- Generic Name or Active Ingridient: Hydromorphone
Many Americans can benefit from hydromorphone detoxification. Hydromorphone is a powerful opioid drug that doctors prescribe to relieve moderate to severe chronic pain.
While most people take hydromorphone as directed, many people use this drug for non-medical reasons, either to get high or to treat a condition other than the one the doctor had intended to treat. About 5 million Americans use painkillers for non-medical use every year.
Approximately 2 million Americans are physically dependent on hydromorphone and other opioids; these individuals must undergo hydromorphone detoxification to free themselves from dependence on this drug.
Anyone who takes hydromorphone regularly, either for therapeutic or non-medical reasons, for more than a few weeks can become opioid-dependent. The human body adapts to the presence of hydromorphone and, with continued use, begins to depend on a certain level of this chemical to feel “normal.” When hydromorphone levels drop quickly, the body struggles to maintain chemical stability. Doctors refer to this as the detoxification process.
The patient feels the struggle for chemical stability through uncomfortable withdrawal symptoms - detoxification causes withdrawal symptoms. These symptoms begin a few hours after the last dose of hydromorphone and continue for several days. Uninterrupted, these symptoms fade on their own as the body completes the detoxification process. These symptoms do not return unless the individual becomes opioid-dependent at a later day.
Detoxification also refers to the medical process of lowering opioid levels under a doctor’s care and receiving drugs to ease withdrawal symptoms. Professional detoxification usually includes professional screening for underlying conditions that may interfere with the detoxification process, medications to reduce discomfort, and professional monitoring to reduce the risk for complications.
Hydromorphone detoxification not only reduces withdrawal, but it facilitates the patient’s entry into rehabilitation and helps him remain in treatment. Detoxification promotes abstinence and reduces the frequency and severity of relapses when they do occur. Hydromorphone helps the patient think more clearly, enables him to work and improves his physical health along with his psychological well-being.
Types of Detox
Doctors and other healthcare professionals have been helping people overcome dependence on drugs for several decades, forging out many different types of treatment plans to fit almost every need. There are now countless specialty clinics offering hydromorphone detoxification and other treatments, staffed with doctors and nurses who receive advanced training in detoxification procedures.
Unfortunately, many opioid-dependent patients still do not use all the professional help available to them - of those who needed help for a substance abuse problem, less than 11 percent receive it at a specialty clinic with trained staff. The rest seek help at a general hospital or mental institution without trained staff. Many even attempt self-detoxification or use homemade treatment plans.
Some people attempt self-detoxification in hopes that self-discipline and determination will lead to recovery. Doctors normally suggest a patient wean himself from hydromorphone by taking a smaller total dose each day. If the patient takes hydromorphone liquid, he could use smaller amount each time he takes a dose. If he is taking hydromorphone pills or capsules, he can decrease dosage by increasing the amount of time between each dose. This tapering method works well for most but persistent withdrawal symptoms prevent many from weaning themselves from hydromorphone.
When tapering does not work, some people try to quit cold turkey by stopping hydromorphone use abruptly. The phrase “cold turkey” refers to the skin’s appearance during hydromorphone self-detoxification: pale, cold and clammy with goose bumps, resembling a frozen turkey.
Many people hope to reduce the severity and duration of withdrawal symptoms by using natural remedies, including acupuncture, meditation, yoga and massage. Others use a nutritional approach, eating ginger or peppermint to relieve to nausea, for example, or use chamomile or cayenne to curb diarrhea.
Some people manage hydromorphone withdrawal symptoms with prescription and over-the-counter drugs. One homemade hydromorphone detoxification approach is The Thomas Recipe, which calls for a benzodiazepine such as Xanax, Valium or Librium to relieve anxiety and help with sleep, Imodium for diarrhea, vitamin B6 and supplements for muscle aches, and L-Tyrosine for a much-needed burst of energy.
Since the 1970s, doctors have been using medicines to help people manage withdrawal symptoms or complete hydromorphone detoxification.
Outpatient clinics usually offer drug maintenance programs rather than hydromorphone detoxification. These drug maintenance programs typically use opioid replacement drugs, such as methadone and buprenorphine, which mimic the effects of hydromorphone. These drugs are weak opioids so they prevent withdrawal symptoms but, when taken as directed, do not produce euphoria. Replacement drugs reduce withdrawal symptoms by preventing hydromorphone detoxification from occurring.
Outpatient care with replacement drugs allow patients to participate in rehabilitation to learn how to live without drugs before enduring the detoxification process. Once the person gains the tools he needs to identify situations that may lead to drug abuse and learns how to refuse drugs when offered, he weans himself from the replacement drug. This type of care is appropriate for individuals who have been opioid-dependent for more than a year, require little supervision and need to work or take care of family while participating in outpatient care.
Methadone is an opioid pain reliever similar to hydromorphone. In the late 1960s, researchers realized weak doses of methadone prevented withdrawal symptoms in opioid-dependent patients. The FDA approved methadone for this use in 1972. Today, approximately 100,000 Americans use a methadone maintenance program.
Someone on a methadone maintenance plan comes to an approved outpatient clinic to drink a beverage containing methadone. Each dose of methadone prevents withdrawal symptoms for 24 to 36 hours. The patient also participates in outpatient rehabilitation including counseling and behavior modification.
Buprenorphine is similar to methadone in that it prevents withdrawal symptoms by stopping the hydromorphone detoxification process from occurring, but buprenorphine treatments are more flexible and private. Doctors can now write prescriptions for buprenorphine that a patient fills at a local pharmacy rather than through a methadone clinic. Early rules restricted prescriptions to one-week supplies and only to those who had been in treatment for nine months or longer. New rules allow even new patients to take home enough buprenorphine to last more than a week.
The typical prescription requires the patient take buprenorphine three times a week. He does so by placing buprenorphine under his tongue, where it dissolves and enters the bloodstream at the appropriate rate.
Suboxone and Subutex
Some recreational users get high on buprenorphine by dissolving the tablet and injecting the drug into a vein. Drug makers prevent this type of intravenous abuse by adding naloxone to the brand name buprenorphine preparations, Suboxone and Subutex. When taken under the tongue as directed, naloxone has little to no effect. When taken intravenously, however, naloxone neutralizes the effects of buprenorphine. Naloxone not only prevents the euphoria associated with intravenous buprenorphine use, it causes withdrawal symptoms in opioid-dependent patients.
Many specialty facilities now offer inpatient hydromorphone detoxification. Patients check into the inpatient clinic, where they receive a mixture of non-opioid medications to relieve the variety of withdrawal symptoms associated with hydromorphone detoxification. Nurses monitor the patients closely and respond to any complications that may arise.
Inpatient care is less uncomfortable that quitting cold turkey and does not prolong the opioid-dependent state like methadone and other outpatient drugs. Patients who have a history of not participating in or benefiting from other forms of treatment may find the structure of inpatient care helpful. Inpatient treatment is appropriate for anyone who requires more supervision during hydromorphone detoxification or who is at high risk for severe withdrawal symptoms or complications. Pre-existing conditions and co-existing substance abuse problems, including alcohol abuse, can also cause complications.
Patients recovering from a drug overdose, or who cannot receive outpatient treatment safely, must engage in inpatient care. Patients suffering from depression with suicidal thoughts, acute psychosis or other serious mental conditions should participate in inpatient hydromorphone detoxification, as should those who pose a danger to themselves or other people.
Rapid Opiate Detox
Rapid detox is a safe and effective procedure that detoxifies the body of hydromorphone while the patient dozes in a comfortable “twilight sleep.” Specially trained anesthesiologists give the patient anesthesia and sedatives before administering the standard detoxification and anti-withdrawal drugs. The patient awakens a few hours later, refreshed and ready for stabilization and recovery.
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 who receive advanced training in rapid hydromorphone detoxification. We have delivered compassionate and effective care for more than a decade. We treat patients as humans, not as drug addicts. We offer complete detoxification, not just a temporary patch for withdrawal.
We screen patients for pre-existing conditions using advanced equipment and techniques to spot any illnesses that may complicate recovery. We then administer a proven regimen of anesthetics, sedatives and detoxification drugs while closely monitoring the patient’s condition. When stable, the patient then moves to our aftercare facility for further treatment.
Hydromorphone detoxification is a natural process that happens by itself without any medical intervention, making self-detoxification the least expensive and most natural detoxification procedure. Self-detoxification is also a private experience - many patients claim the flu or other illness to explain their absence from work or family responsibilities.
Self-detoxification is associated with the highest risk for complications due to uncontrolled withdrawal symptoms and the lack of professional guidance.
Outpatient maintenance therapies are better than self-detoxification in that counselors offer rehabilitation along with replacement drugs stop withdrawal symptoms. Outpatient care is associated with fewer complications than self-detoxification. Patients engage in outpatient rehabilitation to gain the tools they need to live without drugs before attempting a drug-free life.
Outpatient care does not bring the patient to an opioid-free state quickly, as do self-detoxification, inpatient detoxification and rapid detox. Patients remain in treatment for months or years, compared to days or hours for inpatient care. Additionally, some patients become dependent on the replacement drugs offered through outpatient care, prolonging the recovery efforts.
Detox Possible Complications
Hydromorphone detoxification is not a life-threatening procedure but severe and uncontrolled withdrawal symptoms can result in dangerous complications. Pre-existing conditions, pregnancy and co-existing illnesses increase the risk for complications, as do long-term or severe drug abuse.
Self Detox Possible Complications
Uncontrolled withdrawal symptoms and insufficient patient monitoring puts those who attempt self-detoxification at high risk for complications. Extreme and prolonged vomiting and diarrhea can cause dehydration and imbalances in sodium, potassium and other electrolyte levels. The patient may suffer aspiration if he vomits and inhales stomach contents. Aspiration can lead to fluid in the lungs and lung infections.
Relapse is the primary complication associated with hydromorphone detoxification. Without drugs or professional oversight to protect against withdrawal symptoms and complications, patients who try self-detoxification may relapse just to ease the discomfort associated with hydromorphone detoxification.
Relapse increases the risk for toxic overdose. The detoxification process lowers the individual’s tolerance to hydromorphone, making him more sensitive to the effects of hydromorphone - it takes less hydromorphone to produce profound effects. This reduces tolerance means it is possible for someone to overdose on a smaller amount of hydromorphone than he used to take before experiencing even moderate withdrawal symptoms.
Withdrawal symptoms and complications can worsen previously undetected medical conditions; these undiscovered illnesses may also make hydromorphone detoxification more difficult. Without proper medical observation, a worsened illness can lead to unexpected and potentially serious complications.
Outpatient Care Possible Complications
Outpatient care is safer than self-detoxification in that it provides patient monitoring and counseling along with medicines to stop withdrawal symptoms. Outpatient care is more flexible than inpatient care in that patients do not have to stop working or taking care of family while engaging in rehabilitation.
Some patients become dependent on the replacement drugs or have trouble quitting methadone or buprenorphine after completing rehabilitation. Only about one-quarter of methadone users eventually quit drugs completely, while another 25 percent never stop using methadone or other drugs. A full 50 percent of methadone users go on and off treatment for the rest of their lives.
Methadone is associated with an increasing number of deaths in recent years, with the rate of overdose deaths associated with methadone 5.5 times higher in 2009 than it was in 1999. The rate of overdose deaths involving methadone in the United States in 2009 was the rate in 1999. Methadone now accounts for one-third of 15,500 overdose deaths associated with prescription painkillers in the United States even though methadone sales account for only 2 percent of the prescription painkiller market.
Patients may abuse methadone or buprenorphine through improper administration; other forms of hydromorphone therapies do not allow patients access to opioid drugs.
Inpatient Detox Possible Complications
Inpatient hydromorphone detoxification offers the most structure and professional support for opioid-dependent patients. Inpatient care gives maximum protection from withdrawal symptoms and complications, especially when it includes prescreening for pre-existing illness or co-existing substance abuse issues.
Rapid Detox Possible Complications
Patients may suffer complications associated with the anesthesia, sedatives or other drugs used in rapid detox procedures. High doses of sedatives may cause problems with breathing, blood pressure and pulse. Anesthesia administration may cause swelling, bruising or infection at the injection site.
Despite decades of scientific research and clinical studies, hydromorphone detoxification myths prevent many people from engaging in safe and effective care.
Self Detox Myths
Myth: Hydromorphone detoxification is just a matter of willpower and determination. Anyone can perform self-detoxification if he has enough self-discipline.
Fact: Self-detoxification is an intense physiologic process that is more than just mind over matter. Hydromorphone detoxification produces extreme withdrawal symptoms that may result in dangerous or life threatening complications, especially for those with pre-existing illnesses or pregnant patients.
Myth: Home remedies like The Thomas Recipe are safe and effective because they use drugs to ease withdrawal symptoms.
Fact: Only a doctor has the medical knowledge and the legal power to prescribe safe and effective drugs to ease hydromorphone detoxification. Benzodiazepines and other prescription and non-prescription drugs can interact with other drugs in unpredictable and unsafe ways.
Outpatient Detox Myths
Myth: Treatment is too expensive. It would be cheaper to throw opioid-dependent patients in jail.
Fact: One year in prison costs taxpayers about $24,000 per prisoner, whereas one year of methadone costs about $4,700 per patient.
Myth: Methadone is the fast track to living a drug-free life.
Fact: Methadone and other replacement drugs do not bring the patient to a drug-free state; this patient must quit the replacement drug at some point. Most counselors suggest patients stay on methadone for a minimum of 12 months before attempting detoxification.
Inpatient Detox Myths
Myth: Hydromorphone detoxification is not worth the effort: drug addicts always relapse.
Fact: Relapse rates for drug addiction are similar to those of other chronic diseases, such as high blood pressure, diabetes or asthma. In fact, relapse rates for drug abuse are better than high blood pressure and asthma relapse rates.
Myth: Spending resources on drug treatment is like throwing money down a hole.
Fact: Drug treatment saves money for individuals, families and communities. Experts estimate that every dollar spent on drug treatment programs returns a yield between $4 and $7 in reduced drug-related crime rates, criminal justice costs and theft. When these experts add in healthcare costs associated with dependence, savings rise to $12 gained for every dollar spent.
Rapid Detox Myths
Myth: Suffering is an important part of the recovery process. Pain serves as a reminder to stay away from drugs.
Fact: Human suffering is never a part of professional treatment for a medical illness. The demoralizing and uncomfortable experience of hydromorphone detoxification actually makes the entire process more difficult, imposing unnecessary pain upon patients who are already very ill.
Myth: Hydromorphone detoxification must take days for it to be effective
Fact: It takes a reputable expert only an hour or two to perform complete rapid detox.
Detox and Pregnancy
The hydromorphone detoxification process is unsafe for pregnant women - methadone is currently the only approved method for treating opioid dependence in pregnant women.
Opioid dependence places a woman at higher risk of certain illnesses, such as anemia, blood infections, heart disease, hepatitis, pneumonia, depression and other mood disorders. Drug use increases the risk of gestational diabetes, or blood sugar levels that fluctuate widely during pregnancy. Opioid-dependent woman are at greater risk for acquiring or spreading sexually transmitted diseases, HIV/AIDS and tuberculosis.
Drug abuse forces thousands to lead unhealthy lifestyles. Many are unable to work and suffer financial crises that cause a pregnant woman to eat poorly, life in inadequate housing, forego prenatal care or make unwise or illegal choices. Many times a pregnant woman must choose between eating a nutritious meal and purchasing drugs to stop the dangerous detoxification process from harming her child - drugs usually win.
Drug abuse and opioid dependence raises the chances a woman will suffer complications during pregnancy, labor and delivery. She may have a hemorrhage and suffer uncontrolled bleeding, experience inflammation of the membrane surrounding the baby or separation of the tissue between the mother and baby. Opioid dependence may slow fetal growth or cause premature labor and delivery, spontaneous abortion or fetal death. Methadone treatments reduce these complications.
A baby born to a woman who uses hydromorphone regularly during pregnancy may be born dependent on drugs and suffer withdrawal symptoms in the first weeks of life. This baby may suffer low birth weight, seizures, breathing problems, feeding difficulties or death.
Self Detox and Pregnancy
Self-detoxification is unsafe in a pregnant woman
Outpatient and Pregnancy
Methadone is currently the only approved approach to treating opioid dependence in pregnant women, as continued hydromorphone use increases the risk for complications and detoxification is just too dangerous.
An outpatient counselor will usually give a pregnant woman an initial dose of 10 to mg of methadone on the first morning of treatment, and ask her to return that evening for evaluation. Based on her response to treatment, the counselor may increase the next morning’s dosage by 5 - 10 mg. She will return to the clinic twice a day until she finds a safe, effective dose, usually within 48 to 72 hours of the initial dose.
As a woman progresses through pregnancy, she may experience changes in the way her body deals with methadone and require stronger doses to control withdrawal symptoms.
Inpatient and Pregnancy
Many opioid-dependent women choose to start methadone treatments in an inpatient setting where trained staff can monitor her condition and her baby’s response to treatment by observing fetal movements. This inpatient stay typically lasts three days.
Opiate detox symptoms
Hydromorphone detoxification usually causes withdrawal symptoms to appear in two waves, with the first set of symptoms appearing a few hours after the last dose. Initially, a patient may have trouble sleeping and feel agitated or anxious. His muscles may ache, his eyes get watery, he has a runny nose, yawns frequently and sweats profusely.
Later, he may have stomach cramps, diarrhea, nausea and vomiting. His pupils may dilate and he may have goose bumps.
What is the best method to detox from this drug?
The best method to detoxify from hydromorphone depends heavily on the patient’s personal needs. He should choose one that affords the greatest flexibility while still offering safe and effective care. The patient should opt for the program that best reflects his ability to cooperate with and benefit from treatment.
- Hydromorphone Detox