Detoxification is the process of eliminating a drug user’s physical dependence on a drug. This generally involves abstaining from the drug, either by immediately discontinuing its use or gradually reducing the dosage over time. Detoxification typically causes a range of unpleasant symptoms, which are commonly known as withdrawal symptoms.
Sometimes Drugs Help in Detox
Many detox programs use medication to reduce the severity of the symptoms caused by the withdrawal of some drugs. Some of these medications are also used in maintenance therapy to reduce the craving for the drug. The National Institute on Drug Abuse currently recommends medical detoxification for treating physical dependencies on the following classes of drugs:
What is Medical Detoxification?
Rehabilitation for drug abuse generally consists of medical therapy and behavioral therapy. Medical therapy treats physical dependence and behavioral therapy treats psychological dependence. Healthcare professionals generally must resolve the physical dependency before behavioral therapy can be effective. Relapses are a common occurrence with drug abusers, so they often go through the detoxification phase of rehabilitation multiple times.
Medically-assisted detoxification is an important part of drug rehabilitation, but it’s not an effective treatment by itself. Patients who go through detoxification without further treatment typically return to their previous pattern of abuse. They should therefore view medical detoxification as only the first phase in a comprehensive rehabilitation program.
Opioids are drugs that act on the opioid receptor of the brain. They include naturally-occurring drugs such as morphine and codeine in addition to synthesized drugs like heroin and hydrocodone. The most widely-accepted medical treatments for a dependence on opioids are methadone and buprenorphine, which relieve withdrawal symptoms and the craving for opioids. The amount of time required for the medical detoxification of opioid dependence is highly variable, since it depends on the specific patient and detoxification program.
Methadone is sold under a variety of brand names including the following
Drug rehabilitation clinics in the United States typically begin methadone therapy when the patient is already in withdrawal. Patients usually receive a small cast dose of methadone at first, so they may be observed for unusual effects. The patient will then receive the remaining dosage for the first day, assuming no complications occur from the test dose.
How It Works
The dosage of methadone is then gradually increased each day until it is sufficient to suppress withdrawal symptoms or the dosage reaches the maximum allowed by that rehabilitation facility. A common starting dose for methadone is 30 mg per day, which may be increased by five mg per day until reaching a maximum dosage of at least 80 mg per day. The methadone dosage is then adjusted to stabilize the patient’s clinical picture. A patient who is able to abstain from opioids for a certain period of time is typically allowed to take methadone on an outpatient basis as maintenance therapy. The facility will then reduce the patient’s dose of methadone gradually until the patient is able to completely abstain from opioids.
Buprenorphine is a synthetic opioid commonly used for medical detoxification, and it also has uses in pain relief for individuals who are not opioid abusers. It is commonly sold under brand names such as Suboxone and Subutex. Subutex is typically used for medical detoxification since Suboxone contains naloxone, which can cause withdrawal symptoms. The duration of medical detoxification with buprenorphine is typically seven to 10 days. This estimate assumes the patient isn’t physically dependent upon other types of drugs, which may require additional detoxification.
Patients typically receive a single dose of eight mg buprenorphine on the first day, which can be effective for up to three days. However, rehabilitation facilities usually administer buprenorphine each day to ensure the level of this medication remains high enough to relieve withdrawal symptoms. The dosage may be increased to a maximum of 16 milligrams beginning on the second day and maintained at that level before slowly reducing the dosage. The administration of buprenorphine typically ends as much as two days before the end of the detoxification program.
The primary psychoactive ingredient in tobacco is nicotine. Many products are available that provide nicotine in specific doses, allowing the user to gradually reduce their intake of nicotine overtime. The FDA has also approved two drugs for the medical detoxification of nicotine dependence, including bupropion and varenicline. These two medications have different effects on the brain, although they both reduce the chances of a relapse.
Bupropion is sold under brand names such as Budeprion, Wellbutrin and Zyban. The standard course of treatment with this medication lasts between seven and 12 weeks, although the patient must stop using tobacco around day 10. Patients who use bupropion are twice as likely to abstain from tobacco after three months as those who don’t use smoking-cessation medication. The success rate for patients who use buproion is 50 percent higher than those who do not after one year.
Varenicline is sold under the brand name Chantix in the United States and Champix in other countries. It’s a partial agonist for the nicotine receptor, meaning that vernicline stimulates this receptor more weakly than nicotine does. The standard smoking-cessation program with varenicline is 12 weeks. If the patient has stop smoking at this point, treatment with varenicline may continue for an additional 12 weeks. A randomized controlled trial conducted in 2006 showed that the abstinence rate for varenicline was 23 percent after one year, compared to an abstinence rate of 15 percent for buproprion.
The FDA has approved three medications for alcohol dependence, including acamprosate, naltrexone and disulfiram. Acamprosate primarily reduces the symptoms of long-term alcohol withdrawal, including anxiety, and insomnia. Naltrexone prevents the user from achieving the desired effects of alcohol by blocking the opioid receptors in the brain. Disulfiram causes unpleasant side effects when the user drinks alcohol due to the accumulation of acetaldehyde in the blood stream.
Acamprosate is sold under the brand name Campral, and is used exclusively for treating alcohol dependence. A typical dosage is two tablets taken three times a day, with each tablet containing 333 mg of acamprosate. A 2006 study in Brisbane, Australia showed that the 12-week program with acamprosate resulted in an abstinence rate of about 50 percent with the subjects in the study abstaining from alcohol for approximately 45 days.
Naltrexone is primarily used for alcohol dependence, although it is also used in rare cases of opioid dependence that don’t respond well to treatment with methadone or buprenorphine. The brand names for naltrexone include Depade and Revia, although it’s also marketed under the generic name naltrexone hydrochloride. The standard dose of naltrexone is 50 mg per day on an outpatient basis, which is typically combined with alcohol-counseling sessions. The standard outpatient treatment with naltrexone lasts for 16 weeks.
Disulfiram was first synthesized during the 1920s as a treatment for parasitic infestations, although its effects when combined with alcohol were not discovered until 1948. The current trade names for disulfiram include Antabus and Antabuse. The standard treatment with disulfiram consists of one 500-mg tablet per day for the first one to two weeks, followed by a maintenance dose in the range of 125 mg to 500 mg per day. The abstinence rate of patients who complete a treatment program using disulfiram is above 50 percent.
Treatment is the Answer
Medical detoxification should take place in a drug rehabilitation facility to ensure patients receive the correct dose of medication. An inpatient setting also allows medical personnel to monitor the patient’s withdrawal symptoms during the detoxification period. Some treatment programs may also provide medication for maintenance therapy on an outpatient basis.