What is Opiate Detox Like?

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Detox is a necessary component of rehabilitation when it comes to opiate use. Opioids such as heroin, morphine and other prescription painkillers are abused by an estimated 467,000 people according to the National Institute on Drug Abuse (NIDA). Worldwide, that number is between 26.4 million and 36 million. Opioids are a group of drugs, both prescribed and illicitly obtained, used to treat pain. Many of these drugs are derived from either an extract of the poppy plant or is derived from another chemical opiate. Opioids refer to the entire class of drugs while opiates refer to semi- and fully-synthetic opiates like Vicodin. Opioid use is leading to heroin use in prescription opioid users due to its affordability and accessibility. However, because heroin is not regulated as with prescription pain medications, the likelihood of overdose is increased. This is where the life-saving antidote Naloxone comes into play. Popular Opioids and Opiates Include:

  • Codeine
  • Vicodin
  • Oxycontin
  • Percocet
  • Morphine
  • Fentanyl
  • Heroin

But in America and many other modern countries, opiates are both useful and ethical when used properly. As Nick Stockton of Wired Magazine puts it, “OPIATES ARE AMAZING. They make dentistry, not a horror movie, make a broken bone something you can tolerate while waiting in the ER, and kept your great-grandpop from going into shock after being shelled in the trenches of Ypres. Opiates are also amazingly addictive. The government estimates that roughly 1.9 million Americans were hooked on opiates in 2013.” So what can be done about this, and why is kicking the habit of using so difficult? Part of the problem has to do with people not seeking help. “According to SAMHSA’s National Survey on Drug Use and Health, 22.5 million people (8.5 percent of the U.S. population) aged 12 or older needed treatment for an illicit* drug or alcohol use problem in 2014. Only 4.2 million (18.5 percent of those who needed treatment) received any substance use treatment in the same year. Of these, about 2.6 million people received treatment at the specialty treatment program.”

Why are Opioids So Addictive?

This epidemic of drug use and abuse has a lot to do with the strength of opioids and how they affect the user. These popular drugs include Vicodin and Oxycontin since these are most often prescribed for pain. Those recovering from surgery, for example, are frequently prescribed semi or fully synthetic opioids. These drugs work by attaching themselves to opioid receptors in the body – found in the brain, GI tract, spinal cord and in other organs. These drugs reduce the perceived pain and give users a general feeling of well-being. According to a scientific report on opioid dependence, “Brain abnormalities resulting from chronic use of heroin, oxycodone, and other morphine-derived drugs are underlying causes of opioid dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use). The abnormalities that produce dependence, well understood by science, appear to resolve after detoxification, within days or weeks after opioid use stops. The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects—for example, stress, the social context of initial opiate use, and psychological conditioning—and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent.” This is what makes opioids incredibly dangerous to both adolescents and adults. It’s also why America is having such a hard time controlling its abuse.

Opiate Withdrawal Timeline – Symptoms Begin Sooner Than You Think

Some believe that withdrawals are something that happens days or weeks after quitting drugs or alcohol, but in the case of opiate withdrawal, the timer starts as soon as the drug has worn off. Six to 12 hours after taking a short-acting opiate, withdrawal symptoms can begin. For longer-acting drugs, this can be up to 30 hours later. Within 72 hours, withdrawal symptoms peak, and the user may experience:

So what happens when someone stops using opioids? As we said before, with prolonged use of opioids, the brain changes. Essentially what happens when an opioid addict stops using is that the base of the brain’s (locus ceruleus) neurons produce a chemical called noradrenaline. This chemical travels throughout the body where it stimulates things like blood pressure, wakefulness, alertness, and breathing. When opioid molecules link to receptors in the locus ceruleus, they suppress noradrenaline. This results in feeling sleepy, low blood pressure, slowed breathing, etc. The more the drugs are used, the more the neurons try to adjust by increasing the noradrenaline. So when the use of the drug is discontinued, the brain has enhanced activity due to excess noradrenaline. Therefore, and addict begins to feel anxious, jittery, have muscle cramps and diarrhea.

Late Stage Opiate Withdrawal

Late stage withdrawal refers to the seven to ten days following the start of symptoms. Physical symptoms should have passed, but the psychological effects will begin to rear their heads. People in this stage often experience insomnia, drug cravings, weakness, anxiety, and muscle aches. These symptoms can persist for one year or more after drug use is discontinued. This is a very delicate time for users since this is the time they are most likely to relapse. One study showed, “consecutive opiate dependent patients admitted to a residential addiction treatment service for detoxification. We measured the rate of relapse following discharge, and sought to identify factors that were associated with early relapse (i.e., a return to daily opiate use). Follow-up interviews were conducted with 109 patients, of whom, 99 (91%) reported a relapse. The initial relapse occurred within one week in 64 (59%) cases. Multivariate survival analysis revealed that earlier relapse was significantly predicted by younger age, greater heroin use prior to treatment, history of injecting, and a failure to enter aftercare. Unexpectedly, those who were in a relationship with an opiate user had significantly delayed relapse. Those who completed the entire six-week inpatient treatment program also had a significantly delayed relapse. To reduce relapse and the associated increased risk of fatal overdose, services providing residential opiate detoxification should prepare people for admission, strive to retain them in treatment for the full admission period and actively support their entry into planned aftercare to improve outcome.”

Medical Detox Plan: The Safe Way to Stop Using

With withdrawals come intense cravings, according to the report on opioid dependence comments that stress and coping is difficult for addicts, “That drug abuse patients are more vulnerable to stress than the general population is a clinical truism. In the research arena, numerous studies have documented that physical stressors (such as footshock or restraint stress) and psychological stressors can cause animals to reinstate drug use and that stressors can trigger drug craving in addicted humans. The likely explanation for these observations is that opioids raise levels of cortisol, a hormone that plays a primary role in stress responses; and cortisol, in turn, raises the level of activity in the mesolimbic reward system. By these mechanisms, stress may contribute to the abuser’s desire to take drugs in the first place and to his or her subsequent compulsion to keep taking them.” Opioid drugs are dangerous enough that a medically supervised detox is necessary. In 80 percent of detoxifications, medications are used. According to NIDA, for opioids, “Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine®), and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior and help them become more open to behavioral treatments.”

Detox is Just One Part of the Recovery Process

For inpatient or residential treatment centers, those with severe opiate addictions and other co-occurring disorders benefit from 24-hour care. These facilities offer around-the-clock care and intensive care for patients. Licensed facilities have a lot to offer those in detox, including according to NIDA:

  • Therapeutic communities, which are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. The entire community, including treatment staff and those in recovery, act as key agents of change, influencing the patient’s attitudes, understanding, and behaviors associated with drug use.
  • Shorter-term residential treatment, which typically focuses on detoxification as well as providing initial intensive counseling and preparation for treatment in a community-based setting.
  • Recovery housing, which provides supervised, short-term housing for patients, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life—for example, helping them learn how to manage finances or seek employment, as well as connecting them to support services in the community.”

Learn more about what a good detox program can do for you.