There is no such thing as a one-size-fits-all opioid addiction treatment plan. According to the National Institute on Drug Abuse (NIDA), addiction treatment needs to be tailored to individual needs for it to be effective. Every person is different and brings different underlying causes and consequences to treatment. Each of these needs must be addressed during treatment.
But what about detoxification? The detox process is much less clinical than other levels of care in addiction treatment. Since detox is essentially a physical process, wouldn’t treatment be more standardized?
According to the American Society of Addiction Medicine (ASAM), even detox can be subject to personal effectiveness. It says, “No single treatment approach is effective in all cases. In carefully chosen patient populations, both abstinence-based treatment and opioid agonist maintenance treatment are effective, safe and accepted modalities.”
There have been two main approaches to the first stage of treatment in recent years, including abstinence and maintenance. Abstinence involves discontinuing opioid use and managing symptoms in medical detox programs or a hospital setting. Maintenance programs replace the opioid you abused with a safer opioid medication, allowing you to avoid withdrawal symptoms and cravings before entering treatment.
However, research has recently developed a relatively new method of detox called rapid opioid detox (ROD) and ultra-rapid opioid detox (UROD). This method dramatically decreases the time it takes to detoxify from an opioid, allowing one to enter addiction treatment more quickly and avoid a long and uncomfortable treatment timeline. However, it’s a process that may not be for everyone.
Find out more about rapid opioid detox and whether or not it may be a viable option for you.
Rapid opioid detox and ultra-rapid opioid detox are methods of drug detoxification that speed up the process with the use of specific medications. Typical opioid detoxification lasts between five and 10 days, depending on several factors. The timeline by which you experience opioid detox depends on when you last used heroin, the size of the dose you used, and the size of the dose you’ve become dependent on. Generally, the heavier the dose you are used to using and the smaller your last dose, the more quickly you will experience your first withdrawal symptoms.
Your withdrawal timeline will also be quickened if you experienced an overdose and you or someone else administered Naloxone to revive you. Naloxone, sold under the brand name Narcan or Evzio, is essentially an opioid overdose antidote. It’s an opioid antagonist, which means that it attaches to opioid receptors and blocks them from being activated.
If you have opioids in your system, it will kick them off their receptors and block them from binding again. Naloxone has saved many lives from deadly overdose symptoms because it can essentially reverse an overdose. However, the process sends patients into immediate withdrawal in a way that can be extremely uncomfortable and even jarring.
Opioid withdrawal symptoms are often described as flu-like symptoms except much worse than any common flu. Common symptoms include nausea, vomiting, diarrhea, sweating, body aches, headache, and fever. These symptoms reach their peak around two or three days after the dose. These extremely uncomfortable symptoms can represent a significant barrier to treatment for many. Opioid detox dropout rates are a significant problem and can cover a wide range depending on the method of detox. One study found that 34 percent of patients dropped out before completing detox. Between uncomfortable symptoms and drug cravings, many people don’t complete detox or avoid detox altogether.
In rapid opioid detox, the goal is to hasten the withdrawal process and to mitigate discomfort with medication. People who go through this process are prepared for withdrawal with a variety of medications, including Clonidine, which is used to manage autonomic nervous system responses like hypertension, that can be caused by withdrawal.
Then anesthetics are used to sedate you before Naloxone and/or Nalmefene is administered to induce withdrawal. Ideally, you will be sedated through the worst withdrawal symptoms and emerge from the anesthesia with mild symptoms. While standard detox lasts for about a week, one study showed that patients who went through rapid detox successfully moved from detox to an addiction treatment program in just 24 hours.
Rapid opioid detox began to be researched in the late 1990s, and tests generally went well. In 2000, ASAM released a public policy statement that was again updated in 2005. It said that ROD and UROD came with uncertain risks and benefits and that there needed to be more research into the potential consequences of these procedures. Since then, there have been case studies linking fatalities to ROD procedures.
There are a wide variety of ROD methods, and some of them have even used Ibogaine, a drug that was initially studied for its potential for addiction treatment but ultimately dropped because of its cardiotoxicity. The vast array of ROD options makes it difficult to determine the deadly case studies because of the rapid detox process or some other variables.
Still, the potential benefits of anesthesia-assisted rapid opioid detox and the success of initial studies is enough for addiction treatment experts to call for more research into this method of treatment. As recently as July 2017, NIDA announced a meeting of experts aimed at discussing what would be needed to further research into ROD.
In addition to anesthesia assisted detox, this panel of experts also discussed research into the use of other medications like Gabapentin, Buprenorphine, Ketamine, and even cannabinoids. They conclude with many recommendations, one of which was to conduct more research into anesthesia-assisted detox and accelerated detox methods.
Since there is still a need for more research and multiple official drug research organizations like NIDA and ASAM are cautiously approaching this method of detox, it should be kept as a last resort. If you’ve tried and failed to achieve sobriety multiple times with traditional detox methods and medication-assisted treatment isn’t for you, it may be worth exploring. However, it’s always important to make sure that you’re medically treated by board-approved medical professionals with medication approved by the U.S. Food and Drug Administration (FDA). Avoid drugs like Ibogaine, which haven’t been adequately scientifically tested.
Medical detox is currently the safest option for people who would like to stop using opioids. Whether it’s in a hospital or a detox center, medical professionals will help keep you safe and as comfortable as possible, managing your symptoms with 24-hour medical care daily.
If you’ve been through detox and relapsed, maybe even more than once, it may just be a matter of trying again. As with other chronic diseases like diabetes or hypertension, relapse doesn’t mean that your treatment failed; it just means that treatment has to be reinstated and that your relapse prevention plan needs to be reevaluated.
If you or someone you love is struggling with a substance use disorder that involves an opioid, there is help available to free them from active addiction and into lasting recovery. Learn more about opioid addiction treatment and safe detox options by speaking to an addiction treatment specialist at The Palm Beach Institute. Call 855-960-5456 to hear more about how detox works and the therapy options that might be available to you in the full continuum of care in addiction treatment. Call anytime!
American Medical Association. (2013, November 27). Deaths Linked With Rapid Opioid Detox Method Using Anesthesia. from https://jamanetwork.com/journals/jama/article-abstract/1785473
ASAM. (2000, April 1). Rapid and Ultra Rapid Opioid Detoxification. 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
Gold, C., Cullen, D., Gonzales, S., Houtmeyers, D., & Dwyer, M. (1999, December 01). Rapid Opioid Detoxification during General Anesthesia: A Review of 20 Patients. from http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1946181
Hakansson, A., & Hallen, E. (2014). Predictors of Dropout from Inpatient Opioid Detoxification … from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230007/
Litjens, R. P., & Brunt, T. M. (2016). How toxic is ibogaine? from https://www.ncbi.nlm.nih.gov/pubmed/26807959
National Institute on Drug Abuse. (2017, July 6). Advancing the Science of Rapid Opioid Detoxification. from https://www.drugabuse.gov/news-events/meetings-events/2017/07/advancing-science-rapid-opioid-detoxification