When a person has an addiction to a substance and decides to overcome this addiction, the person must first detox from the addictive substance. The best outcomes for detox involve medical oversight, called medical detox, which allows therapists and doctors to oversee the individual’s withdrawal process, and ease or prevent withdrawal symptoms using certain prescription medications.
Sometimes, medical detox involves a tapering process, where a dose of a medication is slowly lowered over time to wean the person off the drug. Oftentimes, as in cases of opiate addiction, individuals are switched to another drug that replaces the opiate and then weaned off that replacement drug. In other instances, medications control withdrawal symptoms and psychological side effects that often occur during the detox process. Other medications help to prevent relapse.
Here are some of the most common medications used for medical detox:
- Buprenorphine: This is a partial opioid agonist that was approved for use by the Food and Drug Administration in 2002. This medication, sold under brand name Subutex, treats opioid addictions due to narcotic prescription painkiller addictions and heroin. Buprenorphine was developed as analternative to methadone, in part because methadone treatment requires enrollment in a highly structured clinic; buprenorphine can be prescribed and dispensed at a physician’s office, which has helped many people gain access to treatment for their opioid addiction.As a partial opioid agonist, buprenorphine binds to the same receptors in the brain as opioid drugs like hydrocodone or heroin, and it produces a mild euphoria, as well as respiratory depression. However, it is not as potent as full opioid agonists. While buprenorphine can reduce the severity of withdrawal symptoms and ease opioid cravings, it does not induce the same high as opioid drugs. Buprenorphine also has a longer half-life, meaning it stays in the body for longer than opiates, so cravings do not occur as often. With the help of a doctor, people can begin to taper their dose of buprenorphine until the body is no longer physically dependent on opiates.
- Suboxone: This detox medication is a combination of buprenorphine and naloxone, an opioid antagonist. When taken as prescribed, the buprenorphine in Suboxone eases withdrawal symptoms and cravings in individuals who are trying to overcome an opioid addiction. However, naloxone acts as an anti-tampering medication, preventing people from abusing buprenorphine, which can, in very large doses, give similar effects as full opioid agonists. When this medication is crushed, snorted, or injected, rather than ingested in pill form, naloxone kicks in to prevent buprenorphine from binding to opioid receptors, forcing the individual to go into withdrawal instead of getting high.
- Naltrexone: This opioid antagonist is prescribed for individuals undergoing medical detox from opiate drugs, including heroin, oxycodone, and morphine. It binds to opioid receptors in the brain and thereby prevents opiate drugs from binding to these sites. That prevents the high associated with taking opioid drugs. This medication is not recommended for people who are undergoing a tapering therapy, such as with methadone or buprenorphine, because naltrexone will block those medications from acting in the brain as well. Although it is not yet fully understood why, naltrexone also seems to help people in treatment for alcohol addiction.
- Clonidine: This medication is primarily a drug that regulates blood pressure, which reduces certain chemicals found in the blood when a person has high blood pressure, allowing the heart to beat more slowly and regularly. Medical professionals have found that clonidine has many off-label uses, however, and one of them is as a treatment for people going through alcohol and opiate withdrawal. This medication eases feelings of anxiety and agitation, as well as muscle aches and cramps, sweating, and cold or flu-like symptoms associated with opiate withdrawal (runny nose being the most common). Clonidine also has some effect on smoking cessation as well.
- Benzodiazepines: There are several types of benzodiazepine medications that can help to ease alcohol withdrawal symptoms. The World Health Organization strongly recommends benzodiazepines, especially long-acting varieties, to reduce the potential for seizures, delirium, and other withdrawal symptoms associated with alcohol use disorder. The benzodiazepines of choice for alcohol withdrawal are chlordiazepoxide, under the brand name Librium; diazepam, under the brand name Valium; and lorazepam, under the brand name Ativan. These medications are often prescribed to treat anxiety and panic disorders, but are also very effective to help weanan individual off of alcohol.
- Medications to manage specific withdrawal symptoms: Although withdrawal symptoms are not the same for every addictive substance, withdrawing from many of them induces nausea, loss of appetite, tremors, anxiety, depression, or other concerns. Medical detox offers management of these symptoms through talk therapy, group therapy, and medications to treat specific symptoms, like anti-nausea medications and antidepressants. Although there are many therapies for alcohol and opiate detox, including tapering therapies, there are no approved medications to treat withdrawal from cocaine, marijuana, methamphetamines, and other types of drugs. The best course of treatment for detox from these substances is management of severe withdrawal symptoms, like mood swings or nausea, through specific medications and complementary therapies.
For people struggling with an addiction, medical detox is the best first step to overcoming that addiction. It is important, after completing medical detox, to continue the rehabilitation process with either inpatient or outpatient rehabilitation. Ongoing therapy is essential to finding a firm footing in recovery.