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Opiate Detoxification

From street drugs like heroin to prescription medications such as OxyContin, Fentanyl and morphine, opiates are some of the most challenging – and most dangerous — drugs to detox from without supervised, professional help. As powerful painkillers that produce intense, euphoric highs, opiates have a notoriously strong addictive pull – with potentially fatal consequences. In fact, poisoning deaths from opiate painkillers alone rose by 300 percent between the seven years between 1999 and 2006, according to the Center for Disease Control (CDC). Fortunately, the best private inpatient or outpatient opiate detox facilities accompany patients through the throes of withdrawal, past the pull of opiate cravings, and usher them into mental clarity and physical well-being.

Understanding the Chemical Need for Detox

Opiates act primarily on a brain chemical known as dopamine, creating the classic euphoria associated with drugs like heroin, morphine and oxycodone. As dopamine levels become repeatedly, artificially spiked through opiate use, the brain eventually adjusts natural production of the neurotransmitter to compensate for the presence of drugs. Due to both the over-activation of dopamine during periods of opiate intoxication and long-term changes in brain chemistry, natural dopamine levels become lowered and depleted.

When opiate use suddenly ceases during detoxification, the brain senses – often for the first time in years – a sharp, persistent chemical imbalance, resulting in strong cravings to reengage in drug abuse. Additionally, psychological consequences, such as depression, anxiety and paranoia, also arise as the brain experiences a lack of mood-enhancing chemicals.

Other Factors Involved in Detoxification

Beyond the chemical imbalance that opiates create, physical addiction to opiates can be exacerbated by the following factors:

  • Opiate Tolerance
    According to the Drug Enforcement Association (DEA), opiate drugs can cause rapidly developing tolerance in chronic users. As tolerance builds, veteran users require higher – and more frequent – dosages of their drug of choice in order to achieve the emotional euphoria of the drug’s “high.” Unfortunately, the addict’s body does not build tolerance to the physical side effects that opiates produce. As a result, increasing damage to the body may result from long-standing addictions. Many addicts will also experience a phenomenon known as “cross-tolerance” – causing addicts who use more than one opiate to automatically experience tolerance to others. Drug tolerance and ensuing high usage levels can present distinct challenges during detoxification, including sharp or intense withdrawal symptoms, enduring cravings and high overdose risk if relapse should occur.
  • Polydrug Use
    Because of their relaxing, sedating effects, opiates often are used in combination with other drugs – particularly stimulants such as amphetamines or cocaine – to balance out their effects. Because each drug will pose unique health risks after enduring use and often will be accompanied by distinct – and possibly conflicting – withdrawal symptoms, detoxification in a professional setting becomes imperative. According to a 2006 University of Oslo study, life-threatening complications can result from polydrug addicts withdrawing from opiates, necessitating particular careful medication and care.
  • Pain Management Issues
    Quite often, opiates have been legitimately prescribed for the alleviation of moderate to severe physical pain arising from chronic conditions, injuries or residual surgical pain. As a result, many addicts have learned to rely on opiates for pain management, in either a doctor-directed setting or by means of self-medication. Unfortunately, once use stops, many patients experience a “rebound effect,” where worsening pain feels all the more excruciating due to lowered pain thresholds. In other cases, opiate withdrawal symptoms – such as deep muscle, joint and bone pain – compound existing physical discomfort. Many professional detoxification centers will provide pain management techniques and nonaddictive alternatives to recovering opiate addicts to ensure comfort and wellness as they heal from addiction.
  • Co-Occurring Disorders
    In some cases, opiate abuse and addiction have taken place as a means of self-medicating psychic wounds. Addicts who suffer from clinical depression, anxiety disorders, trauma-associated dissociative disorders, or personality disorders may rely on opiates as an emotional or psychological escape hatch. Research has consistently shown that concurrent treatment offers the highest success rates for those facing mental health conditions that coincide with drug dependency. From the outset of detoxification, professional clinical staff at a detox center can provide therapeutic support and customized care to allow healing of both psychological challenges and physical addiction.
  • Withdrawal Symptom Severity
    In addition to the forces of cravings and mood disruptions, opiate withdrawal symptoms can also take place as the body adjusts to a drug-free environment. As a result, medical supervision will likely be necessary, particularly after long-standing addictions, or those that have been compounded by secondary physical or psychological issues. The degree of medical intervention used during detoxification will depend largely on symptom count and severity, drugs of choice and recovery facility policy on medical detox (detoxification assisted by medications).

Components of Detoxification

In general, detoxification occurs in two settings – outpatient detox programs or as the first phase of residential addiction treatment. While the detox process will differ according to program structure and type, drug detox will generally include the following components:

  • Assessment and Diagnostic Testing
    Upon intake, patients will be asked to submit to a variety of psychological interviews or tests and physical exams in order to establish a baseline for treatment. Drug testing may be employed to allow addiction professionals to become apprised of any drug combinations present in the system, and to enable them to tailor the detox process to specific drugs of choice. Additionally, physical examinations may be performed. These tests serve to both prevent complications that could arise during detox and to ensure that patients receive medical attention for any physical damage they may have incurred during addiction. Psychological testing allows for identification of secondary mental health issues that may need concurrent treatment.
  • Medical Supervision
    Many detoxification centers will provide medical supervision during the withdrawal process. Vital signs may be monitored to ensure ongoing health, physical checkups may be provided, and medications may be ordered to treat symptoms of withdrawal. Though rare, emergency medical assistance is sought if serious complications occur.
  • Medication Dispensation
    Nonaddictive medications are dispensed to treat any additional mental or physical health conditions uncovered during the detox or intake processes. Withdrawal symptoms are generally managed with sleep medications, natural remedies, nonaddictive painkillers, antidepressants, anxiolytic drugs, and anti-nausea or anti-seizure medications. In detox facilities that provide medical detox, specialized medicines aimed at prevention of relapse, reduction of withdrawal symptoms or alleviation of cravings may be dispensed.
  • Counseling and Peer Support
    Ongoing individualized therapy sessions, process groups and 12-step meetings are made available to patients as they move through the detoxification process. Counseling mechanisms help patients understand the mental and physical changes they are undergoing during detoxification, gain encouragement and support, and learn from the experiences of others as they recover.
  • Wellness Maintenance
    Fitness exercises, alternative therapies and nutritional support are provided to patients as they detoxify from years of addiction. These measures serve to boost mood, release endorphins, enhance energy, ensure nutrients and provide the foundation for a healthy, sober future.

Types of Detox

Depending on the drug of choice, length of addiction, and physical health of the patient, detoxification may take one of several forms. In some cases, all detoxification cases will be treated in accordance with an overall policy of a given drug treatment center. In others, varying methods of detoxification will be employed for different drugs – or on a case-by-case basis. The most frequently used modern methods of detoxification include:

  • Natural Detoxification
    When medications are limited to over-the-counter medicines, herbal remedies and occasional, nonaddictive prescriptions (such as blood pressure medication or antidepressants), detox is deemed “natural.” The concept behind natural opiate detoxification is the allowance of the body to move through withdrawal without assistance from unnecessary medications. In general, withdrawal symptoms and cravings are still managed by natural detox facilities. Some proponents of natural detox suggest that by the experience of the withdrawal process helps act as a deterrent against future relapse.
  • Medically Supervised Detox
    Many detoxification programs explain their programs as “medically supervised.” Though easily confused with “medical detox,” medically supervised detoxification indicates that a facility is staffed by licensed medical professionals (such as physicians or nurses) to supervise the drug detox process. Medically supervised detoxification allows patients to be monitored for vital signs, ensure proper hydration, and provides the assurance that trained medical professionals are available in the event of medical complications. Though both natural and medical detox programs may have physicians or nurses present, the designation of “medically supervised” is generally reserved for programs that favor natural detox.
  • “Medical Detox”
    Medical detoxification is also supervised by nursing staff and physicians, generally on a closer level than natural detoxification programs tend to be. The “medical detox” designation refers to the use of targeted medications aimed at lowering cravings and withdrawal symptoms in patients detoxifying from opiate addiction. Medications used can range from methadone to buprenorphine, and may carry little to fairly high addiction potential – a risk mitigated by close medical supervision and carefully calibrated use.
  • Rapid Detoxification
    Less frequently, some detoxification centers will employ “rapid detox” methods. Rapid detox will often involve sedating the patient at the outset of detox, allowing them to essentially “sleep” through the withdrawal phase and associated opiate cravings. During their sedation, patients are treated with targeted medications aimed at hastening detoxification and managing cravings. As a result, patients find themselves awakening with increased mental clarity, and with zero, few or slight withdrawal symptoms and cravings. Proponents of rapid opiate detoxification point to the method’s ability to overcome one of the most difficult phases of opiate rehabilitation, while opponents suggest that rapid detoxification can foster relapse, as patients do not experience negative symptoms of withdrawal (nor the resulting confidence in having weathered them). Intense medical supervision is imperative during rapid detoxification, as grave health complications can occur, even to the point of fatality.

Commonly Prescribed Drugs for Opiate Withdrawal

In detoxification programs that employ medical detox, specialized medications are used to help combat cravings and reduce withdrawal symptoms. Some of the most popular drugs used to treat opiate withdrawal in medical detox programs include:

  • Methadone
    Methadone is a synthetic opiate that can often is used to substitute for natural opiates such as morphine or heroin. Methadone’s chemical properties allow it to block the effects of other opiates, acting to lessen withdrawal symptoms and provide cravings relief for up to 24 hours. Methadone does not have an analgesic, deadening effect, or provide an intoxicating experience. However, methadone can lead to addiction of its own, and serious medical complications can arise from its use, particularly if combined with other drugs in an outpatient setting.
  • Buprenorphine
    Commonly known by its brand name “Suboxone,” buprenorphine is a specialized opiate derived from thebaine. Used to counteract opioid addiction, buprenorphine does not trigger opiate effects with the intensity of other drugs commonly employed in dependency treatment. Another benefit of buprenorphine is the drug’s lower risk of overdose when compared with other medical options for addiction treatment.
  • LAAM
    Levo-alpha-acetyl-methadol – commonly known as LAAM – offers another medical avenue of treatment for opiate addiction. Synthetically created, LAAM serves to deter addiction by blocking the emotional highs that opiates produce in chronic users. LAAM has also been shown to be effective in lowering the strength of cravings and managing symptoms associated with opiate withdrawal. Doses of LAAM tend to last about 72 hours, making the drug a popular choice for outpatient treatment, requiring doses of just three per week. However, once patients cease LAAM intake, opiate cravings do return.
  • Naltrexone and Naloxone
    Studies have shown that two medications – naltrexone and naloxone – can help block the euphoric effects of even the strongest opiates. Falling into a category of drugs known as opiate antagonists, naltrexone and naloxone have met with some success in preventing episodes of relapse in addicts.

Locating Detoxification Facilities

Opiate detox represents the first step in the journey to wellness after drug addiction. With modern, managed settings, today’s detoxification allows the body to detoxify comfortably while mental clarity and physical strength return. If you or someone you love is battling addiction, we invite you to reach out and call one of our representatives at Rehabs.com. Our addiction referral professionals specialize in matching individuals seeking detoxification services with rehabilitation centers around the nation. Call us today for complimentary, personalized referrals to a detox center with a program tailored to your needs.