Rapid Opioid Detox – Is It for You?

What Are Opioids?

Opioids are prescription medications used to treat moderate-to-severe pain and other conditions, such as diarrhea and coughing. These potent drugs can either come from the opium poppy plant or scientists can make them in a laboratory by using the same chemical structure as the naturally occurring are designed for short-term use because of their addictive nature, found popularity in the 1990s, when chronic pain was treated with stronger drugs, such as OxyContin and Percocet.

This group of drugs, which includes the illegal drug heroin, changes how the brain receives messages about pain. This happens when opioids interact and bind with opioid receptors on the nerve cells in the body and brain. The effects of these drugs make people feel relaxed, happy, and strong states of euphoria in the short-term. But they can also make people sick and cause other problems, including respiratory depression that could lead to coma, permanent injury, or worse, death.

Opioids include pain relievers such as:

• Codeine
• Fentanyl
• Hydrocodone (Vicodin)
• Hydromorphone (Dilaudid)
• Methadone
• Meperidine (Demerol)
• Morphine
• Oxycodone (Percocet or OxyContin)

What Is Rapid Opioid Detoxification?

Rapid opioid detoxification (ROD) is a technique created in the 1980s to help people detoxify from opioid use and shorten the process, which can run seven days to 10 days or longer, depending on the severity of addiction or abuse. ROD involves giving clients an oral opioid antagonist, such as naloxone (Narcan) or naltrexone, to reduce opioid withdrawal symptoms. These antagonists may be given with “moderate sedation orally or ‘conscious sedation,’ intravenously,” according to an archived statement by the Addiction Society of American (ASAM).

There’s also a method called ultra-rapid opioid detoxification (UROD), which involves placing clients under general anesthesia as they receive opioid antagonists intravenously. This procedure, which takes a few hours to complete, triggers an immediate onset of opioid withdrawal symptoms. Because the client is under anesthesia, they likely won’t feel a great deal of discomfort. When they wake up from the procedure, their systems are cleared of the opioid(s) used and they don’t remember of the process that took place.

These procedures typically take place in an intensive care unit in a hospital or a clinical setting. 

Because it is a “rapid” detox, it can take place in a time frame of 24 to 36 hours. Some programs may treat rapid detox clients for 72 hours, or three days.

Other medications also may be given to ease the withdrawal period, which has been compared to the flu because of the similarities in symptoms. Opioid withdrawal is generally not considered life-threatening.

Early Opioid Withdrawal Symptoms (6-12 hours for short-acting opioids; within 30 hours for longer-acting opioids)

• Muscle aches
• Agitation
• Anxiety
• Irritability
• Fast heart rate
• Increased drowsiness/excessive yawning
• High body temperature
• High blood pressure
• Increased tearing
• Insomnia
• Runny nose
• Sweating

Late Opioid Withdrawal Symptoms (These peak within 72 hours and could last up to a week)

• Abdominal cramping
• Diarrhea
• Dilated pupils
• Nausea
• Cramps
• Goosebumps
• Depression
• Cravings
• Vomiting

According to a PatientCare.com article, “The theory behind ROD is that it is easier—and more successful—to detoxify patients from opioids if they are unable to feel any discomfort during the process.”

While opioid withdrawal is characterized by certain symptoms, the timeline for it will vary according to the person. Several factors that should be taken into consideration are:

• Age, sex, health, medical history, and lifestyle
• Person’s weight and body fat percentage
• Duration opioid use
• Opioid consumption and frequency of consumption
• Opioid tolerance
• The manner in which opioids are used (snorted, smoked, injected)
• If opioid use has occurred with other drugs and substances
• Co-occurring disorders

Are There Pros to Doing a Rapid Opioid Detox?

If you or someone you know is considering undergoing a rapid detox for opioid dependence, there are things to consider. In general, rapid opioid detox has drawn its share of concerns among professionals in the medical community. However, there are people who support rapid opioid detox and see the procedure as beneficial in that:

• Clients do not feel pain or discomfort while under general anesthesia.
• It takes place in a clinical setting, such as a hospital, so clients can be monitored 24/7. If any complications arise, clients will be in a place where medical professionals can help them.
• The opioid withdrawal timelines are reduced.
• Counseling and therapy can begin faster after symptoms have subsided.

On the other side of the coin, there are health care professionals who are concerned about the safety of the procedure. Rapid opioid detox raises concerns because:

• There are risks associated with anesthesia. Older adults and those with serious medical conditions are at higher risk of pneumonia, stroke, or heart attack when undergoing surgery.
• It does not address the long-term effects and consequences of opioid addiction, and this process is vital to addiction recovery.
• It makes drug withdrawal too easy because clients skip over the physical painful consequences of opioid abuse. Bypassing this part of the process may not help them make the mental connections they need to resolve not to go back to using.
• Some clients believe after detox that they can forgo further treatment and counseling, a viewpoint that can lead to relapse since the psychological and emotional sides of addiction were not addressed.

Other things to consider is the cost of this procedure, which can be expensive. The cost of anesthesia, as well as the services provided, can come with a hefty price tag. Costs can reach as high as $10,000, and health insurance may not cover these procedures.

Tapering Off Opioids

Other ways to detox from opioid use include tapering clients off opioids by gradually reducing the amount of medication used or using medication-assisted treatment that uses Suboxone to treat opioid addiction. Physicians oversee both methods. They use an opioid taper calculator, called the Morphine Equivalent Dose calculator (MED), to determine how to approach a medical taper for a client coming off opioids. This calculator allows doctors to convert the client’s opioid of choice and the related dosage to morphine, which is used as the baseline.

After that is determined, the physician will decide how much medication to administer during the tapering process. It is advised that short- and long-acting narcotics should be tapered separately, and that tapering short-acting opioids should be done first followed by the long-acting ones.

“We now have several rigorous studies indicating that anesthesia-assisted detox— a costly and risky approach—offers no advantage over other methods,” Dr. Ivan Montoya of NIDA’s Division of Pharmacotherapies and Medical Consequences of Drug Abuse said.

Dr.Montoya notes, “The low retention of patients in subsequent outpatient treatment in the present study, which is not unusual for the opiate-addicted population, highlights the need to engage people in long-term recovery after detoxification.”

Sources

NIDA. (n.d.). Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids

American Society of Addiction Medicine. (2005, April 1) Advocacy. Public Policy Statements. Rapid and Ultra Rapid Opioid Detoxification. Retrieved from https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/rapid-and-ultra-rapid-opioid-detoxification

Centers for Disease Control and Prevention. (n.d.) Drug Overdose. CALCULATING TOTAL DAILY DOSE OF OPIOIDS FOR SAFER DOSAGE. Retrieved from https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf

WebMD. (2019, October 23) Longer Detox for Prescription Pain Med Addiction. Preidt, R. Retrieved from https://www.webmd.com/mental-health/addiction/news/20131023/longer-detox-might-work-better-for-prescription-pain-med-addiction

NIDA. (2006, October 1). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox. Retrieved from https://archives.drugabuse.gov/news-events/nida-notes/2006/10/study-finds-withdrawal-no-easier-ultrarapid-opiate-detox