Inpatient care has a 3-fold higher success rate compared to outpatient detoxification [1].
IMPORTANT: Below, we discuss possible approaches that meet the specific detox needs around prescription drugs. Not all treatment centres will provide these specific interventions.
For an overview of the Abbeycare programme contents for prescription drugs detox, click here.
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
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)
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]
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
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
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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