where doctors can properly evaluate and monitor their condition. Hospital workers monitor the baby’s response to methadone treatment with special equipment that monitors fetal movement. Inpatient methadone initiation typically lasts three days.
Opiate detox symptoms
Detoxification from diphenoxylate and other opioids typically causes two waves of withdrawal symptoms. An opioid-dependent person usually experiences the first set of symptoms a few hours after the last dose of diphenoxylate. He might feel agitated, anxious and have trouble sleeping. He may also have muscle aches, watery eyes and runny nose. He might sweat or yawn excessively.
Later, he may experience stomach cramps, diarrhea, nausea and vomiting. He might have dilated pupils and goose bumps on his skin.
What is the best method to detoxify from diphenoxylate?
Dependence on diphenoxylate or other opioids is complex and personal experience that requires a thoughtful and personalized approach. Experts agree that anyone attempting diphenoxylate detoxification should choose the least restrictive setting that is still likely to deliver safe and effective care. A patient should base his choice on his own ability to cooperate with and benefit from treatment, his ability to refrain from substance abuse and other high-risk behaviors and his own personal need for structure and support.
- Diphenoxylate Detox