People who want to quit using a substance may try a variety of methods. Many detox methods require weeks or even months to completely detox from a substance while minimizing the adverse effects of withdrawal.
Rapid and Ultra Rapid Detox
Physicians began trying to find ways to speed up the process, so rapid detox was invented so patients could have a faster option. According to the New York State Office of Alcoholism and Substance Abuse Services (OASAS), there are two versions of this: rapid detox and ultra-rapid detox. The fastest version is ultra-rapid opiate detoxification (UROD).
Another term for this process is anesthesia-assisted rapid opiate detoxification (AAROD), as reported by the U.S. Centers for Disease Control and Prevention.
This method was created in the 1980s after research at Yale University proved that naltrexone could trigger withdrawal. Along with the use of clonidine, this could assist with detoxing a person from opioids. Methadone is another medication used in rapid detox processes.
What is Methadone?
Methadone is an opioid pain medication that is in the same drug class as other opioids, such as codeine, oxycodone, and morphine, among others. It is prescribed to help people manage pain after a surgery, injury, or chronic illness. The British Journal of Clinical Pharmacology says that methadone is used to help people who want to quit using opiates. It is used with clinical supervision, and it is usually cheaper than other methods of opioid addiction treatment.
When programs talk about medication-assisted treatment (MAT) to withdraw from opioids, they are usually referencing treatment with methadone or buprenorphine. In addition to medications, therapy is critical to MAT.
Methadone involves a long-term tapering schedule that often takes months or, in some cases, even years. Some people dislike the idea of being on a replacement medication for so long, and out of that aversion, rapid detox was born.
Studies by the National Institute for Health and Clinical Excellence (NICE), attributed methadone to successful rehabilitation in most people as of 2008. Evidence over the years has continued to prove that it works well for opioid withdrawal and treatment adherence.
Methadone can also be a drug of abuse. People may abuse the methadone they receive as part of MAT, or they may procure it from other means to satisfy an opioid addiction. These people may opt to undergo rapid detox to withdraw from methadone.
What is Rapid Methadone Detox?
Rapid methadone detox, also called rapid opiate detoxification (ROD), is meant to help patients stop using opioids — in this case, methadone. Patients should be informed of the risks associated with this procedure.
Even though some private facilities offer ROD or UROD, much of the research conducted on both processes was performed more than 10 years ago. Nowadays, many parts of the world only offer these methods as experimental procedures.
Treatment centers that offer this option must prove they are equipped to handle all of its components.
Rapid opiate detoxification is an expensive procedure because licensed physicians must perform it. Though there may be slight variants in the procedure, patients can expect certain elements to be in place, according to OASAS and NSW Health.
Assessment: Patients who seek out this method need to be examined to confirm they are fit to take part in this procedure. Doctors usually look at the following:
- Medical history
- History of substance or alcohol use and misuse
- Mental health
- Motivation and ability to engage in long-term recovery methods
- Documentation from and consultations with other doctors who have regular contact with the patient
Consistent monitoring: Patients are usually sedated, which means a treatment center must be prepared to monitor their health at all times.
Use of opiate antagonists: Naltrexone is most often used because it is known to combat the effects of opiates in the brain. It is also used to treat alcohol addiction by eliminating cravings for the substance. Everyone is different, so it may work better in some people than others.
Anesthesia or sedation: The use of naltrexone removes the feelings of pleasure caused by opiates. This will immediately cause feelings of withdrawal, which can be uncomfortable. Anesthesia and sedation can help people feel more comfortable as their body undergoes withdrawal. They will essentially be sedated while the withdrawal symptoms are in effect.
The use of additional medication: Other medicines are used to control the feelings of withdrawal. Some of these medications include:
- Clonidine. This drug is generally used to treat high blood pressure, per MedlinePlus, but it is sometimes used to lessen symptoms of opioid withdrawal.
- Octreotide. The National Institutes of Health (NIH) reports that octreotide can restrain the production of insulin and reduce nausea during withdrawal.
- Metoclopramide. According to the Mayo Clinic, this medication increases movements in the stomach and intestines. This assists with vomiting and nausea.
Follow-up care: Rapid detox requires intensive physician supervision for a period of three to five days. After this, follow-up visits should occur every week or month as needed. Other forms of aftercare include support groups, ongoing therapy, regular drug tests to ensure continued abstinence, and medical treatment, as needed.
Deciding if it's Right for You
Rapid methadone detox presents many risks. The treatment will generally not be offered as an option in the United States.
A 2014 Vice report mentions that the U.S. National Institute for Health and Clinical Excellence cautions doctors against offering this treatment.
“While the appeal of rapid methadone detox is clear — methadone can quickly process out of the body without experiencing the discomfort or extended timeline of withdrawal — the risks are extensive.”
Also, simply going through detox does nothing to address the root causes of addiction.
Risks of Rapid Detox
Even though doctors are discouraged from offering this treatment, some patients may still seek rapid methadone detox. Vice says they may leave the country to receive it.
The New York State OASAS warns against both rapid methadone detox and ultra-rapid opiate detox (UROD). There are various reasons for this. They include:
- Patients who require recovery need treatment after withdrawal symptoms are gone. Therapy is the backbone of effective addiction treatment.
- There is not enough research to back the theory that faster detox has any benefits. There is data to support the opposite position—that rapid detox may lead to faster relapse.
- The treatment is expensive. Its average cost is between $3,500 and $7,000. It is not covered by insurance due to its experimental classification.
- Sedation increases the risk of fatalities. Some people have died from undergoing rapid or ultra-rapid detox.
Even then, there are other risks to take into consideration when looking into rapid detox methods. In countries where rapid methadone detox is allowed, doctors are cautioned against providing this option for patients who:
- Have been diagnosed with psychosis or other significant cognitive issues
- Are pregnant
- Have issues with their liver, such as jaundice or hepatic encephalopathy
- Have a history of heart complications or heart disease
- Suffer from renal complications
Rapid methadone detox is also risky for people in the following circumstances:
- People who have been treated for depression in the past, unless a thorough assessment clears such individuals
- Those with a lack of a support network, such as people without a place to live or who live in unstable circumstances, including those in volatile relationships with friends or family
- People who have chronic pain whose only option is to use opioid medications
- Those who are dependent on stimulants, alcohol, or benzodiazepines
A Safer Solution
Whether you are addicted to heroin, methadone, or any other opioid, the best path forward is medical detox in a comprehensive addiction treatment program. The complete withdrawal process may take longer, but it is much safer and more effective than rapid detox.