In drug and alcohol detoxification, a medication is given that is the same or similar to the drug being abused. The initial dose is tapered up until withdrawal symptoms are alleviated. The medication is then given in tapering doses down over a specified period of time.
Suboxone is a unique opioid that is used for outpatient detoxification. Suboxone only partially stimulates the opioid receptor – i.e. it is a “partial agonist”. It is therefore safer in regards to the possibility of respiratory depression – unless large amounts of alcohol and/or benzodiazepines (e.g. Valium, Xanax) are consumed with it. Suboxone is unique in that, despite being a partial agonist, it binds so tightly to the opioid receptor that most other opioids are not able to “get in”. If a patient uses non prescribed opioids during their detox, those opioids will have zero effect. Because of this, the risk of respiratory depression is minimal. I will discuss Suboxone in further detail in a future blog.
Symptomatic medications are also prescribed as needed during medical detoxification. Clonidine is an old blood pressure medication that is very helpful for the sweats, chills, and general overstimulation that can felt during opioid withdrawal. Benzodiazepines such as Klonopin or Valium (both long-acting) are very effective in alleviating anxiety. Anti-emetics (medicines for nausea & vomiting) such as Phenergan and Zofran can be prescribed. Over-the-counter medications such as Lomotil for diarrhea, as well as Tylenol and Motrin for body aches, are used as well.
I always tell patients to remember the basics. It is just like having the flu. If you do not drink and you get dehydrated, nothing I prescribe is going to make you feel better. I also recommend having yogurt and ice cream in the house. These are easy to eat, even when not feeling well. In general, people tend to feel better when they have something to eat.
Some patients will only need Suboxone for their detoxification. Other patients need the other medications discussed. Each patient is different, and the treatment needs to be individualized.
I will discuss inpatient detoxification in my next blog….