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Medication Assisted Treatment

It’s common knowledge that the United States is in the grip of an opioid epidemic, with nearly 4.5 million people using non prescription pain relievers despite growing restrictions on prescription opioid access and 435,000 using heroin. In 2015, there were a staggering 20,000 overdose deaths from prescription opioids, and 13,000 solely from heroin.

However, opioids are not the only substance with which the country is currently locked in a struggle. Alcohol, while it may be considered a “safer” substance in contrast to opioids, has plenty of troubling statistics of its own, claiming more than 30,000 deaths due to excessive alcohol use in 2014. Overall, the National Institute on Drug Abuse estimates that the total overdose deaths in the United States in 2016 numbered more than 64,000—nearly double what it was 10 years ago.

But, there is hope, and it starts with addiction treatment. Going through medical detoxification is the vital first step needed to begin the journey of addiction recovery and avoid becoming part of these tragic statistics. Detox can be a difficult process as your body experiences the unpleasant and often painful symptoms of withdrawal, which is why many people who try to detox on their own end up relapsing.

If done improperly, detoxing can be dangerous and, even, fatal. To detox safely and effectively, it should be done in the care of a medical professional at a dedicated treatment center. Apart from the expert care a treatment center can provide to alleviate the danger of detoxing alone, it also allows for safe use of certain medications that ease the discomfort of the detoxification process and help reduce some of the worst of the withdrawal symptoms.

What Are the Dangers of a “Cold Turkey” Detox?

One of the most significant dangers of attempting a detox on your own is making the mistake of doing it “cold turkey,” in other words, to stop using immediately and all at once rather than following a gradual tapering process. With many substances, suddenly thrusting the body straight into withdrawal, especially after a prolonged period of abuse, can be fatal, with symptoms ranging from hallucinations and tremors to dangerously high heart rate and seizures.

When left to their own devices, some people will do excessively risky things to attempt to detox quickly and avoid the symptoms of withdrawal. Heroin detox can be a lengthy, sometimes miserable process, which is why many people jumped on a “fad detox” that promised ultra-rapid detoxification under general anesthesia. This process was not only ineffective but also incredibly unsafe, with side effects such as abnormal heart rhythm, acute renal failure, and, even, death.  

In the case of alcohol, about 10 percent of detoxing alcoholics experience Delirium tremens, a symptom of withdrawal characterized by global confusion, hallucinations, fever, hypertension, and tachycardia. For those that experience Delirium tremens and do not seek treatment, the mortality rate is about 35 percent.

These risks only serve to highlight the importance of detoxing in a controlled environment where medical professionals are on-hand to monitor and help. In this way, you can purge the drugs from your body slowly and safely with specially prescribed medications that can help with several different aspects of the detoxification process.

How Do Medications Help with Detox?

When detoxing from substance abuse, Medically Assisted Treatment or MAT, is often used to smooth the process in the following ways:

  • Withdrawal

    This is perhaps the toughest battle to face in this first phase of recovery. Withdrawal symptoms can vary depending on the length and severity of the addiction, but they are often harsh, taking a heavy toll on both body and mind. Medications such as buprenorphine or mirtazapine can help with alleviating both mental and physical symptoms of withdrawal.

  • Co-occurring conditions

    In many cases, someone may have become addicted to a substance as a way of coping with a mental health condition such as depression or anxiety, which will return and even be magnified during the detox process. Antidepressants like paroxetine or desipramine can help to treat these conditions

  • Relapse prevention

    Medications can help not just to decrease cravings but also re-establish normal brain function and, in the case of medications like naloxone or disulfiram, deter future drug use and minimize the chances of relapse.

What Medications Are Used in Detox and How Do They Work?

Opioids

  • Methadone

    When used short-term under careful administration, methadone can minimize heroin withdrawal symptoms. It is what’s called a full opioid agonist, which means that it produces an effect similar to opioids like heroin, but with significantly milder effects. Methadone can be used to replace heroin during detox, before then having to taper off the methadone usage as well.

  • Buprenorphine

    Much like methadone, buprenorphine is also used to help suppress heroin cravings. Unlike methadone, buprenorphine is only a partial opioid agonist, which means its effects are milder than methadone and is safer to use for long-term treatment.

  • Naltrexone

    Naltrexone works differently from methadone and buprenorphine. Since it is an opioid antagonist, it blocks the euphoric and sedative effects of opioids, keeping users from experiencing a “high,” and therefore decreasing the urge to use.

  • Naloxone

    A pure opioid antagonist, naloxone performs the same function as naltrexone but is much stronger, actively undoing the narcotic effects of drugs like heroin and typically is used to prevent or even reverse life-threatening overdoses when administered as an injection during medical emergencies. The severity of this undoing can be too intense for detox; however, so naloxone is usually used in conjunction with buprenorphine to “soften the blow,” so to speak.

Alcohol

  • Naltrexone

    Also a useful medication for alcohol dependency treatment, naltrexone similarly blocks the euphoric feelings associated with intoxication, reducing cravings, and avoiding a potential relapse.

  • Acamprosate

    This medication is used for “post-acute withdrawal symptoms (PAWS),” which are protracted withdrawal symptoms lasting beyond the initial withdrawal phase, such as anxiety and insomnia. Acamprosate lessens these symptoms, which, in turn, minimizes the chance of relapse due to persistent withdrawal symptoms.

  • Disulfiram

    This medication works to decrease the urge to drink and curb drinking behaviors by blocking the body from chemically breaking down alcohol. What this means is that if someone taking disulfiram has even a small amount of alcohol, within minutes they will experience sweating, vomiting, anxiety, vertigo, chest pains, and more. These effects typically last an hour, and while a person taking it must be very motivated to stay sober or else risk what could become severe health effects, it creates a negative association with alcohol that helps promote and maintain sobriety.

Medications can also be prescribed to help treat general substance abuse and their withdrawal symptoms. For example, though there is currently no FDA-approved medication available for treating cocaine, doctors and researchers have found success in reducing cocaine cravings through the use of antidepressants such as mirtazapine, desipramine, and bupropion. These medications are also useful for treating co-occurring conditions, mitigating symptoms of depression during withdrawal, and even helping to stimulate the appetite to combat the malnourishment that can happen during detox due to symptoms of nausea.

What Are the Risks?

While these medications can make all the difference in successfully detoxing and remaining abstinent after detox, this does not mean that they are risk-free.
Using methadone as a detox drug has been the subject of much controversy due to the danger of tolerance and dependency that can come with extended use. Once someone starts abusing methadone, detoxing from it comes with its own set of unpleasant withdrawal symptoms.
Even partial opioid agonists like buprenorphine pose the danger of dependency if exposure is not tightly controlled. While both methadone and buprenorphine can be extremely effective in weaning someone off heroin and mitigating the withdrawal symptoms, great care must be used to avoid just replacing an opioid with another opioid.

Sometimes the dangers are unrelated to fostering a new dependency, as in the case of naltrexone, which actively decreases a person’s tolerance to opioids. This means that, in the event of a relapse, if someone goes back to using the same dosage of opioids they did before treatment, they run a much higher risk of overdose and death.

There is no such thing as a risk-free medication, but as long as these drugs are administered by a medical professional in extremely controlled doses, they can help create a more effective detoxification process. Medically Assisted Treatment removes the danger of detoxing “cold turkey,” alleviates some of the discomforts of withdrawal symptoms, and increases the likelihood of maintaining sobriety and avoiding relapse, allowing you to focus on the next stage of your recovery.

The Controversy Surrounding Medication Assisted Treatment

But what if these medications aren’t used for mere detoxification purposes? What if these medications are used as an actual form of addiction treatment?

When used in a long-term sense, the connotation these very medications have with the public vastly changes. This is the exact area of controversy that surrounds medication assisted treatment.

Medication assisted treatment, or MAT, is a form of addiction treatment that uses these very medications as the primary method of treatment. The idea is that by utilizing these medications, an addict or alcoholic can cease using and abusing their substances of choice.

When undergoing medication assisted treatment, an addict or alcoholic is on these medications long-term. As opposed to using them for a few days such as in the medical detox model, addicts and alcoholics stay on these medications for a few months up to a few years at a time. An addict or alcoholic is prescribed these medications by a specialized physician and takes their daily dosage typically in the prescribing physician’s office.

opioid pills

However, these medications aren’t just prescribed and the addict or alcoholic is on their way, there are other requirements for this type of treatment as well. Addicts and alcoholics are also required to attend certain meetings and therapy sessions that are incorporated with the use of these medications in MAT.

Many people believe that these medications begin acting as a crutch or a replacement therapy. Instead of addicts and alcoholics seeking long-term recovery through complete abstinence, they begin to rely on these medications instead of drugs or alcohol. Because of this attitude, many people in recovery shun the idea and those who partake in medication assisted treatment completely.

Start Your Journey to Recovery Today!

If you’re ready to start your detox treatment, don’t do it alone. Delphi Behavioral Health Group’s addiction and detox specialists are among the most experienced in the country, and they’re here to help you take that first step towards an addiction-free life. Call us at 844-899-5777 or contact us online so our professional admissions team can help find a detox treatment program that’s right for you.

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