Prescription Drug Detox

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KEY TAKEAWAYS

Detox from prescription medication becomes necessary when, as a result of addiction, the individual is either:

  • Taking a greater quantity of medication than is prescribed
  • 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]. 

prescription drugs 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.

When Is Prescription Drug Detox Necessary?

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 detox using the medication that the patient is addicted to, on a sliding scale over time
  • Tapered detox using a similar medication that mimics the chemical effects of the original medication
  • Symptom-managed detox 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 detox 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 medication
  • 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
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Needs Prescription Drug Detox vs Wants Prescription Drug Detox

There is a difference between those who need to detox from all medications, and those who want to detox 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 medication, 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 to detox 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 detox 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]
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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 [27]

Dangers Of
Detox

Depersonalisation/
derealisation occurring
years after detox [28]

Alcohol withdrawal
syndrome or
PAWS [29]

Long Term
Outcomes

Improved cognitive
function [30]

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 [32].

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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).

Last Updated: February 28, 2024