Opioid Detoxification

Medical Detoxification is a controlled and medically supervised withdrawal from addicting drugs, usually under the care of a physician. Using opioids can cause physical dependence over time and stopping them can result in withdrawal symptoms in people with this dependence. The detoxification process is designed to treat the immediate physical effects of stopping opiod use and to remove toxins left in the body as a result of the chemicals found in opiods.

Medical Supervised Detoxification: In order to withdraw from opioids safely, it may be preferable and in some cases necessary to undergo medically supervised detoxification in a hospital or residential treatment center that has a detoxification unit. This would be recommended for patients who have been using an opioid heavily for a long period of time or for those with other significant health problems. Inpatient detoxification allows the patient to be closely monitored throughout the process and given appropriate medication to prevent severe withdrawal symptoms. It commonly involves slowly decreasing doses of an agent that is related to the original drug of abuse and is now substituted to prevent severe withdrawal.

Rapid Detoxification: In this process drug withdrawal occurs while patients are asleep under general anesthesia. The patient is given intravenous injections of medications called opioid blockers which stop the action of opioid drugs. They also receive injections of other medications that reduce the symptoms of withdrawal such as muscle relaxants or anti-nausea medications. This process results in rapid withdrawal from the physical effects of addiction. Through the use of opioid blockers such as naloxone, and nalmefene, physical detoxification is achieved within 4 to 8 hours. Rapid detox takes place in an intensive care unit of a hospital. Patients are usually discharged within 48 hours following recovery from anesthesia and assessment of their physical status.

Rapid detoxification helps reduce the distress of opioid withdrawal for people who are chemically dependent on narcotics such as heroin, Vicodin, Percocet, Demerol, Dilaudid, Darvocet, OxyContin, opium, morphine, codeine, oxycodone, hydrocodone, prescription painkillers, and all narcotic type drugs. It shortens the detoxification period and spares patients the pain and physical discomforts of withdrawal. It may be of great benefit to patients who suffer from severe withdrawal symptoms and who have failed repeatedly to complete conventional withdrawal programs . However, there are significant costs as well as risks associated with the use of general anesthesia. It is imperative that the procedure be performed by medical professionals who are highly trained in these procedures in a medical setting that is fully equipped to deal with any complications that may arise.

Stepped Rapid Detoxification: This is also done in a medical clinic or hospital with specialized doctors and nurses. As an alternative to rapid detoxification it provides small doses of Narcan (Naloxone) injected just under the skin and naltrexone given orally every hour with mostly oral withdrawal management medications as necessary. This approach using the slower oral and under the skin routes removes the opioid from the body more slowly than intravenous Rapid Detoxification. In addition, the pacing can be controlled and responsive to any withdrawal symptoms that develop in the patient by having them quickly suck on Buprenorphine tablets under the tongue. There is less need for withdrawal management medications. The patient is alert and directly communicating with medical staff until the situation is resolved. It is possible to be detoxified and stabilized on naltrexone maintenance therapy. If someone tries to use any kind of opioid while they are on naltrexone, they feel no effect because all of the receptors are completely blocked.

Ultra Rapid Detoxification: This procedure involves putting patients under general anesthesia and giving them a drug called naltrexone which blocks all their endorphin receptors. This accelerates the withdrawal process, pushing them into 100% detoxification within 5 to 30 minutes. Although this is an extremely painful process it is tolerable under anesthesia. As with rapid detoxification, it is very costly and has significant medical risks.

Outpatient Detoxification: Outpatient medical detoxification is usually safe and effective for people who are more likely to have mild to moderate withdrawal symptoms. For instance, opioid detoxification in the outpatient primary care setting can be accomplished with a variety of medications such as buprenorphine-naloxone (BUP/NX) or clonidine alone or combined with naltrexone. Buprenex, approved by the FDA, can be given on an outpatient basis by physicians who receive a required eight-hour training. Using Buprenex, the detoxification can take between 7-14 days.

Methadone: The most common method of opioid detoxification is to use Methadone in an approved clinic and slowly taper the patient down from the usual dose to zero over a period of approximately 21 days. This process still entails an uncomfortable withdrawal period and patients often use drugs during this time.

Updated May 17, 2018