- Generic Name or Active Ingridient: Propoxyphene
- Muscle aches
- Increased tearing
- Runny nose
- Abdominal cramps
- Dilated pupils
- Goose bumps
- Nausea and vomiting
Doctors prescribe propoxyphene to relieve mild to moderate pain. Propoxyphene is a synthetic drug that relieves pain the same way as opioid drugs made from the opium poppy plant, so medical professionals classify propoxyphene as an opioid analgesic.
Propoxyphene and opioids work with the central nervous system, or CNS, to change the way the brain perceives pain signals. Opioids cause many other CNS actions, the most notable being sedation, relaxation, and a pleasant feeling of euphoria; these prominent neurological reactions make propoxyphene a target for recreational drug abuse.
In time, some of the neurological changes become more permanent, altering the overall thoughts, emotions, and behavioral patterns of the consumer in a way that negatively affects his ability to work, take care of children, or interact with others in a healthy and reasonable way. This can sometimes lead to financial hardship, homelessness, divorce, loss of child custody, and other harmful and demoralizing consequences.
Propoxyphene interacts with other body systems to cause other effects. Opioids work with smooth muscle groups in the body, including muscles in the heart and blood vessel walls to control blood pressure and pulse and the intestinal muscles that propel stool through the digestive tract. The muscles responsible for contracting and dilating the pupils of the eye, and for causing goose bumps while shivering, are also smooth. The CNS and other body system effects of propoxyphene cause a variety of predictable withdrawal symptoms during the propoxyphene detoxification process.
Drug makers would frequently combine propoxyphene with acetaminophen or aspirin to enhance its analgesia. Neither aspirin nor acetaminophen are opioids and do not cause euphoria, so recreational users do not normally target these common, non-prescription drugs. While aspirin and acetaminophen do not cause physical dependence leading to withdrawal symptoms, long-term use of these drugs can cause dangerous, sometimes fatal health hazards and complications during propoxyphene detoxification, including acute liver failure, bleeding, or fatal overdose.
Most people take propoxyphene as prescribed and dispose of the medication when they no longer need it to control pain. Some patients become physically dependent on propoxyphene while using opioids to treat long-term pain; at this time, more than three percent of American adults are on a long-term opioid treatment plan to relieve chronic, non-cancer pain such as arthritis.
About 5 million Americans use painkillers for non-medical use every year. To use a drug for non-medical reasons means to take it to get high or to treat a different condition than the one the doctor had in mind when writing the prescription.
Anyone can become opioid-dependent, whether he takes propoxyphene for therapeutic reasons or for recreational ones. Currently, there are about 2 million Americans dependent on opioids such as propoxyphene.
The body acclimates to the presence of some toxic substances, including propoxyphene and other opioids. With continued use, the system begins to depend on a certain level of propoxyphene to feel normal. When propoxyphene levels fall drastically, the body struggles to detoxify itself from the neurological and physical effects of high propoxyphene levels. The opioid-dependent individual experiences this struggle through flu-like withdrawal symptoms. Doctors refer to this as propoxyphene detoxification.
Propoxyphene detoxification causes withdrawal symptoms in an opioid-dependent person. Withdrawal symptoms reflect the various body systems affected by propoxyphene, including the central nervous system, digestive tract, heart, eyes, and skin.
Opioid withdrawal symptoms tend to appear in two waves, with the first set of symptoms beginning a few hours after the last dose of propoxyphene. Initially, the individual may experience:
Later, the individual may develop other symptoms, including:
Additionally, propoxyphene detoxification may increase blood pressure and pulse. Patients may also suffer symptoms associated with complications caused by toxic aspirin or acetaminophen levels during the detoxification process.
Left uninterrupted, withdrawal symptoms generally persist for five or more days before disappearing on their own as the body completes the detoxification process. Withdrawal symptoms do not return unless the individual returns to an opioid-dependent state.
Someone can reduce the severity of withdrawal symptoms by taking non-opioid drugs, such as Imodium for diarrhea, without disrupting the detoxification process. He could stop withdrawal symptoms completely by taking more propoxyphene, but this halts the detoxification process and returns him to an opioid-dependent state.
Benefits of Propoxyphene Detoxification
Detoxification is only part of recovery from opioid dependence and, by itself, does little to change the behaviors associated with drug abuse. Most opioid-dependent individuals benefit from rehabilitation to learn how to live without drugs. Rehabilitation often includes counseling and behavior modification to teach the participant how to recognize situations that may lead to drug use and how to refuse propoxyphene when offered.
Propoxyphene detoxification ends withdrawal symptoms, making it easier for the individual to participate in rehabilitation. Detoxification and freedom from withdrawal helps a patient remain in rehabilitation long enough to reverse neurological changes resulting from substance abuse, re-establishing healthy thoughts, emotions and behaviors and restoring as much of the patient’s former life as possible. Detoxification improves the patient’s psychological well-being and self-esteem.
Propoxyphene detoxification promotes abstinence as patients enjoy the benefits of a drug-free lifestyle. Detoxification reduces the occurrence of drug use and decreases the severity of drug use episodes when they do occur.
Types of Detox
Detoxification is a natural process that occurs when an opioid-dependent person stops taking propoxyphene or takes an inadequate dose. Detoxification can also refer to the medical process of lowering propoxyphene levels and easing withdrawal symptoms.
Detoxification can occur at home, through an outpatient clinic, or at an inpatient facility. A hospital physician may administer medications, such as naloxone or naltrexone, to lower opioid levels and initiate the detoxification process. Outpatient clinics offer opioid replacement drugs to control the detoxification process, either as a way to reduce withdrawal symptoms or to delay detoxification while the individual participates in rehabilitation. All of these are viable approaches to propoxyphene detoxification as long as they bring the patient to an opioid-free state safely and effectively.
Even though opioid dependence is a serious physiological condition, the social stigma associated with drug abuse prevents many people from getting professional help. Of those Americans who need help with a substance abuse problem, only about 10 percent get it from a specialty facility, such as a hospital, outpatient clinic, or mental health facility. Everyone else tries self-help, working with his family doctor, going to an emergency room, or quitting while incarcerated in jail or prison.
A doctor will usually suggest a patient weans himself from propoxyphene by taking smaller doses each day until he no longer feels withdrawal symptoms. Self-detoxification is appropriate for those who have been opioid-dependent for only a short time or who suffer only moderate withdrawal symptoms.
Tapering works well for most people but lingering withdrawal symptoms prevent many people from completing the detoxification process. These individuals might be tempted to quit cold turkey by discontinuing propoxyphene abruptly. Anyone who quits cold turkey should expect several days of severe withdrawal symptoms. Quitting cold turkey does bring the individual to an opioid-free state if he is able to withstand withdrawal symptoms long enough to complete propoxyphene detoxification.
Someone might use natural remedies to reduce withdrawal symptoms and improve his chances of achieving an opioid-free state. He might use ginger to relieve nausea, for example, or try chamomile to curb diarrhea. Yoga, massage, acupuncture, or meditation can be helpful as well.
Some people create a homemade treatment plan including prescription and non-prescription drugs to ease withdrawal symptoms. One plan is The Thomas Recipe, which calls for a benzodiazepine such as Xanax or Librium to calm nerves and help with sleep, vitamin B6 for muscle aches, and Imodium for diarrhea.
Medical detoxification, sometimes called medication-assisted detoxification, uses opioid and non-opioid drugs to control the onset of detoxification and the severity of symptoms. Medical propoxyphene detoxification can occur at home with medications obtained from an outpatient clinic, or at an inpatient hospital or specialty detoxification clinic. Medical detoxification is appropriate for anyone whose withdrawal symptoms prevent him from discontinuing propoxyphene at the appropriate time.
Outpatient Many outpatient clinics provide opioid replacement drugs, such as methadone and buprenorphine, to control the onset of the detoxification process or to reduce withdrawal symptoms during the tapering process. Methadone and buprenorphine are opioids so consuming these drugs prevent withdrawal symptoms, but therapeutic doses are too weak to get the consumer high.
Many people take methadone or buprenorphine as part of a maintenance program. These drugs delay the onset of the detoxification process while the individual participates in rehabilitation. Once she learns how to live a drug-free life, she weans herself from the replacement drugs.
A large number of people now use methadone or buprenorphine to reduce withdrawal symptoms during the tapering process. To do this, the individual starts on a high induction dose of methadone or buprenorphine then takes a smaller dose each day during the tapering phase. Between induction, stabilization and tapering, it may take someone several weeks to complete outpatient detoxification.
Outpatient detoxification is appropriate for people who have been dependent on propoxyphene for one year or longer, and who are unable to spend time in a hospital for one reason or another.
A previously unknown German chemist first synthesized methadone in his private laboratory in 1939, hoping to create a new opioid pain reliever. Doctors around the world still used methadone as an analgesic, but physicians in the United States prefer to use this drug to treat opioid dependence. In 1964, methadone proved its worth as weapon against opioid-dependence when doctors used it to quell a heroin epidemic devastating New York City. In 1972, the FDA approved methadone for use in the treatment of opioid dependence.
Today, approximately 100,000 Americans use methadone to control dependence on heroin, propoxyphene, and other opioids. Outpatient clinicians may prescribe methadone to help taper propoxyphene use at home. Typically, the physician starts the patient on 10 to 15 mg of methadone and increases it 10 mg each day until the doctor establishes a safe dose that covers withdrawal symptoms. The patient will remain on this dosage for a few days before beginning the tapering phase, reducing dosages by 10 mg each day until reaching an opioid-free state.
Outpatient physicians may recommend buprenorphine instead of methadone as part of a maintenance program or to reduce the withdrawal symptoms during the tapering process. Buprenorphine is available under the brand name, Subutex.
The patient places the buprenorphine tablet under her tongue where it dissolves before entering the bloodstream.
Some people abuse buprenorphine intravenously by dissolving the tablet before injecting the drug into a vein. Drug makers discourage this abuse by adding naloxone to the brand name buprenorphine product, Suboxone. When taken as directed under the tongue, naloxone has no effect on the consumer. When injected into a vein, however, naloxone interferes with buprenorphine to prevent the consumer from getting high. Intravenous administration of naloxone will also cause withdrawal symptoms in opioid-dependent consumers.
Inpatient Inpatient care provides the greatest level of support. Most inpatient facilities prescreen patients for underlying conditions that may interfere with treatment, offer anti-withdrawal medications to make the detoxification process less uncomfortable, and monitor patients closely to reduce complications and discourage relapse.
Detoxification specialists working in inpatient facilities may administer naltrexone to lower propoxyphene levels and initiate the detoxification process. These physicians may then give the patient hydroxyzine or promethazine to ease nausea, Loperamide for diarrhea, and clonidine to relieve a variety of symptoms such as watery eyes, restlessness, and sweating.
Inpatient propoxyphene detoxification is appropriate for anyone whose withdrawal symptoms or complications prevent her from reaching an opioid-free state. Inpatient care is right for anyone with a documented history of poor participation in less restrictive programs, and for those who do not seem to benefit from such programs.
Inpatient propoxyphene detoxification is necessary for anyone recovering from an overdose. Anyone whose health makes outpatient detoxification unsafe should participate in inpatient care. Individuals with severe psychiatric problems that prohibit effective or safe participation in outpatient care should undergo propoxyphene detoxification as an inpatient, especially those with acute psychosis, depression with suicidal thoughts, or who may pose a danger to his own safety or to the safety of others.
Rapid Opiate Detox
Rapid detox benefits most opioid-dependent individuals. Rapid detox specialists administer sedatives and anesthesia before giving the patient the standard detoxification and anti-withdrawal drugs. Patients who engage in rapid detox doze in a comfortable “twilight sleep” during the difficult detoxification process.
Our detox center: Who we are and what we do
We are a group of highly trained board-certified anesthesiologists and other medical professionals who are dedicated to providing exceptional care to opioid-dependent individuals and their families. We have helps thousands of people reach an opioid-free state since opening the doors of our accredited facility more than a decade ago.
We provide compassionate and effective care to our patients. First, we screen for any underlying illnesses that may complicate care. We then create an individualized treatment plan, sometimes including rapid detox to free the patient from dependence on propoxyphene. After completion of the detoxification process, the patient may continue his recovery in our qualified aftercare center.
There are almost as may approaches to treatment as there are people who need it. Choosing between the various approaches to propoxyphene detoxification can be intimidating, so it is sometime helpful to compare treatments to highlight the advantages and disadvantages of each.
Without the expense of anti-withdrawal drugs or medical care, self-detoxification is the cheapest way to reach an opioid-free state in only a few days time. Unfortunately, the lack of medications or professional guidance makes self-detoxification the most uncomfortable way to detoxify the body from the effects of propoxyphene. Without prescreening or close patient supervision, pre-existing conditions and complications can aggravate withdrawal symptoms or cause unexpected or dangerous results.
Outpatient medication-assisted detoxification reduces the incidence and severity of withdrawal symptoms, usually includes some amount of prescreening, and usually provides professional guidance from a trained detoxification specialist. Outpatient detoxification may bring patients to an opioid-free state more slowly than through self-detoxification or inpatient care.
Inpatient care provides the greatest protection from complications and withdrawal symptoms as compared to self-detoxification or outpatient care. Inpatient propoxyphene detoxification is relatively quick - the average length of stay for detoxification is 4 days, compared with 197 days for outpatient therapy using medication-assisted detoxification.
As compared with all other forms of detoxification, rapid detox brings the patient to an opioid-free state in the shortest time - in only one to two hours - and exposes him to the fewest withdrawal symptoms possible. Most patients awaken from rapid detox with no memory of the grueling detoxification process.
Detox Possible Complications
Detoxification from propoxyphene is not typically life-threatening but severe withdrawal symptoms, underlying conditions, long-term propoxyphene abuse, co-existing substance abuse problems, and pregnancy can cause dangerous complications during the detoxification process. Prescreening and professional monitoring help reduce these complications.
Relapse is the primary complication associated with any type of propoxyphene detoxification. Uncomfortable and demoralizing withdrawal symptoms prompt some people to return to propoxyphene use; others may relapse after completing the detoxification process.
Relapse increases the risk for fatal overdose, especially when the individual relapses during or immediately after detoxification. The detoxification process decreases the body’s tolerance of opioids, making the individual more sensitive to the effects of propoxyphene. Diminished tolerance and increased sensitivity make it possible for someone to overdose on a smaller amount of propoxyphene than he used to consume before experiencing even minor withdrawal symptoms.
Fatal overdose from licit drugs is a significant problem in the United States. In 2008, 14,800 Americans died after taking a fatal overdose of prescription drugs. Overdose from legal drugs now kill more people than overdose from cocaine and heroin combined.
People who are dependent on brand name products that combine propoxyphene with acetaminophen or aspirin are at special risk for complications associated with overdoses. Chronic use can cause acetaminophen or aspirin to accumulate in the body. Acetaminophen overdose is the leading cause of acute liver failure in the United States and is one of the most common poisonings globally. Aspirin overdose may cause seizures, high fevers, and death.
Self Detox Possible Complications
The propoxyphene detoxification process can aggravate previously undetected health problems. For example, propoxyphene detoxification may increase blood pressure, pulse and perspiration in a way that worsens some types of heart conditions. Detoxification can also cause the return of pain in patients who take propoxyphene to relieve pain resulting from chronic conditions, such as arthritis.
Even an otherwise healthy patient may suffer complications. Prolonged and extreme vomiting or diarrhea, for example, can cause dehydration or imbalances in electrolytes such as potassium or sodium. The patient may vomit and inhale stomach contents, a dangerous complication that can lead to fluid in the lungs or lung infections.
Outpatient Care Possible Complications
While outpatient care usually provides prescreening and opioid replacement drugs to reduce complications associated with self-detoxification, some outpatients may experience a different set of complications. For example, some patients become dependent on the replacement drugs. Harvard Medical School Publications estimate 25 percent of methadone users eventually abstain from drug abuse, another 25 percent continue to take the drug while 50 percent go on and off methadone forever.
Methadone is not completely safe. Even though methadone sales account for only 2 percent of the prescription painkiller market, methadone accounts for a third of opioid pain reliever deaths. The number of methadone deaths in the United States is on the rise: in 2009, there were 5.5 times as many deaths associated with methadone as there were in 1999. Most of these deaths were the result of abuse and combining methadone with alcohol or other drugs.
Intravenous buprenorphine abuse increases the likelihood of dangerous or fatal complications. Combining buprenorphine with benzodiazepines, like those used in The Thomas Recipe, dramatically increases the risk for death.
Inpatient Detox Possible Complications
Prescreening, a professional treatment plan, safe and effective detoxification and anti-withdrawal drugs, and close patient monitoring make inpatient care the least likely to cause complications, but they still can occur. For example, detoxification from multiple substances is a major complication to inpatient propoxyphene detoxification, especially if the patient is withdrawing from alcohol, benzodiazepines, sedatives, or anti-anxiety drugs while simultaneously trying to quit propoxyphene.
Rapid Detox Possible Complications
Rapid detox is safe and effective but some patients may infrequently experience complications. Rarely, someone might suffer an allergic reaction to the medications used in rapid detox. Strong sedatives can sometimes cause breathing problems or unhealthy blood pressure and pulse readings. Someone might experience infection, bruising or swelling at the anesthesia injection site.
Opioid dependence has been around since before recorded history, as ancient man first discovered the therapeutic and recreational properties of the opium poppy plant. Ancient healers, early physicians, modern-day medical researchers, doctors, and the amassed clinical experience contributed by real opioid-dependent people have gathered a mountain of facts regarding opioid detoxification. Despite this wealth of information, myths obscuring the truth about propoxyphene detoxification prevent countless individuals from getting the help they need.
Self Detox Myths
Myth: Self-detoxification is just a matter of willpower - anyone can do it. Fact: Determination and self-control are important weapons against relapse, but propoxyphene detoxification is an intense physiological process that can cause extreme withdrawal symptoms and complications, especially in the presence of other illnesses or substance abuse issues.
Myth: The Thomas Recipe is safe and effective because it includes prescription and non-prescription drugs to enhance the detoxification process. Fact: Combining medications may cause dangerous drug interactions, especially as the body is detoxifying itself from the effects of propoxyphene.
Outpatient Detox Myths
Myth: Methadone causes weight gain. Fact: Methadone may slow metabolism but weight gain is usually the result of a restored appetite, healthy eating patterns, and increased muscle mass.
Myth: Methadone rots your teeth. and bones. Fact: Many drugs, including methadone, cause a dry mouth that promotes the development of plaque leading to tooth decay and gum disease. Methadone consumers can reduce this complication by increasing water intake and improving dental hygiene habits.
Inpatient Detox Myths
Myth: Treating propoxyphene dependence is useless as 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 - somewhere between 40 and 60 percent even with treatment.
Myth: In this recession, communities cannot afford to waste money on drug treatment programs. Fact: In this recession, communities cannot afford to ignore the potential savings gained from drug treatment programs. For every dollar spent on drug treatment, experts estimate a community saves somewhere between $4 and $7 in reduced drug-related crimes and their related criminal justice costs. Add in savings to the local healthcare system and these savings rise to $12 gained for every dollar spent.
Rapid Detox Myths
Myth: Pain and humiliation are important aspects of propoxyphene detoxification, serving as punishing reminders about the evils of abusing drugs. Fact: Suffering is never an appropriate part of any humane treatment plan. In fact, the uncomfortable and demoralizing withdrawal symptoms prevent many people from completing propoxyphene detoxification. Rapid detox spares the patient from the discomfort of propoxyphene detoxification to improve his chances of achieving an opioid-free state.
Myth: It takes days, weeks, or even months to complete propoxyphene detoxification. Fact: Rapid detox brings patients to an opioid-free state in one to two hours.
Detox and Pregnancy Dependence on propoxyphene and other opioids increases the risk a woman will develop certain medical disorders, such as anemia, blood infections, mood disorders, heart problems, pneumonia, and hepatitis. Opioid-dependent women are more likely to contract infectious diseases, including tuberculosis, sexually transmitted diseases, and HIV/AIDS. An opioid-dependent woman may develop gestational diabetes, or uncontrolled blood sugar levels during pregnancy.
These conditions increase the risk for complications in the mother and fetus during pregnancy, such as hemorrhage, separation or inflammation of the tissue shared between mother and baby, slowed fetal growth, premature labor and delivery, spontaneous abortion, and fetal death. Methadone reduces these complications.
These complications often make propoxyphene detoxification unsafe for a pregnant woman or her unborn baby. Currently, methadone is the only approved treatment plan for opioid-dependent women, although a 2010 study published in the New England Journal of Medicine calls buprenorphine “an acceptable treatment for opioid dependence in pregnant women.”
A baby born to a woman who takes opioids, including propoxyphene, buprenorphine and methadone, may born with neonatal abstinence syndrome, or NAS. These babies suffer intense and sometimes life-threatening withdrawal symptoms during the first weeks of life. NAS may result in low birth weight, seizures, respiratory ailments, feeding problems, and even death.
Self Detox and Pregnancy
The toxic effects and complications associated with propoxyphene may make detoxification unsafe for a pregnant woman and her unborn baby. A pregnant woman should consult with a physician before attempting even tapering.
Inpatient and Pregnancy
Doctors suggest pregnant women start methadone treatments at an inpatient facility, where physicians can monitor the condition of the mother and unborn baby closely. Caregivers will observe the baby’s response to treatment with fetal movement monitoring equipment. Inpatient caregivers should monitor fetal movement at regular intervals. The mother can expect to stay in the hospital for about three days.
Doctors start the woman on 10 to 20 mg of methadone and increase the dosage by 5 to 10 mg each day based on the patient’s response to treatment. The maximum dosage for pregnant women is 60 mg of methadone.
Some women experience break-through withdrawal symptoms towards the end of pregnancy and require larger doses of methadone. Babies born to women taking methadone during pregnancy will remain under close observation in the hospital for 72 hours after delivery.
Outpatient and Pregnancy
Some women prefer to start methadone as outpatients. These women must come to the clinic twice each day, first to receive the daily dose and later for evaluation. These twice-daily visits last only until doctors stabilize her dosages, usually within 48 to 72 hours after the first dose; the patient then visits the clinic only once daily.
Outpatient clinics do not usually have fetal monitoring equipment, so the pregnant woman must obtain this service from a nearby hospital or doctor’s office.
What is the best method to detox from propoxyphene? Each person experiences propoxyphene dependence and detoxification differently, so no single treatment plan is appropriate for everyone. The best method to detox from propoxyphene relies mainly on personal needs. For example, a newly dependent person may be able to taper propoxyphene while someone who has been opioid-dependent for years may require inpatient care to overcome powerful and persistent withdrawal symptoms.
The individual should assess her own level of dependence and severity of withdrawal symptoms, likely risk for complications due to her own ability to refrain from drug use. It depends on the individuals specific needs and he or she should contact us for more information Least restrictive setting that is still likely to be safe and effective. Patients should base choice of treatment centers on the patient’s ability to cooperate and benefit from type of treatment offered, his ability to refrain from substance abuse, avoid high risk behaviors and his need for structure and support.
- Propoxyphene Detox