Detox is the process of ridding the body of the substances it has become dependent on after habitual abuse of them. The process of withdrawing from many substances can be emotionally turbulent and physically uncomfortable. Fortunately, medications can be used to manage the withdrawal symptoms and keep them at a tolerable level.
Which medication is best for detox depends largely on what substances are being used. During the detox process, most people will experience some form of withdrawal from the substances they’ve been abusing. The symptoms of withdrawal vary according to different substances.
Anti-nausea medications like Phenergan and Zofran are popular prescriptions to mitigate this disruptive side effect of withdrawal. Diarrhea can be managed with over-the-counter drugs like loperamide, while headaches and aches and pains throughout the body can be managed with OTC drugs like acetaminophen and ibuprofen. Depressive symptoms are typically treated with prescription antidepressants such as Prozac.
Medications for Heroin and Opioid Painkiller Detox
The treatment for addictions to heroin and prescription opioid pain relievers is the same. The primary methods prescribed now are buprenorphine and methadone. The California Society of Addiction Medicine reports success rates as high as 90 percent for methadone. Buprenorphine is close to the same at 88 percent, per The Fix.
Treatment with either drug requires daily dosing. That being said, buprenorphine offers far more freedom since physicians can prescribe it and send patients on their way. Methadone programs are stricter and require patients to show up to treatment daily for their dose. Patients may also need to supply clinicians with routine urine samples and participate in group therapy activities in order to stay in the treatment program.
Since opiate drugs are so addictive, they are incredibly difficult to quit cold turkey or detox from within a matter of a week or two like other substances. Both methadone and buprenorphine are used to slowly wean individuals off heroin and opioid painkillers over time. In most cases, people need to stay on the treatment regimen for at least a year. This slow weaning process helps to stave off cravings and eliminate the majority of withdrawal symptoms that people would feel without these medication interventions.
During detox from any kind of opioid, people may experience a lot of residual pain throughout the body, as well as abdominal cramping, which can be treated with over-the-counter pain relievers in most cases.
Anxiety often manifests during the course of withdrawal from opiate drugs. Prescription benzodiazepines are commonly used for treating this side effect. They should be used only on an as-needed basis.
Opiates commonly cause constipation. As a result of coming off them and gradually lowering the dose of treatment drugs, diarrhea often sets in and can be chronic. Over-the-counter Imodium may be a solution for this in some cases along with dietary changes.
Another drug that may benefit people detoxing from opiates is dynorphin – an opioid peptide. A European Journal of Pharmacology report noted only 25 percent of participants of one small study who were treated with dynorphin during heroin withdrawal experienced mild side effects.
Medications Used for Detox from Cocaine and Other Stimulants
There are no replacement medications for cocaine and other stimulants, like methamphetamine, the way there are for heroin and opioid painkillers. Instead, rehab centers focus on managing the symptoms of withdrawal, so clients stay comfortable throughout the process. Typical side effects felt when coming down off a stimulant include:
- Slow thought processing
- Intense cravings
- Insomnia or trouble staying awake
- Extreme paranoia and anxiety
- Excessive irritability
- Nausea and vomiting
In addition, people may experience cold chills, depressive moods, and muscle weakness. Different treatment medications can be used to manage these symptoms of withdrawal. People who suffer with nightmares, paranoid thoughts, and anxiety may benefit from prescription benzodiazepines, like Xanax or Klonopin, which can promote more restful sleep and ease incessant worry.
Antispasmodic drugs, such as Bentyl, are often used to treat tremors and restlessness in people withdrawing from cocaine or other stimulant substances. In serious cases of withdrawal, where delusions and delirium present, neuroleptic drugs like risperidone and quetiapine can provide relief of these symptoms.
Medications Used during Withdrawal from Prescription Benzodiazepines
Benzodiazepine abuse can be a challenge to treat since those who abuse these drugs are often suffering from anxiety-based mental health disorders that they needed the medication for in the first place. This class of drugs is actually more likely to be abused when prescribed. In a study of 203 people being treated for co-occurring substance use and serious mental health disorders, 15 percent who were prescribed benzos developed an addiction to them while only 6 percent of those who weren’t prescribed these drugs did, according to the journal Psychiatric Services.
People who are hooked on benzodiazepines have to adhere to a tapered dosing schedule in order to come off them safely and limit the amount of withdrawal effects they experience.
Typically, the tapering schedule decreases by 25 percent of the initial dose every two weeks. Some people may experience immediate onset of withdrawal, but in some cases, withdrawal doesn’t kick in until a couple weeks after tapering has begun.
Trouble falling or staying asleep is a common side effect during withdrawal from benzos, and it is easily treated with sleep aids like Unisom. Irritability and anxiety may be far more difficult to treat since the very drugs that normally treat these issues are those that the individual is dependent on. In these cases, therapy is the best approach.
In severe cases of withdrawal from these drugs, people may experience hallucinations and delusions. These people are good candidates for inpatient therapy and often need atypical antipsychotic drugs, like clozapine, to medicate their symptoms while they continue on with treatment.
Medications for Detox from Hallucinogens, Club Drugs, and Synthetic Drugs
Hallucinogens like LSD, club drugs like MDMA, and cannabinoids and cathinones continue to make their way around the country. Hallucinogens and MDMA withdrawal generally bring symptoms of memory loss and trouble focusing, prolonged states of confusion, and difficulty with learning that may require therapy to mitigate the effects. Other consequences of detox include depression and depersonalization, both of which often necessitate prescription antidepressants and antipsychotics to manage them.
Among synthetic drugs, like bath salts and Spice, more complex treatment cases often arise.
These drugs are known to cause severe side effects during withdrawal, such as violent behavior and persistent cases of amnesia.
Antipsychotics and sedative drugs are options for treating the symptoms, but in most cases, these side effects resolve following the initial detox period.
Medications for Marijuana Withdrawal
Despite common myths, marijuana is addictive and does produce withdrawal symptoms. In 2013, SAMHSA accounted for 289,379 people being admitted to treatment centers across the country citing marijuana as their primary substance of abuse. Many people in detox from marijuana find themselves feeling depressed and tired due to lack of restful sleep during withdrawal. Rage and extreme irritability are also fairly common during detox. Fortunately, all of these side effects are pretty manageable with antidepressants and anti-anxiety drugs.
Medications for Alcohol Detox
People who detox from alcohol or other depressants will commonly experience:
- Excessive perspiration
- Nausea and vomiting
- Loss of appetite
Antidepressants, anti-anxiety medications, and appetite stimulants can help to keep these symptoms at a controllable level. More severe side effects, such as delirium tremens, affect around 10 percent of people who withdraw from alcohol, per the National Institute on Alcohol Abuse and Alcoholism. These severe symptoms can be medicated with benzodiazepines that act as sedatives to calm psychomotor agitation. Valium and Ativan are commonly prescribed for this reason. Delirium tremens is typically fatal for 2-5 percent of people who encounter it during withdrawal, per the National Institute on Drug Abuse.
When more than one substance of abuse is at play, withdrawal can be slightly more complex, but that shouldn’t deter anyone from seeking help. Support groups and therapy are great additions to any detox regimen. Detox on its own is not addiction treatment; it must be followed by a comprehensive rehab program. With the help of professional staff members and medications, as needed, detox can be a manageable and life-changing experience.