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Opiate Detox Centers

codeine pills on transcripts with stethoscopeOpiates (morphine, codeine) are drugs used to manage pain. They are highly addictive, and regular use can lead to dependence and withdrawal.1, 2 The symptoms of opioid detox are not life-threatening. However, the withdrawal process can be uncomfortable and distressing, which can increase the risk of relapse and overdose when people in the midst of withdrawal try to relieve the symptoms.1,2,7

Detox eases symptoms of withdrawal and helps patients lay the groundwork for sustained recovery.3 Medically supervised detox is a highly recommended method of managing the unpleasant symptoms of withdrawal and any associated complications that require medical attention.2

Coming off of opiates “cold turkey” can be unnecessarily difficult and fraught with complications due to a lack of appropriate medical supervision and treatment. Additionally, rapid detox—where patients are sedated through an accelerated detox process—can have its own unnecessary risks.4, 5

To be most effective, patients should follow detox with other forms of treatment and support, such as inpatient or outpatient rehab, private therapy, and/or support groups.3

How Long Does It Take to Detox From Opiates?

The opiate detox timeline and severity of symptoms vary based on the type of opioid the person used, amount used, and length of time it was used.1, 2, 6

However, the timeline generally follows a pattern:

  • Early withdrawal occurs about 6–12 hours from the last dose and includes the following symptoms:
    • Anxiety.
    • Dilated pupils.
    • Excessive yawning.
    • Increased pain response.
    • Muscle or bone aches.
    • Runny nose.
    • Sleep difficulties.
    • Goosebumps.
    • Sweating.
    • Tearing eyes.1, 2, 6
  • Advanced withdrawal symptoms tend to peak at about 24–72 hours and slowly improve over the course of 5–7 days. They include:
    • Restlessness.
    • Alternating bouts of chills and fever.
    • Increased blood pressure and pulse.
    • Intense cravings for opiates.
    • Lack of appetite.
    • Nausea or vomiting.
    • Severe depression.
    • Shakiness.
    • Stomach cramps.1, 2, 6

Treatment

White detox treatment pills pouring out of bottleStaff at opiate detox centers can provide a variety of medications to ease symptoms of opioid withdrawal. Commonly used medications include:

  • Methadone, a long-acting opioid used to make the withdrawal process easier.7, 8 It can be used over a brief course in tapered doses or used more long-term to help people maintain sobriety.2, 7, 8
  • Buprenorphine, which can shorten the withdrawal process and make withdrawal symptoms less painful and distressing. It can also be used long-term.2, 7, 8
  • Suboxone, which is a combination of buprenorphine and naloxone that is used to manage opioid dependence and deter abuse.2, 7, 8
  • Clonidine, a medication that lowers blood pressure and is used to lessen symptoms of withdrawal, including anxiety, cramping, irritability, runny nose, and sweating.2, 7
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or Toradol, which may be used to relieve achy muscles that accompany detox from opioids.8
  • Imodium, which can be used to manage gastrointestinal symptoms, such as diarrhea, and Zofran (ondansetron), which can alleviate nausea and vomiting.8
  • Trazodone, a sleep aid that can help treat the insomnia that accompanies detox.8

At clinics for opiate detox, medical staff are available to regularly assess the needs of each patient, monitor vital signs to identify any potential complications or issues, and administer fluids to prevent dehydration. Medical and psychiatric professionals are on hand to supervise patients and help identify and treat any medical or mental health concerns that may arise during detox.

Facilities for Detox

A variety of opioid detox programs are available. These include:

  • Detox centers, which provide 24-hour supervised care and offer medical treatment and medications to maintain the safety and comfort of each patient. This type of opiate detox facility specializes in monitoring and managing the early recovery period and works with each patient to develop a plan for continued sobriety after discharge.
  • Hospitals, which also provide 24-hour supervised care, medical monitoring, and medication. Hospitals can help manage complications of withdrawal, link patients to appropriate resources to continue treatment, and treat any co-occurring disorders.
  • Inpatient or residential programs, which offer a complete recovery program, from detox to addiction therapy, and aftercare planning. Patients reside at the facility for the duration of treatment and are monitored by specialized staff to make sure they are receiving the level of care that they need.
  • Outpatient programs, which in some cases may run an outpatient detox protocol so that patients can continue to participate in their daily routine. Outpatient rehabilitation programs provide further treatment in both group and individual sessions, although the support tends to be more limited than inpatient facilities.

Patients should ideally choose opiate detox facilities based on a variety of factors. Detox centers or inpatient care are often the treatment choice for individuals with more severe addictions such as heroin or powerful prescription opioids, long-term use, multiple relapses, weak or no support system, or serious medical or mental health issues. An individual with a less severe opiate use disorder and strong supports might receive all the treatment attention they need from services provided on an outpatient basis.

Rapid Detox and Cold Turkey

man experiencing withdrawal symptoms while talking to his doctorThe rapid detox process involves medical staff sedating a patient and then administering an opiate blocker (such as naltrexone) that causes immediate withdrawal symptoms to appear.4, 5 Additional medications are provided to reduce the symptoms of opiate detox.4, 5

Risks associated with this procedure include medical complications or death.4, 5 This risk is increased if patients have any other medical or mental health issues, which often accompany substance use disorders.5 Medical insurance does not cover rapid detox, so the procedure can be extremely costly as well as dangerous.5

In addition, studies of the effectiveness of rapid detox show no advantage over traditional treatment, and follow-ups show that many patients do not continue with further treatment, lowering the chances of maintaining long-term sobriety.5

Quitting opiates cold turkey is possible, but it is very difficult. Some strategies and drawbacks include:

  • Self-tapering, which is accomplished by reducing the amount used over a period of time. This can be very difficult to do, as once the more painful withdrawal symptoms and intense cravings begin, it may be more tempting to stop tapering.
  • Over-the-counter medications, which can be used to manage specific symptoms, such as Imodium or Pepto-Bismol for gastrointestinal issues, ibuprofen or acetaminophen for pain relief, or sleep aids for insomnia. This strategy can be problematic, since these medications may not be as effective as prescribed medications and can lead to overuse that can cause other health concerns. Medical care may not be readily available to manage any complications that arise.
  • Natural remedies, which may seem tempting to manage opiate detox symptoms. But herbs and supplements may have adverse interactions with each other and with other medications or may be contraindicated for use in those with other existing health conditions. Melatonin is a common supplement used to promote sleep, though it can interact with some medications. Melatonin supplements may also contain contaminants.10

Quitting opiates “cold turkey” can be associated with various risks.

  • Dehydration from nausea, vomiting, and diarrhea can lead to imbalances in electrolyte levels.2,9 Continued vomiting can lead to aspiration, where stomach contents are inhaled into the lungs, placing the person at risk of choking or lung infections.9
  • Opiate withdrawal can cause depression, and in some cases, this can lead to a greater risk of suicide, especially if there is an underlying mental health disorder. Withdrawal can worsen co-existing medical or mental health conditions, especially if there is a condition causing pain.2
  • The most serious risk of quitting opiates without professional help is an increased risk of relapse and overdose, since withdrawal drastically reduces one’s tolerance, while increasing cravings.9 Relapse is common during and right after detoxing.

Detoxing is not a comfortable process, but the discomfort can be eased significantly with medication and medical monitoring. Attending a detox center where medical supervision and medication-assisted treatment is provided is the safest, most effective way to get off opiates and start a sober life.

Sources

  1. Drug Enforcement Administration. (2015). Drugs of Abuse.
  2. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment.
  3. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd Edition>.
  4. Centers for Disease Control and Prevention. (2013). Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012.
  5. National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier with Ultrarapid Opiate Detox.
  6. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Association.
  7. National Institutes of Health. (2016). Opiate and Opioid Withdrawal.
  8. Kleber, H.D. (2007). Pharmacologic Treatments for Opioid Dependence: Detoxification and Maintenance Options. Dialogues in Clinical Neuroscience, 9 (4): 455–470.
  9. National Institutes of Health. (2016). Opiate and Opioid Withdrawal.
  10. Mayo Clinic. (2014). Is Melatonin a Helpful Sleep Aid — and What Should I Know About Melatonin Side Effects?

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