Around 2.5 million people ages 12 and older in the United States battled opioid addiction in 2015, the American Society of Addiction Medicine (ASAM) publishes. Opioid withdrawal can be intense, and individuals may be hesitant to enter into a long-term treatment program as recommended by the National Institute on Drug Abuse (NIDA,) which states that ideally an addiction treatment program should last at least 90 days. In answer to this issue, the idea of rapid detox, or ultra rapid detox, was introduced over 25 years ago.
ASAM recommends against rapid opioid detox, warning that the possible benefits (which are currently unclear) do not outweigh the risks, and it should therefore be avoided. Rapid detox can be potentially dangerous and even life-threatening, as the Centers for Disease Control and Prevention (CDC) reports on several fatalities that were a result of this method of opiate detox.
Withdrawal symptoms may still occur after rapid detox is completed. It’s never recommended to stop opioids “cold turkey,” or suddenly, once a person is dependent on them because of the difficult withdrawal syndrome that begins after the drugs process out of the body. Opioid drugs flood the brain with dopamine, a neurotransmitter that is related to emotional regulation, movement, memory and learning functions, and the way a person processes pleasure and reward. With regular use of these drugs, the brain expects their disruption and no longer produces and absorbs dopamine at normal rates. Then, when the drug wears off, withdrawal symptoms often appear.
Physically, opioid withdrawal is like a particularly intense case of the flu, as heart, blood pressure, and respiration rates are elevated, body temperature spikes, and chills are interspersed with sweats. Nausea and vomiting, diarrhea, headache, dizziness, yawning, runny nose, watery eyes, muscle aches, and joint and back pain are common. Depression, restlessness, insomnia, anxiety, irritability, trouble thinking clearly, and focusing difficulties are also symptoms of opioid withdrawal. While rapid detox attempts to bypass all of these side effects by inducing them while a person is under anesthesia, it is an expensive procedure that comes with many risks.
It is also merely a method of trying to force opioids out of the body, and it does not address any of the social, behavioral, or emotional issues that result from opioid abuse and addiction. Relapse and potential overdose are real concerns of this method of detox since these issues aren’t addressed.
Detox should always be viewed as part of an overall addiction treatment program and not as a standalone method of care. Rapid detox is not a “cure” for opioid addiction. Instead, it may offer false hope for a “quick fix” that will likely not be effective. Instead, a medical detox program followed by a complete addiction treatment plan can help to sustain long-term recovery and reduce instances of relapse.
Detox may be performed on an outpatient or inpatient basis, and for opioid drugs, in general, a medical detox program is considered ideal. Medical detox programs are usually offered as residential programs that provide around-the-clock medical care and supervision for an average of 5-7 days. During this time, vital signs are continually monitored, and medical needs are addressed.
Medications are also often dispensed. For opioid detox, instead of stopping the opioid drug suddenly, opioids are often slowly tapered off to avoid the shock of sudden withdrawal. Shorter-acting opioids (like heroin) may be replaced with methadone or buprenorphine, which are both longer-acting opioid drugs. Buprenorphine is also a partial opioid agonist as opposed to a full agonist, which means that it doesn’t produce the same “high” even if a person attempts to abuse it. After a certain level of the drug is present in the bloodstream, it stops working, reaching a plateau of effectiveness. This works as a deterrent for abuse.
Buprenorphine is also commonly combined with a dormant dose of the antagonist drug naloxone. With buprenorphine combination products, the antagonist component doesn’t activate unless the medication is altered for abuse, serving as another layer of abuse deterrence.
Medical detox also often uses other medications to work on specific symptoms of withdrawal, such as sleep aids for insomnia, mood stabilizers for depression, non-steroidal analgesics for pain, and clonidine for sympathetic nervous system irregularities.
A detox program also provides supportive care and encouragement as well as a safe place to allow the drug to process out of the body. Individuals can then be transitioned into an addiction treatment program directly following detox where they can receive education, life skills training, and tools to avoid relapse. Behavioral therapies, support groups, and counseling sessions further help to promote recovery, as do holistic and adjunctive measures, such as massage therapy, nutrition planning, yoga, mindfulness meditation, art therapy, exercise programs, and more.
A detailed medical and mental health evaluation upon admission to treatment can determine if there are any co-occurring disorders that will require integrated and simultaneous care. Addiction is a brain disease, and the whole person needs to be cared for to promote sustained recovery and an improved overall quality of life.