A client’s detox stay will vary based on the length of substance use and the specific substance abused. In general, the average stay at a drug and alcohol detox facility is around 7 days.
There exists a drug in this world that is one of the most addictive substances known to man. It has the capability to tear families apart, destroy lives and utterly change a person’s personality. Chemically, it hijacks your brain and changes neural pathways to the point where getting the fix is all you care about. It even causes some people to wish for death yet continue to use it. Diamorphine (or Diacetylmorphine) is a substance sought after for its ability to produce a strong euphoric effect in the human body. You may know it by the drugs more common name, Heroin.
Derived from the opium poppy (papaver somniferum), heroin has a lengthy history of being a controlled substance sought for the strong analgesic effects (pain killing properties) and the “feel-good” rush that it brings. It is for this reason that over the last century, drug makers have tried to replicate and enhance the properties of drugs derived from the poppy plant. Today these derivatives are used in hospitals (OxyContin, oxycodone, hydromorphone, oxymorphone and hydrocodone are some examples) but also flood the streets for recreational use (today the most common are fentanyl and carfentanil). Even when prescribed under the supervision of a medical professional, opioids are highly addictive. On the street, what is being sold is even stronger.
One aspect of heroin and other opioids that makes these drugs so highly addictive are the symptoms of withdrawal. Most heroin addicts need to get their “fix” every 4 to 8 hours in order to avoid becoming “dope sick”. For those who suffer from a substance use disorder who have abused heroin or other opioids they understand the highly unpleasant symptoms associated with withdrawing from heroin. Some people have described the feeling of heroin withdrawal as, “feeling like dying”. While opioid withdrawals are highly unpleasant, they are not usually fatal. The withdrawal process is similar to a severe flu with symptoms such as: chills, fever, body aches, diarrhea, nausea, insomnia, fatigue, sweating and cravings.
To attempt to go through the withdrawal process at home is not easy. The cravings can be overpowering, and a person will often find themselves giving in to these cravings as opposed to going through an unpleasant withdrawal on their own, thus renewing the cycle of chemical dependency. A medical detoxification facility is recommended for drug or alcohol dependency. The stay at detox usually will last about a week and is highly structured. Once a client is admitted to detox they will be evaluated by the medical staff, tested for alcohol and drug levels in their system, and shown to their bed. The typical day to day activities will consist of designated times throughout the day to check vitals and be given medication. There will be options to participate in groups and attend commitments held by outside speakers throughout your stay. There will be set times for meals and even smoke breaks if the facility allows for it. While under the care of medical professionals at a detox facility you will be monitored and usually given different options for your chemical detox treatment by the clinical staff. There are several different detox protocols when dealing with heroin and opioid drug abuse. Some of the more well-known medication for heroin detox protocols are methadone and buprenorphine (Suboxone).
Methadone has been the most used agent for detoxification from various opioids. This is in part because of how long it has been around. Methadone has been used as a treatment for opioid dependency in the United States since 1947. It is a long acting opioid in and of itself, that displaces opioids from the bodies chemical receptor sites and reverses opioid withdrawal symptoms. The way it is administered in a medical detox setting is as a taper. Based on the client’s baseline levels of opioids in their system when they arrive at the detox, a starting dosage is established for the methadone treatment protocol. The starting dosage will usually be held off for a certain amount of time based on the client’s vitals and drug level in their system at the time of intake. This is done to prevent possible overdose as the client may still be intoxicated by other opioids when they enter detox and usually will not be dosed until after they begin showing signs of withdrawal symptoms. The client will be monitored and reevaluated as the dosage is tapered down each day for approximately 5 days.
Buprenorphine is becoming more and more popular for use in detoxes for heroin users. Buprenorphine is also sold under the more well-known brand name of “Suboxone”, and it is a partial opioid agonist. Much like methadone it displaces heroin and other opioids from the chemical receptors in the addict’s body. Suboxone is relatively safe as it has a “ceiling effect” due to being a mixture of buprenorphine and naloxone (Narcan). When used as a detox protocol, an initial dosage is given to a client and much like methadone they are tapered off from Suboxone over several days. The medical staff at a detox will withhold the first dose until withdrawal symptoms present, as being dosed too early with Suboxone can result in precipitated withdrawal symptoms that can be highly unpleasant.
While methadone and Suboxone are the primary medications used for those in detox for opioid abuse, one can also expect what are known as “comfort meds” to be offered at most detoxes. Some of these comfort meds are given to alleviate certain symptoms associated with opioid withdrawals. Such medications are: hydroxyzine (for anxiety), clonidine (to reduce elevated blood pressure), trazadone and quetiapine (for insomnia) and even Zofran or Promethazine (for nausea). Some clients will opt for only comfort medication in lieu of methadone or Suboxone protocols for their detox.
As stated earlier, the detox process is just the first step in the recovery process. It is an important piece considering how difficult it is to get through the worst of the physical side effects as you come off the drugs.