- Has a documented history of not engaging fully or benefiting from less restrictive programs
- Is at risk for severe withdrawal symptoms or complications
- Has co-existing conditions or substance abuse problems that make outpatient care unsafe
- Is recovering from an overdose and cannot receive treatment safely as an outpatient
- Has psychiatric problems that impair his ability to engage in outpatient treatment, especially acute psychosis or depression with suicidal thoughts
- Exhibits behaviors that may cause danger to the patient himself or to others
Opioid detoxification is for people who have become physically dependent on this type of drug and suffer withdrawal symptoms when they stop using opioids. According to statistics cited by the Institute of Addiction Medicine, about 2 million Americans are opioid-dependent. Opioid detoxification helps these individuals achieve an opioid-free state.
People have been using opium to relieve pain since at least 4,000 BC. Drug makers create semi-synthetic opioids out of the natural opiates morphine, codeine and thebaine extracted from the opium poppy plant, Papaver somniferum. Drug makers create synthetic opioid drugs that act like natural opiates and synthetic opioids. Modern opioids include morphine, codeine, hydrocodone, oxycodone, methadone, fentanyl and heroin.
Doctors prescribe opioids to treat moderate to severe pain caused by illness, trauma, and invasive medical or dental procedures. Opioids are the most powerful analgesics known to exist. People in the United States take the most opioids of any nation - even though Americans represent only about 5 percent of world population, they gobble up 80 percent of the global opioid supply. Hydrocodone is the most widely prescribed drug in the U.S., with pharmacists filling more than 139 million prescriptions for products containing hydrocodone in 2010. Oxycodone is another widely prescribed opioid, with U.S. pharmacists dispensing 58.2 million prescriptions for drugs containing oxycodone in 2010.
Most people take opioids as directed but some use these drugs for non-medical reasons, either to get high or for discomfort unrelated to the condition the doctor had intended to treat when she wrote the prescription. About 5 million Americans use opioids and other painkillers for non-medical use every year. Nearly 10 percent of Americans use hydrocodone for non-medical purposes. Using opioids for non-medical purposes increases the risk for side effects, complications and for developing dependence on opioid drugs.
Opioids work with the central nervous system, or CNS, to change the way the brain interprets pain signals. Other CNS effects include sedation, relaxation and pleasant feelings of euphoria. Opioids cause other physical and neurological changes that alter the way a person thinks, feels and behaves. Chronic use causes some of these changes to become more permanent, negatively affecting thought patterns, overall health, ability to work, and intrapersonal relationships.
Anyone who uses opioids regularly for therapeutic or non-medical reasons can become opioid-dependent. Her body grows accustomed to the presence of opioids, eventually depending on a certain level of opioids to feel normal. If she were to skip a dose or take an inadequate dose, her opioid levels will drop and her body will struggle to regain chemical stability. Doctors refer to this as opioid detoxification.
The patient experiences opioid detoxification through uncomfortable, flu-like withdrawal symptoms. These symptoms begin a few hours after the last adequate dose and persist for five or more days. Left untreated and uninterrupted, these symptoms will fade as the body completes the detoxification process and do not return unless the patient returns to an opioid-dependent state.
Someone can use non-opioid medications to reduce the severity of these withdrawal symptoms. These drugs do not interfere with the detoxification process and can actually help the patient achieve an opioid-free state. The patient may stop the detoxification process at any time by relapsing to opioid use; relapse halts withdrawal symptoms but it also returns the patient to an opioid-dependent state.
Opioid detoxification also refers to the medical process of lowering opioid levels and addressing withdrawal symptoms. There are many approaches to completing the opioid detoxification process, including self-detoxification, outpatient therapy and inpatient detoxification. Each approach is valid so long as it helps the patient achieve an opioid-free state in a safe and effective manner.
Opioid detoxification is only one part of a complete treatment plan for opioid dependence. By itself, opioid detoxification does little to change the behaviors that can cause relapse. Most opioid-dependent people benefit from rehabilitation that teaches them how to lead drug-free lives. Rehabilitation frequently includes counseling and behavior modification that help patients identify situations that can lead to drug use and to refuse drugs when offered.
Detoxification usually encourages the patient to enter rehabilitation and to remain there long enough to reverse some of the neurological and physical effects of opioid-dependence. Opioid detoxification promotes abstinence and reduces the frequency and severity of relapses when they do occur. Detoxification improves the patient’s physical, mental and social health, restoring his ability to work, take care of family and interact with others.
Types of Detox
Each person experiences dependence on opioids in a different, highly personal way. One person might be dependent on opioids for only a short time and suffer only minor withdrawal symptoms. Another individual may require intense supervision to overcome a chronic or severe substance abuse problem. Consequently, there is no single treatment plan that is right for everyone. Some people may even need to engage in more than one form of opioid detoxification before finding one that brings them to an opioid-free state.
More than 21 million people in the United States needed treatment for a substance abuse problem, such as opioid dependence or alcoholism, in 2011. Of those that needed help, only about 10 percent received treatment in a specialty facility, such as an inpatient hospital, outpatient clinic or mental health centers. Everyone else tried self-help, consulted a personal physician, got treatment in a hospital emergency room or went through detoxification while incarcerated at a jail or prison.
The National Institute on Drug Abuse, or NIDA, states there were 1.8 million admissions to U.S. treatment centers for help with drug and alcohol abuse during 2008. While most admissions were for alcohol abuse, opioids accounted for about 20 percent of drug-related admissions.
When it is time for a patient to stop using opioids after a lengthy illness or long-term pain, the attending physician will usually suggest the patient wean himself from opioids. The patient takes smaller doses each day - just enough to suppress withdrawal symptoms - until he no longer needs the drug to feel normal. Someone who tries self-detoxification can reach an opioid-free state in a few days or weeks.
Lingering and stubborn withdrawal symptoms prevent some people from tapering opioids. These individuals might try quitting cold turkey by discontinuing opioid use abruptly. This sudden cessation causes intense withdrawal symptoms, especially if the patient does not use anything to protect himself.
The phrase “cold turkey” refers to the way the patient’s skin looks during opioid detoxification. He may have pale, cold and clammy skin with goose bumps, resembling a plucked and frozen turkey.
Many people use natural remedies to ease symptoms. Someone might use ginger or peppermint to soothe nausea, for example, or try chamomile or cayenne to ease diarrhea. Another person might try meditation, yoga, massage or acupuncture.
Many people take a scientific approach and develop a treatment plan including anti-withdrawal medications. One well-known treatment plan is The Thomas Recipe, which calls for Librium or Ativan to calm anxiety and promote sleep at night, L-Tyrosine for energy during the day, and vitamin B6 with supplements and hot baths for muscle aches and restless leg syndrome.
Many patients choose medication-assisted detoxification through qualified outpatient and inpatient facilities. Outpatient clinics typically supply patients with opioid drugs for home use; these drugs reduce withdrawal symptoms during tapering. Inpatient medication-assisted detoxification programs typically use non-opioid drugs to address withdrawal symptoms and control complications.
Many outpatient clinics use opioid drugs, such as methadone and buprenorphine, to treat opioid-dependent patients. Patients can use these drugs in one of two ways: to delay detoxification while the patient participates in rehabilitation or to reduce withdrawal symptoms as the patient weans himself from opioids. Because methadone and buprenorphine are opioids, they keep opioid levels from falling. This prevents the detoxification from occurring so the patient does not feel withdrawal symptoms. When taken as directed, methadone and buprenorphine do not get the patient high.
The patient may also take methadone or buprenorphine to reduce the severity of withdrawal symptoms during opioid detoxification. The patient typically starts out on a high dose of methadone or buprenorphine during the early induction phase and takes weaker dosages during the later tapering phase.
German scientists first synthesized methadone as a pain reliever in 1939. Doctors around the world still use methadone as an analgesic. During the early 1960s, doctors discovered methadone stopped withdrawal symptoms in heroin addicts. In 1964, doctors used methadone to address a heroin epidemic sweeping across New York City. In1972, the FDA approved methadone for use in the treatment of opioid dependence.
Approximately 100,000 Americans use a methadone maintenance program to control dependence on opioids, such as heroin, OxyContin, fentanyl, oxycodone, oxymorphone and opium. These patients come to an approved clinic each day to drink a beverage containing methadone. One dose controls symptoms for 24 to 36 hours.
Some patients use buprenorphine as part of a maintenance program or as a way to reduce withdrawal symptoms during opioid detoxification. While there is no set tapering schedule, someone could complete opioid detoxification in as little as one week, spending the first one to three days in the induction phase and tapering the remaining days. A patient places a buprenorphine tablet under her tongue where it dissolves and enters the bloodstream.
Suboxone and Subutex
Some people abuse buprenorphine intravenously by dissolving the tablet before injecting it into a vein. Drug makers deter this abuse by adding naloxone to the brand name buprenorphine preparations, Suboxone and Subutex. Taken under the tongue, naloxone has little to no effect. When administered intravenously, however, naloxone interferes with the action of buprenorphine so that the consumer does not get high. Furthermore, naloxone causes withdrawal symptoms in an opioid-dependent person.
Inpatient opioid detoxification provides the greatest protection from withdrawal symptoms and complications. Doctors treat the individual symptoms of opioid withdrawal with a wide variety of safe, effective medications. Nurses monitor the patient’s condition closely and address any complications that could interfere with treatment.
Inpatient treatment is appropriate for anyone who:
Rapid Opioid Detox
Rapid opioid detoxification is a safe and efficient approach that rids the body of opioids while the patient dozes in a comfortable “twilight sleep.” Doctors anesthetize and sedate the patient before beginning the detoxification process; patients awaken a few hours later, renewed and refreshed.
Our detox center: Who we are and what we do
We are a group of board-certified anesthesiologists and other highly trained medical professionals who deliver compassionate and effective care. We have helped thousands of people achieve an opioid-free state since opening the doors of our fully accredited hospital more than a decade ago.
We treat our patients as people, not as drug addicts. We prescreen patients for underlying conditions that could complicate treatment before developing a personalized treatment plan. Rapid detox may bring patients to a drug-free state in as little as one to two hours. After complete opioid detoxification and stabilization, patients may continue treatment in our qualified aftercare facility.
Every approach to opioid detoxification has its advantages and disadvantages. It can be helpful for someone to compare the different treatment plans to determine the best approach for her.
Without the cost of anti-withdrawal medications or professional guidance, self-detoxification is the least expensive. However, without the benefits of anti-withdrawal drugs or professional guidance, self-detoxification is associated with increased incidence and severity of withdrawal symptoms and complications. Self-detoxification can result in an opioid-free state in a few days or weeks.
Outpatient care is not free but it does provide professional support and safe, effective medications to either relieve withdrawal symptoms or mask them with opioid replacement drugs and reduce complications. Outpatient care can result in complete opioid detoxification as long as the patient eventually quits methadone or buprenorphine; this can occur within days or weeks, or the patient may be unable to reach an opioid-free state and remain on a replacement drug forever.
Most inpatient facilities offer complete detoxification in days. Inpatient opioid detoxification provides the greatest protection from withdrawal symptoms and complications. Inpatient facilities supervise patients more closely than other forms of treatment, reducing the risk for relapse.
More patients complete inpatient detoxification than with outpatient care. Completion rates are highest for detoxification services - about 66 percent - and lowest for outpatient treatment, at about 42 percent. The inpatient stay is shorter than outpatient treatment: the average length of stay for inpatient opioid detoxification is 4 days, compared with 197 days for medication-assisted therapy.
Rapid detox is the most efficient approach, offering fast and complete opioid detoxification in the shortest time possible, bringing the patient to an opioid-free state in a few hours rather than days, weeks or months. Rapid detox is also the most humane approach to opioid detoxification, sparing the patient from the uncomfortable and demoralizing withdrawal symptoms that prevented him from quitting opioids in the past.
Detox Possible Complications
Opioid detoxification is not usually fatal but severe withdrawal symptoms, acute or long-term opioid abuse, pre-existing conditions, pregnancy and co-existing substance abuse issues can cause dangerous complications. All approaches to opioid detoxification place the patient at risk for developing complications that can interfere with treatment.
Relapse is the primary complication associated with opioid detoxification. Patients may relapse to reduce withdrawal symptoms during the detoxification, or return to opioid use after completing the detoxification process. Relapse increases the risk for overdose because it reduces the patient’s tolerance to opioids and increases his sensitivity to the effects of these drugs.
Because of reduced tolerance and increased sensitivity, it is possible for someone to overdose on a smaller amount of opioids than he used to consume before feeling even minor withdrawal symptoms. Opioid overdoses claimed 14,800 American lives in 2008, killing more people than overdose from cocaine and heroin combined.
Self Detox Possible Complications
Without anti-withdrawal medications or professional supervision, uncontrolled withdrawal symptoms may cause complications in addition to relapse. Prolonged and extreme vomiting or diarrhea can cause dehydration and imbalances of electrolytes, such as potassium and sodium.
Opioid detoxification can worsen previously undiagnosed or pre-existing conditions to cause unexpected and potentially serious complications. The detoxification process can increase blood pressure, raise pulse and produce sweating that can worsen an underlying heart condition. Opioid detoxification may cause pain to return for patients who take these drugs to relieve chronic pain.
Outpatient Care Possible Complications
Outpatient care reduces complications such as dehydration and electrolyte imbalance but outpatients may still relapse; some even become dependent on the replacement drug. Harvard Medical School Publications estimate one-quarter of methadone users eventually quit drugs completely while another 25 percent continue to take the drug. The final 50 percent go on and off methadone forever.
Methadone is not entirely safe either. Even though it represents only 2 percent of prescription painkiller sales, methadone accounts for a third of all deaths related to opioids. The number of deaths associated with methadone is rising. In 2009, there were 5.5 times as many deaths associated with methadone as there were in 1999.
Most of these deaths were associated with methadone abuse and frequently involved the use of alcohol or other medications. There is some risk for buprenorphine abuse, as the abuser dissolves and injects the buprenorphine tablet.
Inpatient Detox Possible Complications
Anti-withdrawal medications and close patient supervision reduces complications such as dehydration, electrolyte imbalance, dependence on replacement drugs and relapse. Prescreening reduces complications associated with pre-existing conditions.
While inpatient care provides the greatest protection from withdrawal symptoms, other complications can occur. Patients battling withdrawal from multiple substances, especially alcohol, benzodiazepines, sedatives and anti-anxiety drugs are at special risk for developing complications during inpatient opioid detoxification. Patients may suffer reactions from the medications used in inpatient opioid detoxification.
Rapid Detox Possible Complications
Patients may rarely suffer an allergic reaction or other complication associated with the drugs used in rapid detoxification procedures. Strong sedatives, for example, can cause some patients to experience trouble with breathing, blood pressure and heart rate. A patient may have bruising, swelling or infection at the anesthesia injection site.
Since its discovery more than 6,000 years ago, people have been struggling with dependence on opium and its opioid derivatives; doctors have been looking for ways to ease opioid withdrawal symptoms ever since.
In 1805, a young German pharmacist extracted morphine and codeine from opium. Doctors began prescribing morphine as a cure for opium addiction before realizing the addictive properties of morphine. An English chemist first synthesized heroin in 1874; doctors then prescribed heroin to help patients overcome dependence on morphine. At least two heroin epidemics swept across the United States, with the first following WWII and the second beginning during the Vietnam War in the 1960s. Physicians began prescribing methadone to heroin addicts, mostly enlisted men who had served in Vietnam, during the second epidemic.
In the two centuries since Freidrich Wilhelm Adam Serturner first extracted morphine and codeine from opium, doctors have learned a lot about opioid detoxification. Despite decades of scientific research and the real-life clinical experience gained from patients and the doctors who care for them, myths shrouding opioid detoxification often prevent thousands of people from getting the treatment they need.
Self Detox Myths
Myth: Anyone with enough self-discipline can do opioid detoxification at home without help from anti-withdrawal drugs or professional guidance - it is just mind over matter.
Fact: While self-discipline helps the patient refuse drugs when offered, opioid detoxification is an intense physiological process that can sometimes cause extreme withdrawal symptoms and serious complications, especially in those with undiagnosed illnesses or co-existing substance abuse problems.
Myth: Using a combination of prescription and non-prescription drugs like those suggested in The Thomas Recipe makes self-detoxification safe.
Fact: Combining prescription and over-the-counter medications may cause dangerous drug interactions, especially in those already taking powerful opioids or other drugs.
Outpatient Detox Myths
Myth: A community could save a lot of money by tossing addicts in jail to dry out rather than providing treatment.
Fact: A year of methadone costs only about $4,700 per patient while that same year in prison would cost approximately $24,000 per prisoner.
Myth: Methadone rots your teeth and bones.
Fact: Methadone, like other drugs, can cause a dry mouth. Left untreated, a dry mouth promotes dental plaque that leads to tooth decay and gum disease. Patients can reduce this risk by drinking more water and improving dental hygiene habits by brushing and flossing at least daily.
Inadequate doses of methadone can cause bone ache, a symptom of methadone withdrawal. Anyone who suffers bone ache should ask his doctor to increase methadone dosage.
Myth: Methadone causes weight gain.
Fact: Opioid dependence usually causes weight loss, sometimes leading to malnutrition. Opioid detoxification corrects eating patterns, which usually improves muscle mass and fat storage. Methadone may slow metabolism and cause urinary retention.
Inpatient Detox Myths
Myth: It is pointless to try opioid detoxification - drug addicts always relapse because they want to be dependent on drugs.
Fact: Nobody wants to have a chronic disease, especially opioid dependence. Like other chronic conditions, patients battling opioid dependence experience periods of relapse and remission. Relapse rates for drug addiction are similar to those of other chronic diseases, such as high blood pressure, diabetes or asthma. Even with treatment, relapse rates for drug addiction are 40 to 60 percent.
Relapse does not mean treatment has failed - it just means the patient must return to treatment and seek out therapy that provides more structure and support.
Myth: Spending money on drug treatment is like throwing money down a hole. Communities just cannot afford wasting money on treatment in these tough economic times.
Fact: Drug treatment actually saves money. Experts estimate that for every dollar a community spends on drug treatment programs, it saves between $4 and $7 in reduced drug-related crime rates, criminal justice costs and theft. Factor in savings to local healthcare institutions and these savings rise to $12 gained for every dollar spent.
Rapid Detox Myths
Myth: Pain and humiliation are important features of opioid detoxification as this suffering will serve as a deterrent to later drug abuse. Withdrawal symptoms serve as punishment for drug abuse.
Fact: Patients should never be punished for suffering from a medical condition; human suffering is never an appropriate part of any medical treatment plan. In fact, the discomfort and demoralization of withdrawal symptoms frequently cause patients to relapse.
Rapid detox is an effective and humane approach to medical detoxification because it removes the pain and suffering associated with withdrawal. Rapid detox patients enjoy a pleasant twilight sleep instead of enduring endless days of detoxification.
Myth: It takes days or weeks to complete opioid detoxification.
Fact: It takes a reputable expert only one to two hours to perform rapid detox.
Detox and Pregnancy
Opioid-dependent women are at high risk for developing medical conditions, such as anemia, blood infections, heart problems, mood disorders, hepatitis and pneumonia. Dependence on opioids also increases the risk for contracting and spreading infectious diseases, such as sexually transmitted diseases, HIV/AIDS, and tuberculosis. Opioid dependence can also cause gestational diabetes, marked by wildly fluctuating blood sugar levels during pregnancy.
These conditions can lead to complications for both the mother and the unborn baby during pregnancy, labor and delivery, such as hemorrhage and uncontrolled bleeding, inflammation or separation of the tissues between mother and fetus, slow fetal growth, premature labor and delivery, spontaneous abortion and fetal death.
Methadone reduces these complications. Currently, methadone is the only approved approach to treating opioid dependence in pregnant women. Babies born to women taking methadone during pregnancy will remain under close observation in the hospital for 72 hours after delivery to determine the effects of these therapeutic opioids on the newborn.
Using opioids regularly during pregnancy may result in neonatal abstinence syndrome, or NAS. A baby born with NAS suffers withdrawal symptoms during the first weeks or months of life. NAS babies also suffer from low birth weight, seizures, breathing problems, feeding difficulties and death. These babies tend to stay in neonatal intensive care units for weeks or months to complete the opioid detoxification process safely.
Self Detox and Pregnancy
Because of the high risk for dangerous complications that can affect the health of both the mother and the unborn baby, self-detoxification may be unsafe. A pregnant woman should consult a physician before trying to wean herself from opioids.
Outpatient and Pregnancy
A pregnant woman might start methadone as an outpatient. Doctors tend to start pregnant women on 10 to 20 mg of methadone and increase dosages slowly, just enough to cover withdrawal symptoms. It usually takes 48 to 72 hours to find the right dose. Some women need stronger doses towards the end of pregnancy. The maximum dosage for a pregnant woman is 60 mg of methadone.
Inpatient and Pregnancy
It is safer for pregnant women to start methadone treatment as an inpatient, where doctors can adjust dosages based on professional observation and nurses monitor the mother and baby closely for complications. Most inpatient hospitals have equipment to measure fetal movements at regular intervals to assess the baby’s response to treatment. This inpatient stay typically lasts three days.
Opiate detox symptoms
Opioid detoxification causes withdrawal symptoms that tend to appear in two waves. Initially, the patient may feel agitated, anxious, and have trouble sleeping. He may have achy muscles, watery eyes, a runny nose, and he may sweat or yawn excessively. Later, he might develop stomach cramps, diarrhea, nausea and vomiting. His pupils may dilate to become unusually large and he may have goose bumps on his skin.
What is the best method to detox from this drug?
Everyone experiences opioid dependence in a different way, so it is likely that the best method of opioid detoxification relies heavily on individual needs. The patient should assess her own ability to refrain from opioids and avoid those high-risk behaviors that lead to drug abuse then choose a treatment approach that reflects these capacities. She should choose the least restrictive form of treatment that is still likely to help her achieve a drug-free state in a safe and effective manner.
- Opioid Detox