Prescription Drug Detox

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KEY TAKEAWAYS

Detoxification from prescription medication becomes necessary when:

Users are taking a greater quantity of medication than is prescribed
Users are taking medication originally prescribed for a different patient

Medical professionals usually carry out detoxification in either a hospital or a residential rehab.

Inpatient care has a 3-fold higher success rate compared to outpatient detoxification [1].

What Is Prescription Drug Detox?

Detoxification from prescription treatment means removing dependence on drugs either in a hospital, residential rehab, or at home.

Prescription medication detoxification works by ceasing intake of drugs, while managing withdrawal symptoms using medication.

Indicators Of Prescription Drug Addiction

Indicators of prescription drug abuse include:

Trying to obtain prescription medicine illegally
Regularly claiming to have lost prescriptions and asking for replacements
Stealing or using others' prescriptions
Hiding how much medication has been prescribed or taken from friends and family
Multiple visits to doctors or seeing other doctors to access more drugs
Neglecting work or home commitments to obtain or take drugs
Becoming more isolated than normal

How Is Prescription Drug Detox Done?

Different approaches used during prescription detoxification are:

Tapered detoxification using the medication that the patient is addicted to, on a sliding scale over time
Tapered detoxification using a similar medication that mimics the chemical effects of the original medication
Symptom-managed detoxification using alternative medications to the substance of active addiction

Which approach to use is decided by professionals who:

Consider the recency, frequency, and intake levels of drug use
Undertake a joint assessment of physical and mental health with addiction specialists
Consider previous detoxification success rate to inform current prescription
Consider pre-existing health concerns (liver injury, blood infections, etc.) that may impact detoxification

Where Prescription Detox Takes Place

Header	Unsupervised Detox	Outpatient Detox
Duration	Up to 90 days	3-14 days
Advantages Of Approach	Unsafe practice with potentially fatal consequences	Able to continue with life/work commitments with appropriate public sector oversight
Cost	Free (NHS)	Free (NHS)
Risks	Hallucinations and seizures - potentially fatal	Withdrawal symptoms when left unsupervised

Header	Private Detox	Hospital Detox
Duration	14-28 days	Up to 60 days
Advantages Of Approach	Away from addiction triggers and able to identify underlying causes of addiction	24-hour supervision for severe withdrawal symptoms
Cost	£	Free (NHS)
Risks	Minimal	Minimal [2]

Prescription Drug Detox & Medicine Prescribed In The Community

Prescription drug detoxification is typically set up in the community and either carried out in the community or a private treatment facility.

A private treatment provider will only detoxification when appropriate, meaning each clinic's medical professional must assess each client individually to decide whether detoxification is appropriate.

In most cases, a doctor in a private medical setting will only intervene upon prescribed medicine by an external doctor if:

It is required for safe detoxification - drug use has been over/under-reported to external doctors
Unexpected side effects mean a change in medication is needed
The external doctor is aware of changes made to prescription and has explicitly approved
The patient developed an allergy to prescription drugs
The patient experiences an acute decline in condition since being assessed in the community -e.g., has developed jaundice
The patient has become pregnant since being assessed

Prescription Drug Detox vs "Cold Turkey"

Header	Prescription Drug Detox	“Cold Turkey”
Risks	Managed via individualised care plans	Not managed professionally; risk of severe withdrawal symptoms
Side Effects	Muscle spasms Vomiting Chills Insomnia Terror Controlled with detox medication	Seizures, psychosis and dehydration - uncontrolled and risk of fatality
Timescales	28 + days	Up to 6 months
Long Term Outcomes	59% experience successful treatment without relapse [3] Reduced relapse as removed from addiction environment Longer time lapse between potential relapses [4] Reduced organ/vascular diseases [5]	52% experienced severe withdrawal symptoms 26% relapsed 4+ times 26% took 1+ year to discontinue drug use [6]

Detoxing From Multiple Prescription Drugs Simultaneously

The complications involved in detoxification from multiple medications, as compared to one substance alone, are:

A 3.6% increased risk of seizures and psychosis [7]
Patients may have abused drugs typically used in detoxification (valproate, paracetamol, ibuprofen, or sleeping pills), meaning these medications cannot be used for detoxification
Difficulty predicting reactions to drug withdrawal - particularly if stimulant and depressant drugs have been mixed
Different withdrawal timelines lengthen withdrawal symptoms - e.g., opiate withdrawal takes up to 10 days, whereas barbituates take up to 8 weeks [8]

Here at Abbeycare, our clinicians routinely approach multiple prescription drug detoxification by completing a joint assessment that takes into account the clients':

Mix of drugs used and how they interact
History of intake
Other health concerns outside of addiction

Needs Vs Wants Prescription Drug Detox

There is a difference between those who need detoxification from all medications, and those who want detoxification from all medications but should not.

Examples of those wanting prescription detoxification, but who do not need to, include:

Wanting to detox from anti-depressants that are routinely prescribed, considered safe, and well tolerated (e.g. citalopram, sertraline, or fluoxetine)
Those taking low-risk medication for high blood pressure or diabetes (e.g. lisinopril, candesartan, or warfarin)

Examples of those needing to detoxify from prescription drugs, but who do not want to, include:

Misusing drugs that negatively interact with each other (e.g. NSAIDs and warfarin)
Interactions increasing side effects (e.g. oxycontin mixed with antibiotics, amiodarone, or bleomycin)

The requirement for prescription drug detoxification depends on whether active addiction is present.

Those who want detoxification willingly may achieve better results due to:

Less pre-existing liver stress
Fewer established patterns and triggers of addiction
Less exposure to enablers/ other drug users

Detoxing From Maintenance Medication

Special considerations are required when a client wishes to detoxify from a maintenance medication, such as:

How long the maintenance medication will stay in the body - for example, methadone has a half-life of up to 59 hours [9]
If the patient is planning to become or is pregnant - methadone withdrawal can lead to a miscarriage or early birth [10]
Possibility of relapse back to the original addictive substance - e.g. using heroin after high-dose methadone detoxification
Concerns of developing an addiction to drugs used during detoxification - particularly if multiple previous substances have been abused

Detoxification from maintenance medication must be endorsed by GPs or other medical professionals who prescribe maintenance medication.

Detoxification must also be communicated to the pharmacy providing medication.

When Detoxing From Prescription Drugs Is NOT Appropriate

During Pregnancy

While detoxification from prescription drugs during pregnancy is possible, detoxification from maintenance drugs, such as methadone or buprenorphine, can cause miscarriage or early labour [10].

Doctors may replace faster-acting benzodiazepines (diazepam and clorazepate) with longer-acting benzodiazepines (flurazepam or prazepam) to reduce harm to the baby [11].

Psychoactive Medications

Desire for detoxification may increase when the patient is feeling well as a result of taking medication in the correct prescribed dosage.

Instead of detox, doctors recommend switching the patient's current antipsychotic for one with fewer side effects (e.g., quetiapine or ziprasidone) [12].

Epilepsy In Benzodiazepine Withdrawal

Detoxification from benzodiazepines may not be appropriate when the patient suffers from pre-existing epilepsy, as benzodiazepines reduce epileptic seizures.

When a patient wishes to withdraw, doctors must give the patient another anti-seizure medication before withdrawal occurs [13].

Multi-Substance Abusers

It is not appropriate to attempt detoxification combined prescribed and illicit drug users from only prescribed drugs when:

Detox symptoms of prescribed drugs outweigh detox symptoms of illicit drugs
Patients do not declare illicit drug use and aren't correctly diagnosed detox medication

Suicidal Ideation

Detoxification is inappropriate for those experiencing suicidal ideation as it may exacerbate symptoms of depression or anxiety and worsen suicidal thoughts [14].

Lack Of Supervision

When detoxing in the community, a lack of professional observation can mean detoxification is inappropriate, as:

Family members administering medication are not experienced and may not be able to supervise full-time, leading to risk of relapse or incorrect dosage.
Detoxification nurses can only supervise medication for only 15 minutes, four times a day, leading to risk of withdrawal symptoms occurring without observation.
Being supervised during the day in an outpatient facility but not during the night, leading to risk of relapse [15]

Anti-Depressant Interactions

Fluvoxamine (an anti-depressant) raises methadone plasma levels by up to 100%, causing methadone as a detox medication to be overprescribed [16]
Dextromethorphan (an anti-depressant) is metabolised by the P450 (CYP) 2D6 isozyme, that methadone inhibits [17]
Duloxetine (an anti-depressant) may cause increased duloxetine levels when combined with methadone [18]
St John's Wort (a complementary anti-depressant) increases the processing of drugs from the system, lengthening detox [19]
Tranylcypromine, phenelzine, and isocarboxazid (MAOI anti-depressants) mixed with tramadol, methadone, and dextromethorphan (phenylpiperidine opioids) can cause serotonin syndrome, resulting in death [20]

Warfarin

It is inappropriate to detox when taking Warfarin as ibuprofen and acetaminophen, commonly used during detox, increase bleeding in Warfarin users [21].

Chronic Underlying Pain

Detoxing is not appropriate when the patient is suffering from undiagnosed chronic pain as:

Potential undiagnosed causes of pain such as cancer, multiple sclerosis, and AIDS can cause immune dysregulation in patients detoxing from prescription medication [22]
Detoxification does not solve chronic pain; a solution must be found before removing prescribed medication

Personal Preference

Patients may wish to detox from all prescribed medication as a result of:

Not wanting to be on medication long-term
Experiencing side effects of combined medication
Believing that alternative treatments/ coping mechanisms will function instead of medication

However, detoxing may not be appropriate if the patient needs medication to manage an ongoing condition (e.g. schizophrenia, bipolar, or borderline personality disorder).

Benzodiazepine Users

Benzodiazepine users may be unable to detox appropriately as benzodiazepine detoxification can take up to 18 months, and professional supervision may not be available for that timeframe [23].

Detoxing From Prescription Drugs vs Detoxing From Other Substances

Header	Prescription Medication	Opioids	Stimulants
Detox Timescales	Up to 6 months	28+ days	2 weeks
Severity Of Withdrawal Symptoms	Insomnia, seizures, panic attacks, suicidal ideation, respiratory depression	Rhinorrhea, myalgia, diarrhoea, pupillary dilation, tachycardia [24]	Hallucinatio ns, paranoia, decreased cognitive ability, insomnia
Dangers Of Detox	Possibility of cross-addiction to detox drugs	Opioid withdrawal syndrome and precipitated withdrawal - potentially fatal	Post-acute withdrawal syndrome (PAWS)
Long Term Outcomes	Reduction in heart disease, kidney failure, liver disease and brain damage	Regain white matter loss, reduction in risk of HIV infection [25]	Reduction in risk of hypertensio n, arrhythmia, and coronary artery disease [26]

Header	Benzodiazepines	Alcohol
Detox Timescales	28+ days	7-10 days
Severity Of Withdrawal Symptoms	Panic attacks, seizures, tremor	Delirium tremens, seizure, hallucinations
Dangers Of Detox	Depersonalisation/ derealisation occurring years after detox [27]	Alcohol withdrawal syndrome or PAWS
Long Term Outcomes	Improved cognitive function [28]	Preventing further liver damage and increasing life expectancy of five years in cirrhosis sufferers by 50% [29]

Prescription Drug Detox At Abbeycare

Here at Abbeycare, each client is assessed individually before admission to determine:

The severity, length of usage, and amount of medication abused - to create an individualised care plan
Assessing other biological, medical, and psychological factors combined with a sliding scale of medication and alternative medication to reduce risks
Medication for underlying chronic pain, and how best to address that during detoxification
Underlying chronic conditions which require to be managed via medication beyond detox

Abbeycare offers detox alone and as part of a complete rehab programme.

References

[1] Stahler, Gerald J., et al. “Residential and Outpatient Treatment Completion for Substance Use Disorders in the U.S.: Moderation Analysis by Demographics and Drug of Choice.” Addictive Behaviors, vol. 58, July 2016, pp. 129–35.. “Clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment.”
[2] Center for Substance Abuse Treatment. “4 Physical Detoxification Services for Withdrawal from Specific Substances.” NIH GOV, Substance Abuse and Mental Health Services Administration (US), 2016.. “The consensus panel agrees that for alcohol, sedative-hypnotic, and opioid withdrawal syndromes, hospitalization (or some form of 24-hour medical care) is generally the preferred setting for detoxification, based on principles of safety and humanitarian concerns. When hospitalization cannot be provided, a setting that provides a high level of nursing and medical backup 24 hours a day, 7 days a week is desirable. The panel readily acknowledges that social detoxification programs are, for some communities, the only available resources for uninsured, homeless individuals. Social detoxification is preferable to detoxification in unsupervised settings such as the street, shelters, or jails. The panel also notes that in some large urban areas, social detoxification programs have longstanding, excellent reputations of providing high-quality supervision and nurturance for their clients. Social detoxification programs are organized and funded by a variety of sources, including faith-based organizations, community charities, and municipal and other local governments.”
[3] Eastwood, Brian, et al. “Effectiveness of Inpatient Withdrawal and Residential Rehabilitation Interventions for Alcohol Use Disorder: A National Observational, Cohort Study in England.” Journal of Substance Abuse Treatment, vol. 88, May 2018, pp. 1–8. "Of treatment leavers, 59% achieved the SCNR outcome (IW: 57%; RR: 64%; IW/RR: 57%)."
[4] Joe, George W., et al. “Retention and Patient Engagement Models for Different Treatment Modalities in DATOS.” Drug and Alcohol Dependence, vol. 57, no. 2, Dec. 1999, pp. 113–25.. “Structural equation models showed there were positive reciprocal effects between therapeutic involvement and session attributes in all three modalities, and these variables had direct positive effects on treatment retention. Motivation at intake was a strong determinant of therapeutic involvement.”
[5] Singh, Varun Parkash, et al. “A Review on Renal Toxicity Profile of Common Abusive Drugs.” The Korean Journal of Physiology & Pharmacology : Official Journal of the Korean Physiological Society and the Korean Society of Pharmacology, vol. 17, no. 4, Aug. 2013, pp. 347–57. “The renal complications include a wide range of glomerular, interstitial and vascular diseases leading to acute or chronic renal failure.”
[6] Read, John. “The Experiences of 585 People When They Tried to Withdraw from Antipsychotic Drugs.” Addictive Behaviors Reports, vol. 15, Mar. 2022. “Responding to specific questions, 72% reported classical withdrawal effects of the kind associated with other central nervous system medications, including nausea, tremors, anxiety, agitation and headaches. 52% of these categorized those effects as ‘severe’. 26% had tried four or more times to discontinue, and 23% took at least one year to successfully withdraw completely. In response to the open question, 73% reported one or more withdrawal effects, most frequently, insomnia, nervousness and extreme feelings; 26% reported one or more positive outcomes, most frequently more energy/alive and clearer thinking; and 18% reported psychosis.”
[7] Dunsæd, Frode, et al. “Standardised Detoxification in Cases of Polydrug Use.” Tidsskrift for Den Norske Legeforening, Oct. 2016. “Complications like delirium tremens, epileptic seizures and psychosis (3.6 %) were rare.”
[8] World Health Organization. “Withdrawal Management.” NIH GOV, World Health Organization, 2009. “Short-acting benzodiazepines include oxazepam, alprazolam and temazepam. Withdrawal typically begins 1-2 days after the last dose, and continues for 2-4 weeks or longer. Long-acting benzodiazepines include diazepam and nitrazepam. Withdrawal typically begins 2-7 days after the last dose, and continues for 2-8 weeks or longer.”
[9] NCBI NIH Gov. “Chapter 3B: Methadone.” Substance Abuse and Mental Health Services Administration (US), 2018. “The half-life of methadone can vary from 8 to 59 hours85 depending on the patient. The average is 24 hours.”
[10] Office On Women's Health. "White Paper: Opioid Use, Misuse, and Overdose in Women." Dec. 2016.
[11] Bounds, Connor G., and Vivian L. Nelson. “Benzodiazepines.” National Library of Medicine, StatPearls Publishing, 30 Jan. 2024. “Most benzodiazepines are classified as former FDA pregnancy category D medication, indicating some fetal risk, but potential benefits may allow the use in pregnant women (when fetal mortality increases by 10% for every minute of maternal seizure activity). Several studies have indicated that specific benzodiazepines (diazepam and chlordiazepoxide) may increase the risk of congenital malformations, including cleft palate in the fetus. Others, such as flurazepam and temazepam, are considered pregnancy class X drugs, as they have been shown to produce neonatal lethargy and problems in skeletal development (exencephaly and fusion or asymmetry of ribs) in neonates, respectively.”
[12] Chokhawala, Krutika, and Lee Stevens. “Antipsychotic Medications.” National Library of Medicine, StatPearls Publishing, 26 Feb. 2023. “Quetiapine is the least likely to cause extrapyramidal side effects. The most common side effects of quetiapine are somnolence, orthostatic hypotension, and dizziness. Ziprasidone has almost no weight gain but can cause prolongation of QTc.”
[13] Hu, Xiaohong. “Benzodiazepine Withdrawal Seizures and Management.” The Journal of the Oklahoma State Medical Association, vol. 104, no. 2, Feb. 2011, pp. 62–65. “Withdrawal seizures usually occur in patients who have been taking these medications for long periods of time and at high doses. Seizures have also been reported with less than 15 days of use and at therapeutic dosage.”
[14] Kelly, Lourah M., et al. “Correlates and Predictors of Suicidal Ideation and Substance Use among Adults Seeking Substance Use Treatment with Varying Levels of Suicidality.” Journal of Substance Abuse Treatment, vol. 119, Dec. 2020, p. 108145. “Rates of SI and suicide attempts are substantially higher among adults seeking substance use treatment compared to the general population.”
[15] Hayashida, Motoi. “An Overview of Outpatient and Inpatient Detoxification.” Alcohol Health and Research World, vol. 22, no. 1, 2024, p. 44. “Outpatients can more easily choose not to keep their detoxification appointments and, consequently, fail to complete detoxification.”
[16] Bertschy, G., et al. “Probable Metabolic Interaction between Methadone and Fluvoxamine in Addict Patients.” Therapeutic Drug Monitoring, vol. 16, no. 1, Feb. 1994, pp. 42–45. “In the remaining three patients, the interaction was more pronounced (40-100% increase of the MTD plasma level/dose ratio).”
[17] Lotrich, Francis E., et al. “Dextromethorphan-Induced Delirium and Possible Methadone Interaction.” American Journal of Geriatric Pharmacotherapy, vol. 3, no. 1, Elsevier BV, Mar. 2005, pp. 17–20. "Dextromethorphan is a commonly used antitussive agent that can be purchased over the counter. It is metabolized primarily by the cytochrome P450 (CYP) 2D6 isozyme. Methadone has been found to inhibit CYP2D6, indicating a potential for interaction with dextromethorphan.”
[18] Gore, Mugdha, et al. Selecting an Appropriate Medication for Treating Neuropathic Pain in Patients with Diabetes: A Study Using the U.K. And Germany Mediplus Databases. no. 4, July 2008, pp. 253–62. Accessed 29 June 2023. “Several neuropathic pain medications have potential for drug-drug interactions with medications prescribed to diabetes patients. Examples include (neuropathic pain medications vs. diabetes medications): duloxetine, paroxetine, and methadone (CYP2D6 inhibitors).”
[19] McCance-Katz, Elinore F., et al. “Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and Other Frequently Prescribed Medications: A Review.” American Journal on Addictions, vol. 19, no. 1, Jan. 2010, pp. 4–16. “Table 2.”
[20] Edinoff, Amber N., et al. “Clinically Relevant Drug Interactions with Monoamine Oxidase Inhibitors.” Health Psychology Research, vol. Vol. 10, no. 4, Nov. 2022. “Analgesics that are known to be weak serotonin reuptake inhibitors (SRIs) and should therefore be avoided by patients on an MAOI include phenylpiperidine opioids, meperidine (pethidine, Demerol), tramadol, methadone, and dextromethorphan.”
[21] NHS. “Taking Warfarin with Other Medicines and Herbal Supplements.” NHS UK, 28 Apr. 2022. “Do not take aspirin or ibuprofen while you’re taking warfarin unless a doctor has said it’s OK. They increase the chance of bleeding.”
[22] Re, Guo-Fen, et al. “Dynamics and Correlations in Multiplex Immune Profiling Reveal Persistent Immune Inflammation in Male Drug Users after Withdrawal.” International Immunopharmacology, vol. 107, Elsevier BV, June 2022, pp. 108696–96. “Notably, immune dysregulation remained through and may last longer than 12 months after withdrawal in heroin and METH users.”
[23] Benzodiazepine Information Coalition. “Detox, Cold Turkey, Abrupt Cessation - Benzodiazepine Information Coalition.” Benzodiazepine Information Coalition, 12 Sept. 2024. Accessed 23 May 2025. “The central nervous system is slow to heal after benzodiazepine withdrawal, in some cases taking anywhere between 6-18 months for patients to report a full recovery. If the symptoms of withdrawal last beyond 18 months, it can be considered protracted.”
[24] Shah, Mansi, and Martin R. Huecker. “Opioid Withdrawal.” NIH GOV, StatPearls Publishing, 2023. “lacrimation or rhinorrhea, piloerection ‘goose flesh,’ myalgia, diarrhea, nausea/vomiting, pupillary dilation, photophobia, insomnia, autonomic hyperactivity (tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia).”
[25] World Health Organization. “People Who Inject Drugs.” World Health Organization, 2023. “Globally, around 11 million people inject drugs. Approximately 1 in 8 (or 1.4 million) of these people are living with HIV.”
[26] Kim, Sung, and Taehwan Park. “Acute and Chronic Effects of Cocaine on Cardiovascular Health.” International Journal of Molecular Sciences, vol. 20, no. 3, 2019, p. 584. “(e.g., electrocardiographic abnormalities, acute hypertension, arrhythmia, and acute myocardial infarction).”
[27] SA, Adelaide,. “Benzodiazepine Withdrawal Management | SA Health.” SA GOV AU, 2022. Accessed 23 May 2025. “depersonalisation/derealisation.”
[28] Golombok, Susan, et al. “Cognitive Impairment in Long-Term Benzodiazepine Users.” Psychological Medicine, vol. 18, no. 02, May 1988, p. 365. Accessed 2 Apr. 2019. “It was found that patients taking high doses of benzodiazepines for long periods of time perform poorly on tasks involving visual-spatial ability and sustained attention. This is consistent with deficits in posterior cortical cognitive function.”
[29] NHS Inform Scotland. “Alcohol-Related Liver Disease.” NHS Inform Scotland, 2019. “It’s generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who has alcohol-related cirrhosis and doesn’t stop drinking has a less than 50% chance of living for at least 5 more years.”

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: October 31, 2025