Opioid Detox Guide
What Are Opioids?
Opioids include both legal prescription pain medications and illicit drugs like heroin. Opioids originally came from the opium poppy plant; however, many are made synthetically in a lab.1
Prescription opioids are typically used to treat moderate to severe pain; however, they are generally used with caution as they are powerful medicines that can be dangerous when misused. Regular use of opioids, even at therapeutic levels, can result in physiological dependence or withdrawal because of their addictive nature.1
Signs and Symptoms of Opioid Addiction
The American Society of Addiction Medicine (ASAM) defines addiction as a chronic, yet treatable medical condition that involves complex interactions in brain circuits, genetics, environment, and a person’s unique life experiences.2 People struggling with addiction compulsively use substances despite harmful consequences that interfere with their daily functioning.2
Addiction to opioids is referred to as an opioid use disorder (OUD), a problematic pattern of opioid use that leads to clinically significant impairment or distress.3 The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) provides 11 criteria that clinicians use to diagnose OUD. A person must meet at least 2 criteria in a 12-month period to be diagnosed with an OUD.
DSM-5 Criteria for Opioid Use Disorder (OUD)
The DSM-5 criteria for opioid use disorder are as follows:3
- Opioids are often taken in larger amounts or over a longer period than was intended.
- Persistent desire or unsuccessful efforts to cut down or control opioid use.
- A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
- Craving, or a strong desire or urge to use opioids.
- Recurrent opioid use that leads to failure to fulfill major role obligations at work, school, or home.
- Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
- Important social, occupational, or recreational activities are given up or reduced because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous.
- Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance to opioids.
- Withdrawal when stopping opioid use.
Tolerance and Withdrawals
If a person is taking their prescribed dose of opioid medications, tolerance and withdrawal do not apply to OUD, as those two criteria can occur even when taking medicine as directed.
While only a physician or qualified clinician can diagnose someone with an opioid use disorder, there are behaviors of someone who might be suffering from opioid addiction. Behaviors associated with prescription opioid misuse include:5
- Taking more of the medication than prescribed.
- Taking someone else’s prescription.
- Taking the medication for unintended effects, like to feel high.
- Seeking prescriptions from multiple physicians.
How Addictive Are Opioids?
Opioids are effective pain relievers that are generally considered safe when used for short periods, as directed.1 However, opioids can also make people feel very relaxed and “high,” which is why people occasionally misuse opioids even when they are prescribed by a doctor for a legitimate medical issue. This is dangerous because opioids can be highly addictive, and over time, opioid use can lead to tolerance, dependence, and even addiction.1
The scope of opioid misuse can’t be underestimated. Over 9 million people, ages 12 and older, reported misusing prescription pain relievers in 2020 in the U.S. alone, while over 2 million people, 12 and older, reported having a prescription opioid use disorder that same year.5
Opioid Overdose Risk
One of the effects of opioids is that it slows a person’s breathing. This is a normal side effect, however, if someone takes too much of an opioid, breathing can be slowed to such a point that it can cause hypoxia, a result of insufficient oxygen reaching the brain.1 Hypoxia resulting from an opioid overdose can cause coma, brain damage, or even death.1
Opioid Withdrawal Symptoms
People who have developed a physiological dependence on opioids will experience withdrawal symptoms when they stop using opioids or significantly reduce their dose.9 Symptoms of opioid withdrawal can begin as soon as a few hours after a person’s last use.1
Common withdrawal symptoms include:1
- Muscle and bone pain.
- Sleep problems.
- Chills (goosebumps).
- Severe cravings.
- Uncontrollable leg movements.
- Diarrhea and vomiting.
Opioid Addiction Treatment
A medically assisted detox can benefit people with opioid use disorders as medical staff can help to manage acute physical and psychological symptoms of withdrawal and help make people more comfortable during the process.7
After a person has completed detox and is medically stable, they may benefit from additional rehab treatment. Further treatment can address underlying issues that may have led to a person’s substance misuse, including any associated medical, vocational, legal issues, or co-occurring mental health disorders.7
Treatment should be individualized to meet the unique needs of each person.7 Treatment should also be appropriate to a person’s age, culture, gender, and ethnicity.7
The following treatment settings are available depending on one’s specific circumstances:8
- Inpatient treatment: Also referred to as residential treatment, this type of treatment provides 24-hour care where a person lives at the facility. Short-term residential treatment may last 3 to 6 weeks, while long-term residential treatment can up to 12 months.8
- Outpatient treatment: This type of treatment can vary in intensity but typically includes substance use education, individual, and group counseling. It also allows a person to live at home and continue their normal routines while receiving treatment.8
- Detox centers: Some facilities only focus on providing detoxification services at varying levels of intensity from outpatient care to medically managed inpatient detox. People may enter a detox center before moving on to other forms of treatment. Detox services can also be a part of inpatient and outpatient treatment facilities that offer varying levels of care. Medication is often used in detox facilities to support opioid withdrawal.10
Within these treatment settings, several different interventions may be used to help a person through the recovery process:
- Behavioral therapy: Behavioral therapy is a common form of therapy in addiction treatment and can help people address motivation, develop healthy coping strategies, improve problem-solving skills and learn to foster positive relationships.7
- Aftercare: Treatment programs should include strategies to help people stay engaged in their recovery process even after treatment is over. 12-Step programs, other mutual support groups, counseling, and community are encouraged.7
- Amenities: Many treatment facilities will offer additional amenities to support a person during their recovery. Amenities may include alternative forms of therapy, fitness classes, art, outdoor recreation, and more.
Medications for Opioid Addiction
Medications are commonly used to treat OUD in detox and in ongoing treatment.11 Using medication to treat OUD has shown a reduction in opioid use and risk of death from overdose.11
Depending on the phase of treatment a person is in, there are several treatment medications that may be helpful. There are medications for withdrawal and detox, maintenance during OUD treatment (once detox is complete), and opioid overdose.
Opioid Withdrawal Medications
Treatment medications used during opioid withdrawal can help reduce withdrawal symptoms and cravings while helping a person to feel more comfortable. Withdrawal medications include the following:
- Methadone is an opioid agonist, which activates the same opioid receptors in the brain as whatever opioid was being used. It is a long-acting opioid meaning a person does not feel the intense euphoria or intoxication like shorter-acting opioids.12Methadone can also reduce withdrawal symptoms and cravings.12 Federal regulations state that methadone must be administered by a certified opioid treatment program.11, 12
- Buprenorphine is a partial opioid agonist, which means it only partially activates opioid receptors. It has fewer side effects and a lower potential for misuse and overdose.10 Buprenorphine can reduce cravings and minimize withdrawal symptoms.12 It’s administered by certified physicians.12 Buprenorphine can be given in combination with naloxone and is known by the brand names Suboxone or Zubsolv. Naloxone blocks opioid effects so you won’t get high if you relapse.13
- Clonidine is not FDA-approved for opioid withdrawal but may be used off-label to reduce withdrawal symptoms.10 It cannot cause intoxication and it is not reinforcing, which is unlike other withdrawal medications.10
- Lofexidine is an FDA-approved, non-opioid medication used to treat withdrawal symptoms.12
Medications Used After Detox
After detox, some people may remain on treatment medications to help them avoid relapse. Medications that people may continue taking can include methadone or buprenorphine.12
Naltrexone may also be used to help prevent relapse after medically supervised withdrawal.11 Naltrexone blocks the rewarding effects of opioids, so a person doesn’t get high or feel euphoria if they use opioids again.12
Naloxone is an opioid overdose medication, which is used to rapidly reverse the effects of an opioid overdose.14 It attaches to opioid receptors and blocks the action of opioids.14 It is available as an emergency nasal spray or injection.13 The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that anyone who uses opioids should have a naloxone prescription.11
Finding Opioid Detox Near Me
American Addiction Centers is one of the leading providers of addiction treatment and co-occurring disorders in the U.S., with treatment facilities located across the country.
If you or someone you love needs help, call one the caring admissions staff at to learn about treatment options and to check your insurance coverage at our facilities.
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