Avoiding Relapse With Safe Opioid Detoxification
Substance abuse is a serious problem today. When it comes to dangerous opioids, such as heroin, fentanyl and prescription opioids, such as morphine, hydromorphone, oxycodone, and hydrocodone, opioid overdose can be deadly. What is the best way to address this drug abuse crisis? First, we must help patients detox off of opioid addictions. Then, we must offer treatment options that include long-term maintenance and mental health treatment.
Getting past opiate withdrawal.
Opioid abuse can persist for years. One reason for this is the fear of serious withdrawal symptoms. These flu-like symptoms are nothing to take lightly. Many patients with opioid use disorder continue using their opioid of choice, not because they enjoy getting high, but to avoid getting sick. In fact, it is common for opioid users to no longer get high at all from using their drug of choice. They continue to use drugs just to avoid getting sick and to “feel normal”. When an opioid user stops opioid use for a short period of time, withdrawal symptoms begin. These can include nausea, runny nose, chills, muscle aches, and muscle cramps. Opiate withdrawal has been described as a flu-like syndrome times 100. Addiction is already a difficult condition to overcome because of the drug cravings that haunt the drug user long after they have quit drugs. Opioid addiction is especially difficult because of the physical sickness of opiate withdrawal in addition to the drug cravings. Unfortunately, relapse and opioid overdose is all too common. The success rate of traditional addiction treatment is very low.
Addiction Medicine now provides detox with Medication Assisted Treatment.
According to SAMHSA, medication, in addition to mental health therapy, is often the best way to detox off of an opioid or opiate. Medications used in detoxification include methadone, buprenorphine and naltrexone. While traditionally, detox has been thought to be a short-term medical treatment, we now know that detox must be followed by long-term medication-assisted therapy to be effective. When meds such as buprenorphine or naltrexone are stopped too soon, opioid cravings can be a concerning symptom. Cravings put the patient at high risk of relapse and possible overdose. Therefore, long-term detox treatment is superior to short-term detoxification.
In order to begin taking buprenorphine, or a medication that contains buprenorphine, such as Suboxone, Subutex or ZubSolv, the patient must first stop the opiate or opioid that they are currently using. Wether it is heroin, fentanyl, methadone, oxycodone, oxycontin, hydrocodone, hydromorphone or hydromorphine or a combination of opioids, these must be stopped for a significant amount of time before starting buprenorphine. For many short acting opioids, the waiting period is typically 12-24 hours. For long-acting opioids, the wait can be several days. During this waiting time, the patient will experience withdrawal symptoms. Fortunately, there are medications that can make withdrawal more tolerable. Clonidine or lofexidine are non-opioid medications that can reduce opiate withdrawal discomfort by blocking norepinephrine release. These meds are often used as a part of addiction treatment to ease the transition from abusing an opiate or opioid to taking buprenorphine. Gabapentin has also been shown to help with the withdrawal phase of opioid detox treatment. Getting through this brief period of withdrawal is an important part of medical opiate addiction treatment.
After dealing with the opioid withdrawal phase, medication-assisted treatment can be started. The type of treatment partially depends on the length of opioid withdrawal that the patient can tolerate. For example, methadone can be started quickly with little or no withdrawal period. Buprenorphine usually requires around 24 hours after the last opioid use. Naltrexone can require a week or more of abstinence from any opiate or opioid. When treating addiction, the setting of the patient is important. If a patient has been quickly detoxed and is confined to residential, long-term treatment, naltrexone may be an ideal medication to start. This is because the patient will have been clean from opioids for enough time to start naltrexone. Otherwise, buprenorphine tends to be the best option for most patients since the waiting period is only about a day. For patients who have difficulty with buprenorphine treatment, methadone may be the best option. Regardless of which medication is used, it is generally accepted now that detox should last for well over a year and possibly indefinitely. This form of detoxification is maintenance with medication-assisted treatment. It is the best way to treat addiction to an opiate or opioid and to prevent opioid overdose.
Drug abuse and prescription opioids
While we typically think of addiction involving street drugs and opioid addiction being all about heroin and fentanyl injected on the streets with dirty needles, the reality of addiction is that prescription, and even over-the-counter drugs are abused even more than street drugs. Prescription opioids are a serious problem. Abuse of prescription opioids can even lead to the abuse of street opioids, such as heroin. Fortunately, when it comes to opioid addiction and opioid abuse, the same treatment medications and detox protocols can work for addiction to street opiates and prescription opioids alike.
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