Opiate and opioid abuse is a growing national crisis. Many efforts are being made to address it. One of them is improving addiction treatment. Breaking free from substance addiction almost always starts with detox. So detox is a key area of focus.
However, there is no consensus on the ideal detox strategy. For most patients, relapses occur during and after detox. Many who have the resources return to formal treatment to try again.1
Medication-assisted treatment (MAT) employs developed drug(s) as part of the detox and treatment program. These drugs can support behavioral therapies— another major tool in addiction care. MAT is mainly used for treating addiction to opiates (like heroin) and other opioids (pain pills).
While not a treatment per se, detox is a useful first step in a comprehensive, evidence-based program. Treating the “whole person” is vital. If there’s a co-occurring mental illness, integrated care is needed.2
Office‐based treatment of opiate addiction has been unavailable in the U.S. since the early 1900s. So, most doctors today have little or no practice in treating such addictions. Doctors often treat substance related issues (like infectious diseases). Yet, they likely don’t know how to treat the substance use disorder itself.3
Weighing the Various Service Options Available Today
Unlike the care for other toxic drugs, there are many types of detox services for opiate addiction – all under three main categories. Each of these approaches has distinct pros and cons. Yet, they all target the same goal: freedom from addiction.
1. Non-medicated Residential Services
While rarely used today, one detox option involves no medication at all. Since some patients can become dependent on the drug used for detox, this approach may actually result in a quicker transition to drug-free living. The patient simply stops opiate use “cold turkey.” For some, the brief discomfort is worth it.
In this approach, patients may, within a few weeks, be totally free of their physical addiction to opiate. They are then able to move on to behavioral therapy. In that next step, opiate craving and psychological dependence are worked through. Therapy may take the form of individual or group counseling.4
2. Medicated Residential Treatment
While more treatment agents are available for treating opiates than for other abused drugs, none of them are curative. These medications can, however, diminish withdrawal symptoms and cravings. They may also block opiate effects. The FDA has approved several different medications for treating opiate addictions.
Medications used in MAT for opiate addiction are regulated. They can only be dispensed through a Substance Abuse and Mental Health Services Administration-certified opioid treatment program (OTP).5
There are three types of medications commonly used in helping abusers of opiates and other opioids:
- Agonists – These activate opioid receptors.
- Partial agonists – These activate opioid receptors but produce a smaller response.
- Antagonists – These block the opioid receptors and interfere with the reward effects of opioids.6
Methadone, levo-alpha acetyl methadol (LAAM), buprenorphine, buprenorphine with naloxone, and naltrexone are the most commonly used drugs for opiate addiction. This includes those used in the detox phase. These drugs can treat people on short-acting opiates. Heroin, morphine and codeine are examples. They can also treat people on semi-synthetic opioids. These include oxycodone and hydrocodone.7
The right medication for a patient is based on many factors. One of these factors is the patient’s specific needs. MAT medications may, in some cases, be taken for months, years or even a lifetime. Deviating from prescription, however, can be dangerous. Check with the doctor before ending any medication.2
Federal law requires that patients under care in an OTP receive not only medication (if appropriate), but also medical, counseling, vocational, educational and other services.6
Furthermore, since an adequate period of treatment is a strong predictor of lower one- and two-year readmission rates back to formal treatment, residential care shows better long-term results overall than outpatient care.8
3. Medicated Outpatient Treatment
Opiate abusers may find it helpful to begin and maintain abstinence with a brief but intensive outpatient detox involving medication. (Follow-up treatment, likewise, may include a supportive prescription.)
Studies indicate that naltrexone is a highly effective opioid antagonist for this therapy. Patients in clinical trials had a higher abstinence rate with naltrexone than without.
Naltrexone blocks the receptors where opioids bind and exert their effects. If a patient slips and takes an opiate, there’s no euphoric high. It’s like an “insurance policy.” It prevents a single lapse from becoming a full-blown relapse.9
There are other outpatient strategies being used as well. Again, a patient’s specific needs must be considered for giving the best complete care.
Opiate Withdrawal Symptoms Can Vary, Depending on the Drug, Dose, and Duration
Early symptoms of withdrawal include:
Late symptoms of withdrawal include:
While these symptoms can be very uncomfortable, they are not life-threatening. Symptoms usually start fairly soon after stopping use. For heroin, it’s within 12 hours of last use. For methadone, 30 hours after use.10
Integrated, Comprehensive Care Works Best
An effective detox of opiates includes not only medical stabilization, but also cleansing the body of toxins. It prepares the patient for the rehab phase of treatment. A light at the end of the tunnel can be seen.
Successfully linking these treatment phases reduces the “revolving door” phenomenon of repeated relapses and withdrawals. In doing so, time and expense are reduced, as is pain.11
Michael’s House offers world-class opiate and opioid detox and rehab services. Located in Palm Springs, California, we can be reached 24/7. Just call us at 760.548.4032 to learn more about opiates, opioids, addiction, detox, rehab and/or aftercare. We can also treat co-occurring mental issues in a dual diagnosis. Go with a name you can trust. We have provided expert, personalized care to thousands of people just like you.
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1 “Opioid Dependence Treatment: Options in Pharmacotherapy.” National Center for Biotechnology Information, U.S. National Library of Medicine. Web. Accessed 8 July 2017.
2 “Medication and Counseling Treatment.” Substance Abuse and Mental Health Services Administration, 28 September 2015. Web. Accessed 8 July 2017.
3 “Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction.” National Center for Biotechnology Information, U.S. National Library of Medicine. Web. Accessed 8 July 2017.
4 Mcgregor, Sherrie, Ph.D., “Detoxing from Drugs and Alcohol.” PsychCentral.17 May 2016. Web. Accessed 8 July 2017.
5 “Certification of Opioid Treatment Programs (OTPs).” Substance Abuse and Mental Health Services Administration.28 September 2015. Web. Accessed 8 July 2017.
6 “What Are the Treatments for Heroin Addiction?” National Institute on Drug Abuse. November 2014. Web. Accessed 8 July 2017.
7 “Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.” National Center for Biotechnology Information, U.S. National Library of Medicine. Web. Accessed 8 July 2017.
8 “Outcomes of Residential Treatment of Substance Abuse in Hospital- and Community-Based Programs.” National Center for Biotechnology Information, U.S. National Library of Medicine. Web. Accessed 8 July 2017.
9 “Patients Addicted to Opioid Painkillers Achieve Good Results with Outpatient Detoxification.” National Institute on Drug Abuse.11 February 2015. Web. Accessed 8 July 2017.
10 “Opiate and Opioid Withdrawal.” MedlinePlus, U.S. National Library of Medicine. 20 April 2016. Web. Accessed 8 July 2017.
11 “Detoxification and Substance Abuse Treatment.” National Center for Biotechnology Information, U.S. National Library of Medicine. Web. Accessed 8 July 2017.
