Many people think detoxification (aka detox) is the standard of care for treating people with opioid use disorder (OUD). What is detox? In medical terms, it’s more accurately known as “medically supervised withdrawal”. Withdrawal is an unavoidable consequence of stopping chronic opioid use, causing symptoms like irritability, insomnia, muscle aches, and depression and often leads to intense cravings to keep using drugs.
The goals of detox are to eliminate the body’s physical dependence on opioids, minimize withdrawal symptoms, and transition into an aftercare rehab program. But more often than not, it is not successful. In fact, detox doesn’t treat the underlying addiction, and often backfires and causes far more harm than good. Here’s what you might not know about opioid addiction and outcomes following detoxification.
The rehab detox approach
The traditional, old school response to an individual seeking help for opioid addiction is to begin the detoxification process. These programs may be inpatient- or outpatient-based treatment at a hospital, rehab facility, detox center, shelter, or doctor’s office. Inpatient detox is usually recommended for patients who have been unable to stabilize their drug use in the home setting or require intensive treatment for seizure risks related to alcohol or benzodiazepine use.
The process varies depending on the program and needs of the individual. In general, it looks like this:
- The patient is evaluated to determine the severity of their addiction. This includes medical and psychological assessments and sometimes blood and urine testing. A medical team then develops a detox treatment plan.
- Patients stop opioid use at this point, and medical professionals must monitor progress as patients begin to detox from the drug or drugs of choice. Programs typically offer both taper medications to ease off of the drug of choice and adjunctive medications (non-opioid, non-habit forming medications that are used in conjunction with a primary treatment, e.g., ibuprofen) to ease discomfort from withdrawal symptoms.
- The detox facility may also offer medical care and counseling throughout the process but there is a lot of variation in quality across programs.
Following detox, patients are usually intended to be discharged to a residential or outpatient rehab program to continue treatment and reduce the risk of relapse. However in reality, many patients leave prematurely or complete a 3-5 day detox regimen but never receive follow up services.
So, what’s the problem? Is detox dangerous?
Whether you’ve gone through detox yourself or know someone who has, you know it’s an incredibly grueling process. You’ve always been told it’s a necessary or even good step to recovery. But there is more you should know:
The truth is that patients who complete “medication-free” detoxification for opioid use are at a higher risk of death during their first month following the program. Such programs do not provide medications like methadone or buprenorphine, which are an essential part of long-term treatment to reduce the risk of relapse and overdose.
While using medication for opioid use disorder (OUD) may seem counterproductive to some, it is the gold standard of care supported by all federal health agencies. This treatment approach is often referred to as medication-assisted treatment (MAT) or medication for opioid use disorder (MOUD). Brain and body chemistry change when an individual develops addiction. Both become dependent on the continued presence of opioids, which is what causes withdrawal symptoms when drugs are taken away or no longer available. Your brain even develops a tolerance after repeated exposure to protect itself from toxic side effects.
That tolerance goes away during medication-free treatment. The brain is no longer protected and becomes hypersensitive to the effects of drugs. The main problem with this is that a majority of detox and medication-free treatment programs result in a relapse, with over 60% of patients quickly returning to active opioid use. One small study of 137 patients found that following an inpatient detox program, 94 of them experienced reduced or lost tolerance, and 3 patients died of an overdose within 4 months of discharge. With no tolerance and no medication to assist with ongoing treatment, patients are at a much higher risk of overdose and death.
What about rapid detox?
One especially troubling trend is “rapid opioid detox,” which claims to be a fast and easy way to rid the body of addictive substances. The practice is dangerous and puts patients at risk of relapse and harmful side effects.
During rapid detox, a physician administers an opioid blocker (or opioid antagonist) called naltrexone. This forces the body into a withdrawal-like state and is meant to accelerate the normally 10-day process. Often, the physician will sedate patients using an anesthetic to get them through the worst of their withdrawal symptoms. It’s sold as a quick and painless treatment, but many providers mislead patients into thinking their addiction is cured. The cravings will return as soon as the naltrexone wears off, which usually happens within a few days.
The greatest danger of rapid detox is the naltrexone/anesthetic cocktail. This combination puts a massive amount of stress on the body and has led to suffocation, heart attack, and death. No peer-reviewed studies support the safety or effectiveness of rapid opioid detox compared with traditional treatment with buprenorphine. Several studies show this program has an unusually high risk of adverse events and life-threatening side effects. This is a treatment you should avoid at all costs despite all of the promises you may read online.
Is there an alternative?
Detox has clear problems, especially when programs are medication-free. Thankfully, there is an effective, evidence-based alternative. Whether you call it medication-assisted treatment (MAT) or medication for opioid use disorder (MOUD), this approach demonstrates a lower risk of relapse and opioid overdose. A large study of over 40,000 individuals undergoing MOUD treatment showed a 76% reduction in overdoses at 3 months and a 59% reduction at 5 months. In other words, it works!
MAT is the most effective treatment for opioid use disorder, and Ophelia is working to make it more accessible than ever. We offer telehealth MAT services so you can receive real, life-changing treatment from the comfort of your home. Learn all about our process, treatment services, and your future care team. Ready to begin? Book a quick screening and 15-minute welcome call.