Safe Detox Treatments for Heroin
ARTICLE OVERVIEW: Safe detox treatments should be administerd by trained, medical professionals. For example, medications such as clonidine, buprenorphine, methadone, and lofexidine can be prescribed to ease symptoms of withdrawal. Rapid opiate detox is not considered standard or medically necessary; it is also questionably safe.
TABLE OF CONTENTS:
- The Brain on Heroin
- What is Detox?
- Detox At Home?
- Rapid Heroin Detox
- Is Tapering Possible?
- How To Detox Safely
- Safety During Withdrawal
- Who’s at Risk of Addiction?
- Your Questions
The Brain on Heroin
Heroin is an illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. Although heroin may be smoked or “snorted” (inhaled through the nose), heroin is often “cut” with products such as sugars, starch, or powdered milk and then injected as a liquid.
How does it work in the brain?
Heroin binds to and activates specific receptors in the brain called mu-opioid receptors (MORs). Our bodies naturally create neurotransmitters that connect to these receptors to regulate pain, release hormones, and help us feel happy. When heroin stimulates the same receptors in the reward center of the brain, it triggers the release of the neurotransmitter dopamine, causing EXTREME pleasure, and reinforcement of drug taking behavior.
One of the most significant effects of heroin use is addiction. In addition, with regular use, a tolerance develops, where more and more heroin is needed to achieve the same effect. As higher doses are taken over time physical dependence and addiction will develop. Within a few hours after the last administration of heroin, withdrawal may occur, producing intensely negative effects such as drug craving, restlessness, muscle and bone pain, and vomiting.
What Is Detox?
During any detox, the body gets rid of drug toxins which have accumulated and altered the body’s normal chemistry. A user will experience a number of predicable symptoms. These symptoms manifest because when heroin (a depressant) is no longer available, it takes a few days for the brain to stop sending “speed up” signals to the other body systems. Once the body reaches a chemical homeostasis, these symptoms resolve and detox is finished.
The first symptoms of a heroin detox start within 12 hours after the last dose. During this stage, a person can expect to experience what has been described like “a very bad flu”. Some of these symptoms can persist for weeks to months later. Often, people first report feel a sense of doom or extreme anxiety, however, symptoms of heroin withdrawal are rarely life-threatening.
Common symptoms reported during withdrawal include:
- Abdominal cramps
- Cold sweats
- Dilated pupils
- Disturbed sleep
- Drug cravings
- Excessive yawning
- Pain and cramps the body
- Priapism (s condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended)
The severity and intensity of withdrawal from heroin symptoms depend on the level of use and the level of physical dependency for each person.
The duration of detox symptoms is expected to be about 7-10 days, peaking at about the third day after the last use. Surviving the first three days of heroin detox is a big success. What follows in the next 2-3 days will not be easy either, but the worst is mostly behind you.
It is crucial to work on boosting the immune system by eating right and staying hydrated during the first week of detox. Anxious behavior and nausea may persist, but it is manageable. Healthy food and positive thoughts are a must if one is determined to beat this addiction.
Detox at Home?
Can or should you detox from heroin at home?
Given the unpredictability and possible severity of withdrawal symptoms, it is highly recommended that anyone considering detox seeks medical supervision. A medical professional will monitor the symptoms and assist in case complications occur. They will also be able to give medications that could lessen the intensity of the symptoms, thus making the whole process less traumatic and more bearable.
In sum, you might try to detox from heroin at home. However, withdrawal symptoms are difficult and uncomfortable. Many people relapse in order to avoid the full course of detox. This is another reason why medical detox is recommended.
Lots of effective treatments are available to treat both heroin dependence and addiction. So, you want to look into medications AND talk therapy. Both approaches help to restore a degree of normalcy to brain function and behavior, resulting in healthier, happier people. In fact, the research shows that for many people, integrating both types of treatments is the most effective approach.
Pharmacological treatment: Scientific research has established that medicines increase retention in treatment programs and decrease drug use, infectious disease transmission, and criminal activity. Medications work through the same receptors affected by heroin but are safer and less likely to produce the harmful behaviors that characterize a substance use disorder. Effective medications include:
1. Methadone (Dolophine or Methadose) is a slow-acting opioid agonist. Methadone is taken orally so that it reaches the brain slowly, dampening the “high” that occurs with other routes of administration while preventing withdrawal symptoms. Methadone has been used since the 1960s to treat heroin use disorder and is still an excellent treatment option, particularly for persons who do not respond well to other medications. Methadone is only available through approved outpatient treatment programs, where it is dispensed to persons on a daily basis.
2. Buprenorphine (Subutex or Suboxone) is a partial opioid agonist. Buprenorphine relieves drug cravings without producing the “high” or dangerous side effects of other opioids. Suboxone is taken orally or sublingually and contains naloxone (an opioid antagonist) to prevent attempts to get high by injecting the medication.
The FDA approved buprenorphine in 2002, making it the first medication eligible to be prescribed by certified physicians through the Drug Addiction Treatment Act. This approval eliminates the need to visit specialized treatment clinics, thereby expanding access to treatment for many who need it. Additionally, the Comprehensive Addiction and Recovery Act (CARA), which was signed into law in July 2016, temporarily expands prescribing eligibility to prescribe buprenorphine-based drugs for MAT to qualifying nurse practitioners and physician assistants through October 1, 2021. In February 2013, FDA approved two generic forms of Suboxone, making this treatment option more affordable. The FDA approved a 6-month subdermal buprenorphine implant in May 2016 and a once-monthly buprenorphine injection in November 2017, which eliminates the treatment barrier of daily dosing.
3. Naltrexone (Vivitrol) is an opioid antagonist. Naltrexone blocks the action of opioids, is not addictive or sedating, and does not result in physical dependence. In 2010, the injectable long-acting formulation of naltrexone received FDA approval for a new indication for the prevention of relapse to opioid dependence following opioid detoxification. Administered once a month, Vivitrol may improve compliance by eliminating the need for daily dosing.
Behavioral treatment: The many effective behavioral are often a part of outpatient and residential treatment programs. Approaches such as contingency management and cognitive-behavioral therapy have been shown to effectively treat heroin use disorder, especially when applied in concert with medications. Contingency management uses a voucher-based system in which persons earn “points” based on negative drug tests, which they can exchange for items that encourage healthy living.
Cognitive-behavioral therapy is designed to help modify the person’s expectations and behaviors related to drug use and to increase skills in coping with various life stressors. An important task is to match the best treatment approach to meet the particular needs of the person.
Rapid Opiate Detox
Q: Is rapid heroin detox safe?
A: It is not clear, as state and federal licensing vary on this treatment method. While it is possible to rapidly detox from heroin, it is generally not recommended. Methods are not yet standardized or regulated.
Q: What is rapid opiate detox, exactly?
A: One method involves using naltrexone in conjunction with anesthesia or sedation, antiemetic ondansetron, antidiarrheal octreotide, and clonidine and benzodiazepines.
There is another method for rapid detox using naloxone in conjunction with acupuncture and electrical stimulation, which increases endorphin and lessens the symptoms. Both methods require follow up rehab to help prevent relapses, which are very likely. It is important to note that rapid detox is more costly and dangerous and can be achieved with medical assistance and supervision only.
NOTE HERE: If you are considering ultrarapid, anesthesia-assisted detoxification, note that people suffer withdrawal symptoms as severe as those endured by persons in detoxification by traditional methods, according to a NIDA-funded clinical trial. Researchers Dr. Eric Collins and colleagues at the College of Physicians and Surgeons of Columbia University. The study concluded that there is no compelling reason to use general anesthesia in the treatment of opiate dependence, especially as it presents particular safety concerns.
THE BOTTOM LINE: If you are considering rapid detox, speak with your supervising physician and request further information.
Is Tapering Possible?
Tapering is the act of lowering drug dosage over time to achieve complete withdrawal with minimal adverse effects. When it comes to heroin, the drug itself is the problem: it is unpredictable to estimate dosing. So, tapering procedures are often done with other medications and always under medical observation.
So, no, it is not possible to taper down off heroin.
How To Detox Safely
The safest way to detox from heroin is by seeking medical help. Under supervision, doctors and nurses can help prevent severe withdrawal symptoms, as opposed to cold turkey detox method when the symptoms are much more intense and the likelihood for relapsing much bigger. As explained above, the symptoms can be relieved with medications, which is why seeking medical supervision and assistance during this stage is highly recommended.
With the help of a medical professional, you will also receive emotional support. More and more detox clinics incorporate psychological support as a part of a clinical detox. The turmoil can be much more bearable and the success rate higher. Even if one considers detoxing from heroin alone, consultation with a medical professional prior to commencing is a must.
Last but not least, detox is a successful beginning only if combined with behavioral rehab treatment. Having support and staying persistent during this stage is crucial if one is determined to stay away from heroin for good. So, be sure that any time in detox is followed by an outpatient or inpatient psycho-social treatments for addiction.
You need to get to the reasons WHY YOU USE to prevent yourself from slipping back into using dope as a coping mechanism.
Safety During Withdrawal
The safest way to withdraw from heroin is under medical supervision. Treatment can ease symptoms and increase your chances of success. Before starting any withdrawal treatment make sure to clearly state if you suffer any of the following, because of the elevated risk of exacerbate them or generate any drug interaction:
- Acute alcohol dependence.
- Head injury.
- Respiratory deficiency.
- Severe hepatic impairment.
- Treatment with monoamine oxidase inhibitors (first type of antidepressant developed).
- Ulcerating colitis or Crohn’s disease (inflammatory bowel diseases).
- Urethral obstruction.
ALSO KNOW THIS: You are at increased risk of overdose due to reduced opioid tolerance during and after detox. Therefore, if you should use opiates or opioids for any reason, physicians must use a smaller amount than usual to reduce the risk of overdose.
Who Is Most At Risk Of Heroin Addiction?
- People who use prescription opioid pain relievers.
- People who are addicted to cocaine.
- People without insurance or enrolled in Medicaid.
- People living in a large metropolitan area.
- 18 to 25 year olds.
Tracking trends in heroin use can help focus prevention efforts by identifying whether the rate of use is rising. The National Survey on Drug Use and Health (NSDUH) collects information about heroin use, initiation, treatment, perceived availability, and perceived risk of using heroin:
- Heroin use remains relatively uncommon in the United States, with an estimated 681,000 past year users in 2013 (0.3 percent of the population aged 12 or older
- Heroin rates, perceptions of the riskiness of heroin use, and perceptions about the ease of obtaining heroin have changed over the past decade, but they have not varied in recent years.
Do you have additional questions about heroin detox treatments? Please share your questions and/or experiences with successful (or not) heroin detox and we will try to respond to you personally and promptly.
Reference Sources: CDC: Heroin
CDC: Today’s Heroin epidemic
FDA: FDA grants marketing authorization of the first device for use in helping to reduce the symptoms of opioid withdrawal
NCBI: Withdrawal management
NCBI: Naloxone treatment in opioid addiction: the risks and benefits.
NCBI: Buprenorphine tapering schedule and illicit opioid use
NIDA: Signs of Heroin Use and Addiction
NIDA: Study finds withdrawal no easier with ultrarapid opiate detox
NIH: Maintenance medication for opiate addiction: the foundation of recovery
NSDUH: Results from the 2016 National Survey on Drug Use and Health
SA HEALTH: Opioid withdrawal management
SAMHSA: The CBHSQ report: trends in heroin use in the United States: 2002 to 2013
Photo credit: Ars Electronica