Medical detoxification is the process of eliminating drugs, alcohol, and any associated toxins from the body to achieve sobriety. They also are beneficial in treating acute intoxication, and ensure the individual undergoing detox is physically and mentally stable before moving on to ongoing care in an addiction recovery treatment program.
The withdrawal symptoms someone can expect to experience during detox depends on the substance in question as well as the severity of the addiction.
Withdrawal symptoms can make detox difficult to deal with, especially without medical intervention, which frequently leads to relapse. Detoxing in the care of a professional medical detox center can help avoid relapse and make detox easier to get through. One of the ways they can do this is by administering various detox medications.
Why Use Medications During Detox?
The concept of using drugs during a process to flush them from someone’s system can at first seem counterintuitive and possibly even harmful. However, medication-assisted treatment (MAT) during detox can be essential to not only a more comfortable but also safer detox process.
The withdrawal process during detox can be unpleasant at best and life-threatening at worst. Detox medications can help deal with whatever unpredictable symptoms or complications might arise during detox.
There are a variety of medications that have received official approval from the U.S. Food and Drug Administration (FDA) for use during medical detox, from prescription opioids to over-the-counter supplements.
Detox medications are often used to help people undergoing detox deal with withdrawal symptoms common to most substances, including:
- Drug cravings
- Muscle pains
Detox medications also can be used to wean someone off the substance they have become addicted to by tapering down the dosage slowly rather than trying to stop using cold turkey and bringing on symptoms like seizures.
What Medications Are Used in Detox?
Doctors will often use over-the-counter medications such as Dramamine to deal with nausea, Tylenol for aches and pains, and natural supplements like melatonin for insomnia. Depending on the substance someone is detoxing from, prescription anti-depressants may also be used to help curb the symptoms of depression and suicidal thoughts.
Detox Medications for Opioids
The opioid crisis continues to hold the country in its grip with a still-rising toll of overdose deaths. Fortunately, however, whether someone has been using prescription opioids like Vicodin or illicit, more potent ones like heroin, detoxing from opioids is rarely, if ever, a life-threatening experience.
Still, Opioid Withdrawal Can Be Extremely Uncomfortable, With Painful And Unpleasant Withdrawal Symptoms. The Symptoms Commonly Associated With Opioid Withdrawal Include All Of The General Substance Withdrawal Symptoms Listed Above, As Well As:
- Fever and chills
- Agitation and mood swings
- Rapid or irregular heartbeat
- High blood pressure
- Difficulty concentrating
- Uncontrollable crying
Depending on the opioid in question and the severity of someone’s addiction, they might not experience all of these symptoms. But even dealing with just a few at the same time can become overwhelming without medical intervention. Even relatively milder symptoms such as diarrhea, vomiting, and sweating could lead to dangerous levels of dehydration if not carefully monitored.
Some common detox medications used to help treat opioid withdrawal are actually other, weaker opioids. These opioids are used for the double-purpose of lessening drug cravings as well as weaning users off stronger opioids like heroin.
Common opioid detox medications include:
Methadone has perhaps the longest history as a form of MAT during opioid detox. Methadone is strong enough to help relieve cravings but weak enough that, when administered carefully by a medical professional, it does not get the user high.
Methadone is medically useful because of how long its effects last. It can remain in the body anywhere from 15 hours to 55 hours, depending on the dosage, and replace shorter-acting opioids like heroin and take up space in the brain’s opioid receptors.
The goal of using methadone during detox is for it to replace the opioid the user is detoxing from, followed by a steady lowering of the methadone dosage to achieve sobriety.
Methadone has a history of clinical effectiveness when paired with counseling and therapy, but remains controversial due to its own potential for abuse and addiction. Methadone use during detox must be carefully restricted and monitored, and a detox team will typically try using other medications before moving to methadone.
Buprenorphine is another opioid that is used for the same purpose as methadone. The major difference is that buprenorphine is what’s known as a “partial opioid agonist,” which makes it much weaker than “full agonist” opioids and gives it less addictive potential.
Otherwise, buprenorphine works in much the same way, taking up space in the opioid receptors to ease cravings and keeping other opioids out to block any euphoric effects associated with an opioid high. A dose generally lasts about 24 hours.
Despite being much weaker, buprenorphine use during detox requires the same careful monitoring, as it is still often abused and possesses the potential for dependency.
Finally, Suboxone is the name-brand version of the combination of buprenorphine and a drug called naloxone. Naloxone is what is known as a “full opioid agonist,” meaning that it negates the effects of opioids entirely, switching off the brain’s opioid receptors.
Naloxone is used under the brand name Narcan to reverse opioid overdoses, but it is too strong to use on its own during detox due to how it will trigger sudden, intense withdrawal symptoms. Suboxone is meant to combine the most beneficial effects of buprenorphine and naloxone to make an opioid detox medication that is less likely to be abused.
Detox Medications for Depressants
Alcohol, benzodiazepines like Xanax and Klonopin, as well as non-benzo sedatives and barbiturates can all be grouped under the umbrella of central nervous system (CNS) depressants. These substances all have severe, dangerous, and potentially deadly withdrawal symptoms.
Because Of This, Detox Should Not Be Attempted Without Professional Medical Supervision. On Top Of Cravings And The Other Standard Symptoms Of Withdrawal, Common Withdrawal Symptoms For Depressants Like Alcohol And Benzodiazepines Include:
- Panic attacks
- Severe insomnia
- Suicidal behavior
- Delirium tremens
- Memory loss
- Uncontrollable crying
- Increased heart rate
- High blood pressure
- Vivid nightmares
Benzodiazepines and other sedatives can be particularly dangerous if someone attempts to stop using them all at once after a long period of regular abuse. This can throw the nervous system into hyperactive shock and trigger grand mal seizures.
For alcohol, delirium tremens brings a whole other set of potentially deadly consequences as well. In cases like these, detox medications are not only useful for easing the discomfort caused by withdrawal; they can also mean the difference between life and death.
The medications commonly used during detox include the previously mentioned anti-depressants and melatonin, along with anticonvulsants, in case of complications from seizures. Other medications administered during depressant detox include:
Much like opioids, benzodiazepines (benzos for short), despite the dangers associated with their abuse, can often be useful in treating dependence on alcohol as well as other benzos. For alcohol, certain benzodiazepines like Valium are helpful in inducing sedation to ease anxiety and as an anticonvulsant while having a very low risk of negative interaction.
Like methadone and buprenorphine, benzodiazepines can be used in tapering schedules to slowly lower someone’s dosage until it’s safe for them to stop using without triggering a seizure.
Also, like methadone and buprenorphine, using benzos as detox medication requires very strict and careful dosage control and monitoring to avoid further abuse and addiction.
Detox Medications For Alcohol
We are commonly fooled about the toxic effects alcohol produces because of its legality, and how ingrained it has become in our culture. In every movie, we see the stars drinking to ease their pain or drinking to enhance the moment.
Unfortunately, alcohol is portrayed in such a positive fashion because it is such a deadly drug. Alcohol withdrawal is among the most dangerous of all drugs in existence, and specialized medications are required to overcome withdrawals safely.
As we mentioned above, delirium tremens (DTs) is a real possibility when it comes to easing off of alcohol. Delirium tremens is one of the most severe forms of alcohol withdrawal, and it involves sudden and severe mental or nervous system changes.
Delirium tremens occur during abrupt cessation from alcohol after an extended period of drinking. The risk is enhanced when you do not eat enough food. It can also be caused by infections, head injury, or illness in those with a history of heavy alcohol consumption. It occurs most frequently in those with a history of alcohol withdrawal.
It is most common in those who drink four to five glasses of wine, seven to eight pints of beer, or one to two drinks with liquor daily for several months. It also affects those who have used alcohol in excess of 10 years.
Those with a long history of alcohol abuse must get into treatment to overcome their alcohol withdrawal. They will be given medication to alleviate their symptoms, and to ensure their safety during the transition.
Some medicines that are approved by the U.S. Food and Drug Administration (FDA) include:
- Antabuse: It is a medication used to discourage individuals from consuming alcohol. When someone uses Antabuse and drinks, they will experience a severe reaction that makes them violently ill. It is considered aversion therapy, and it uses punishment to decrease the likelihood someone will repeat a specific behavior.
- Campral (acamprosate): This drug inhibits the actions of excitatory neurotransmitters. It reduces cravings for alcohol in those in formal alcohol abuse recovery. It is more effective after someone has been abstinent from alcohol for several days, or up to two weeks. It may not stop someone from drinking, but it has been shown to reduce cravings and someone’s desire to drink.
- Naltrexone: This drug was initially used to treat those with opioid use disorders, but it can also reduce cravings for alcohol. There have been some studies showing it is more effective in treating alcohol cravings than opioids. It does not address withdrawal symptoms for those in active recovery from alcohol.
Detox Medications For Stimulants
Stimulants are a little different from the other substances on this list because the symptoms associated with stimulant withdrawal are mainly mood-based and psychological, as opposed to nausea, vomiting, and other flu-like physical symptoms.
The reason for this is that most stimulants focus their effects on a brain chemical called dopamine that regulates emotions, cognition, and feelings of pleasure and motivation.
Along with some of the common withdrawal symptoms like depression, anxiety, and insomnia, other stimulant withdrawal symptoms include:
- Suicidal behavior
- Impaired cognition
- Concentration problems
- Agitation and mood swings
- Extreme fatigue
- Vivid nightmares
- Emotional numbness
- Dulled senses
- Impaired memory
Unlike opioids, there are no medications that have been specifically approved for stimulant detox, but many detox centers will utilize anti-depressants, certain muscle relaxants, modafinil, a medication that’s meant to treat sleep disorders, and on some occasions, buprenorphine.