INPATIENT DETOX
Inpatient detoxification is offered in medical hospitals, psychiatric hospitals,
and medically managed residential treatment programs. Inpatient detox programs are staffed by physicians, nurses and trained professionals so that the detox process can be closely monitored.
Advantages of an inpatient detox include:
- The patient is in a protected setting where access to drugs and alcohol is restricted;
- The withdrawal process may be safer, especially if the patient is dependent upon high levels of sedative-hypnotic drugs, since the physician can observe him or her closely for serious withdrawal symptoms, and medications can be adjusted;
- Medical hospitals are best suited for people who are detoxing from sedative-hypnotic drugs or who have had medical complications such as seizures in the past
- Residential detox program can be medically managed or social model. They are not in a hospital setting, although sometimes they may be attached to a hospital. The difference is generally in staffing. Medically managed detox programs have medical staff whereas social model programs are staffed by trained non-medical personnel. Both programs may use medications although social model programs tend to prefer non-medicated detoxes;
- Psychiatric hospitals occupy an important niche in the spectrum of detoxification settings because they are the preferred settings for patients who are psychotic, suicidal, or homicidal
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OUTPATIENT DETOX
Outpatient detoxification has three major advantages: It is less expensive; it is less disruptive; and it allows the patient to remain in the same setting where he or she will function when drug free.
Many opiate detoxes are now done on an outpatient basis in a doctor's office using medications.
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RAPID DETOX, "ULTRA RAPID OPIATE DETOX"
Relatively pain-free, rapid detox is achieved while under general anesthesia and under the
supervision of an anesthesiologist. The patient remains "asleep" while the body is treated with a regimen of medications and undergoes the detoxification process. It is believed that when the patient awakes, he or she is free from any dependence upon opiates.
In many respects the process is beneficial since the patient can then be admitted to a traditional addiction or chemical dependency treatment program drug-free.
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METHADONE
These clinics may provide medically supervised withdrawal for persons abusing heroin who do not want to enter a methadone maintenance program but instead want to use methadone or withdrawal only, as well as for people who want to withdraw from methadone maintenance. The clinics, which must be licensed by the Food and Drug
Administration, the Drug Enforcement Administration, and State regulatory
agencies, are the only programs in which methadone maintenance may be conducted
for opiate addicts.
In July 1993, the FDA approved levo-alpha-acetylmethadol (LAAM) for use as a
maintenance medication. It is a Schedule II controlled substance, which categorizes it as a medication with medical uses but also with a high potential for abuse. Withdrawal from LAAM produces similar symptoms to those produced by withdrawal from methadone.
Buprenorphine is a potent analgesic that is available by prescription as a sublingual tablet in many parts of the world. In the United States, it is available by prescription as an analgesic in an injectable form (Buprenex). The doses of buprenorphine under investigation for maintenance treatment are considerably higher than those commonly prescribed for treatment of pain.
The level of physical dependence produced by buprenorphine is not as great as that produced by methadone or heroin; therefore, most patients find buprenorphine easier to discontinue than methadone. Some patients can eventually be switched from buprenorphine maintenance to treatment with an opiate antagonist such as naltrexone.
Buprenorphine is safer than methadone or LAAM if an overdose is ingested.
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© 2003 Rapid Detox Referral
