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Tuesday, May 12, 2020

What Medications Are Used In Addiction Detox?

When an individual uses a large amount of substances over a long period of time, the brain and body can become addicted. To function again normally requires a period of detoxification.

The necessity of detox for individuals seeking treatment for substance misuse boils down to the concepts of tolerance and withdrawal.

Tolerance: The need to increase the dose of a substance ingested in order to achieve the same effect as previous doses. 
Withdrawal: Adverse effects experienced when the substance is no longer present in the system. 

Each of these concepts points to the body’s dependence on the substance in order to function normally. 

How does withdrawal work?

For those seeking recovery, when they begin to halt the use of these substances, they enter a ‘withdrawal period’ as the body is adjusting to the lack of the preferred substance effects. The absence of the numbing effects of the drug can make individuals feel extremely sick and can even be life-threatening. That is why often a medically managed detoxification is considered to be the safest and most effective treatment during withdrawals. 

Withdrawals vary based on the type of substance, therefore medically managed withdrawal should be tailored to each individual’s medical needs. This detox period can last anywhere from a few days to a few weeks and is best managed under a physician’s care in a medically supervised and secure environment.

What medications are used?

In a medically managed detox, multiple medications are used to combat the symptoms of withdrawal, prevent life-threatening symptoms, and maintain safety and comfortability. Medications vary based upon what substances the individual has been taking, and what medical risks are associated. 

Some medications used in the detoxification process are:

Drug of Addiction
Common Medications Used in Detox
Naltrexone, while an opioid antagonist that prevents the effects of opioids, also reduces the urge to drink or use. Gabapentin is used for pain relief.  Studies show using these in combination has improved withdrawal and abstinence outcomes. 
Propranolol is a beta-blocker that can also help with alcohol withdrawal. For severe withdrawals, benzodiazepines may be used short-term.
Opioids (heroin, prescription opiate pills)
Opioid antagonists like naltrexone can be used in pill form, or as an injection called Vivitrol. Another option is opioid agonists like Methodone. Methadone will stay in one’s system longer and can help relieve withdrawals and cravings. Methadone and Suboxone (buprenorphine and naloxone) can be used as a part of Medication-Assisted Treatment (MAT) as a way to taper off of opioids slowly or remain on a small dosage to deter using heroin. This is often done as part of the harm reduction model, as explained below.
Often medial detox requires a safe and structured tapering using benzodiazepines themselves. In adjunct, Barbiturates can be used for insomnia, anxiety, and as a preventative measure for seizures, and antipsychotics may be used for delirium.
Stimulants (cocaine, methamphetamine, prescription amphetamines) 
While there is no official medication protocol for detox from stimulants, some medications can be used to treat psychological symptoms associated with withdrawal. This includes Gabapentin for pain relief, Trazodone for insomnia, and antidepressants for depression and fatigue.

What is the harm-reduction model?

The harm-reduction model is both a philosophy of treatment and public health approach towards those who misuse substances. Under this model, we are encouraged to treat those who utilize drugs with respect and compassion rather than judgment and shame, with the goal of reducing negative consequences associated with drug use. 

Rather than subscribing to an abstinence-only model, harm-reduction acknowledges that there are multiple paths to recovery and it is important to meet people where they are at. 

Principles of the harm-reduction coalition

While avoiding minimizing the dangerous and harmful effects of drug use on individuals and communities is the backbone of our work, however...
  • Drug use is a part of our world, and rather than ignore it or condemn it, communities can take steps towards limiting the negative consequences associated with it.
  • Drug use severity is on a spectrum and that various ways of using are safer than others.
  • Providing services and resources is essential for those engaging in substance use and that those who use/used to misuse substances have a voice in the creation and implementation of these programs.
  • Empowering those who use drugs themselves to share information, and support each other can be incredibly powerful.

Programs that incorporate harm reduction models can include advocacy and outreach programs, needle exchanges to prevent the spread of bloodborne pathogens, supervised injection sites to prevent overdose and accidental death, take-home Narcan (or naloxone) kits to prevent overdose, and peer support services.

How is the harm-reduction model incorporated in addiction treatment?

In a treatment program, the harm-reduction model means to understand that addiction is a disease and that addictive behavior, and “relapse” or “slips” are possible, even for those who are well-intentioned in their pursuit of treatment. Rather than this being an automatic termination from treatment, the harm-reduction model seeks to meet people where they are on their journey, and instead offer more support and treatment to help them maintain long term recovery. 

Another example is by offering Medication-Assisted Treatment (MAT) for those using opioids. This substitution program allows individuals to have fewer withdrawals, cravings, risk of relapse and ultimately leads to improved health and recovery outcomes. Individuals can utilize MAT to taper off of opioids or continue daily dosages for years. 

The harm reduction model is an evidence-based and holistic approach to improving substance misuse and related consequences for individuals, families, and communities.

Recovery Support at The Haven

At The Haven, we recognize that medically-assisted withdrawal management is only the first stage of addiction treatment and without effective treatment, does little to change long-term addictive drug use. After detoxification at The Pines, we strongly urge you to consider continuing your journey with us, through residential treatment and beyond. Call today to get started.