Drug detoxification
Encyclopedia
Drug detoxification is a collective of interventions directed at controlling acute drug
intoxication
and drug withdrawal. It refers to a purging from the body of the substances to which a patient is addicted and acutely under the influence. The process of detoxification aims at lessening the physical effects caused by the addictive substances.
Detoxification programs do not necessarily treat the other aspects of drug addiction: namely, psychological aspects of addiction
, social factors, and the often complex behavioral issues that are intermingled with addiction.
There are typically three steps to drug detoxification:
Since the original procedure was used on addicted soldiers in Israeli army, it has been gradually perfected by new medications that have since been approved by FDA to help control the effects of the withdrawal. The detoxification drug treatment procedure involves administering intravenous medications that remove opiates from the opioid receptors while the patient is sedated. The detox is done under anesthesia to avoid extreme discomfort and pain from opioid withdrawal symptoms. Additional medications are given to counteract the withdrawal manifestations and to comfort the patient.
while given treatment drugs, such as naltrexone
, can avoid the extreme pain associated with such treatments, say proponents, and bypass the major effects of withdrawal. Critics argue that the treatments can be very expensive and that safety has not been sufficiently demonstrated. A 2005 clinical study on "ultra rapid detox" for heroin addicts, comparing buprenorphine
-assisted or clonidine
-assisted opioid detoxification to anesthesia-assisted detoxification, reported that anesthesia patients commonly underwent withdrawal when they awoke from, had a similar study dropout rate (approximately 80%), and some anesthesia patients experienced severe medical complications. Another 2005 study compared clonidine-assisted detoxification to (rapid) clonidine-naloxone precipitated withdrawal under anesthesia, reporting no significant differences in degree or duration of pain, withdrawal severity, or drug craving, with similar withdrawal sequelae, oral naltrexone compliance levels, and abstinence from heroin four weeks following detoxification.
According to a 2001 analysis of 13 Australian drug treatment trials, conducted by Australia
's National Drug and Alcohol Research Centre
, rapid opioid detoxification was determined to be the most effective method of getting people off drugs in the short term, however long-term rates of continued treatment were less successful; in contrast, methadone
maintenance treatments were determined to be more cost-effective with patients more likely to remain in treatment.
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."
Drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...
intoxication
Drug overdose
The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced...
and drug withdrawal. It refers to a purging from the body of the substances to which a patient is addicted and acutely under the influence. The process of detoxification aims at lessening the physical effects caused by the addictive substances.
Detoxification programs do not necessarily treat the other aspects of drug addiction: namely, psychological aspects of addiction
Substance dependence
The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...
, social factors, and the often complex behavioral issues that are intermingled with addiction.
There are typically three steps to drug detoxification:
- Evaluation: Upon beginning drug detoxification, 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 diagnosisDual diagnosisThe term dual diagnosis is used to describe the comorbid condition of a person considered to be suffering from a mental illness and a substance abuse problem. There is considerable debate surrounding the appropriateness of the term being used to describe a heterogeneous group of individuals with...
, and mental/behavioral issues. - 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.
- 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 rehabilitationDrug rehabilitationDrug rehabilitation is a term for the processes of medical or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines...
program.
History of Rapid Opioid detox
Rapid opiate detox was created in Israel almost 20 years ago by Dr. Andre Waismann, who still practices his craft in Brazilai Medical Center in Ashdod, Israel.Since the original procedure was used on addicted soldiers in Israeli army, it has been gradually perfected by new medications that have since been approved by FDA to help control the effects of the withdrawal. The detoxification drug treatment procedure involves administering intravenous medications that remove opiates from the opioid receptors while the patient is sedated. The detox is done under anesthesia to avoid extreme discomfort and pain from opioid withdrawal symptoms. Additional medications are given to counteract the withdrawal manifestations and to comfort the patient.
Rapid Detoxification
The often painful symptoms of drug withdrawal may last for several days and can stand as a barrier to the treatment of a drug abuse problem. Some practitioners use "rapid" or "ultra rapid" detoxification methods to condense the withdrawal process into a considerably shorter period of time, about two hours, while the addict is asleep. Rapid detox patients placed under anesthesiaAnesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
while given treatment drugs, such as naltrexone
Naltrexone
Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade...
, can avoid the extreme pain associated with such treatments, say proponents, and bypass the major effects of withdrawal. Critics argue that the treatments can be very expensive and that safety has not been sufficiently demonstrated. A 2005 clinical study on "ultra rapid detox" for heroin addicts, comparing buprenorphine
Buprenorphine
Buprenorphine is a semi-synthetic opioid that is used...
-assisted or clonidine
Clonidine
Clonidine is a sympatholytic medication used to treat medical conditions, such as high blood pressure, some pain conditions, ADHD and anxiety/panic disorder...
-assisted opioid detoxification to anesthesia-assisted detoxification, reported that anesthesia patients commonly underwent withdrawal when they awoke from, had a similar study dropout rate (approximately 80%), and some anesthesia patients experienced severe medical complications. Another 2005 study compared clonidine-assisted detoxification to (rapid) clonidine-naloxone precipitated withdrawal under anesthesia, reporting no significant differences in degree or duration of pain, withdrawal severity, or drug craving, with similar withdrawal sequelae, oral naltrexone compliance levels, and abstinence from heroin four weeks following detoxification.
According to a 2001 analysis of 13 Australian drug treatment trials, conducted by Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
's National Drug and Alcohol Research Centre
National Drug and Alcohol Research Centre
The National Drug and Alcohol Research Centre is an Australian research institution focusing on treatment and intervention in drug and alcohol abuse. Located at the University of New South Wales Randwick campus, in the suburbs of Sydney, NDARC was established in May, 1986, and officially opened in...
, rapid opioid detoxification was determined to be the most effective method of getting people off drugs in the short term, however long-term rates of continued treatment were less successful; in contrast, methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
maintenance treatments were determined to be more cost-effective with patients more likely to remain in treatment.
Origin of the Term
The concept of "detoxification" comes from the discredited autotoxin theory of Dr. George E. Pettey and others. David F. MustoDavid F. Musto
David Franklin Musto was an American expert on U.S. drug policy and the War on Drugs who served as a government adviser on the subject during the Presidency of Jimmy Carter...
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."