Painkiller Detox and Withdrawal
Prescription painkillers are opioid medications that manage pain and, furthermore, exhibit activity throughout the brain’s pleasure centers. Their interaction with opioid receptors in the brain results in a down-modification of the sensations of pain and, in a dose-dependent manner, ultimately produces feelings of euphoria. While prescription painkillers are used safely and effectively by millions of people, they also carry a high risk of abuse.
As prescriptions for opioid painkillers have increased over the last decade, so has the number of people addicted to them. In 2012, the National Institute on Drug Abuse (NIDA) estimated that 2.1 million people had abused prescription painkillers at some point.
If you or someone you know abuses prescription painkillers or has made unsuccessful attempts at quitting, immediate treatment is essential. During this process, it is important to understand that managing opioid withdrawal can be a trying process, as the symptoms have the potential to be overwhelmingly uncomfortable and can trigger relapse.
Supervised detox helps to alleviate discomfort associated with opioid withdrawal and set the stage for a comprehensive addiction treatment program.
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When someone has been abusing painkillers, they may become dependent on the drug. Essentially, an opioid-dependent individual will begin needing the opioid in order to simply feel normal. This happens because the body is subject to repeated use of the drug and eventually adapts to its presence.
When physical dependency on opioid painkillers has set in, a withdrawal syndrome is frequently experienced when use of the drugs stops. The severity of withdrawal symptoms will depend on the person, as well as the frequency and severity of abuse. Symptoms can also manifest in stages.
Early Withdrawal Symptoms
- Muscle aches.
Late-Onset Withdrawal Symptoms
- Abdominal cramping.
- Dilated pupils.
The Substance Abuse and Mental Health Services Administration (SAMHSA) states that the combination of medication-assisted treatment (MAT) and behavioral therapy can be very effective for both treating substance use disorders and maintaining recovery. Specific treatment medications may vary depending on the clinic, hospital or treatment center you attend.
It’s important to note, however, that you can detox without the use of prescription medications. It is possible to detox from opioid painkillers at home or in a nonmedical (“social”) detox program where you will simply be monitored and given support during the process. In fact, while use of medications in detox and drug treatment has become widely accepted, there are still a number of treatment centers that will eschew medications in lieu of more natural methods and supportive care.
If you’re considering detoxing without help at home, understand that you may face significant discomfort that may increase the risk of relapse – especially if you continue to have access to the abused prescription painkillers. This risk is the reason that many people choose to enter into formal detox programs even if they decide to forego medical-assisted techniques. Even without pharmacologic intervention, the support and structure provided in a detox center can help an individual undergoing withdrawal to successfully complete the process.
Should I Try Ultra-Rapid Detox?
Some programs advertise the use of ultra-rapid detox to ease the process of withdrawal. Ultra-rapid detoxification involves putting the individual under general anesthesia and administering opioid antagonist medication to hasten the onset of withdrawal symptoms. Theoretically, an anesthetized patient won’t experience the most acute symptoms of withdrawal – but it doesn’t mean this is a good idea.
This method claims to speed up the withdrawal process; however, recent research has proven this statement inconclusive and shows that it may be dangerous when the patient has certain preexisting medical conditions.
What Happens During Detox for Painkillers?
Supervised detoxification often involves the administration of medications that provide a steady, low dose of opioids. These medications act on opioid receptors in the brain, without giving the user the highs and lows of drug use. As part of a long-term treatment plan, these “maintenance” medications may continue to be administered after detox is completed, and eventually tapered over time.
When you enter an inpatient detox program, a doctor or medical staff member will evaluate you to determine the severity of your opioid (and any other substance) dependence. Questions might include the following:
- How long have you been taking the medication?
- Are you taking any other drugs?
- Do you drink alcohol?
- What are your drug-taking and drinking habits and patterns?
- Have you been in treatment before?
- Do you have other health problems?
- Are you taking any other medications for any other conditions?
You will also undergo physical examination to check your physical health. You’ll be assessed for any medical conditions, including blood borne diseases such as HIV or hepatitis (high risks for injection users).
Afterward, tailored treatment options are laid out and goals for treatment are discussed. The timeline and protocol for detox will vary according to the individual. You may be given anti-anxiety agents or other supportive medications, for example, if you are experiencing especially distressing withdrawal symptoms.
Some centers will focus on a tapering methodology. This means that over time, medical staff will gradually reduce the dosage and/or frequency of administration. In doing so, the body will eventually become used to not having opioids in the system.
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Medication-Assisted Treatment (MAT)
Depending on the program and your needs, your treatment plan may incorporate the use of medications to manage withdrawal and cravings. These might include:
- Methadone – A full opioid agonist administered orally or via injection, methadone activates the brain’s opioid receptors similarly to the abused opioid drug in question. With a relatively metered onset of effect, and a longer half-life than many of the abused opioid counterparts, the patient will experience some of the positive opioid effects but will avoid the intense highs and crashing withdrawal. Methadone must be taken in appropriate doses to minimize risk and requires regular visitation to a methadone clinic. A single dose of methadone lasts anywhere from 24-36 hours.
- Buprenorphine – A partial opioid agonist taken orally or sublingually (under the tongue), buprenorphine only partially activates the brain’s opioid receptors, discouraging overdose by dampening feelings of euphoria and lowering the ceiling of effects.
- Naltrexone – This opioid antagonist prevents opioids from acting on the brain to provide the usual rewards that come with getting high, discouraging abuse.
- Naloxone – An opioid antagonizing compound that may result in immediate heroin withdrawal symptoms, naloxone is used to discourage opioid abuse and reverse symptoms of overdose. It is included with buprenorphine in the combination treatment drug known as Suboxone.
The judicious administration of medication should keep withdrawal symptoms at bay. Often, these medications are given with the intention of tapering them over a set period, e.g., 30 days. However, they may be used on a continued basis for the maintenance of sobriety and prevention of relapse.
Medication-assisted treatment is not administered unilaterally – it is tailored to each individual. Physical and psychological assessments, as previously stated, will determine treatment protocol including the type of medication and dosage.
Post-Detox Addiction Treatment
Detox is only the first step in recovery from addiction. Once detox is complete, treatment for addiction can begin. This will typically involve therapy to uncover and address the underlying causes of your substance use.
Therapy will vary depending on:
- The treatment center type (e.g., outpatient vs. inpatient).
- Treatment center philosophy (e.g., 12-step programs or non 12-step alternatives)
- Patient preferences.
- Any potential co-occurring psychiatric disorders present (e.g., dual diagnosis approaches).
Behavioral therapies are the most common therapies, addressing the users incentive to start and continue using substances. They may be administered in the form of:
- Group therapy (in the presence of other addicts).
- Family therapy (involving family members).
- Individual therapy (one-on-one).
Various behavioral interventions will also be taught to address the user’s cravings during and after treatment to help with relapse prevention.
Why Should I Enter an Opioid Detox Program?
Anyone addicted to opioids can benefit from entering a formal detox program. However, some people have a hard time accepting that they may have developed an addiction in the first place, since the abused medication was prescribed to them by a doctor. You might be suffering from an addiction to painkillers and need treatment if you are:
- Taking medicine prescribed for someone else.
- Taking more than what’s been prescribed to you.
- Using the medicine to get high.
- Using the medicine in ways that are not prescribed (crushed and snorted or injected).
Abusing opioid painkillers is extremely dangerous. If you’re misusing these drugs, you’re subject to a number of physical health dangers like respiratory depression, which, in cases of overdose, can become serious enough to cause coma or death. Between 1999 and 2010, the rates of prescription painkiller overdose more than quadrupled, exceeding the combined death rates for heroin and cocaine overdose (Volkow, Frieden, Hyde & Cha, 2014).
Every day that you abuse painkillers, you put yourself in danger. Treatment can help you clear your body of these drugs and begin a new healthy life. While it is possible to detox alone, the withdrawal syndrome can be sufficiently intense to trigger relapse even in the most committed person.
Supervised detoxification not only ensures physical comfort and safety during the withdrawal process, it also keeps the user safe from relapse and potential overdose.
How do I Find a Pain Pill Detox Program?
Detoxification for prescription painkillers can occur in an inpatient or outpatient setting.
Inpatient detox and treatment provides 24-hour medical care and supervision. For this reason, there is little chance of relapse or dealing with any significant medical complications during the process. Residential treatment centers commonly offer 30-, 60- and 90-day programs that include detoxification, medication, and counseling. Depending on the program, other amenities and alternative therapies like yoga, meditation, or even equine therapy.
Outpatient care will provide similar therapeutic services that one would find in inpatient care; trained medical staff, detoxification, and counseling, among others. These services, however, are available on a schedule (usually a few hours several times per week). Outpatient care might not be appropriate for someone with a particularly stubborn addiction or who has easy access to drugs at home.
What to Ask Yourself When Choosing Treatment
When choosing a detox and treatment program, you should also consider the following:
- Does the treatment center I’m considering offer medication-assisted treatment (MAT)?
- Is the staff there highly trained?
- Do I need treatment beyond detoxification?
- Do I want inpatient or outpatient treatment?
- Can I take time off work to attend treatment?
- NOTE: Many employers allow for leave to get addiction treatment. Speak with your employer if you’re unsure.
- If choosing inpatient treatment, what kind of services would be best for me?
- Do I prefer a 30-, 60-, or 90-day program?
- Is a longer-term residential program appropriate for me?
- What methods of therapy (group, family or individual) do I need?
- What activities are available?
- If choosing inpatient treatment, should I find somewhere close or further away from home? How much support you have at home from friends and family may help you make this decision. If for example, you have friends or family members that contribute to your substance use in any way, you might consider a treatment center further away.
- National Institute on Drug Abuse, & Volkow, N. D. (2014, May 14). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse. Retrieved March 4, 2016, from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
- (2016, February 19). Prescription Drug Abuse. Retrieved March 4, 2016, from https://www.nlm.nih.gov/medlineplus/prescriptiondrugabuse.html
- Ricardo Buenaventura, M., Rajive Adlaka, M., & Nalini Sehgal, M. (2008). Opioid complications and side effects. Pain physician, 11, S105-S120.
- Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-assisted therapies—tackling the opioid-overdose epidemic. New England Journal of Medicine, 370(22), 2063-2066.
- Center for Substance Abuse Treatment, U.S. Department of Health and Human Services, & Substance Abuse and Mental Health Services Administration. (2011). Medication-Assisted Treatment: Facts for Families and Friends. Retrieved March 4, 2016, from http://store.samhsa.gov/shin/content/SMA09-4443/SMA09-4443.pdf
- Harvard Medical School. (2009, June). Treating opiate addiction, Part I: Detoxification and maintenance. Retrieved March 9, 2016, from http://www.health.harvard.edu/mind-and-mood/treating_opiate_addiction_detoxification_and_maintenance
- Whelan, P. J., & Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of neurosciences in rural practice, 3(1), 45.
- (2016, March 2). Opiate Withdrawal. Retrieved March 10, 2016, from https://www.nlm.nih.gov/medlineplus/ency/article/000949.htm