Medically-supervised opioid detox involves the use of certain medications a doctor prescribes, to reduce the severity of withdrawal symptoms that can accompany the ceasing of using opioids. Symptoms that can be uncomfortable or painful include anxiety, drug cravings, restlessness, gastrointestinal distress, tachycardia, and excessive sweating.
The two most commonly used medications prescribed for opioid withdrawal are agonists methadone and buprenorphine (a partial agonist). Alpha-2 adrenergic agonists like clonidine and lofexidine are also used. The aim is to have the patient wean off the drug(s) as smoothly as possible with medication-assisted treatment.
When this approach is used, it usually doesn’t result in sustained abstinence from opioids, nor does it address reasons for the abuse in the first place. It also doesn’t address the damage done to relationships, finances, or employment. It also doesn’t consider the physical, emotional, mental, or spiritual health of the individual. Keep in mind that full detoxification from opioids is only successfully achieved in transitioning to the intramuscular medication naltrexone. The patient will still be in a state of physiological dependence on opioid agonism when transitioning to methadone or buprenorphine.
It’s important to note that the use of these medications to detox from opioids safely is a short-term treatment and that to recover fully, there needs to be long-term solutions. With that said, here is a timeline of starting the medically-assisted medication, buprenorphine, for opioid detox.
Naltrexone blocks the sedative and euphoric effects that opioids produce, so the person taking it doesn’t get the high it is used to achieving. This is so the individual’s brain can reset itself without the addictive drug, and the person’s cravings subside. The Food and Drug Administration, or the FDA, approved the use of naltrexone to help reduce the effects of withdrawal. If someone is using medically-assisted withdrawal with methadone or buprenorphine for detox, they have to be entirely off it to start naltrexone.
The drug can be given in pill form daily or as an injectable once a month. Naltrexone works differently than methadone or buprenorphine, which activates opioid receptors in the body that suppress cravings. With naltrexone, it binds and blocks opioid receptors, which helps reduce opioid cravings, and there’s no worry of abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) has more information on using these medical-assisted medications for opioid abuse.
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