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Does prescription opiate detox have to be painful?

Break Free; Prescription Opiate Detox

For so many of us, the drugs we were originally prescribed for pain relief result in far greater pain than they ever resolved. Seductive, potent, and when prescribed by a doctor, seemingly legitimate; these drugs catch far too many of us in a web of dependency, and once caught, it's very hard to get free.

It Doesn't Matter How You Got Addicted

Because we buy these pills at the pharmacy we forget that these prescription opiates can addict as readily as heroin, and that some have called the eventual detox off of prescription medications even more painful than street corner and illicit opiates of abuse. Ultimately, it doesn’t matter at all how you got addicted, and whether you took a little extra for fun, or whether you just took them for pain…but for too long, the problems you face are one and the same.

Symptoms of Prescription Opiate Detox

Individually experienced symptoms vary greatly depending on the severity of abuse, the duration of the addiction, and even the health and physiology of the individual; but in general, some commonly experienced symptoms of opiate withdrawal are:

  • Nausea
  • Insomnia
  • Pain
  • Anxiety
  • Depression
  • Vomiting
  • Seizures
  • Irritability
  • Leg restlessness
  • Diarrhea

Symptoms will generally present within hours of the last dosage, and gain steadily in severity until peaking within a day or so of cessation of use. Symptoms will endure with intensity for a period of three or four days before gradually subsiding, although lingering symptoms of detox may persist for months.

Prescription Opiate Detox Treatment Options

Once you decide to break free from prescription opiate addiction, you have five basic  options to choose from

  1. Go cold turkey on your own
  2. Slowly taper down
  3. Enter a medical detox program
  4. Get an ultra rapid opiate detox
  5. Enter an opiate substitution program, using methadone or Suboxone

Cold Turkey Detox

The length and intensity of the withdrawal pains will vary depending on the length and intensity of your use. In general, longer acting medications, like methadone, result in a more prolonged but slightly less intense withdrawal period than shorter acting medications like OxyContin. The withdrawal period is very uncomfortable and many people who attempt a cold turkey detox fail to complete their attempt due to the intensity of the withdrawal symptoms.

Also, because people who detox without assistance rarely get any addiction treatment either, the relapse rates back to opiate abuse are very high. Too often, the pains of a cold turkey detox are endured for little long term gain...

Cold turkey prescription opiate detox is an option, but because the success rates are low and the discomfort high, it may not be your best choice.

Historically, opiate addiction was often treated within the criminal justice system, a kind of forced cold turkey detox to abstinence. Relapse rates for this form of treatment near 100%1

Tapering

Many people who become dependent on prescription opiates are able to minimize withdrawal pains while working towards complete abstinence from opiate by tapering down their daily dosage over a period of weeks or months.

Dose tapering is a very sensible way to break free from opiate dependence, but it is rarely a successful approach for those that are addicted and dependent on opiate drugs.

  • People who are opiate dependent have become physically dependent on opiates to function. Anyone who takes opiates, whether legitimately or otherwise, for an extended period of time will become physically dependent.
  • People who abuse opiates, whether prescribed legitimately or not, are at high risk for opiate addiction. People who are opiate addicted will crave the drugs and use their medications for reasons other than pain control, the opiates will become a central focus of their life, they will lose control over their use of opiates and continue to use/abuse these medications despite becoming aware of the harms that occur from that use.2

If you are opiate dependent only, and never take your medication in higher doses or with higher frequency than prescribed, then dose tapering is probably a good choice for you, and you should speak with your doctor to make a safe and sensible plan to proceed from.

If you are opiate dependent and opiate addicted, then you may find it difficult or impossible to stick to a tapering regimen. After all, since a hallmark of opiate addiction is a loss of control over how much and how often you use it is unlikely that you will have the control needed to steadily reduce your daily dosage.

Learn more about the difference between opiate addiction and opiate dependence.

Medical Opiate Detox

In a medical opiate detox, you receive medications and nursing care to reduce the severity of the withdrawal symptoms that you experience. In most cases, medical opiate detox occurs on an inpatient basis under supervision. This increases the safety of the process (although opiate detox is rarely dangerous – simply very uncomfortable) and increases your likelihood of making it through the intense initial phase of detox pains without relapsing.

In some cases, you will briefly transfer onto lower doses of longer acting opiate medications, like methadone or buprenorphine, to reduce the intensity of the withdrawal symptoms.

Other medications used in a medical opiate detox can include:

  • Clonidine – a medication that can reduce the anxiety, agitation, muscle aches, cramping and sweats of the withdrawal period. This is a commonly used medication for opiate withdrawals
  • Medications for diarrhea and vomiting

The medical detox period will end when the withdrawal pains subside substantially in intensity. The duration of a medical detox will vary depending on the type of opiate that was abused, your age and general level of health and the length/intensity of the opiate abuse. Longer acting medications like methadone result in a more protracted withdrawal period than shorter acting drugs like Vicodin or Oxycontin. A medical detox generally takes between one and two weeks to complete.

People who complete a medical detox program only and do not follow detox with any addiction treatment and/or medications are at extreme risk to relapse back to opiate use. Medical opiate detox is not considered addiction treatment, merely something that gets you ready and able to participate in addiction treatment.

*Warning – Most people who OD on opiates do so when relapsing after detoxification. Once through the withdrawal process your opiate tolerance (ability to handle large quantities of these drugs) diminishes greatly. Once fully detoxed, taking a dosage that would previously get you pleasantly high might now be enough to kill! 3

Ultra Rapid Opiate Detox

The premise behind an ultra rapid opiate detox is that you progress through an accelerated and intensified period of withdrawal pains while under anesthesia and numb to the agony you’d otherwise be experiencing.

While this obviously sounds very attractive, many experts express caution over the procedure, arguing the risks and costs may outweigh the benefits (if any).

Criticisms of ultra rapid opiate detox include:4

  • There is a risk of vomiting while under anesthesia, and a corresponding risk of death. The American Society for Addiction Medicine (ASAM) warns people to undergo such a procedure only in hospital facilities equipped to perform emergency intubations.
  • Research studies do not show that people who undergo ultra rapid opiate detox are less likely to relapse
  • Research studies do show that people who have underwent an ultra rapid opiate detox procedure continue to feel moderate to severe withdrawal pains for some time following the procedure
  • The cost of an ultra rapid procedure is far greater than for other treatment options

Ultra rapid detox may be a reasonable option for a person that is unwilling to use methadone or Suboxone and unwilling to proceed through a conventional medical detox program, so long as they receive the procedure in a facility equipped for life saving interventions and so long as they are well informed of the risks and benefits of the procedure and the risks and benefits of other options.

To sum it up – ultra rapid detox doesn’t always alleviate the pains of withdrawal greatly, it costs more than comparable treatments, it doesn’t offer a better long term prognosis and compared to alternative treatments, it is far more dangerous.

Suboxone or Methadone

Suboxone and methadone are medications that:

  1. Take away drug cravings
  2. Take away feelings of opiate withdrawal
  3. Don’t get you high, so you can function normally one again

People use these medications for varying lengths of time (longer is generally better), get stabilized financially, in living arrangements and with personal relationships – and when they are feeling good and ready, start to taper down off the meds.

Although some people reject the idea of opiate substitution programs using methadone or Suboxone, thinking they are just trading one addiction for another, studies show that people using methadone and Suboxone are far less likely to relapse than people who detox using other methods, far less likely to commit crimes and far more likely to get health and avoid accidental overdose.

Put simply, people who want the very best chance at long term abstinence from the abuse of opiates should strongly consider either Suboxone or methadone, coupled with ongoing addiction treatment.

Read more:

Suboxone – the basic facts you need to know

Methadone – the basic facts you need to know

References
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Page last updated Sep 02, 2015

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