Medications Used in Detox

The main goal during detox is to remove drugs or alcohol from the body and to physically stabilize the person struggling with addiction.

According to the 2016 National Survey on Drug Use and Health, about 3.6 million adults 18 or older received substance use treatment in the previous year. This number represents 1.5 percent of all adults including 624,000 young adults aged 18 to 25 and about 3.0 million adults aged 26 or older.1 Many treatment programs begin with a detox program that can be either residential or outpatient, depending on the circumstances. Both types of programs often use utilize medications to manage withdrawal symptoms that can be uncomfortable and even dangerous if left untreated.

Some of these symptoms include:

  • Nausea
  • Vomiting
  • Muscle Aches
  • Diarrhea
  • Headaches
  • Irregular heart rate
  • Fever, sweats, and chills
  • Insomnia
  • Restlessness
  • Anxiety and depression
  • Confusion
  • Hallucinations
  • Shaking and seizures

 

Why Medicine During Drug Detox?

When you or a loved one abuses drugs or alcohol, physical and psychological dependency can develop. When the drugs are stopped, withdrawal symptoms appear. These can differ, depending on your drug of choice and length of the addiction. For example, alcohol, opioids and benzodiazepines when stopped suddenly and without medical supervision can result in severe and even life-threatening withdrawal symptoms.

Tired young woman

Medical detox uses medications to take the edge off and ensure your safety through medical monitoring and supervision in a specialized detox facility. A successful detox program is comprehensive and may also use psychotherapies to help you begin the recovery process.

Some detox medications are approved by the U.S. Food and Drug Administration to treat substance abuse and dependency during detox and recovery, while others are effective for managing withdrawal symptoms. There are no medications approved for the treatment of benzodiazepine or stimulant withdrawal, although different medications can relieve certain side effects and drug cravings.

Medications used during detox may vary and may include:

Alcohol Detox
  • Acamprosate
  • Disulfiram
  • Naltrexone
  • Benzodiazepines, including diazepam and chlordiazepoxide
  • Anticonvulsants such as Depakote or Tegretol
  • Anti-nausea medications
  • Antidepressants2
Stimulant Detox

(Stimulant detox includes cocaine, methamphetamine, and prescription ADHD medications)

  • Modafinil
  • Antidepressants
  • Antipsychotics like olanzapine
  • Benzodiazepines such as diazepam
Sedative or Tranquilizer Detox

(Includes prescription benzodiazepines or benzos):

  • Substitution of long-acting benzodiazepines for short-acting ones like diazepam or chlordiazepoxide
  • Antiadrenergic agents such as clonidine
  • Flumazenil

Addiction medicine is constantly evolving. As new effective medications become available they may be added to detox protocols. Your medical team will determine which medications are best suited for your personal situation during a detox program.

Drugs for Opioid Detox

Heroin and most opioid narcotics are short-acting agonists, meaning they don’t stay in the system for an extended period of time. By switching to a longer-acting opioid like methadone, the person struggling with addiction is able to take fewer doses to keep receptors in the brain engaged.

Buprenorphine is a partial opioid agonist and doesn’t fully activate the receptor sites, although it is useful in reducing drug cravings and withdrawal symptoms.3 Buprenorphine was approved by the FDA in 2002 to treat opioid dependency specifically.4 Methadone and buprenorphine can be administered in lower and fewer doses during detox and replace other opioids in the brain without causing the same euphoric or intoxicating effects.

Methadone

Methadone is dispensed in federally regulated clinics as a tablet, generally taken once per day and classified by the Drug Enforcement Agency (DEA) as a Schedule II controlled substance.5 Drug scheduling refers to a drug’s potential for abuse and dependency versus its medicinal value, with one having the strictest regulations and five being the least regulated. Methadone is an opioid narcotic and therefore does have the potential to be abused.

Buprenorphine

Methadone

Buprenorphine, being only a partial opioid agonist, has less potential for abuse due in part to the ceiling effect that occurs when you take more than intended. After levels of buprenorphine reach a certain amount in the bloodstream, the drug no longer produces any euphoria. Buprenorphine is a Schedule III controlled substance and can be prescribed by a doctor either in tablet form or more commonly in a sublingual film strip.

Subutex is a buprenorphine product generally used as an opioid replacement during early detox. Suboxone and Zubsolv also contain naloxone, which is a partial opioid antagonist that prevents opioid from attaching to receptor sites. This means that if you try to take other opioids while on Suboxone or Zubsolv, they will have no effect, and you may start to experience withdrawal symptoms. The naloxone component may serve as an abuse deterrent; therefore, these medications are generally used later on in a detox program.

One of the risk factors for taking buprenorphine medications during detox is the potential for precipitated withdrawal, which is the rapid onset of intense withdrawal side effects. You should wait to begin opioid replacement therapy during detox until early withdrawal symptoms have started and the other opioid drugs are mostly out of your system.

Be sure to share all pertinent information regarding the drugs you took, dosage amount, and time of your last dose with the medical professionals assisting you during detox in order to avoid precipitated withdrawal and other negative drug interactions.

Additional Detox Medications and Supplements

Withdrawal symptoms from most drugs and alcohol typically include emotional side effects, such as anxiety and depression, and, in some cases, suicidal thoughts and behaviors. Mood-stabilizing medications, antidepressants, and antiadrenergic agents can assist in regulating these difficult emotions during detox.

The withdrawal symptoms of using both heroin and prescription opioids range from feeling restless to experiencing nausea and vomiting. The most common withdrawal is insomnia. Anyone trying to recovery from substance abuse will experience similar withdrawals.Antidepressants often work by stimulating the production of dopamine or serotonin in the brain, which are commonly affected by substance abuse and dependence. Buspirone acts on the serotonergic system of the body and may be an alternative to methadone tapering during detox, as it has no abuse potential.

Other drugs may be used for specific withdrawal symptoms and may not be necessarily designed for substance abuse treatment. Anti-nausea medications may be useful during alcohol withdrawal, for instance. Antipsychotic medications like olanzapine can also manage symptoms of psychosis during detox and withdrawal. Modafinil is a narcolepsy drug sometimes used to counteract the crash that can accompany stimulant withdrawal. Herbal supplements, vitamins, and minerals may be recommended by your doctor during detox to help with recovery and healing as well.

Finding Help for Drug and Alcohol Addiction

Detox is only the beginning comprehensive addiction treatment.

After detox and diagnosis, a program of psychotherapy, counseling, group therapy, family therapy and other holistic options, including nutrition, yoga, meditation and spiritual counseling, help heal the entire person, body, mind and spirit. We can help you or your loved one choose a program that offers a full continuum of care that includes medically-supervised detox.

Recognizing you have a problem and reaching out for help is the first step. Call our toll-free helpline, 760-548-4032, now to speak to an admissions coordinator. We are standing by to assist you.


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Sources

1 Receipt of Services for Substance Use and Mental Health Issues among Adults: Results from the 2016 National Survey on Drug Use and Health.” SAMHSA - Substance Abuse and Mental Health Services Administration. Sept. 2017.

2 Common Drugs and Medications to Treat Symptoms from Alcohol Withdrawal.” WebMD. Accessed June 9, 2018.

3 Treating Opioid Use Disorder With Medications.” WebMD. Accessed June 2018.

4 Postmarket Drug Safety Information for Patients and Providers - Subutex (Buprenorphine Hydrochloride) and Suboxone Tablets (Buprenorphine Hydrochloride and Naloxone Hydrochloride).” U S Food and Drug Administration, Center for Biologics Evaluation and Research. Accessed June 9, 2018.

5 Controlled Substance Schedules.” DEA Diversion Control Division. Accessed June 9, 2018.

Speak with an Admissions Coordinator 760-548-4032