June 11, 2021
- Individuals who are chronically exposed to opioids develop physical dependence and experience withdrawal symptoms if the daily dose of opioids is reduced or stopped abruptly. Detoxification is a process of removing physiological dependence while managing opioid withdrawal.
- Detoxification alone is not a treatment for OUD and increases an individual’s risk for relapse, overdose and death when not followed with medications for opioid use disorder (MOUD).
- Several medications help to reduce the symptoms of opioid withdrawal during the detoxification process.
- Determining the approach to manage opioid withdrawal for individual patient’s depends upon their plans for treatment.
- The goal must be to maximize the probability of long term treatment engagement and to minimize the impact of OUD on the patient’s health and functioning.
What is Detoxification
Medically supervised withdrawal or “detoxification” is the process of taking a person off an opioid on which he or she is physically dependent. The term detoxification is usually called medically supervised withdrawal management to destigmatize the process. The process can be fast or slow and can be done under a variety of levels of care and supervision. “Detox” works differently in different people and in different treatment plans. When supervised by a physician, medications are available to help make this process both safer and more comfortable.
Is Detoxification Always the Best Thing for People with Opioid Use Disorder?
Although it seems intuitive to start treatment for opioid use disorder with “detoxing” and stopping all opioids, this is not always the best course of action. We know that people who complete a detox soon after stopping using illicit opioids have a very high chance of returning to opioid use. In some studies, more than 90% people who completed detoxification returned to opioid use over the next few months. (1) In most cases, it is therefore important to focus on the long-term plan for treatment with a medication for opioid use disorder and only then to consider how to approach detoxification. The process of “detoxification” commonly utilized in substance use treatment has no clinical utility in the absence of a plan for maintenance treatment and has no evidence for improving outcomes unless serving as a bridge to long term follow up options. “Detoxing” a person off of opioids without clear motivation by the individual to maintain abstinence or without a follow up plan that is likely to maintain sustained abstinence through the use of MAT increases the patient’s risk for overdose and death in the case of any return to use.(2)
What are the Goals of Detoxification?
However, a good detoxification program accomplishes many important goals in a person’s recovery:
- Rid the body of its daily, physical dependence on opioid drugs
- Lessen or relieve the pain of withdrawal
- Address any other medical problems
- Prevent relapse by:
- Providing help during the most difficult parts of withdrawal
- Connecting patients with continued treatments
- Educating patients about their risk of relapse and ways to stay healthy, to help prevent relapse
- Facilitate induction onto medication for opioid use disorder for continued treatment.
What is a Successful Detoxification?
- Detoxification is only the first stage of opioid addiction treatment!
- Few patients can continue to stay completely away from opioids without continued treatment with medications immediately after detox.
- Continued treatment after detox can help a person regain mental and physical health and well-being. Besides helping patients to avoid returning to drug use, continued treatment can assist patients with larger goals of improving employment, healing relationships, and possibly addressing past criminal behavior.
- Because of the high risk for relapse within opioid addiction, detoxification may be needed more than once in a person’s course of treatment.
What are the Different Kinds of Detoxification Programs?
There are many kinds of detoxification programs. Detox programs can occur in inpatient, residential, day, or outpatient settings. Treatment can and should look different for people with different needs, preferences, and personalities. Because medications for opioid use disorder are so important to recovery, programs that discourage or do not offer these medications after detoxification should be avoided.
Opioid withdrawal is generally less medically dangerous than withdrawal from other substances, like sedative-hypnotics or alcohol. However, detoxification can still be very difficult and uncomfortable, and attempting detoxification without medical help often results in relapse. Some patients who can’t complete detoxification on an outpatient basis may be admitted to a medical facility as inpatients to complete withdrawal. Inpatient detoxification is also recommended for patients physically dependent on more than one kind of drug, or for patients with complicated medical issues.
Detoxification in a medical setting is often accompanied by starting patients on medication to lessen withdrawal symptoms and prevent relapse. See later section: “Detoxification and Agonist Maintenance.”
|Outpatient vs. Inpatient Detoxification Programs |
|What is it?||Pros||Cons|
|Outpatient||Patients come to a treatment center for medications, counseling, and medical treatment during detoxification, but still live at home.|
|Inpatient||Patients live in a treatment center during the entire detoxification process, where they receive medical care and counseling.Some inpatient programs do not end after detoxification. In longer-term inpatient programs, patients spend extra time in a medical facility learning about substance abuse disorders, to confront and address the negative effects of addiction in their lives, ways to make lifestyle changes, and coping strategies to prevent relapse.|
|Combination Programs/ Partial Hospitalizations are also available in some areas.|
After Detoxification: What’s Next?
The best addiction treatments include continued treatment after detoxification. A patient should work with his/her doctor to find the kind continuing treatment that is best based on the patient’s needs, safety concerns, and local resources. The patient’s finances, insurance, criminal justice status, past responses to treatments, and any co-occurring psychiatric disorders may also be considered.
Treatment options include both inpatient and outpatient treatment, individual or group therapy, and/or medications. Patients should check with their insurers to find out which treatments are covered, and to locate doctors in their area that provide covered addiction services.
Some inpatient programs do not end after detoxification. In longer-term inpatient programs, patients spend extra time in a medical facility learning about substance abuse disorders, to confront and address the negative effects of addiction in their lives, ways to make lifestyle changes, and coping strategies to prevent relapse.
 Weiss RD, Potter JS, Fiellin DA, Byrne M, Connery HS, Dickinson W, et al. Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Arch Gen Psychiatry. 2011;68(12):1238-46.
 Nunes EV, Shulman M. Commentary on Stein et al. (2020): Whither detoxification in the face of the opioid epidemic? Addiction. 2020;115(1):95-6.
 Polydorou, S., & Kleber, H. D. (2008). Detoxification of Opioids. In M Galanter & H Kleber (Eds.), Textbook of Substance Abuse and Treatment (4th ed.) Arlington, VA: American Psychiatric Publishing.
 Weiss, R. D., Potter, J. S., & Iannucci, R. A. (2008). Inpatient Treatment. In M. Galanter & H. Kleber (Eds.), Textbook of Substance Abuse and Treatment (4th ed.) Arlington, VA: American Psychiatric Publishing.
 Weiss et al. Inpatient Treatment.
 Weiss et al. Inpatient Treatment.
Some examples of these types of drugs are clonidine and propranolol. These medications are often used during detox to help treat the withdrawal symptoms from alcohol, opiates, and benzodiazepines.
- Changes in appetite.
- Changes in mood.
- Chills or shivering.
- Muscle pain.
A tapering plan may be beneficial for patients who have been taking opioid medications multiple times a day for more than two weeks but less than six months: Maintain the same interval between doses and instead cut down the quantity by about 10% to 20% every 3 to 4 days.
- Attend a medical detox program. ...
- Exercise regularly. ...
- Eat balanced and nutritious meals. ...
- Stay hydrated. ...
- Stick to a structured sleep schedule. ...
- Join a support group.
- Limit alcohol. Your liver metabolizes more than 90% of the alcohol you consume ( 3 ). ...
- Focus on sleep. ...
- Drink more water. ...
- Reduce your intake of sugar and processed foods. ...
- Eat antioxidant-rich foods. ...
- Eat foods high in prebiotics. ...
- Decrease your salt intake. ...
- Stay active.
An increase in your blood pressure is another symptom of withdrawal when detoxing from alcohol. This can be very serious. If this symptom is prolonged, seek a professional in the medical field as soon as possible.
Generally, withdrawal symptoms last 3-7 days. But, the exact length depends on the substance being misused and the severity of the misuse. In some cases, it can take days, weeks, or months to rid the body of substance completely.
- Central nervous system depressants, such as alcohol, benzodiazepines, barbiturates, and opioids.
- Central nervous system stimulants, including cocaine and similar drugs, amphetamines, and methamphetamine.
Symptoms can include insomnia, irritability, changing moods, depression, anxiety, aches and pains, cravings, fatigue, hallucinations and nausea. The person may be hot and cold, have goosebumps, or have a runny nose as if they have a cold.
–The longer the duration of previous opioid therapy, the longer the taper may take. Most commonly, tapering will involve dose reduction of 5% to 20% every 4 weeks.
It's generally best to taper slowly. Doctors often recommend tapering about 10% per week or month. Once you get down to the lowest dose, you can then think about taking the opioid less often so there's more time between doses. Once you're taking opioids less than once a day, it should be OK to stop.
Powerful drugs like opiates, heroin, and methamphetamine lead to some of the most severe examples of life-threatening drug withdrawal symptoms. Extreme delusion and hallucinations during the withdrawal may cause a person to hurt themselves or others.
- Muscle aches.
- Increased tearing.
- Runny nose.
While there are many factors that contribute to drug and alcohol addiction, including genetic and environmental influences, socioeconomic status, and preexisting mental health conditions, most professionals within the field of addiction agree that there are four main stages of addiction: experimentation, regular use, ...
- Drink Warm Water With Lemon Juice. ...
- Swap Caffeinated Drinks With Green Tea. ...
- Avoid Packaged Fruit Juices. ...
- Purify Your Body With Water. ...
- Get Adequate Sleep. ...
- Include Probiotics In Your Daily Diet. ...
- Drink Cinnamon Or Fenugreek Tea.
- Drink lots of water. Drink water. Your body flushes out the toxin through stool, sweating and urination, which leads to loss of water. ...
- Make sure your digestive system is healthy. Food rich in fiber. ...
- Keep your liver healthy. Eat broccoli.
Most detoxification programs recommend removing highly processed foods and foods to which some people are sensitive, such as dairy, gluten, eggs, peanuts and red meat.
It's encouraged to drink water throughout the day to stay properly hydrated. Along with helping to lower blood pressure, it can assist in lubricating the body, reducing the risk of conditions like kidney stones and urinary tract infections, and it can help improve brain function.
- Lose extra pounds and watch your waistline. Blood pressure often increases as weight increases. ...
- Exercise regularly. ...
- Eat a healthy diet. ...
- Reduce salt (sodium) in your diet. ...
- Limit alcohol. ...
- Get a good night's sleep. ...
- Reduce stress. ...
- Monitor your blood pressure at home and get regular checkups.
- Take a warm bath or shower. Stay in your shower or bath for at least 15 minutes and enjoy the warm water. ...
- Do a breathing exercise. Take a deep breath from your core, hold your breath for about two seconds, then slowly exhale. ...
Opioid Withdrawal Timeline
Generally: Symptoms start sometime between 8 and 24 hours after you last use the drugs. You feel worst between 48 and 72 hours (2-3 days) after your last use. Symptoms stop sometime between 4 to 10 days after you last used.
When you withdraw something, the item you withdrew is a withdrawal. It's pronounced the same way as withdraw, but with an "l" at the end (with-DRAWL). Like all nouns, withdrawal can be the subject or direct object in a sentence.
Withdrawal syndrome, also known as discontinuation syndrome, occurs in individuals who have developed physiological dependence on a substance and who discontinue or reduce their use of it.
- Clonidine (Catapres, Catapres-TTS) ...
- Propranolol (Inderal) and other blood pressure medications. ...
- Venlafaxine (Effexor, Effexor XR) ...
- Paroxetine (Paxil) ...
- Benzodiazepines. ...
- Topiramate (Topamax) ...
- Gabapentin (Neurontin)
Fatigue. As with anxiety and depression, fatigue is common and normal for people withdrawing from drugs and alcohol.
- Find out about your medication.
- Don't stop suddenly.
- Choose a good time to start.
- Talk to your GP or health care team.
- Make a tapering plan.
- Give yourself time.
- Come off one medication at a time.
- Tell people close to you.
- abdominal cramping.
- goosebumps on the skin.
- nausea and vomiting.
- dilated pupils and possibly blurry vision.
- rapid heart rate.
- high blood pressure.
You might have certain symptoms if you suddenly stop gabapentin: withdrawal symptoms such as agitation, restlessness, anxiety, insomnia, nausea, sweating, or flu-like symptoms. The risks of withdrawal are higher if you're taking high doses or have been on gabapentin for longer than 6 weeks.
When you first quit, you might notice a lot of coughing and phlegm. This is a good sign. Your lungs are trying to clear out the tar and other dirt trapped inside your airways. Help your lungs by allowing yourself to cough and spit this stuff out.
What is foxy? Foxy and foxy methoxy are common names for a synthetic drug with the chemical name 5-methoxy-N, N-diisopropyltryptamine (5-MeO-DIPT). Abused for the hallucinogenic effects it produces, foxy belongs to a class of chemical compounds known as tryptamines.
- Start with lemon water. Start your day by waking up with a glass of warm or cold lemon water. ...
- De-bloat with breakfast. ...
- Clean up your diet. ...
- Have an afternoon tea. ...
- Get moving!
Detox pills and diets can use a variety of substances to "purge" the body of toxins. The laxatives, supplements, and even the "helpful" bacteria used in some of these products can cause severe gastrointestinal issues. Some people on detox diets and cleanses can have problems with diarrhea, nausea, and vomiting.
7 Ways to Detox and Cleanse Your Kidneys Naturally - YouTube