In most instances, people who are addicted to opiates will relapse within 6 months after commencing opiate withdrawal. By some estimates, the relapse rates run as high as 80% or more, and each time the person relapses, the next attempt to quit becomes that much more difficult for them.
Detoxification for an individual addicted to short‐acting opiates, such as heroin or opioid prescription painkillers, is only a part of the overall approach to treatment. Opiate withdrawals can be painfully unpleasant and the craving intensities often require medication assistance to keep the individual engaged in the process. Treatment becomes part of the opiate withdrawal protocol whenever there is an interest in treatment for opioid addiction.
The Aims of Opiate Treatment
The aims of opiate treatment are to reduce or stop opiate use, improve health and social functioning, and to prevent further harms commonly associated with opiate addictions. According to the World Health Organization (WHO) “Opioid dependence is characterized by a series of symptoms that have long-term prognostic implications.” In other words, opioid dependence can lead to several predictable symptoms for which treatment options now exist.
By using the long acting opioid agonist, methadone, or partial agonist, buprenorphine, for detox treatment as part of the opiate withdrawal protocol, there is evidence of increased reductions in illicit opiate use and behaviors that typically accompany these addictions both during the detox and afterward with significant decreases in mortalities, diseases, relapses, and overdoses.
Why is Treatment Part of the Opiate Withdrawal Protocol?
The majority of opiate users will relapse within 6 months of detox.
After continuous disruptions to the brain and central nervous system from opioid intoxications, it takes a while for normal functioning to be reestablished. Acute physical withdrawal symptoms can be overcome in a matter of several days through non-medication assistance, but, the severity and durations will vary by individual and are, more often than not, a catalyst to continued use.
Opiate withdrawal symptoms, cravings, and uncontrollable physiological responses can compel the person toward opiate relapse at any time. According to NIDA,” Addiction is a chronic, often relapsing brain disease” and “the brain changes that occur over time challenge an addicted person’s self-control and hamper his or her ability to resist intense impulses to take drugs.”
Including treatment as a part of opiate withdrawal protocol is more effective in managing the illness successfully. Like other chronic illnesses such as diabetes, asthma, or heart disease, treating the immediate or acute negative symptoms is not enough and requires lifestyle changes and possibly medications to prevent more serious consequences.
Medication Assisted Detox
A single detoxification episode should not be promoted as an effective treatment for long term abstinence. Some individuals will relapse multiple times before they get the right opiate addiction treatment that keeps them in recovery.
The purpose of using medications such as methadone or buprenorphine for detoxification from short‐acting opioids is to provide a smooth transition from a state of physical dependence on short acting opioids to a state of opioid abstinence, while minimizing cravings and withdrawal symptoms. According to the National Institute on Drug Abuse “Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.”
Naltrexone and naloxone are opioid antagonist drugs that can cause precipitated withdrawals by displacing the short acting opioids from the opioid receptors more quickly. These medications are often used in rapid detox treatments and can be helpful to those who are overdosing or experiencing an unintentional opiate poisoning and for those who have developed an opiate dependency, but, are not chronically addicted
Who is a Candidate for Treatment as Part of the Opiate Withdrawal Protocol?
While they are undergoing the detox process, it is important to initially assess and periodically reassess a patient’s motivation for opiate addiction treatment and their willingness to engage in appropriate counseling and/or a structured rehabilitation program.
Treatment then, becomes an important part of the opiate withdrawal protocol whenever there is:
- An interest in treatment for opioid addiction
- A reasonably expected compliance with treatment
- A patient understanding of risks and benefits of using medication assisted treatment therapies
- No contraindications to use of the medications such as hypersensitivity or aversions to use
- Willingness to follow safety precautions
- Agreement to participate in the proposed treatment plan
Who Needs to Consider Long Term Detox or Maintenance Treatment as Part of the Opiate Withdrawal Protocol?
Treatment as part of the opiate withdrawal protocol can serve a multitude of purposes. Beyond reductions in illicit opiate use, it can help the addict see their problems from a different perspective, improve their self-reliance, and empower them to seek and effect changes in their life. At the same time, treatment can provide access to physical and psychiatric care, psychosocial interventions, and help to provide for their needs and the needs of their families.
In many cases of opiate addiction, treatment will be required in the long term or may be a lifelong event and those who may need this type of help are:
- Those who have co-existing psychological problems with cognitive functioning, social interactions, behavioral issues, or other mental health disorders that impair their ability to enjoy life.
- Those who are at high risk of relapse due to environmental, social, or other contributing factors or overdose.
- Those who are at risk health-wise due to IV use, needle sharing, or compromised health.
- Those who have a history of unsuccessful attempts to quit.
