Opiate Withdrawal and Detox

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Opiate addiction is a worldwide disease of epidemic proportion. It affects people of every nation, ethnicity, culture, and socioeconomic status. Recently, the American Society of Addiction Medicine released its annual report that listed some staggering statistics, illustrating the pervasiveness of opiate addiction:

  • 9 million* Americans abuse or are addicted to prescription opiates
  • 75% of those addicted to prescription opiates will make the switch to heroin during the course of their addiction.
  • 517,000 Americans are addicted to heroin
  • 17,000* Americans die annually from prescription opiate overdose
  • 46 deaths each day
  • 2 deaths every hour
  • At the height of the opiate addiction epidemic, in 2013, over 100 Americans died of opiate overdose every day.

Most addiction specialists define opiate addiction as a chronic, relapsing, progressive brain disease, characterized by compulsive drug seeking and drug use, despite negative and harmful consequences. As users develop tolerance to the drug, the physical condition of the user deteriorates. Over time, the user’s body and brain adapt to the presence of the drug; abstaining from using leads to uncomfortable physical and psychological withdrawal symptoms. There are two phases of withdrawal: acute and post-acute. Acute withdrawal symptoms typically begin 24-36 hours; symptoms last approximately 1-2 weeks

Symptoms of Acute Opiate Withdrawal:

  • Extreme anxiety, agitation
  • Tremors, muscle spasms, cramps, aches
  • Hot-and-cold flashes
  • Profuse sweating
  • Nausea, Vomiting, Diarrhea
  • Yawning
  • Flu-like symptoms, including running nose, watery eyes
  • Abdominal cramping
  • Low energy, lethargy, loss of motivation

It is important to remember that acute-withdrawal symptoms, although non-fatal, can lead to life-threatening complications, Opiate Withdrawal and Detox Opiate addiction is a worldwide disease of epidemic proportion. It affects people of every nation, ethnicity, culture, and socioeconomic status. Recently, the American Society of Addiction Medicine released its annual report that listed some staggering statistics, illustrating the pervasiveness of opiate addiction:especially if the user is in a compromised state of health. A frequent complication encountered by individuals attempting to detox by themselves is dehydration; in severe cases of dehydration, electrolyte imbalances can cause delirium, hallucinations, and if left untreated, possible death. For this reason, detoxification should be done in an addiction treatment center when possible. There are many methods of detoxification available in modern treatment facilities; some offer radical, accelerated detox and many offer gradual detox with opiate replacement therapy as an adjunct treatment. The goal of detox is to remove all traces of the opiate and residual toxins from the body, thereby returning the body to its natural, balanced state.

Detoxification Methods

  • Accelerated Medical Detoxification
Accelerated medical detoxification is a radical method of detox. The patient is asleep during the process, under general anesthesia, and administered opiate blockers, such as naltrexone and nalmephine and symptom management medications intravenously. Medications include hypertensives, anti-nausea, and muscle relaxers. The body can be detoxed of all opiates and residual toxins in as little as 30 minutes; the patient is discharged within 48 hours. This method has serious risk factors and is rather controversial. It is beneficial to people who suffer severe withdrawal symptoms and have repeatedly failed at other detoxification attempts.

  • Stepped Rapid Detoxification
Similar to accelerated medical detox processes, stepped rapid detox is done in a medical clinic or hospital with specialized doctors and nurses. The patient is given subcutaneous opiate blockers every hour, for 2-4 hours, bringing on rapid withdrawal effects.  The patient is also given buprenorphine tablets under the tongue, which act like Suboxone by blocking significantly reducing the discomfort of the withdrawal symptoms. The patient communicates with the medical staff throughout the process.  

  • Medical Detoxification
Typically done in an inpatient or residential style treatment facility, medical detox is the most common way for opiate addicts to safely detox from opiates. Under medical supervision, the patient is gradually tapered from opiates, given opiate replacement medications, or taken off opiates and given withdrawal management medications. The patient can communicate with staff and staff can monitor the patient’s physical and mental health throughout the process. Most patients are detoxed within 21 days; many are discharged to a long-term treatment facility or outpatient treatment programs to reduce chances of relapse and to help manage post-acute withdrawal.

  • Outpatient Detoxification
Many people with choose to detox from opiates on their own, with the help of a physician and support group, on an outpatient basis. Typically, patients are given an opiate replacement medication, such as methadone or Suboxone; these medications are partial opioids that minimize withdrawal symptoms, but do not provide a “high” or euphoria. The goal of methadone and Suboxone treatment is to gradually taper off over a period of 2-6 weeks; however, due to the post-acute withdrawal symptoms of characteristic of opiate addiction, many people choose to remain on methadone or Suboxone treatment for long periods.

drug-1070943_1920 Opiate addiction is very resistant to treatment because continued use of opiates changes the brain’s neural pathways and cognitive function. Opiates effect on the brain’s limbic system, the area commonly referred to as the “reward center” is long lasting.  When opiates are present in the body, the brain’s limbic system is flooded with dopamine, the neurotransmitter responsible for pleasure and the sense of well-being. Without opiates, an opiate-dependent user experiences dysphoria, a profound state of dissatisfaction and unease, users in this state often describe it as feeling “uncomfortable within one’s skin”. In extreme cases, dysphoria is accompanied by apathy, a lack of emotional response to otherwise pleasurable events. Together, dysphoria and apathy can lead to depression and suicidal thoughts. These psychological symptoms are post-acute withdrawal symptoms of opiate addiction; symptoms can last up from six to twenty-four months after last use.

Symptoms of Post-Acute Opiate Withdrawal:

  • Loss of self-esteem and confidence
  • Insomnia
  • Racing thoughts
  • Depression
  • Apathy
  • Dysphoria
  • Personality changes, frequent mood swings
  • Memory loss
  • Decreased ability to concentrate
  • Decreased ability to manage or cope with stress

For those recovering from opiate addiction, the long-term withdrawal symptoms make relapse a very dangerous possibility. Relapsing after a period of abstinence can be fatal because drug tolerance is significantly reduced by abstinence. Individuals accidentally overdose when they relapse because they often return to using a high dose or amount of drug.

Outpatient treatment and opioid replacement therapies have proven to significantly reduce the rate of relapse and effectively treat the psychosocial factors that play a significant role in chronic opiate addiction. Opiate addiction is a treatable disease and long-term sobriety is a possibility for all people struggling with opiate addiction. The most important step is finding the right treatment and treatment facility for your addiction needs.

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