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.
This includes administering medication as part of medical maintenance therapy or medication addiction treatment. It is done to keep someone undergoing detox stable and in the least amount of discomfort as 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.
The three main stages of medical detox treatment are:
At first blush, the idea of a patient using drugs while in treatment as the addictive substance is removed from their body seems counterintuitive.
However, medication can be extremely useful during detox, especially when it comes to addressing withdrawal symptoms. Depending on the substance and severity of an addiction, withdrawal symptoms can be extremely unpredictable and dangerous, whether a co-occurring mental health disorder is present or not.
A variety of medications have been approved by the U.S. Food and Drug Administration (FDA) to be used for therapeutic purposes during detox. These range from over-the-counter medications like Tylenol to prescription opioids drugs that, under different circumstances, someone might require detox from.
Detox medications are frequently employed to help those in withdrawal deal with unpleasant, common withdrawal symptoms such as:
Detox medications are used in what is known as medication-assisted treatment (MAT). Part of the process includes weaning someone off of a substance by slowly reducing the dosage until it is safe to stop using it. This is also known as maintenance therapy, and it is often employed when a patient is in treatment for opioid dependence.
The act of slowly reducing the addictive substance in a person’s body and replacing it with an approved maintenance medication is also known as tapering.
Patients are placed on a tapering schedule for addictive substances that are dangerous when use stops abruptly, like heroin or Xanax.
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.
From prescription medications to heroin, opioids are key players in the addiction and overdose epidemic ravaging the United States.
On average, 130 Americans die each day from an opioid overdose, according to the U.S. Centers for Disease Control and Prevention.
Detoxing from opioid dependence is rarely life-threatening but still extremely difficult. There are some very uncomfortable and sometimes painful withdrawal symptoms, including all of the previously mentioned common symptoms of drug and alcohol withdrawal, as well as:
In summary, while these symptoms are not considered life-threatening, they can border on the unbearable.
Common opioid withdrawal effects, which manifest as flu-like symptoms, include diarrhea, vomiting, and sweating.
In a groundbreaking report on heroin addiction, one person told The New York Times that withdrawal feels like “a demon crawling out of you.”
Another described it this way: “Everything hurts. It hurts to comb your hair. It hurts to shave. You have no energy. You feel weak. You feel a sense of desperation…”
Nevertheless, opioid withdrawal symptoms can lead to severe dehydration and become medically dangerous if a patient is not medically monitored.
The common detox medications used to treat opioids, however, are other, weaker opioids — or some combination of them — that are used in medical maintenance therapy to stave off cravings and treat withdrawal.
Ultimately, these detox meds are employed to wean the user off potent, addictive 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 a long-acting opioid with a half-life of anywhere between 15 and 55 hours, depending on the dosage.
The long amount of time it spends in someone’s system is what makes methadone useful in a therapy known as methadone tapering.
Methadone tapering is a form of the aforementioned weaning process. It involves administering carefully monitored amounts of methadone to relieve cravings and withdrawal symptoms, replacing shorter-acting opioids like heroin. It works by 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, methadone is still controversial because it can be addictive and its use is strictly regulated by the federal government. It can only be administered by sanctioned and approved clinics.
Typically, a medical detox team will try other medications before turning to methadone.
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Buprenorphine is also an opioid used to treat opioid addiction like methadone. However, buprenorphine acts as a “partial opioid agonist.” What this means is that, unlike other “full agonists” that produce intense effects on the brain’s opioid receptors, buprenorphine is far weaker in action. Thus, it is incapable of producing the euphoric high that people get from other, more potent opioids.
So, rather than causing a high, buprenorphine does what methadone does: takes up space in the receptors to keep other opioids out. This action 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. Therefore, 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 like heroin, effectively “switching off” the brain’s opioid receptors.
Because of its effects, naloxone is useful as an overdose reversal drug. However, it is also 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 alone, 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 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 behavior.
Benzodiazepines, alcohol, and barbiturates are all known as central nervous system depressants and 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:
Detox medications can quite literally be a lifesaver when it comes to detoxing from central nervous system depressants. Common detox medications for this include:
Acamprosate is specifically used 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 exhibit some 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 the very real dangers of benzodiazepine abuse have been described, this does not mean that they cannot be helpful in treating addiction to alcohol or even other benzos.
Benzos can be used to wean people off stronger versions of drugs in its class in the same way methadone and buprenorphine can help wean people off 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 disulfiram is that it can rewire the brain of an alcohol-dependent person where they associate those extremely negative effects with drinking. This association can significantly reduce the urge to consume alcohol. However, because it is such an unpleasant drug, many people in detox will refuse to take it.
Thus, it is considered ineffective, as someone needs to be motivated enough to take it in the first place.
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:
The few physical symptoms can generally be treated with over-the-counter (OTC) medications such as ibuprofen, but the psychological symptoms will most likely require stronger forms of detox medications, most commonly:
Modafinil works like cocaine and other stimulants because it inhibits the reuptake of dopamine, but at a much weaker level. This can help to ease cravings and treat the sleep-disorder issues which often accompany stimulant withdrawal.
National Institute on Drug Abuse. (n.d.). Pharmacotherapies. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies
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Substance Abuse and Mental Health Services Administration (SAMHSA). (2015, June 15). Medication and Counseling Treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment
The U.S. Centers for Disease Control and Prevention. (2018, December 19). Opioid Overdose. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
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