The main goal during detox is to remove drugs or alcohol from the system and stabilize physically.
For the last several years, between eight and 10 percent of the American adult population aged 12 and older needed specialty treatment for an alcohol or drug abuse or dependency problem, the National Survey on Drug Use and Health (NSDUH) reports. Many treatment programs begin with a detox program that can be either residential or outpatient, depending on the circumstances. Both types of programs may utilize medications in order to manage withdrawal symptoms that can be uncomfortable and even dangerous if left untreated.
Withdrawal symptoms are usually accompanied by drug cravings. They can be both physical and emotional, and they can include nausea, vomiting, muscle aches, diarrhea, headaches, irregular heart rate, fever, sweats, chills, insomnia, restlessness, anxiety, depression, confusion, hallucinations, shaking and seizures.
Why Medications Are Sometimes Needed
When you abuse drugs or alcohol for a period of time, you may develop a physical and psychological dependency on them, and when you stop taking them, withdrawal symptoms may start. Withdrawal may differ, depending on the type of substance you are dependent on and the length of time you abused drugs or alcohol. For instance, alcohol, opioids and benzodiazepines should never be stopped suddenly without medical supervision, and sometimes intervention as withdrawal can be severe and even life-threatening, especially in the case of alcohol withdrawal. The longer you abuse drugs or alcohol, the more dependent your body likely is on them as well.
Medical detox uses medications to take the edge off and ensure your safety with medical monitoring and supervision in a specialized detox facility. A successful detox program is comprehensive, and it may use both pharmacological methods and psychotherapies in order to help you recover.
Some medications are specifically approved by the U.S. Food and Drug Administration, or FDA, to treat substance abuse and dependency during detox and recovery while others are primarily effective on specific withdrawal symptoms. Currently, there are no medications for the treatment of benzodiazepine or stimulant withdrawal, although different medications may be used during detox to relieve certain side effects and drug cravings.
Medications used during detox may vary and may include:
Opioid detox (heroin and prescription opioid pain relievers):
- Suboxone and Zubsolv
- Antidepressants or antiadrenergic agents
- Benzodiazepines, including diazepam and chlordiazepoxide
- Anticonvulsants such as Depakote or Tegretol
- Anti-nausea medications
Stimulant detox (cocaine, methamphetamine, and prescription ADHD medications):
- Antipsychotics like olanzapine
- Benzodiazepines such as diazepam
Sedative or tranquilizer detox (prescription benzodiazepines or benzos):
- Substitute long-acting benzodiazepines for short-acting ones like diazepam or chlordiazepoxide
- Antiadrenergic agents such as clonidine
Science continues to evolve, and as new medications become available or evidence shows that others may be effective in additional ways, they may be added to detox protocols. Your medical team will determine which medications are best suited for your personal situation during a detox program.
The Centers for Disease Control and Prevention
, or CDC, estimates over two million American adults are addicted to prescription opioid medications. These medications include Vicodin, OxyContin, Percocet, morphine, codeine, and hydrocodone products that are prescribed to relieve pain sensations. When abused, they can cause a euphoric high that can be addicting.
As opioid narcotics are becoming more difficult and expensive to abuse, more people may turn to heroin. Approximately 4.6 million Americans admitted to using heroin at least once in their lifetime, according to a study reported by CNN in 2012, and 467,000 were considered to be dependent on heroin, which is more than double the number of those classified as heroin-dependent in 2002.
Opioids bind to opioid receptor sites in the brain and circumvent the natural reward and pleasure mechanisms. Once your brain expects the drug’s chemical interaction, it may no longer produce the same levels of dopamine, one of the neurotransmitters responsible for pleasure naturally, thus changing the chemical makeup of your brain. When you then take the drugs away, your brain has to struggle to try and restore previous levels of dopamine in order for you to feel happiness, and this can take time.
Withdrawal symptoms can be difficult emotionally, including anxiety and depression. Physical symptoms may mirror the side effects of a bad case of the flu. Withdrawal generally starts within 12 hours of your last dose for an opioid with a shorter half-life and 30 hours for those with longer half-lives. Withdrawal may peak in a few days and can continue for weeks. In order to manage withdrawal, longer-acting opioid agonists, such as methadone or buprenorphine, may be used during detox.
Heroin and most opioid narcotics are short-acting agonists, meaning that they don’t stay in the system for an extended period of time. By switching to a longer-acting opioid like methadone, you will be able to take fewer doses to keep the receptors in the brain engaged. Buprenorphine is a partial opioid agonist and doesn’t fully activate the receptor sites, although is useful in reducing drug cravings and withdrawal symptoms and was approved by the FDA in 2002 to treat opioid dependency specifically. Methadone and buprenorphine can be administered in lower and fewer doses during detox and replace other opioids in the brain without causing the same euphoric or intoxicating effects.
Methadone is dispensed in federally regulated clinics as a tablet, generally taken once per day and classified by the Drug Enforcement Agency (DEA) as a Schedule II controlled substance. Drug scheduling refers to a drug’s potential for abuse and dependency versus its medicinal value, with one having the strictest regulations and five being the least regulated. Methadone is an opioid narcotic itself and therefore does have the potential to be abused and create a dependency.
Buprenorphine, being only a partial opioid agonist, has less potential for abuse due in part to the ceiling effect that occurs when you take more than intended. After levels of buprenorphine reach a certain amount in the bloodstream, the drug no longer produces any euphoria. Buprenorphine is a Schedule III controlled substance and can be prescribed by a doctor either in tablet form or more commonly in a sublingual film strip.
Subutex is a buprenorphine product generally used as an opioid replacement during early detox. Suboxone and Zubsolv also contain naloxone, which is a partial opioid antagonist that blocks opioid from attaching to receptor sites. This means that if you try to take other opioids while on Suboxone or Zubsolv, they will have no effect, and you may start to experience withdrawal symptoms. The naloxone component may serve as an abuse deterrent; therefore, these medications are generally used later on in a detox program.
One of the risk factors for taking buprenorphine medications during detox is the potential for precipitated withdrawal, which is the rapid onset of intense withdrawal side effects. You should wait to begin an a opioid replacement therapy during detox until early withdrawal symptoms have started and the other opioid drugs are mostly out of your bloodstream. Be sure to share all pertinent information regarding the drugs you took, dosage amount, and time of your last dose with the medical professionals assisting you during detox in order to avoid precipitated withdrawal and other potential negative drug interactions.
Other Medications and Supplements
Withdrawal symptoms from most drugs and alcohol typically include emotional side effects, such as anxiety and depression, and, in some cases, suicidal thoughts and behaviors. Mood-stabilizing medications, antidepressants, and antiadrenergic agents can assist in regulating these difficult emotions during detox.
Antidepressants often work by stimulating the production of dopamine or serotonin in the brain, which are commonly affected by substance abuse and dependence. Buspirone acts on the serotonergic system of the body and may be an alternative to methadone tapering during detox, as it has no abuse potential. It also showed a reduction in withdrawal symptoms for heroin addicts in a trial published by the Journal of Clinical Pharmacology. Antiadrenergic agents generally activate serotonin receptors in the brain and function as mood enhancers. Clonidine is one such medication commonly used during detox.
Other drugs may be used for specific withdrawal symptoms and may not be necessarily designed for substance abuse treatment. Anti-nausea medications may be useful during alcohol withdrawal, for instance. Antipsychotic medications like olanzapine can also manage symptoms of psychosis during detox and withdrawal. Modafinil is a narcolepsy drug sometimes used to counteract the crash that can accompany stimulant withdrawal. Herbal supplements, vitamins, and minerals may be recommended by your doctor during detox to help with recovery and healing as well.
The National Alliance on Mental Illnesses (NAMI) reports that 50 percent of drug abusers and 30 percent of alcohol abusers also suffer from mental illness and substance abuse may be a form of self-medication. Therefore, mental illness and substance abuse regularly co-occur, and medications may be required to treat mental illness symptoms during detox. Substance abuse can make mental illness worse and interfere with treatment, just as mental illness symptoms may be complexly intertwined with substance abuse withdrawal side effects. Dual diagnosis treatment ensures that both disorders are treated simultaneously by teams of medical professionals who work together to achieve the best results.
Drug and alcohol cravings may be both psychological and physical, and while they may be partially managed with medications, psychotherapy may produce the best results in alleviating cravings and compulsive drug-seeking behaviors long-term. Acamprosate, disulfiram, and naltrexone are approved by the FDA for the treatment of alcohol dependency, as published by American Family Physician. These drugs serve mainly to deter alcohol abuse as they may increase withdrawal symptoms and block receptor sites in the brain when alcohol is introduced simultaneously. They may be useful later in a detox program to help prevent relapse when used in conjunction with behavioral therapies.
Detox should be a part of a comprehensive treatment program that also includes therapies and counseling sessions in addition to pharmacological methods. A return to drug or alcohol use after a period of detox, or a relapse, can be especially dangerous as it can increase the odds for a life-threatening overdose.
We can help you or your loved one choose a program that offers a full continuum of care that may include a medical detox program as well as a substance abuse treatment program designed to provide you with a long and sustained recovery. We are standing by to assist you. Call now.