Opiate Detox

What Are Opiates?

Opiate drugs are powerful painkillers [1].

Under this classification, opiate drugs include legal and illegal painkiller medications, which are also called opioid painkillers.

Legal opiate drugs are prescribed and administered in a safe way, with corresponding correct dosages.

Legal forms of opiate drugs are:

• Codeine
• Fentanyl
• Hydrocodone
• Methadone
• Morphine
• Oxycodone

Meanwhile, heroin is an illegal opiate drug.

Primarily, legally prescribed opioid painkillers are used to treat the following conditions: [2]

• Moderate to severe pain
• Pain experienced by cancer patients
• Pain during the end-of-life stage
• Chronic non-malignant pain (CNMP), which are caused by injuries or diseases that last longer than 3 to 6 months.
• Osteoarthritis
• Fibromyalgia
• Tissue or nerve damage
• Chronic abdominal pain such as pancreatitis and Crohn’s disease
• Acute pain – short-term and caused by specific events such as accidents, surgery, or childbirth
• However, because opioid drugs are highly addictive, they are prone to misuse and abuse.

Some become addicted to opioid drugs accidentally, because of inadequate warning/advice.

Some also turn to heroin after prescription drugs become unavailable and/or heroin presented as a cheaper option [3].

The Drugs Wheel

The Drugs Wheel is a way of classifying drugs based on the effects they have on the body [4].

According to the Drugs Wheel, opiates can cause:

• Euphoria – the feeling of getting high
• Relaxation or a sense of peace/well-being
• Relief from pain
• Slowed-down concentration
• Sleepiness and inattentiveness
• Feeling “floaty”
• Reduced sex drive

Why Are Opiates Addictive?

Opiates take effect on the nervous system (brain + spinal cord + nerves branching off to different parts of the body). [2]

Opiates have powerful, painkilling effects in too-high levels.

These high levels are not naturally achieved by the human body.

Opiates change the chemistry of the brain, making the brain used to the too-high level of pain relief.

When opiate use is stopped, pain relief is reduced significantly.

Since the body got used to a high level of pain relief, any measure of pain can come across as intolerable.

It is in this light that withdrawal symptoms surface.

For individuals who rely have become dependent on opiates to block all effects of pain, nothing but the pain relief that opiates offer will do.

In an attempt to stop the feeling of pain, more opiates are sought, even if the prescription has run out.

Alternatives to lower types of painkillers can also be rejected because of their less-than-potent effects.

Individuals may also prefer the used-to dosage of opiate even if the expert recommendation is to scale down.

Withdrawal symptoms associated with stopping opiate use are:

• Sensitivity to stress
• Anxiety/ Irritability
• Body coordination can be jerky (can have tremors)
• Abnormal sleep pattern (either insomnia or sleeping too much)
• Emotional numbness/ blanking out/ daydreaming
• Easily distracted
• Loss of focus/ memory problems

The potent, fast-acting nature of opioids is hard to match.

Some describe getting rid of opiates as moments spent in panic, when the reality of not using is scarier than the actual experience.

Some describe opiate withdrawal as depressing, because without the drug, feelings of helplessness surface.

Some say they crave using the drug so as to stave off withdrawal symptoms; the use of the drug does not anymore give pleasure.

Individual bodies differ, but some could be genetically vulnerable to opioid addiction.

This is especially true if a person has a family history of alcohol and/or drug use.

• Excessive Use or Misuse
• Opiate Addiction
• Physical Dependence on Opiates
• Psychological Dependence on Opiates

Opiate Detox: The First Step in Rehab

In a rehab clinic, professional help assists in overcoming opiate withdrawal symptoms.

Stopping the use of fentanyl, morphine, codeine, and heroin can be described with the following timeline: [5]

6 to 30 Hours After Opiate Use Stops:

• Being emotional, in tears, or feeling down
• Anxiety, excessive anger
• Resistance, denial, attempts to escape the detox process
• Excessive yawning, sleepiness
• Conversely, insomnia
• Muscle pains and aches
• Runny nose, feeling as if having a flu
• High blood pressure
• Sweating excessively

72 Hours After Opiate Use Stops:

• Diarrhoea
• Nausea
• Vomiting or gastric pain
• Goosebumps/ Cold flashes
• Craving for opiates

Lingering Withdrawal Symptoms

• Memory is not like what it was before usage of opiates
• Slower intellectual performance
• Sexual performance problems like impotence and irregular menstrual periods
• Teeth and gum problems

In addition, for heroin users, there is a risk of developing Heroin Use Disorder.

This type of condition means a person will seek heroin even in the face of negative circumstances, in such a way that drug-seeking becomes the highest priority in life.

For opiate detox and withdrawal help, some turn to professional help in a rehab clinic like Abbeycare.

The staff members in a private clinic are trained to anticipate the needs of persons in recovery, understanding that:

• Opiate recovery needs time, and is not a quick fix
• Opiate Detox is only one part of the recovery process
• With a good experience in opiate detox, relapse is prevented
• Holistic treatment of the problem is the focus, not just the surface signs of addiction

Warning About Opioid Overdose

Aside from being highly addictive, opiates can cause death due to overdose [6].

Overdose situations can be avoided by:

• Taking the exact dose as prescribed
• Not mixing opioids with other pain medications
• Not using opioids and alcohol together
• Not mixing opioids with anti-anxiety drugs and anti-depressants
• Ensuring that opiate drugs are kept away from children and/or teenagers

Opioid overdose is life-threatening. In the event of overdose, immediate emergency attention is necessary.

What Opiate Detox Rehab Is Like

During the first few days, the initial reaction to withdrawal and opiate detox may be strongly focused on physical withdrawal symptoms.

However, some may feel emotionally overwhelmed, and may feel unable to continue.

It is at this point that a personalised opiate detox programme helps.

With a dedicated case manager, there is a greater chance of completing treatment with emotional and/or moral support. [7]

A typical day in rehab for Heroin addiction could look like:

Morning:

• Meditation / Reflection
• Detox medication (if prescribed)
• Breakfast
• Therapeutic session

Midday – Afternoon

• Lunch
• Therapeutic session (for example Cognitive Behavioural Therapy/ Holistic Care)

Evening

• Dinner
• One-to-one individual keywork session with care manager
• Or accompanied attendance to a mutual aid (support) meeting

Therapeutic Help

In terms of effectiveness, treatments available for opiate addiction that show most promise are: [7]

• Cognitive Behavioural Therapy
• 12 Step Facilitation

Opioid rehab success rate is not readily determined, as clinics vary widely in the type of treatments and length of treatments used.

What is clear is the fact that these approaches are the most utilized, with universal appeal.

After rehab, the use of the techniques learned can be carried on to support group sessions.

Insights can also be explored in-depth in individual therapy with addiction counsellors.

Opiate Rehab Aftercare

In an abstinence-based rehab clinic such as Abbeycare, a long-term commitment to recovery from opiate addiction requires adherence to an aftercare regimen.

Aftercare boosts the chance of full recovery because:

Emotional and psychological support helps to alleviate feelings of loneliness

Being in contact with a sponsor or an accountability partner encourages compliance to recovery commitments

There is motivation through hope in a common vision of recovery

New decision-making skills are learnt because of suggestions for the practical side of recovery

Sticking with an aftercare plan creates structure in a life previously described as chaotic

In addition, an aftercare plan is made with peers who are also in recovery.

As a result, different points of view can help when someone is stuck with a problem that is hindering recovery from opiate addiction.

Treatment with Naltrexone

Naltrexone is an opiate antagonist. Its main action is to stop endorphins (the body’s natural painkillers) [8].

When endorphins are blocked, the body compensates by producing more endorphins. When this happens, painful feelings are lessened.

In the UK, the NHS permits the use of Naltrexone as a drug to manage opiate dependency.

Naltrexone can also be given as Low Dose Naltrexone for the management of pain in some cases [8].

To add, Naltrexone can be helpful in treating Alcohol Use Disorder [9].

The prescription can be available with local GPs. Sometimes, the drug is sold under the names Nalorex®, Adepend® or Opizone®.

Naltrexone is given as a 50mg dose in tablet form.

However, in some cases, it can also be administered with an injection.

During inpatient care in a rehab clinic, Naltrexone treatment is begun after the detoxification process has been completed.

This is because Naltrexone is most effective when opioids have been completely removed from the body.

As part of a comprehensive treatment plan, Naltrexone is only used when counseling and social support programs are in place.

Dealing with Pain In Recovery

Pain management treatment is necessary, even if the person seeking pain relief is in opioid addiction recovery.

Guidelines for health care worker dictate that adequate pain relief should be given for mild, moderate, and severe pain. [10]

The first step in adequate pain management is determining which level pain is experienced.

The second step in adequate pain management is recognizing that acute pain is a medical emergency.

Acute pain is short-term, and should be treated aggressively.

If the person experiencing the acute pain is in addiction recovery, steps must be made to guarantee that:

• The addiction concerns do not overshadow the pain being felt
• “Less addictive” medicines are prescribed in a thoughtful manner
• Under-dosing does not happen, because this leads to self-medication and psychological harm
• Professionally, experts are reminded that pain comes from psychological origins, with little to no physical basis are exceptions more than the norm. [10]

In a rehab clinic such as Abbeycare, Addictions counselors can work with clients to distinguish the contributions of feelings and thoughts to how pain is experienced.

It is hoped that after in-depth discussion and probing, clients can see that:

Pain is sometimes motivated by cultural factors

The expression and experience of pain can be encouraged or discouraged depending on who the person is with

Mental health factors play a huge part in the interpretation and handling of pain.

Specific Ways to Handle Pain

• Stress reduction techniques, specifically those learnt in therapy
• Mindfulness practices such as meditation, yoga, and hypnosis
• Physical exercise – it is important that the exercise chosen is safe and does not risk more injury
• A regular sleep schedule
• Regular physical exercise
• Supplements or vitamins (inadequate nutrition can lead to fatigue and momentary depression)
• Foods rich with probiotics and Omega-3 fatty acids, as these can lower inflammation (inflammation is associated with some types of chronic pain) [11]
• Activities that engage creativity
• Sustaining long-term recovery by sticking to the aftercare plan in rehab
• Alumni programs from the rehab clinic, where past clients come visit present clients
• Continued communication with addiction counselors, sponsors, and members of mutual aid groups

FAQ

• Does opiate detox work?

Yes, it does. But for opiate detoxification to work, the following elements need to come into place:

Correct assessment of the condition, including other conditions that may affect recovery chances

Comprehensive treatment – inpatient/structured care can give etter care than outpatient care [6]

Medical attention (if needed)

• Is there opiate rehab without insurance?

Because individual needs are different, pricing for opiate rehab without insurance is discussed during a client’s initial conversation with Abbeycare.

See the Pricing page for more information or use the Abbeybot below  below to get guideline pricing.

Note that all pricing is subject to agreement from both the clinic’s Admissions and Clinical teams.

• What to avoid while detoxing on opiates?

Detoxing from opiates necessitates avoiding: [6]

• Alcohol
• Anti-depressant medication – such as citalopram, dapoxetine, and escitalopram
• Anti-anxiety medication – such as Selective serotonin reuptake inhibitors (SSRIs) including sertraline and paroxetine
• Other addictive substances/drugs

During detox, a high-fibre diet rich with anti-oxidants can help flush out toxins. [12]

Adequate hydration by drinking plain water is also highly recommended

In an inpatient rehab clinic, nutritious food is considered part of holistic recovery.

Many do not pay attention to good nutrition when in a state of active opiate addiction.

Nutritional deficiencies can cause lack of energy to engage in activities necessary to make changes in a lifestyle without opiate use.

• Is there treatment for opiate addiction without rehab?

Inpatient rehab can be the best option because it provides structured, comprehensive care for this serious condition.

But if inpatient care is not available or hard-to-obtain, outpatient rehab is the next best option.

Without professional help, there might be some serious health risks including: [12]

• Severe diarrhoea
• Vomiting often, which can lead to choking
• Dehydration
• Lung infections
• Seizures

The NHS can provided outpatient care through services available in local drug centres.

Mutual aid groups also offer free meetings, although meetings, though immensely helpful, are not a complete form of therapeutic care.

• What are the side effects of detoxing from opiates?

Physical withdrawal and psychological withdrawal are the two main sources of side effects from opiate withdrawal.

Physical withdrawal effects can include fever-like responses, sleeping problems, tremors, and cardiovascular (heart-related) complaints. [12]

Psychological withdrawal has more to do with feelings associated with stopping the use of opiates. The most common psychological signs of opiate withdrawal are:

• Mood changes – anxiety level can be high; depressed feelings can surface
• Aggressiveness/ Restlessness
• Lack of motivation to do daily things
• Repeatedly thinking about opioid use
• Fears that detox won’t be successful
• Denial of the seriousness of the situation

How To Book

To book into Abbeycare for Opioid help, contact Abbeycare direct on 01603 513 091.

Pricing

References

1. Centers for Disease Control and Prevention. (2018). Opioid Basics. Retreived from: https://www.cdc.gov/drugoverdose/opioids/index.html
2.  Rosenblum, A. (2009). Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions. Exp Clin Psychopharmacol. 16(5), 405–416. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/
3.  NIDA for Teens. (2020). The Connection Between Pain Medications and Heroin. Retrieved from: https://teens.drugabuse.gov/blog/post/connection-between-pain-medications-and-heroin
4.  Alcohol and Drug Foundation. (2019). Drug Wheel. Available at: https://adf.org.au/insights/drug-wheel/
5.  Rodriguez, A. Opiate Withdrawal: What It Is and How to Cope with It. Retrieved from: https://www.healthline.com/health/coping-opiate-withdrawal#dependence-andaddiction
6.  Substance Abuse and Mental Health Services Administration. (2019). Opioid Overdose. Retrieved from: samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose
7.  Substance Abuse and Mental Health Services Administration. (2019). Recovery and Recovery Support. Retrieved from: https://www.samhsa.gov/find-help/recovery
8.  MultipleSclerosisUK.(2015). Choices Low Dose Naltrexone. Retrieved from: https://www.ms-uk.org/sites/default/files/Choices%20-%20Low%20Dose%20Naltrexone%20PDF%20Version.pdf
9.  Specialist Pharmacy Service NHS (2020). What is the evidence for low dose naltrexone for treatment of multiple sclerosis? Retrieved from: https://www.merseycare.nhs.uk/media/3368/naltrexone-2017-final.pdf
10.  Prater, C., Zylstra, R., Miller, K. (2002). Successful Pain Management for the Recovering Addicted Patient. Prim Care Companion J Clin Psychiatry. 4(4), 125–131. DOI: 10.4088/pcc.v04n0402. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC315480/
11.  Minihane, A. et al (2015). Low-grade inflammation, diet composition and health: current research evidence and its translation. Br J Nutr., 114(7), 999–1012. DOI: 10.1017/S0007114515002093. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579563/
12.  National Institute on Drug Abuse. (2018). What are the long-term effects of heroin use? Retrieved from: https://www.drugabuse.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use