The Drug Abuse Warning Network, a division of Substance Abuse and Mental Health Services Administration, conducted a survey in 2009 that showed that approximately 4.5 million people made emergency department visits that were related to drug usage. Of those visits, a total of 205,407 people made drug-related emergency department visits seeking detoxification or substance abuse treatments. Medical detoxification, or detox, is used to get a person off an addictive substance.
Medical detox is the process of safely and systematically withdrawing a person from addicting drugs (or substances), typically under the supervision of a physician or medical professional. Because addictive substances have the ability to cause physical dependency if taken for a long period of time, users can experience withdrawal symptoms when they stop taking the drug or lower their dosage. The detox process is intended to treat the immediate physical effects of ending substance use, helping individuals make it safely through the detox process so they can proceed to the bulk of addiction treatment.
According to the National Institute on Drug Abuse, detox is typically the first step in a drug addiction treatment program.
It allows the body to purge itself of all toxins in the body while also managing the symptoms the individual may be experiencing due to withdrawal. In some cases, managed medication is administered to assist in the detox process and lessen the effects of withdrawal. The type of medication administered depends on the type of substance the user is detoxing from. Certain substances of abuse have medications that are approved for use in addiction treatment; in other instances, medications may be used to address specific withdrawal symptoms.
Types of Detox Medications
According to Ceida, there are three main classifications of drugs: depressants, including alcohol; stimulants; and hallucinogens, with each category causing different physical effects. Medications typically used during detox are detailed below according to each drug classification.
Depressants and Opiates/Opioids
- Buprenorphine: According to Substance Abuse and Mental Health Services Administration, buprenorphine is used assist in detox from opiates, such as heroine and prescription painkillers. This medication can be administered in qualified and approved settings, including doctors’ offices, correctional facilities, and community hospitals. Buprenorphine is only a part of a treatment plan and should be taken in association with counseling and other treatment types.
Buprenorphine is designed to reduce consumption of opiates, lessen the physical need for opiates, and reduce withdrawal side effects and cravings. The medication gives the user a similar feeling of wellbeing as heroin and prescription painkillers do, but the feeling is significantly less intense.
Buprenorphine does have side effects the user might experience, such as difficulty sleeping, fever, nausea and other digestive problems, muscle cramps and aches, and feelings of irritability or distress.
- Naloxone: Naloxone is commonly used to reverse opiate overdose. It is also often used in conjunction with buprenorphine or with other medications after detox in order to prevent relapse. The medication essentially blocks opiate receptors sites, so if a person takes heroin or another opiate of abuse, the drug will have no effect. If a person is experiencing overdose, naloxone essentially bumps the opiate in question off receptor sites, essentially reversing the overdose. Naloxone’s half-life is shorter than the half-lives of heroin and prescription painkillers, however, so overdose can occur again if additional medical treatment is not sought.Buprenorphine and naloxone are combined in the brand name medication Suboxone, and the presence of naloxone discourages users from attempting to abuse Suboxone since such abuse will bring no pleasurable effects.
Side effects of naloxone include dizziness, body aches, weakness, irritability, nervousness, digestive problems, fever, runny nose or sneezing not related to a cold, chills, and goosebumps.
- Methadone: Methadone has a long history in treating addictions to substances like heroin and narcotic painkillers. It is considered effective and safe if taken as prescribed. For most effective results, it is recommended to partner methadone use with a comprehensive medication-assisted treatment program that includes social support and therapy.
Methadone makes pain-related symptoms more bearable while also blocking the euphoric effects normally associated with opiates. It can be administered in liquid, wafer, or pill form, and it is generally taken once or twice per day. Many states require that patients visit methadone clinics on a daily basis in order to get their doses since the drug does have abuse potential.
Since methadone has the potential to be addictive, it is vital to use it only as prescribed. It also should not be taken with alcohol, or when driving or operating machinery. Methadone has potential side effects, including chest pain, increased heartbeat, hallucinations, difficulty breathing, confusion, and rash or hives on the face or throat. It is safe for pregnant or nursing mothers to take when properly administered.
- Lorazepam:– According to an article in the Industrial Psychiatry Journal, Lorazepam is used in alcohol detox to lessen some of the associated withdrawal symptoms. As a result of alcohol detox, people can experience various medical issues, including seizures. Lorazepam helps reduce the risk of continual seizures, thereby increasing the likelihood that people remain safe throughout alcohol detox.
- Naltrexone:– According to Mayo Clinic, naltrexone is used in alcohol detox, and it can also help those in recovery from narcotic addictions. The main function of naltrexone is to block the effects produced by narcotics or alcohol, especially stopping the “high” feeling associated with use.
A side effect of naltrexone is it will cause withdrawal symptoms in those who suffer from physical dependency on narcotics and should be used once a user is no longer dependent on the substance of abuse. A user must cease narcotic usage for at least 7-10 days prior to using naltrexone.
There are a number of different medications that naltrexone should not be mixed with, including methadone, opium, oxycodone, codeine, and buprenorphine. It can also negatively affect those suffering from other medical conditions, such as depression, kidney disease, liver disease, or mental illness. Any co-occurring medical or mental health issues should be assessed by a medical professional prior to prescribing this medication.
- Acamprosate: According to the National Institutes of Health, acamprosate is a medication used to assist in alcohol detox. It is to be used along with counseling and social support as part of a comprehensive treatment program since it does not constitute addiction treatment on its own. Acamprosate helps the brains of people who have longtime abuse or addiction issues related to alcohol return to how they were prior to alcohol abuse. Even though the medication can help in the detox process, it does not prevent any withdrawal symptoms that are associated with discontinuing alcohol use.
The medication is available in a delayed-release tablet form and should be taken three times a day with or without food. It is recommended to take at mealtimes to make it more convenient for the patient.
- Disulfiram: Disulfiram is a medication used to treat alcoholism, and its use should be partnered with psychotherapy and other support services. It is designed to interfere with how the body breaks down alcohol, and it will produce negative and unpleasant effects if combined with alcohol, thereby lessening the individual’s desire to drink.
According to National Institute on Drug Abuse, no medication has yet been approved to assist in detoxification from stimulants. Behavioral therapies are recommended for users to assist in the detox process. It is also recommended to taper drug dosages to potentially lessen withdrawal symptoms. In medical detox, medications may be prescribed to treat specific withdrawal symptoms, such as antidepressants or sleep aids.
There currently are no government-approved medications to treat hallucinogen addiction. According to the Substance Abuse and Mental Health Services Association, the most effective pharmacological treatments for hallucinogen detox are antidepressants and antipsychotics, as both can help to stabilize patients as the drugs process out of the body.
Common Withdrawal Symptoms
According to American Family Physician, the following are some of the most common withdrawal symptoms associated with different types of drugs or substances:
- Alcohol: panic, anxiety, paranoia, hallucinations, delusions, illusions, hyperarousal, restlessness, elevated blood pressure, dilated pupils, disorientation, clouded consciousness, agitation, and tremors
- Stimulants: depression, suicidal thoughts or behavior, paranoia, anhedonia, social withdrawal, hypersomnia, psychomotor retardation, and increased appetite
- Opiates: muscle cramping, anxiety, digestive problems, strong urges for drugs, elevated pulse and blood pressure, dilated pupils, excessive mucus and runny nose, insomnia, excessive tear secretion, and piloerection
Some of these withdrawal symptoms can be treated with other medications to make the process more comfortable.
Medications Used in Conjunction with Detox
According to Harvard Medical School, depression is caused by a chemical imbalance in the body. It is possible for depression to stem from stressful life events, medication, and medical problems. Drugs can affect neurotransmitter production, and the user may develop depression. Because of this, antidepressants might be necessary during the recovery process. According to the National Institutes of Health, desipramine is one example of an antidepressant medication used along with other types of treatment in addiction treatment. The main functions of desipramine are to provide mental balance and combat the symptoms of depression.
A common symptom of substance withdrawal is anxiety. In some instances, it is appropriate to use an anti-anxiety medication during detox. Clonazepam is a medication used to treat anxiety disorders in general, and it can also be used during detox. It is used to calm users suffering from panic attacks and other anxiety-related symptoms. Some of the physical and emotional symptoms clonazepam treats include shortness of breath, headaches, pounding heartbeat, twitching, digestive problems, sleep problems/fatigue, and numbness or tingling caused by anxiety.
According to National Institutes of Health, diazepam can also be used to cope with anxiety-related withdrawal symptoms caused by alcohol abuse or addiction. It should be taken 1-4 times a day with or without food. It can be habit-forming so it should not be taken in any dose larger than prescribed. Diazepam can also help with muscle spasms and seizures related to alcohol withdrawal.
According to Mayo Clinic, benzodiazepines are sometimes also used for short-term anxiety relief. Benzodiazepines are sedatives and only used in limited circumstances, as they can lead to physical and psychological dependency. They should be carefully monitored and only used for a short period of time due to their addictive potential.
Anti-nausea medications can be taken to assist with digestive problems associated with withdrawal. Over-the-counter medication like meclizine or loperamide, may help with any digestive-related issues due to opiate withdrawal and make people more comfortable during detox.
According to the National Institute on Drug Abuse, detox should not be a singular treatment method; it should be followed with behavioral-based therapy and, if appropriate, other medications to assist in the recovery process. Detox alone will not effectively address addiction issues. Because withdrawal can cause long-lasting effects, such as dysphoria or depression, it is vital that people seek support and additional forms of treatment after detox. It is also important to understand that treating withdrawal is not the same as treating addiction or abuse.
It is important for users who are following a medication-assisted treatment (MAT) plan to work with a medical professional throughout the entire process. MAT is designed to take a “whole person” approach to treating substance addiction or abuse. A balance of medication, therapy, and other forms of support can help a person in recovery remain sober for the long-term.