All addictive substances act by changing the way nerve cells, neurons, in the brain communicate with each other. Neurons normally communicate by releasing small amounts of natural chemicals that activate special receptors on other neurons. Addictive substances cause increased activation of specific receptors, which leads to the euphoric effects of the drug. But the increasing receptor activation also causes a decrease in the number of receptors. When the substance is no longer used, the decrease in receptors disrupts communication between neurons, which causes withdrawal symptoms until the receptors have had time to return to normal. The goal of detox is to manage these initial withdrawal symptoms.
Heroin Withdrawl Symptoms
Heroin belongs to a class of substances called opiates, which also includes drugs such as Oxycontin and Vicodin. All opiates cause similar withdrawal symptoms, and the basic detox protocol is the same for all, as detailed in "Harrison's Principles of Internal Medicine," in the chapter titled "Opioid Drug Abuse and Dependence." Opiate withdrawal symptoms typically include nausea, diarrhea, profuse sweating, restlessness and increased sensitivity to muscle and joint pain. While highly unpleasant, these symptoms are not dangerous, except in rare cases when other significant medical conditions are also present. Opiate detox typically lasts five to seven days, which is enough time to greatly decrease the severity of withdrawal symptoms.
Comfort Medications
Medications that reduce the severity of withdrawal symptoms are the mainstay of opiate detox. There are several highly effective medications that help to control symptoms such as nausea or diarrhea. Ibuprofen is also used to reduce muscle and joint pain. In addition, a medication called clonidine is extremely useful for reducing symptoms such as sweating and restlessness. Since clonidine also lowers blood pressure, its use is sometimes limited if a patient's pressure gets too low.
Methadone
Methadone is a long-acting opiate that is sometimes used as part of opiate detox. Typically, 25 or 30 milligrams of methadone are given on the first day, and the dose is decreased by five milligrams each day over the course of the detox. Methadone reduces the severity of withdrawal by providing low-level activation of opiate receptors that is decreased gradually. Use of methadone in detox varies from state to state, due to legal restrictions, and from facility to facility, since dispensing it requires a special license.
Opiate Detox in Context
While withdrawal symptoms present a significant early barrier to discontinuing opiate use, they are only one part, and often one of the smaller parts, of opiate addiction. Long after withdrawal symptoms have completely resolved, recovering addicts will still have cravings for the euphoric effects of opiates and will still be driven by social and psychological cues that encourage relapse. To deal with these issues, most opiate detox takes place within inpatient treatment programs so that patients can be gradually transitioned into long-term drug rehabilitation as the detox progresses.
Rapid Detox
Rapid detox is an approach to managing opiate withdrawal that has recently become available. Under the care of an anesthesiologist, patients are given some form of sedation, after which the drug naltrexone is administered. Naltrexone completely blocks activation of opiate receptors, which induces withdrawal symptoms too severe to be tolerated if the patient were fully awake, but which also causes a rapid increase in the number of receptors. Symptoms are resolved in one to two days instead of the typical five to seven. While rapid detox may be appropriate in the rare cases where physical dependence is the most significant aspect of addiction, it adds considerable risk and does not allow for effective transitioning into crucial long-term treatment.
References
- "Harrison's Principles of Internal Medicine"; Dennis L. Kasper; 2005
