Before explaining the different medications that can be used during detox, it’s first necessary to understand the detoxification process itself. Detox is a procedure in which any drugs, alcohol, and the toxins associated with them, are flushed from the body to achieve sobriety, treat acute intoxication, and mitigate the mental and physical harm caused by chronic, long-term substance addiction.
In medical detox treatment, whether it’s on an inpatient or outpatient basis, someone undergoing detox does so with at least some level of medical supervision and support, which includes administering medication as part of medical maintenance therapy or medication addiction treatment. This is done to keep someone undergoing detox stable and in the least amount of discomfort possible. A medical detox team is also tasked with handling any complications that can arise during detox, either due to withdrawal symptoms or for other reasons.
Where doctors will conduct a general physical and mental health exam and screen clients for co-occurring disorders, measure drug levels in their bloodstream, and more, using this data to determine how best to meet the client’s needs.
Which is exactly what it sounds like, and takes place during the withdrawal phase of detox. Stabilization means keeping the person in detox stable, safe from harm, and also minimizing any pain, cravings, or discomfort caused by withdrawal symptoms, including seizures or other more extreme symptoms that can sometimes arise.
The final stage, this mostly involves preparing the client for post-detox treatment and providing resources and information regarding how best to go about with ongoing care.
WHY USE MEDICATION IN DETOX?
At first, the idea of using drugs treatment during a period in which someone is meant to be removing them from their body can admittedly sound counterintuitive. However, medication can be extremely useful during detox, especially when it comes to dealing with withdrawal symptoms, which can be extremely unpredictable depending on the substance, the severity of the addiction, and whether or not a co-occurring disorder is also present.
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There’s actually a variety of medications that have been approved by the U.S. Food and Drug Administration to be used for therapeutic purposes during detox, ranging from over-the-counter medications such as Tylenol to drugs like prescription opioids that, under different circumstances, someone might require detox from.
Detox medications are frequently employed to help those in withdrawal deal with unpleasant, extremely common withdrawal symptoms such as:
- Muscle pain
Detox medications are used in what is known as medical maintenance therapy. Part of the process of weaning someone off of a substance is by slowly reducing the dosage until it is safe to stop using. This is called a tapering schedule and is necessary for some drugs that are extremely dangerous to immediately quit all at once.
Central nervous system depressants like benzodiazepines, in particular, can trigger an intense shock to the body when stopped abruptly after chronic abuse, which can lead to potentially life-threatening symptoms such as delirium, seizures, and more.
DETOX MEDICATIONS FOR OPIOIDS
Currently, opioids, from prescription medications to heroin, are the key players in the addiction and overdose epidemic ravaging the United States. Detoxing from opioid dependence is rarely life-threatening but still extremely difficult, with some very uncomfortable and sometimes painful withdrawal symptoms, including all of the previously mentioned common symptoms of drug and alcohol withdrawal as well as:
- Intense drug cravings
- Irregular heart rate
- Mood swings
Combined, these symptoms can border on unbearable and can often be dangerous, especially in the instance of flu-like symptoms such as diarrhea, vomiting, and sweating, which can lead to severe dehydration. This could become medically serious if the person in withdrawal is not being medically monitored.
The common detox medications used in the treating of opioids, however, are other, weaker forms of opioids used in medical maintenance therapy to stave off drug cravings and wean the user off of strong opioids like heroin. Some of the most commonly utilized opioid detox medications include:
Methadone has a long history as a detox medication for opioid dependency. It is, itself, a long-acting opioid with a half-life of anywhere between 15 and 55 hours, depending on the dosage. The lengthy amount of time it spends in someone’s system is what makes methadone so useful in a therapy known as methadone tapering.
Methadone tapering is a form of the weaning process mentioned and involves administering carefully monitored amounts of methadone to relieve cravings and withdrawal symptoms, replacing the much shorter-acting opioids like heroin and taking up space in the body and brain’s opioid receptors.
The goal of methadone as a detox medication is to replace the opioid someone has become addicted to and then lower the dosage of methadone with the eventual outcome of achieving sobriety.
Although it has been proven to be clinically effective when paired with counseling and behavioral therapy and has been in use for many years, it is still somewhat controversial due to the fact that methadone itself can be addictive and its use must be strictly regulated by a medical professional. Typically, a medical detox team will try other medications before turning to methadone.
Buprenorphine is also an opioid that is used to treat opioid addiction for the same reasons as methadone. However, buprenorphine is what is known as a “partial opioid agonist.” What this means is that, unlike other “full agonists” that have such intense effects on the brain’s opioid receptors, buprenorphine is extremely weak and incapable of producing the euphoric high that people get from other, more powerful opioids.
So, rather than causing a high, buprenorphine does what methadone does: takes up space in the opioid receptors to keep other opioids out and helps to curb withdrawal symptoms, generally for about 24 hours a dose. Unfortunately, even though it is much weaker than most opioids, like methadone, it too possesses addictive potential, and the use of buprenorphine must also be carefully monitored.
Suboxone is the brand name for a combination of buprenorphine and another drug called naloxone. Unlike the previous two substances, naloxone is a full opioid antagonist, which means that it negates the effects of full agonists such as heroin, effectively “switching off” the brain’s opioid receptors.
Because of its effects, naloxone is useful as an overdose reversal drug but is too dangerous to prescribe alone for someone in detox, as it carries the risk of triggering sudden, potentially fatal withdrawal symptoms. Instead, it is combined with buprenorphine in an attempt to create a detox medication that is less addictive than buprenorphine on its own, as well as less dangerous than naloxone on its own.
Naltrexone is another opioid antagonist, binding to the brain’s opioid receptors without activating them and blocking the opioids and their effects. Much like naloxone, it is commonly used for treating and reversing overdoses. It is also is used during addiction and detox treatment with the aim of gradually reducing opioid cravings.
However, as with every other detox medication, to truly be effective, it should be combined with behavioral therapy and some form of counseling, to treat the root issues behind someone’s addictive behaviors as well.
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DETOX MEDICATIONS FOR DEPRESSANTS
Benzodiazepines, alcohol, and barbiturates are all known as central nervous system depressants, and they have some of the most serious and dangerous withdrawal symptoms of any kind of substance. The sudden cessation of depressants can throw a dependent person’s nervous system into overdrive and bring on the typical run of withdrawal symptoms along with:
- Severe insomnia
- Suicidal thoughts and behavior
- Panic attacks
- Delirium tremens
Acamprosate is used specifically to treat the symptoms of alcohol withdrawal during detox. The method which acamprosate uses to help balance out the brain’s chemistry and GABA levels (the neurotransmitter most affected by central nervous system depressant use) is not completely understood, but it does have proven evidence of effectiveness. However, depression and suicidal thoughts are both common side effects of acamprosate use, so it should always be administered with caution and carefully monitored.
While we did just illustrate the very real dangers of benzodiazepine abuse, this does not mean that they themselves cannot be helpful in treating addiction to alcohol or even other benzos. Benzos can be used to wean people off of stronger versions of the substance in the same way the methadone and buprenorphine can help wean people off of more powerful opioids. Also like methadone and buprenorphine, benzodiazepine administration requires strict dosage control, counseling, and behavioral therapy.
Generally sold under the brand name Antabuse, disulfiram works by interfering with how the body breaks down alcohol, creating an extremely unpleasant reaction when someone drinks an alcoholic beverage. Reaction symptoms can include nausea, heart palpitations, migraines, and sometimes even difficulty breathing.
The logic behind the use of disulfiram is that it can rewire the brain of someone dependent on alcohol to associate these extremely negative effects with the act of drinking alcohol, therefore significantly reducing the urge to drink. However, because it is such an unpleasant drug, many people in detox will refuse to take it, and so it is considered ineffective, as someone needs to be motivated enough to take it in the first place.
DETOX MEDICATIONS FOR STIMULANTS
Stimulants are a bit different from the other substances on the list due to the fact that they mostly act on the levels of dopamine in the brain, which is responsible for regulating mood and emotions. Because of this, most of the stimulant withdrawal symptoms are psychological and mood-based rather than physical, including:
- Inability to concentrate
- Muscle pain
- Mood swings
- Impaired thinking
- Suicidal thoughts or behavior
- Inability to feel pleasure
- Disturbed sleep patterns
The few physical symptoms can generally be treated with over-the-counter medications such as ibuprofen, but the psychological symptoms will most likely require stronger forms of detox medications, most commonly:
Modafinil is, again, another medication similar to methadone in that it works in much the same way as stimulants like cocaine, inhibiting the reuptake of dopamine, but at a much weaker level. This can help to both ease cravings and treat the sleep-disorder issues that can often accompany stimulant withdrawal.
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