Detox Centers-Medical Detoxification for Drugs and Alcohol
Detox Centers-Medical Detoxification for Drugs and Alcohol
DETOX CENTERS SHOULD USE EVIDENCE-BASED TREATMENT STRATEGIES
There are a number of different modalities that can be used to provide a medically supervised opioid withdrawal. In the next few paragraphs, we are going to discuss what Evidence-Based Treatment options are available, and how to minimize the effects of opioid withdrawal.
There are a few main categories in which medications can be classified:
- Standard Protocols using common medications which target a wide range of post-acute withdrawal symptoms
- Adjunctive medications are medications used in conjunction with standard treatments targeting specific symptoms
- Alternative treatments, most medications, for which available research is insufficient to establish their efficacy in supervised withdrawal
The majority of the medications discussed in this paper have undergone randomized, placebo-controlled studies to assess the efficacy and safety profiles of these substances in the treatment of substance use disorders.
STATISTICS OF SUBSTANCE ABUSE
Currently, there are over 20 million people in the United States who are both active and former addicts. According to the Centers for Disease Control and Prevention (CDC), from 2000 to 2015, more than half a million individuals died from drug overdoses. 91 Americans die every day from an opioid overdose. In 2017, the number of opiate overdose deaths has jumped to 144 per day. Addiction plays a multi-faceted role in how it affects society. Not only is it detrimental for the abuser’s overall health and risk of developing the disease, but it also affects incarceration rates, vehicle accidents, employment and the overall financial burden placed on the government and health insurers. The National Institute on Drug Abuse has estimated that the annual financial burden to be in excess of $78.5 billion, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
APPROACH TO EVIDENCE-BASED TREATMENTS
As we can see, Opioids have a substantial economic impact. As such, their addictive properties have to be tapped into so that patients who are dependent on opioids can go through a medically supervised withdrawal using agents such as buprenorphine versus methadone which is an alpha-2 adrenergic agonist.
EVIDENCE-BASED TREATMENT WITH BUPRENORPHINE VS METHADONE
Buprenorphine and methadone have comparable efficacy when used in patients who are undergoing medically assisted withdrawal management. According to several meta-analyses of clinical trials, buprenorphine is considered a first-line medication and preferred over methadone. Buprenorphine gives greater flexibility in substance abuse treatment. This is due to the fact that methadone’s risk of lethal overdose limits its efficacy/use in a clinical setting. Buprenorphine has been shown to more effective in keeping withdrawal symptoms at bay as the taper nears completion versus methadone, where symptoms and cravings increase after completing the regimen.
EVIDENCE-BASED TREATMENT WITH OPIOID AGONISTS VS ALPHA-2 ADRENERGIC AGONISTS
Studies have found that buprenorphine and methadone are better treatment regimens when used in supervised withdrawals when compared to medications such as clonidine and lofexidine. After studying 1264 patients undergoing medically assisted withdrawal management, it was found that the retention and completion rate was higher in those patients who were treated with buprenorphine versus the alpha-2 adrenergic agonists. Another study found that methadone was superior to medications such as clonidine in reducing withdrawal symptoms from opiates. The use of clonidine and lofexidine, both of which have similar levels of efficacy, can be used instead of buprenorphine in programs that prohibit the use of controlled substances.
STANDARD EVIDENCE-BASED TREATMENTS
BUPRENORPHINE/NALOXONE
Buprenorphine is classified as a partial mu-opioid agonist that is effectively used to combat withdrawal from opioid dependence. It possesses many advantages for which it is used in a medically supervised treatment, such as a high affinity for the mu-opioid receptors versus the substances of abuse. When buprenorphine is given in combination with naloxone, which is an opioid antagonist, it discourages abuse of intravenous buprenorphine as the naloxone can precipitate withdrawals, which are not desirable. Generally, the ratio of buprenorphine to naloxone is 4:1.
A potential disadvantage to buprenorphine is that it can precipitate or worsen opioid withdrawal if not administered correctly according to protocol. In order to avoid this, a patient must be in a state of mild to moderate withdrawal when starting the treatment.
Buprenorphine potentially can cause respiratory depression, but its partial agonist properties limit this effect by preventing complete activation of mu-opioid receptors, making the drug relatively safe in overdose. Buprenorphine has been reported to cause fatal respiratory depression when taken in combination with other substances, especially benzodiazepines and alcohol, or when abused intravenously at high doses. Common side effects of buprenorphine include sedation, headache, nausea, constipation, and insomnia.
METHADONE
Along the same lines as buprenorphine, methadone is a mu-opioid agonist, however instead of being a partial agonist, it is a full agonist. This is an old and effective treatment for withdrawal from opioids. Contrary to buprenorphine, methadone does not precipitate into withdrawals, and it has an additive effect to opioids already in one’s system. A major disadvantage of methadone is that it can be lethal in overdose, and for that reason it can only be administered in an opioid treatment program.
Some adverse effects from methadone include a prolonged QT interval and cardiac arrhythmias. Acute side effects of methadone include constipation, mild drowsiness, excess sweating, peripheral edema, and erectile dysfunction. Constipation should be aggressively treated with docusate/sennosides
ALPHA-2 ADRENERGIC AGONISTS
Clonidine and lofexidine are included under this category. These drugs help to lessen the withdrawal symptoms of opioid withdrawal, and help to relieve autonomic symptoms, such as sweating, diarrhea, intestinal cramps, nausea, anxiety, and irritability. These substances are not 100% effective in treating withdrawal symptoms, and patients do generally prefer opioid agonists over these drugs.
EVIDENCE-BASED TREATMENT AT SOUTH FLORIDA SUBSTANCE ABUSE TREATMENT CENTERS
At Rehab South Florida, a premier Florida drug and alcohol treatment center, several evidence-based therapeutic and diagnostic modalities are utilized at our facility, in order to provide comprehensive care to our patients. These modalities have been tried and tested, and use the latest, cutting-edge technology to provide in-depth insight into different areas of interest pertaining to drug and substance abuse and tend to veer away from traditional pharmacological approaches employed in current practice.
Evidence-based Treatment programs are integrated into the core fundamentals of the program and services to assist the struggling addict find resolve in their plight with substance abuse. A high level of attention is given to educating patients on the risks associated with substance abuse and the therapeutic alternatives. Detox of South Florida is very fortunate to have a dedicated team of healthcare providers available 7 days a week to address the medical needs of our patients.
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