Opioid Detoxification

What is opioid detoxification?

Opioid detoxification is the process in which an opioid-addicted individual withdraws from the opioid drug(s). Detoxification is usually done in a controlled way and is medically supervised, often under the care of a physician. There are different types of opioid detoxification, including medical detoxification (inpatient or outpatient), rapid detoxification, and detoxification with the use of an opioid such as methadone. Some individuals may choose not to use medical assistance and instead detoxify at home, with or without the use of over-the-counter medications to treat withdrawal symptoms.

By itself, opioid detoxification is not a solution to opioid addiction, as most addicts will eventually begin using opioids again unless they get further help. In a 2010 study looking a opioid-dependent patients admitted to an inpatient detoxification, 91% of patients were found to have relapsed after the detox, with 59% relapsing within one week of the detoxification.^[1] Another study looking at success of opioid-dependent patients after an inpatient detoxification found that after 6 months, 50% of patients were physically dependent on an opioid again.^[2]

Detoxification Process

The opioid detoxification process varies with the method being used and an individual's opioid use history. The intensity and duration of the withdrawal also depend on the opioid that an individual is addicted to. No single approach to detoxification is guaranteed to work the best for every individual.

Medical detoxification is a supervised detoxification that is usually done in a hospital or residential treatment center that has a detoxification unit. A medical detoxification done in a hospital or treatment center is also called an inpatient detoxification. Individuals who enter an inpatient detox have usually been using opioids heavily for a longer period of time and they are more likely to have more intense withdrawal symptoms. Those with other significant health problems on top of their opioid addiction may also choose to do an inpatient detox.

Inpatient detoxification allows for the patient to be continuously monitored throughout the withdrawal process and given medication to treat withdrawal symptoms. A drug such as methadone or buprenorphine is commonly administered in gradually decreasing doses over the course of several days. Other medications may be administered as needed to treat withdrawal symptoms such as nausea, diarrhea, and insomnia. Clonidine, an anti-hypertensive drug, is also sometimes added to both shorten the duration of withdrawal and to relieve physical symptoms.

An outpatient medical detoxification may also be done, usually with individuals experiencing mild to moderate withdrawal symptoms. Outpatient detoxification is the same as an inpatient detoxification, other than the fact that it's done at home rather than in a clinical setting where the patient is monitored by medical staff. The same medications that are used for inpatient detoxification can be prescribed to individuals in an outpatient detox.

Rapid detoxification, also known as anesthesia-assisted rapid opioid detoxification (AAROD), is a method of opioid detoxification where the patient is given doses of an opioid antagonist (e.g. naltrexone) to precipitate withdrawal while under anesthesia. Rapid opioid detoxification is usually done under the supervision of an anesthesiologist, with the acute procedure lasting from 4 to 8 hours. Though anesthesia-assisted detoxification is marketed as a quick and easy way to withdraw from opioids without having to experience painful withdrawal symptoms, studies have patients commonly experience withdrawal symptoms after awaking from anesthesia, with no difference in withdrawal severity or duration.^[3][4]

Tapering

Tapering is also a common method used in opioid detoxification. Tapering is the process of gradually reducing one's dose over a period of time and can be performed as part of a medical opioid detoxification or by an individual on their own. The rate at which dosages are decreased varies, with the goal of tapering being to lessen to severity of withdrawal symptoms. In medical detoxes, patients are often switched to a dose of either methadone or buprenorphine, and then the dose is tapered over a period of several days. The length of the taper depends on the protocol at the hospital or treatment center where the detox is being performed. There are short detoxes where the patient is tapered off of an opioid over 5 or 7 days, and longer detoxes that can last 21 days or more.

Self-tapering at home can be done with an individual's opioid of choice, though users often switch to a short-acting opiate like Self-tapering at home can be done with an individual's opioid of choice, though users often switch to a short-acting opiate like for the course of the taper. Doing a self-taper has the advantage of being able to choose how much to reduce the dose and the time between dose reductions. Some individuals may choose to taper slowly over a period of several months to ensure minimal discomfort from withdrawal symptoms. The disadvantage to self-tapering is that it may be difficult for addicts to reduce the dose on their own.

After Detoxification

After the process of opioid detoxification, individuals often continue their recovery by attending with treatments such as counseling. Even with continued counseling, most addicts will return to using opioids. Many addicts go through a cycle of detoxing, staying clean for a period of time, and relapsing back into addiction. This cycle often repeat itself several times, with some addicts staying clean for years at a time before relapsing again.

For many opioid addicts, medication-assisted treatment (MAT) such as methadone maintenance is the best treatment for their addiction. At the proper dose, medication-assisted treatment prevents withdrawal symptoms and relieves the need for another opioid drug. This allows the patient to stabilize their life without the stress and chaos associated with active addiction. Many patients on MAT continue their treatment indefinitely and are able live healthy and stable lives, remaining abstinent from other opioid drugs.

1. ^ Smyth BP, Barry J, Keenan E, Ducray K. Lapse and relapse following inpatient treatment of opiate dependence. Irish Medical Journal 2010 Jun; 103(6):176-9. [PubMed]
2. ^ Broers B, Giner F, Dumont P, Mino A. Inpatient opiate detoxification in Geneva: follow-up at 1 and 6 months. Drug and Alcohol Dependence 2000 Feb; 58(1-2):85-92. [PubMed]
3. ^ Arnold-Reed DE, Hulse GK. A comparison of rapid (opioid) detoxification with clonidine-assisted detoxification for heroin-dependent persons. Journal of Opioid Management 2005 Mar-Apr; 1(1):17-23. [PubMed]
4. ^ Collins ED, Kleber HD, Whittington RA, Heitler NE. Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial. JAMA 2005 Aug; 294(8):903-13. [PubMed] [PDF]

Related Pages

• Opioid Withdrawal

  Opioid withdrawal refers to the symptoms that can occur after stopping or reducing intake of opioid drugs in opioid-dependent persons. Find out what the symptoms of withdrawal are and how long they last.

• Anesthesia-Assisted Opioid Detoxification

  What is anesthesia-assisted rapid opioid detoxification (AAROD), also called ultra rapid opioid detoxification (UROD)? Is it really the quick, withdrawal-free method of detoxification it is advertised as?

• Methadone Maintenance

  Methadone Maintenance Treatment (MMT) has been proven to be a safe and effective treatment for opioid dependence and addiction. Read about the history of methadone and how a methadone treatment program works.

• Buprenorphine Treatment

  What is buprenorphine (Suboxone, Subutex)? How does buprenorphine treat opioid addiction? Why is buprenorphine combined with naloxone? Learn about buprenorphine treatment, a relatively new method of medication-assisted treatment.