A medication that is the same or similar to the drug being abused is given to the patient until withdrawal symptoms are alleviated. The medication is then given in downward tapering doses. This allows for a safer and more comfortable withdrawal for the patient.
Suboxone is an excellent medication for the outpatient detoxification from opiates (heroin) and opioids (Oxycontin, oxycodone, Percocet, Vicodin, and Lortab). There are a number of reasons that suboxone is such a good option. It is considered a very safe medication. Suboxone is known as a partial agonist, meaning it partially stimulates the opiate receptor. This means that it has what we call a ceiling effect, so that at a given dose the medication has no more effect. This translates into it having a low risk of respiratory depression, which is a low risk of stopping breathing.
The other thing about Suboxone is that the buprenorphine, which is the narcotic part of the medication, binds very tightly to the opioid receptor. It binds so tightly that other opiates and opioids cannot get in, so that if a patient decides to use Heroin or Percocet during their detox, those medications will have no effect, and there will also be no additive affect of two opioids with the potential for serious side effects like respiratory depression.
Suboxone is also interesting because in order to start the medication, the patient actually has to be somewhere between early to moderate withdrawal. If Suboxone is started too early, it would actually send the patient into precipitated withdrawal, which is ten times worse than regular withdrawal. So what needs to be done is keep the patient as comfortable as possible overnight before they come in for what is called induction. A number of medications can be used overnight to make patients more comfortable. Clonidine is a gold standard type of medication for opioid withdrawal. It is an old blood pressure medication, and it treats what are called hyperadrenergic symptoms. These are the stimulating symptoms of withdrawal, the sweats, chills and shakes.
I also use the class of medications called benzodiazepines to keep the patient comfortable overnight, medications such as Klonopin, Valium and Ativan. These alleviate anxiety, which is frequently a big part of the withdrawal syndrome, and at a minimum, it helps patients to not care as much that they basically feel terrible. I also remind patients to consider themselves as having the flu, and remember the basics such as pushing fluids. Nobody is going to feel well if they get dehydrated, it doesn’t matter what is prescribed.
Tylenol and Motrin are recommended for aches and pains, as well as Imodium for upset stomach. I also recommend that patients keep yogurt or ice cream in the house, because those are easy to eat when you don’t feel well. Each patent is different, and my approach in general is to tailor treatment to each individual patient.
Stuart Kloda, M.D. is an addiction medicine physician in New York City. He is an expert in the treatment of opioid and opiate addictions:
website Based Treatment for Opiate and Opioid Addictions