Detox may conjure up ideas of juice cleanses and or facial scrubs for some people, but medical detox is no cucumber on the eyes. When you become dependent on a psychoactive drug, withdrawal comes with a range of uncomfortable symptoms, some of which can be medically dangerous.
Medical detox is the process of helping a person through withdrawal with a team of medical professionals and any necessary medications. People in detox are in the highest level of care available in addiction treatment with, according to the American Society of Addiction Medicine, 24-7 medical management and monitoring.
It may seem counterintuitive to use chemical substances during the process in which you are trying to remove chemical substances from your body. However, with medical supervision, certain medications can be a helpful tool in the detox process. Withdrawal symptoms you experience in detox depend on the drug you become dependent on, the existence of other medical or mental disorders, and how long you were in active addiction.
Some symptoms can be extremely uncomfortable, whether they are felt physically or emotionally. Withdrawal can cause anxiety and depression, muscle aches, and nausea, all of which can sometimes be mitigated by medications.
In some cases, it can be dangerous to quit certain drugs abruptly. Central nervous system depressants dull the activity of your nerves. When they are suddenly stopped, your nervous system can go into overdrive. This reaction can cause dangerous symptoms like panic, seizures, delirium, and catatonia. In such cases, it may be necessary to use medications to wean you off the drug.
Medications can also be used to ease specific symptoms that are typical of certain types of withdrawal. For instance, nausea is common in opioid withdrawal, so you may be given medicine to counteract an upset stomach, vomiting, or diarrhea.
Addiction withdrawal is often an uncomfortable process, but you don’t have to go through it alone. Medical detox is centered on helping you safeguard your sobriety and making the process of becoming free from drugs as painless as possible.
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Various medications and pharmacotherapies approved by the U.S. Food and Drug Administration are used to treat withdrawal symptoms. Everything from Tylenol to opioids is used to treat addiction and its symptoms. Sometimes medications are used to address the effects of addiction itself, while others are used to mitigate symptoms of withdrawal.
Different medications can be used to treat different forms of addiction and withdrawal. The proper medications often depend on the specific set of symptoms you encounter. However, some symptoms like insomnia, headaches, and nausea are fairly common. They can be treated with mild medications like anti-inflammatories, mild sedatives, Imodium, and other common symptom relievers.
Below are common symptoms of drug withdrawal that are treated in detox and the medications used for each.
Opioids are the driving force behind the United States’ current addiction epidemic. Substance withdrawal can come with uncomfortable symptoms, including:
Opioid withdrawal symptoms are often compared to the flu because they share similar symptoms. While symptoms can be all but unbearable, withdrawal is not thought to be life-threatening. However, in some cases, medical complications can lead to life-threatening medical situations.
For instance, sweating, vomiting, and diarrhea can lead to dehydration. If you are on your own when this occurs, it can be deadly.
Methadone is a long-acting opioid that’s often used to treat opioid addiction. It is sometimes used to wean users off opioid addiction in a treatment called methadone tapering. The drug has a half-life of 15 to 55 hours, which gives it a much longer duration of action than other opioids like heroin. This allows detox patients to experience relief from cravings and withdrawal symptoms for up to two days. In detox, administration of the drug is strictly regulated.
More commonly, methadone is used as a maintenance drug, which is when harmful illicit drugs are replaced with regulated alternatives without the goal of achieving complete abstinence. This type of treatment is controversial.
Methadone itself can cause intense withdrawal symptoms that include flu-like symptoms of other opioids as well as tachycardia, hyperventilation, tremors, and hypertension. Because of this, weaning is done very carefully, and the drug is used as a last resort.
Buprenorphine is another opioid that is sometimes used to treat opioid addiction. Unlike morphine and heroin, buprenorphine is only a partial agonist of the opioid receptor. That means it doesn’t produce as profound effects as other full-agonist opioids. It doesn’t cause the euphoric sensations that prescription opioids do.
Instead, it staves off withdrawal symptoms, including drug cravings for up to 24 hours. However, like methadone, buprenorphine can be addictive, causing withdrawal symptoms of its own.
Suboxone is a medication that combines buprenorphine with naloxone, an opioid antagonist that can reverse opioid overdoses. Naloxone can bind to opioid receptors and block its activation and its effects. When a person who’s using an opioid takes naloxone, it will kick the opioids off their receptors and block them, stopping intoxication and overdose dead in its tracks.
People who are opioid-dependent take Suboxone. It’s placed under the tongue and absorbed in the mouth. The buprenorphine becomes active, staving off withdrawal symptoms and cravings, but the Suboxone can’t make it to the bloodstream through the mouth. So, it remains inactive.
The naloxone comes into play if someone tries to abuse the drug by taking it in a way that would make the buprenorphine more potent. If the drug is injected, the naloxone will kick in and prevent a high, also causing withdrawal symptoms.
Naltrexone is an opioid receptor antagonist that blocks the binding of opioids and stops them from affecting the body. As an antagonist, it binds to opioids but doesn’t activate them. Naltrexone is commonly used to treat overdose, and it can even be purchased over the counter in some states.
As an addiction treatment, it is used to stop the euphoric effects of opioids, and theoretically, this is said to gradually reduce cravings. However, if addiction has its roots in unresolved mental or emotional issues, this may just redirect the problem to another unhealthy addictive behavior. Plus, naltrexone should only be used as a therapy after medical detox because the drug can actually send opioid users into immediate withdrawal.
Where opioid addiction is concerned, medications should not take the place of treatment. If used, they should be used with behavioral therapies and other interventions that get to the root of the problem. In detox, symptoms can be managed without the use of other opioids.
Central nervous system depressants like alcohol, benzodiazepines, and barbiturates come with some of the most dangerous withdrawal symptoms.
When you become dependent on alcohol or other depressants, your brain has gotten used to the increased activity of gamma-Aminobutyric acid (GABA), an inhibitory chemical that lowers the excitability of the nervous system.
Your brain may start to increase the production of excitatory effects to counteract these effects and return brain chemistry to normal.
When you abruptly stop drinking alcohol or taking benzos, GABA effects are also abruptly stopped.
The chemicals in your brain that counteract the effects of depressants continue to work, sending your nervous system into overdrive.
This causes withdrawal symptoms like:
Benzodiazepines are often used to wean people off alcohol or other benzos. This helps to avoid serious withdrawal symptoms by helping your brain chemistry slowly return to normal levels. However, the therapeutic use of benzos needs to be carefully administered by a medical professional. This kind of treatment should also be accompanied with or followed up with counseling or behavior therapy.
Acamprosate is a medication used to treat alcohol withdrawal symptoms during detox. It works on the same GABA receptors that are affected by alcohol and benzodiazepines. However, the exact method by which the chemical helps to balance brain chemistry is not fully understood.
Generally, it is thought to modulate the GABA receptor and agonize the NMDA receptor, which plays a role in the functioning of neurons. However, depression and suicidal thoughts are side effects of the drug, so it should be used with caution.
Disulfiram, sold under the brand name Antabuse, is a drug that interferes with the breakdown of alcohol in your system and causes an unpleasant reaction when you drink alcohol. Reactions can include nausea, flushing, and palpitations.
The theory behind this is that the negative effects of drinking alcohol while on disulfiram will rewrite the processing of alcohol in your reward center. However, only highly motivated clients opt to take disulfiram. It’s generally thought to be ineffective because clients and patients rarely choose the drug.
Stimulants have a unique range of symptoms during withdrawal. Generally, they work by flooding the synapses in the brain with dopamine, a feel-good chemical that is largely responsible for the regulation of mood and emotions.
During withdrawal, the majority of the symptoms will be psychological and emotional. Symptoms include:
Since muscle aches and pains are common, most physical symptoms can be treated with anti-inflammatories like ibuprofen. However, psychological symptoms can be extreme. Meth, especially, can limit a person’s ability to feel pleasure by damaging dopamine receptors in the brain. This can result in deep depression and suicidal thoughts. During detox and treatment, these symptoms can be treated with a variety of medications and clinical therapy.
Modafinil is a mild dopamine reuptake inhibitor, which means it works in the brain in a similar way to cocaine, although much less powerful. This can increase wakefulness and treat sleep issues like narcolepsy and hypersomnia. It can help ease some of the symptoms of stimulant withdrawal.
In some cases, stimulant withdrawal can cause serious depression. Stimulants stop the reuptake dopamine, which causes the natural chemical to bind to more dopamine receptors. Some stimulants, like meth, can also increase the amount of dopamine that’s released. This can flood the receptors with dopamine to the point of damaging them.
With fewer working dopamine receptors, you may not be able to feel pleasure from normal, everyday activities. This can cause a condition called anhedonia and deep depression that can sometimes escalate to suicidal thoughts or actions. Medications that can help manage depression in treatment can help in your recovery.
For patients with particularly bad tremors or shaking symptoms, anticonvulsants like vigabatrin and topiramate may be prescribed. They are primarily used to treat epilepsy and seizures, but they can calm down the nervous system in a way that can be helpful in treating some withdrawal symptoms.
If you or a loved one is struggling with addiction or chemical dependency, it’s important to seek medical attention before quitting the drug cold turkey. Since some drugs can cause potentially dangerous physical symptoms, it’s important to speak to a doctor about your particular case before you try to take care of the problem on your own.
Even if you aren’t dependent on a depressant that can be potentially dangerous in withdrawal, detox can still help you avoid other uncomfortable symptoms, and it may help you avoid a relapse.
Addiction is a chronic and progressive disease. It can last a long time, and it may get worse before it gets better. Even when it seems under control, it has a tendency to affect different aspects of your life before you realize it. Addiction can have a negative impact on your health, finances, and personal relationships if it’s not treated early.
Treatment can help prevent these consequences before they occur, or it can help deal with them after they happen. Take the first steps toward recovery from active addiction by learning more about detox medication and the medical detox options you might have.
National Institute on Drug Abuse. (2018, March 6). Prescription CNS Depressants. Retrieved from https://www.drugabuse.gov/publications/drugfacts/prescription-cns-depressants
National Institute on Drug Abuse, (January, 2017). Pharmacotherapies. NIDA. Retrieved April, 2017 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies
Darke, S, (August, 2016).Yes, People Can Die from Opiate Withdrawal. National Drug and Alcohol Research Centre. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/add.13512
SAMHSA. (2019, April 11). Naloxone. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone
SAMHSA. (2019, May 7). Buprenorphine. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine