Drugs That Require Medically-Assisted Detox

Detoxification is often the first step in drug or alcohol treatment programs, and it involves the removal of toxins from the bloodstream.

Detoxification is often the first step in drug or alcohol treatment programs, and it involves the removal of toxins from the bloodstream.

One of the indicators of addiction is the onset of withdrawal symptoms when drugs are removed from the body. These side effects may range from mild to severe to even life-threatening, depending on the type of drug you abused, method of abuse, and level of dependency.

Withdrawal symptoms can be both physical and psychological, and they are usually accompanied by drug cravings as well. Many times, stopping substance abuse suddenly, or “cold turkey,” is not recommended, and medically assisted detox may be the best route.

Medically assisted detox is accomplished in a controlled environment supervised by medical personnel around the clock. Some drugs require a slow and controlled weaning, or tapering schedule, in order to reduce the amount of drugs in the system down to zero over a period of time. Others may require the use of medications during detox in order to manage withdrawal symptoms and cravings.

Addictions to some drugs are more likely to require medically assisted detox than others, and the most likely candidates include:

• Prescription opioids
• Heroin
• Benzodiazepines
• Alcohol

The goal of medically assisted detox is to stabilize physically, and it should be undergone in a specialized facility with 24-hour medical care.

Opioids

Opioid drugs include both prescription narcotics like OxyContin, Percocet, Vicodin, fentanyl, morphine, and codeine products as well as the street drug heroin. Opioid drugs come from the opioid poppy plant and bind to opioid receptors in the brain, effectively blocking pain sensations and producing calming and euphoric feelings. These drugs are highly addictive, and the Drug Enforcement Agency, or DEA, classifies many of them as Schedule I or II controlled substances, meaning that they have limited medicinal use and a high potential for abuse and dependency.

Drug overdose death is the leading cause of death in the United States, and according to the Centers for Disease Control and Prevention (CDC), 44 Americans die from a prescription opioid overdose every day. The National Institute on Drug Abuse (NIDA) further estimates that in 2012, over 2 million Americans aged 12 and older were addicted to prescription opioid painkillers, and an additional 467,000 were addicted to heroin.

Opioid addiction must first be managed with medically-assisted detox in order to control the difficult emotional and physical side effects of withdrawal, which include:

• Nausea and/or vomiting
• Chills alternating with sweats
• Diarrhea
• Muscle aches
• Runny nose
• Excessive tearing
• Restlessness
• Trouble sleeping
• Agitation
• Depression
• Anxiety
• Irritability

While these withdrawal symptoms are generally not life-threatening, they can be very uncomfortable. They generally start within 12 hours of the last dose of a short-acting opioid and within 30 hours for a longer-acting one. Symptoms can be managed by tapering off the dosage or by switching to a longer-acting opioid such as methadone. Opioids with longer half-lives stay in the system longer, therefore decreasing the need to take them more often. If Vicodin is the drug one is detoxing from, additional detox information is available including side effects, symptoms and potential detoxification timelines.

Methadone is a tablet dispensed by federally regulated clinics once a day during methadone maintenance therapy. It is intended to help the user detox from short-acting opioids, such as heroin. Methadone is still an opioid with the potential for abuse, however.

Other options are buprenorphine products such as Suboxone and Subutex, which are prescription sublingual dissolvable strips approved by the U.S. Food and Drug Administration (FDA) to treat opioid dependence. Subutex contains only buprenorphine, and it is generally used during the initial detox period. It is a partial opioid agonist with a long half-life, meaning that it partially activates the opioid receptors in the brain and remains in the bloodstream for longer periods, therefore keeping withdrawal side effects and drug cravings to a minimum. Buprenorphine products have a ceiling effect as well, meaning that at a certain point no matter how much you take, you won’t get the desired “high,” thus reducing the potential for abuse.

Suboxone is generally used during the maintenance period of treatment and also contains naloxone, which is a partial opioid antagonist that remains dormant if used as directed. If abused and injected, however, the naloxone takes effect and blocks opioid receptors from receiving opioids and inducing withdrawal. It is important to be honest with the medical professionals assisting you during detox from opioids since starting a medical protocol too soon can precipitate opioid withdrawal, which can be more intense than standard opioid withdrawal syndrome. Adjunct medications, such as mood stabilizers, may also be used during opioid medical detox in order to manage the emotional aspects of withdrawal.

Related Topic: Opioid replacement therapy

Benzodiazepines

Xanax and its generic form alprazolam are some of the most prescribed psychiatric drugs in the United States. According to the National Institute of Mental Health (NIMH), about 85 million prescriptions were written in 2007, and in 2008, one in 20 American adults between the ages of 18 and 80 were prescribed benzos. Benzodiazepine medications are prescription tranquilizers that act as central nervous system depressants, calming anxiety and panic, and helping people sleep. They also slow down heart rate and blood pressure, and reduce body temperature and respiration, creating calm and relaxed feelings. Commonly prescribed benzos include:

• Xanax
• Valium
• Klonopin
• Ativan
• Librium

Benzodiazepine withdrawal, like opioid withdrawal, is not generally life-threatening. Medically assisted detox can help manage the primarily psychological side effects that include insomnia, a return of anxiety or panic symptoms, and depression. Sometimes benzodiazepine abusers report a protracted withdrawal syndrome that can continue for as long as six months.

Benzodiazepine medications work on the gamma-aminobutyric acid, or GABA, receptors in the brain and increase feelings of pleasure while decreasing your “fight or flight” response. Over time, you can develop a tolerance and dependency to these pharmaceuticals even when taking them as directed. Medical professionals recommend slowly lowering your dosage overtime during medically-assisted detox in order to avoid difficult withdrawal side effects.

Xanax and Ativan are short-acting benzos that may be substituted for longer-acting ones such as Valium or Librium during medically managed detox in order to smooth out potential side effects.

Alcohol

While opioids and benzodiazepine drugs may not be life-threatening during withdrawal, suddenly stopping alcohol consumption if someone has a severe alcohol dependency can be fatal. Alcohol is a central nervous system depressant that is commonly abused due to the release of dopamine, or pleasure cells, drinking can create.

In 2013, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimated that as many as 16.6 million Americans aged 18 or older suffered from an alcohol use disorder. The majority of American adults, 86.8 percent, also reported drinking alcohol at some point in their lifetime, and 24.6 percent admit to binge, or excessive, drinking in the month prior to the 2013 survey, the NIAAA further reports.

Heavy episodes of drinking usually result in some form of withdrawal symptoms within eight hours of the last drink. Most adults can relate to these hangover symptoms that may include nausea, drowsiness, fatigue, vomiting, dehydration, mental fog, headache, insomnia, rapid heart rate, sweating, short-term memory lapses, and muscle aches. Regular drinkers who have an alcohol use disorder will also experience emotional side effects during withdrawal, such as depression, anxiety, irritability, mood swings, trouble concentrating, nightmares, and jumpiness.

A more serious and potentially life-threatening alcohol withdrawal is called delirium tremens, or DTs, and symptoms are:

• Fever
• Agitation
• Hallucinations
• Confusion
• Seizures

DTs is a severe form of alcohol withdrawal that, according to the Annals of General Psychiatry, affects between 5 and 24 percent of those battling an alcohol use disorder. In order to avoid alcohol withdrawal side effects and combat cravings, medically assisted detox is often necessary.

Benzodiazepine medications are commonly used during alcohol detox in order to prevent seizures and stabilize moods. Vitamin and mineral supplements may also be helpful in replacing nutrients that may be displaced by alcohol. Other adjunct medications, such as beta-blockers, may be used during alcohol withdrawal and should be monitored by a medical professional during medically assisted detox.

The safest and generally most successful detox process is performed by highly trained medical professionals in a specialized facility after a comprehensive assessment has been done indicating the best method or medication to use during treatment. Each person will respond to treatment in an individual way, and medications should be tailored to each person’s specific needs. The duration of detox will depend on the level of dependency as well as personal and physiological factors.

Medically assisted detox can help you or your loved one reach a safe physical balance and should be followed with psychotherapy and counseling sessions in order to address the emotional aspects of addiction and the causes behind it.

The Recovery Village specializes in alcohol addiction treatment, and our state-of-the-art facilities and services ensure that you or your loved one will receive the highest possible quality of care in a confidential and comforting environment. Contact an admissions counselor today for more information.