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Drug detoxification (informally, detox) is variously the intervention in a case of physical dependence to a drug; the process and experience of a withdrawal syndrome; and any of various treatments for acute drug overdose.
A detoxification program for physical dependence does not necessarily address the precedents of addiction, social factors, psychological addiction, or the often-complex behavioral issues that intermingle with addiction.
The United States Department of Health and Human Services acknowledges three steps in a drug detoxification process:
- Evaluation: Upon beginning drug detoxification, a patient is first tested to see which specific substances are presently circulating in their bloodstream and the amount. Clinicians also evaluate the patient for potential co-occurring disorders, dual diagnosis, and mental/behavioral issues.
- Stabilization: In this stage, the patient is guided through the process of detoxification. This may be done with or without the use of medications but for the most part the former is more common. Also part of stabilization is explaining to the patient what to expect during treatment and the recovery process. Where appropriate, people close to the addict are brought in at this time to become involved and show support.
- Guiding Patient into Treatment: The last step of the detoxification process is to ready the patient for the actual recovery process. As drug detoxification only deals with the physical dependency and addiction to drugs, it does not address the psychological aspects of drug addiction. This stage entails obtaining agreement from the patient to complete the process by enrolling in a drug rehabilitation program.
The often painful symptoms of drug withdrawal may last for several days and can stand as a barrier to the treatment of a drug abuse problem. Some practitioners use "rapid" or "ultra rapid" detoxification methods to condense the withdrawal process into a considerably shorter period of time, about two hours, while the patient is asleep. Rapid detox patients placed under sedation and/or anesthesia while given treatment drugs, such as naltrexone, can avoid the extreme pain associated with such treatments, say proponents, and bypass the major effects of withdrawal.
Critics argue that the treatments can be very expensive and that safety has not been sufficiently demonstrated. A 2005 clinical study on "ultra rapid detox" for heroin addicts, comparing buprenorphine-assisted or clonidine-assisted opioid detoxification to anesthesia-assisted detoxification, reported that anesthesia patients commonly underwent withdrawal when they awoke from, had a similar study dropout rate (approximately 80%), and some anesthesia patients experienced severe medical complications. Another 2005 study compared clonidine-assisted detoxification to (rapid) clonidine-naloxone precipitated withdrawal under anesthesia, reporting no significant differences in degree or duration of pain, withdrawal severity, or drug craving, with similar withdrawal sequelae, oral naltrexone compliance levels, and abstinence from heroin four weeks following detoxification.
According to a 2001 analysis of 13 Australian drug treatment trials, conducted by Australia's National Drug and Alcohol Research Centre, rapid opioid detoxification was determined to be the most effective method of getting people off drugs in the short term, however long-term rates of continued treatment were less successful; in contrast, methadone maintenance treatments were determined to be more cost-effective with patients more likely to remain in treatment.
Origin of the term
The concept of "detoxification" comes from the discredited autotoxin theory of George E. Pettey and others. David F. Musto says that "according to Pettey, opiates stimulated the production of toxins in the intestines, which had the physiological effect associated with withdrawal phenomena... Therefore treatment would consist of purging the body of toxins and any lurking morphine that might remain to stimulate toxin production in the future."
Rapid detox controversy
Rapid opiate detoxification therapy, which critics claim lacks long-term efficacy and can actually be detrimental to a patient's long-term recovery, has led to controversy. Additionally, there have been many questions raised about the ethics as well as safety of rapid detox following a number of deaths resulting from the procedure.
- U.S. Department of Health and Human Services (2006). "Detoxification and Substance Abuse Treatment". pp. 4–5.
- "Rapid Drug Detox: Hope or Hoax?", Fox News, January 24, 2005
- Rapid Detox Safety Protocol https://opiates.com/rapid-detox/safety.html
- "Study: Anesthesia-based detox dangerous", USA Today, August 23, 2005
- Collins ED, Kleber HD, Whittington RA, Heitler NE (August 2005). "Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial". JAMA 294 (8): 903–13. doi:10.1001/jama.294.8.903. PMID 16118380.
- Arnold-Reed DE, Hulse GK (2005). "A comparison of rapid (opioid) detoxification with clonidine-assisted detoxification for heroin-dependent persons". J Opioid Manag 1 (1): 17–23. PMID 17315407.
- "The great divide over detox", Sydney Morning Herald, December 3, 2005
- Musto, David F. (1999). The American Disease: Origins of Narcotic Control (3rd ed.). Oxford University Press. p. 76. ISBN 0195125096.
- Dyer, Clare (1998-01-17). "Addict died after rapid opiate detoxification". BMJ Publishing Group. Retrieved 2009-02-22.
- Leeder, Jessica; Donovan, Kevin (2006-03-10). "Coroner probes `rapid detox' death: Addict succumbed during procedure. Second fatality linked to clinics.". Toronto Star. Retrieved 2009-02-22.
- Hamilton, R. J., Olmedo, R. E., Shah, S., Hung, O. L., Howland, M. A., Perrone, J., Nelson, L. S., Lewin, N. L. and Hoffman, R. S. (2002), Complications of Ultrarapid Opioid Detoxification with Subcutaneous Naltrexone Pellets. Academic Emergency Medicine, 9: 63–68.