The abuse of opioid drugs and addictions to them have become a significant problem in our society. Drugs that have been developed for patients in severe pain have been abused by those who are family members, those who have stolen the drugs, and probably more commonly, have been bought from legitimate patients for much-needed cash.
The commonly abused drugs listed below belong to the opioid class.
- Meperidine is a fast-acting opioid, also known as Demerol
- Hydromorphone, a strong central acting drug, also known as Palladone or Dilaudid
- Alfentanil, also known as Alfenta, is a short-acting synthetic opioid analgesic drug
- Fentanyl, also known as Duragesic, is a rapid onset and short duration of action
- Remifentanil, also known as Ultiva, is an ultrashort-acting drug
- Sufentanil, also known as Sufenta, is up to 10 times stronger than its parent drug Fentanyl and 500 times more potent than morphine
- Etorphine is an extremely potent drug that is up to 3,000 times more potent than morphine. Legally, it can only be used by veterinarians and is often used for elephants
It is very difficult to withdraw from these drugs when they have been abused. Abusers of these drugs take many times the therapeutic dose and more often than that taken by a person who has prescribed these drugs legally.
The fear of the symptoms of withdrawal that keep most addicted persons from trying to go through withdrawal. New methods of helping addicts deal with withdrawal from opioids have been developed to help them avoid symptoms.
Antagonist Detoxification Methods
There are several methods that have been shown to have an effective role in helping patients withdraw more completely and easily from opioid dependency and to remain drug-free after detoxification.
These methods include :
- Tapering off the use of the opioid with methadone or buprenorphine.
- Discontinuing opioids and using the oral drub clonidine to help suppress the symptoms of withdrawal.
- Rapid and Ultra-Rapid Detoxification which depend on the use of antagonist-assisted detoxification while anesthetized or sedated. Antagonists are drugs like naltrexone and naloxone which interfere with the opioid drug connecting to the brain’s receptors.
The Rapid and Ultra-Rapid methods accelerate the withdrawal of patients from opioid drugs by using anesthesia or sedatives compared to traditional methods.
The methods differ between the Rapid and Ultra-Rapid methods are how deeply the patient is anesthetized while undergoing withdrawal.
- When the Ultra-Rapid Detoxification is used, the patient is fully asleep for several days and is not aware of any withdrawal symptoms.
- With Rapid Detoxification, the patient is more lightly sedated with either a mild oral sedative or with ‘conscious sedation’ with an intravenous drug that aids in calming the withdrawal symptoms.
Which Detox Treatment Is Safer and More Effective?
According to the American Society for Addiction Care, there is a difference between these two related antagonist-assisted detoxification methods. Reviewers from the Cochrane Database Reviews examined available literature to compare and determine the safety and usefulness of the Rapid and Ultra-Rapid methods.
They concluded that detoxification, by itself, is not a treatment for addiction. The ASAM does not support this treatment unless there is an integrated program of services that will help the addict recover.
They also concluded was that there is not enough evidence to support using heavy sedation or anesthesia to manage opioid addiction as is used in Ultra-Rapid Detoxification and that further study is necessary.
This survey also found that using minimal sedation with an opioid antagonist and an alpha-2 adrenergic agonist, such as used in Rapid Detoxification, increased the chance that the patient would enter into naltrexone treatment, compared to a patient without the help of minimal sedation.
The goal in treatment for addiction, as stated by the ASAC, is for patients to be able to function optimally with their families and their communities. They point out that abstinence, by itself, does not assure optimal functioning, nor does detoxification address the dysfunctions of addiction.
A 1998 article in the Journal of the American Medical Association pointed out in the case of Rapid Detox, the lack of studies, numbers of subjects, variations in protocols and randomized design made approval of the method impossible. Since that article appeared, the ASAC finds that the reasons for those conclusions still stand.
If an addict wants to undergo detoxification, they should know that Rapid Detoxification is probably safer than the Ultra-Rapid Detox method. However, it is critically important that this detoxification be only an initial part of treatment for drug addiction. The addict must receive counseling from professionals to begin to reintegrate with their family, job and society as a whole.