Drug detoxification

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Drug detoxification (informally, detox) is variously construed or interpreted as a type of "medical" intervention or technique in regards to a physical dependence mediated by a drug; as well as the process and experience of a withdrawal syndrome or any of the treatments for acute drug overdose (toxidrome). The first definition however, in relation to substance dependence and its treatment is arguably a misnomer and even directly contradictory since withdrawal is neither contingent upon nor alleviated through biological excretion or clearance of the drug. In fact, excretion of a given drug from the body is one of the very processes that leads to withdrawal since the syndrome arises largely due to the cessation itself and the drug being absent from the body; especially the blood plasma, not from ‘leftover toxins’ or traces of the drug still being in the system.

Contents

Some addiction medicine practitioners use the term withdrawal management instead of detoxification. [1] [2]

A detoxification program for physical dependence does not necessarily address the precedents of addiction, social factors, psychological addiction, or the often-complex behavioral issues that intermingle with addiction. [3]

Process

The United States Department of Health and Human Services acknowledges three steps in a drug detoxification process: [4]

  1. Evaluation: Upon beginning drug detoxification, [5] a patient is first tested to see which specific substances are presently circulating in their bloodstream and the amount. Clinicians also evaluate the patient for potential co-occurring disorders, dual diagnosis, and mental/behavioral issues.
  2. Stabilization: In this stage, the patient is guided through the process of detoxification. This may be done with or without the use of medications but for the most part the former is more common. Also part of stabilization is explaining to the patient what to expect during treatment and the recovery process. Where appropriate, people close to the addict are brought in at this time to become involved and show support.
  3. Guiding Patient into Treatment: The last step of the detoxification process is to ready the patient for the actual recovery process. As drug detoxification only deals with the physical dependency and addiction to drugs, it does not address the psychological aspects of drug addiction. This stage entails obtaining agreement from the patient to complete the process by enrolling in a drug rehabilitation program.

Rapid detoxification

Richard B. Resnick MD was the first scientist to investigate the idea of accelerated detox under anesthesia. In 1977, [6] he published a paper detailing the first procedures using Naloxone and clonidine. Shortly afterward, physicians began discussing anesthesia to reduce pain during rapid detox. Norbert Loimer, MD, Ph.D. published a paper in the '80s outlining the success of opiate detoxification under general anesthesia. Resnick and Loimer's early research served as the foundation for all forms of detoxification under sedation procedures used today. While physicians' protocols significantly differ, they still adhere to the principles described in the early publications. [7] The combined use of clonidine and naltrexone was found to be a rapid, safe, and effective treatment for abrupt withdrawal from methadone, as detailed in a paper published in The American Journal of Psychiatry in 1986. [8]

Since then, numerous clinics around the world have implemented detoxification under sedation procedures to assist patients in overcoming opioid use disorder. These procedures involve the administration of anesthesia and other medications to facilitate rapid detoxification of the body, effectively reducing the painful and uncomfortable symptoms of withdrawal. While the effectiveness of rapid detox has been a subject of debate, it remains a popular treatment option for certain individuals grappling with opioid addiction. The pioneering efforts of Resnick and Loimer have paved the way for ongoing research and advancements in this field, ultimately aiding more individuals on their journey to recovery.

Etymology

The concept of "detoxification" comes from the discredited autotoxin [9] theory of George E. Pettey and others. David F. Musto says that "according to Pettey, opiates stimulated the production of toxins in the intestines, which had the physiological effect associated with withdrawal phenomena. [...] Therefore treatment would consist of purging the body of toxins and any lurking morphine that might remain to stimulate toxin production in the future." [10] [11]

Rapid detox controversy

Naltrexone therapy, which critics claim lacks long-term efficacy and can actually be detrimental to a patient's long-term recovery, has led to controversy. Additionally, there have been many questions raised about the ethics as well as safety of rapid detox following a number of deaths resulting from the procedure. [12] [13] [14]

Some researchers say that relapses to injection use of illicit opioids during or following repeated detoxification episodes carry the substantial potential for injury associated with uncontrolled drug use and include drug overdose, infections, and death. [15]

See also

Related Research Articles

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Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for chronic pain and also for opioid use disorder. It is used to treat chronic pain, and it is also used to treat addiction to heroin or other opioids. Prescribed for daily use, the medicine relieves cravings and removes withdrawal symptoms. Withdrawal management using methadone can be accomplished in less than a month, or it may be done gradually over a longer period of time, or simply maintained for the rest of the patient's life. While a single dose has a rapid effect, maximum effect can take up to five days of use. After long-term use, in people with normal liver function, effects last 8 to 36 hours. Methadone is usually taken by mouth and rarely by injection into a muscle or vein.

<span class="mw-page-title-main">Naloxone</span> Opioid receptor antagonist

Naloxone is an opioid antagonist: a medication used to reverse or reduce the effects of opioids. For example, it is used to restore breathing after an opioid overdose. Effects begin within two minutes when given intravenously, five minutes when injected into a muscle, and ten minutes as a nasal spray. Naloxone blocks the effects of opioids for 30 to 90 minutes.

<span class="mw-page-title-main">Hydromorphone</span> Opioid drug used for pain relief

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Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

<span class="mw-page-title-main">Opioid use disorder</span> Medical condition

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

<span class="mw-page-title-main">Buprenorphine</span> Opioid used to treat pain & opioid use disorder

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<span class="mw-page-title-main">Naltrexone</span> Medication

Naltrexone, sold under the brand name Revia among others, is a medication primarily used to manage alcohol use or opioid use disorder by reducing cravings and feelings of euphoria associated with substance use disorder. It has also been found effective in the treatment of other addictions and may be used for them off-label. An opioid-dependent person should not receive naltrexone before detoxification. It is taken by mouth or by injection into a muscle. Effects begin within 30 minutes, though a decreased desire for opioids may take a few weeks to occur. Side effects may include trouble sleeping, anxiety, nausea, and headaches. In those still on opioids, opioid withdrawal may occur. Use is not recommended in people with liver failure. It is unclear if use is safe during pregnancy. Naltrexone is an opioid antagonist and works by blocking the effects of opioids, including both opioid drugs as well as opioids naturally produced in the brain.

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<span class="mw-page-title-main">Opioid antagonist</span> Receptor agonist that acts on one or more of the opioid receptors

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<span class="mw-page-title-main">Lefetamine</span> Chemical compound

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<span class="mw-page-title-main">Lofexidine</span> Medication used for opioid withdrawal

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Treatment Improvement Protocols (TIPs) are a series of best-practice manuals for the treatment of substance use and other related disorders. The TIP series is published by the Substance Abuse and Mental Health Services Administration (SAMHSA), an operational division of the U.S. Department of Health and Human Services.

<span class="mw-page-title-main">Opioid overdose</span> Medical condition

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<span class="mw-page-title-main">Opioid withdrawal</span> Withdrawal symptoms of opiates

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<span class="mw-page-title-main">Andre Waismann</span> Israeli physician

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Opioid agonist therapy (OAT) is a treatment in which prescribed opioid agonists are given to patients who live with Opioid use disorder (OUD). In the case of methadone maintenance treatment (MMT), methadone is used to treat dependence on heroin or other opioids, and is administered on an ongoing basis.

References

  1. ↑ "SAMHSA updates opioid treatment program standards, including telehealth, and proposes removing "x" waivers to prescribe buprenorphine".
  2. ↑ "Adult Substance Use Withdrawal Management Services | Texas Health and Human Services".
  3. ↑ "Find Info on Medical Detox".
  4. ↑ U.S. Department of Health and Human Services (2006). "Detoxification and Substance Abuse Treatment": 4–5.{{cite journal}}: Cite journal requires |journal= (help)
  5. ↑ Thomas, Scot; MD. "Detox from Addiction – Importance of Drug and Alcohol Detox". American Addiction Centers. Retrieved 2020-09-23.
  6. ↑ Resnik, Richard (April 1977). "Naloxone-precipitated withdrawal: A method for rapid induction onto naltrexone". Clinical Pharmacology & Therapeutics. 21 (4): 409–413. doi:10.1002/cpt1977214409. PMID   849672. S2CID   23047907.
  7. ↑ Kleber, H D (November 1982). "Clonidine and naltrexone. A safe, effective, and rapid treatment of abrupt withdrawal from methadone therapy". Archives of General Psychiatry. 39 (11): 1327–1332. doi:10.1001/archpsyc.1982.04290110077013. PMID   7138234.
  8. ↑ Kleber, H D (July 1986). "The combined use of clonidine and naltrexone as a rapid, safe, and effective treatment of abrupt withdrawal from methadone". The American Journal of Psychiatry. 143 (7): 831–837. doi:10.1176/ajp.143.7.831. PMID   3717421.
  9. ↑ "Autotoxin Definition & Meaning". Dictionary.com. Retrieved 2022-05-13.
  10. ↑ Musto, David F. (1999). The American Disease: Origins of Narcotic Control (3rd ed.). Oxford University Press. p. 76. ISBN   0195125096.
  11. ↑ "Information About Alcohol Detoxification". Archived from the original on 2022-04-08. Retrieved 2016-11-20.
  12. ↑ Dyer, Clare (1998-01-17). "Addict died after rapid opiate detoxification". BMJ Publishing Group. Retrieved 2009-02-22.
  13. ↑ Leeder, Jessica; Donovan, Kevin (2006-03-10). "Coroner probes 'rapid detox' death: Addict succumbed during procedure. Second fatality linked to clinics". Toronto Star. Retrieved 2009-02-22.
  14. ↑ Hamilton, R. J., Olmedo, R. E., Shah, S., Hung, O. L., Howland, M. A., Perrone, J., Nelson, L. S., Lewin, N. L. and Hoffman, R. S. (2002), Complications of Ultrarapid Opioid Detoxification with Subcutaneous Naltrexone Pellets. Academic Emergency Medicine, 9: 63–68.
  15. ↑ Ling W, Amass L, Shoptaw S (Jun 2006) "A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network." PMID: 16042639
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