For people struggling with an opiate addiction, detoxification might seem terrifying. While they may know that the process is rarely life threatening, they may also be quite familiar with the extreme discomfort that withdrawal from opiates can bring. In fact, advanced addicts may feel these uncomfortable pangs in the hours that pass between hits of the drug. The idea of spending hours or days in this sort of pain may keep people from even considering detox, even if it means that they never tackle their addiction directly.
While withdrawing from opiates alone, without the help of medical professionals, might certainly be uncomfortable, entering an opiate detoxification program may allow the person to experience a completely different form of withdrawal. With supervision and the judicious use of medications, people can go through opiate withdrawal with only a minimal amount of discomfort.
The Testing Stage
At the beginning of the detoxification process, medical professionals will attempt to determine what the person has been taking, and when the last dose of drugs was consumed. Interviews can help with this process, but medical professionals might also perform blood or urine tests to confirm that the information the person provided in the interviews was both true and accurate. This is an incredibly important detail to get right due to the effects of opiates on the human body and the effects of the drugs given to combat opiates.
When opiates enter the body, they travel to the brain and latch onto specific receptors found there. It’s a bit like watching a person put a cap on a pen; the tip is covered and is no longer responding to the world outside. Some medications given for opiate detoxification knock those caps off the receptors, leaving the end completely exposed, and this can cause extreme discomfort. In order to ensure that this does not happen, medical professionals need to tweak when the detoxification drugs are given.
Fast-acting opiates tend to cause a significant amount of problems in detoxification, and sudden withdrawal is more likely when people take these sorts of drugs. Fast-acting opiates include drugs like:
- Crushed OxyContin pills
According to the National Alliance of Advocates for Buprenorphine Treatment, people who use these drugs need to abstain from their use for 12 to 24 hours before certain types of detoxification medications are given. They may still be enrolled in their treatment programs, but they may not be given some types of medications until this time has passed. These fast-acting drugs tend to stay completely latched onto receptors for long periods of time, and providing specific types of detoxification medications can knock those drugs off their receptors and plunge the person into discomfort. Similarly, people who use whole OxyContin pills may need to wait at least 24 hours before drugs are given, and people who have been abusing methadone may need to wait even longer. These drugs also stay active in the system for a long time.
Medications have a key role to play in the detoxification process, as they can keep unpleasant symptoms from occurring. Medical professionals often outline what opiate withdrawal symptoms look and feel like, and they periodically ask patients to speak up when they feel these symptoms begin to appear. According to the U.S. National Library of Medicine, mild symptoms can include agitation and anxiety, while severe symptoms might include:
- Abdominal cramping
- Chills and goose bumps
Mild symptoms might be treated with supportive care, including aspirin and plenty of fluids. But, if symptoms continue to escalate, medications can be used to ease gastrointestinal distress and agitation. If symptoms increase even more, stronger medications might also be provided. One such medication, clonidine, was originally created to address high blood pressure issues, but it’s also been proven helpful in reducing feelings of stress and anxiety in people undergoing opiate withdrawal. It’s not given to all people right away, however, as it can cause some symptoms of sedation.
The decision to escalate the medications provided isn’t random. In fact, according to an article published in the American Journal of Drug and Alcohol Abuse, there are two separate systems medical professionals can use to assess how the person is feeling as detoxification progresses. One scale, the Subjective Opiate Withdrawal Scale, contains 16 symptoms, and patients are asked to rate the intensity of those symptoms on a periodic basis. Another scale, the Objective Opiate Withdrawal Scale, contains 13 symptoms that medical professionals can see on their own, without asking the person any questions at all. These tools allow medical professionals to monitor the progress carefully, and know exactly when a medication intervention is needed.
Opiate Medication Therapies
Once the appropriate amount of time has passed and the person no longer has high doses of active opiates available in the body, there are two medications that can be used as replacement “caps” for the opiate receptors: methadone and buprenorphine. Both have been proven effective in helping to quell symptoms of withdrawal and reduce cravings for drug use. The decision to use one drug over another is often highly dependent on the person’s previous history of drug use and prior attempts to stop using drugs.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the proper starting dose of methadone can vary, depending on the level of drugs the person has taken in the past. The initial dose is often provided as an estimate, and when it is given, medical professionals watch the patient carefully for signs of sleepiness, clumsiness or other indicators that the dose is too high. Similarly, if the patient continues to report discomfort, the dose might be too low. Once the proper dose is found, it’s typically given once per day and slowly tapered over a period of three to five days, SAMHSA reports.
Buprenorphine is given in a similar manner, with adjustments taking place to ensure that the proper dose is found. The main advantage of this medication is that it can be provided in patch and tablet form, allowing the person to take home a prescription for the medication and go through detoxification at home. Buprenorphine can also be prescribed by medical doctors that are not attached to an opioid treatment program, which again makes the medication attractive to people who may not want to enter a formal detoxification program and who would prefer to work on detox at home, with the help of their family doctors.
Both of these medications can be effective in reducing discomfort associated with detoxification. For example, a study published in the journal Clinical Pharmacology and Therapeutics found no significant differences in retention rates, drug use or symptom severity between people who were given methadone and people who were given buprenorphine. Both medications seemed to help people get through their detoxification processes.
Preparing for Care
The first step is to decide one’s options for detoxification. Since opiate detox can be very uncomfortable and even dangerous without medical assistance, it is advisable to speak with a treatment admissions counselor and get admitted to a rehab facility or hospital for detox. Limited insurance coverage may narrow the options, but at the very least a doctor may be able to put the addict on a tapering program to make withdrawal symptoms more tolerable. Medical advice should always be sought before opiate detox since it can be dangerous and even fatal to go “cold turkey,” depending on the severity of the addiction. Cost is an important factor to consider in any detox or rehab program. Some patients may not be able to afford inpatient treatment, but there are many advantages to inpatient treatment that make it worth the cost. If it’s still not an option, some patients may select outpatient treatment to address their needs.
There are some very good reasons to choose inpatient detoxification programs, however. For example, a study in the journal BMJ found that only 17 percent of people completed opiate detoxification outpatient programs, while 81 percent of people completed inpatient detoxification programs. This is an important point to consider. While medications can help to ease the physical symptoms of withdrawal, the physical distress is only one part of the detoxification process. The person still has:
- Habits that support drug use
- Friends or family members who also use
- Access to drugs
- A lack of coping skills to resist temptation
All of these deficits can be addressed in formal treatment programs for addiction, but if the person is just entering detoxification, those programs have not yet taken hold. It might be all too easy for the person to slip right back into old habits, if left at home where those old habits first had the chance to blossom.
By contrast, an inpatient program is a controlled environment in which no drugs are present, and the person is completely removed from his/her normal surroundings. Thoughts about drugs may persist, but it will be much harder to act upon those thoughts when surrounded by a team of medical professionals who are all encouraging the person to keep moving forward, to keep fighting and to keep working on the addiction. This increase in motivation can be one of the best parts of an inpatient program.
Another important part of the preparation process involves making a commitment to sticking with therapy, no matter what happens. According to the National Institute on Drug Abuse, the withdrawal process typically takes seven to 10 days to complete, but true recovery from opiate addiction may take up to six months. When that is complete, many more months of work are needed in order to ensure that a relapse does not occur. By taking time to prepare for the journey, people can ensure that they will stay involved and committed to health, and they’ll complete the entire process as planned.
If you have additional questions about opiate detoxification, please contact us at The Canyon. We have many years of experience in helping people recover from the addiction issues they face. We’re here to help. Contact us today.