The Dangers of At-Home Detox from Opioids

The opioid drug class includes the illicit drug, heroin, and prescription opioids such as codeine, hydrocodone, hydromorphone, oxycodone, morphine, and methadone. Today, opioid abuse has become an epidemic; in 2014, an estimated 4.3 million Americans reported nonmedical opioid use and 435,000 Americans used heroin.¹

Chronic opioid use can lead to the development of dependence, which is the body’s adaptation to the presence of a substance. When a person develops opioid dependence, they will experience withdrawal symptoms when attempting to abstain from using.¹ 

Although, by nature, opioid withdrawal is not life-threatening, it can be extremely unpleasant.^1,2 As a result, many treatment professionals recommend that patients attempting to withdraw from opioids seek medical assistance and detox treatment.³ At-home detox, while possible, presents numerous dangers, potential medical complications, and relapse risks.

Signs of Addiction

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines several diagnostic criteria used by physicians and other treating professionals to make a diagnosis of opioid use disorder or addiction. Among these criteria are the following signs, symptoms, and changes in behavior:²

• Taking larger or more frequent doses of opioids than intended
• Failing to cut down or control use
• Experiencing strong craving or desires to use opioids
• Continuing opioid use despite inability to fulfill obligations at home, school, or work
• Using opioids despite physical or psychological problems exacerbated or caused by opioid use
• Sacrificing important hobbies or activities in favor of opioid use
• Using opioids in dangerous situations, such as while driving
• Developing tolerance, which means that the user requires higher doses to achieve desired effects

Additionally, you may be addicted to opioids if you experience withdrawal symptoms when use is dramatically reduced or abruptly discontinued or if you use opioids to alleviate or avoid withdrawal symptoms.²

Opioid Withdrawal Symptoms

The DSM-5 indicates that withdrawal symptoms typically emerge after prolonged and heavy opioid abuse (over the course of several weeks or longer). People who abruptly quit or significantly decrease use may experience some of the following signs and symptoms:^2,3

• Anxiety
• Insomnia
• Dysphoria, or a state of unease
• Rapid pulse
• Elevated blood pressure
• Muscle aches or spasms
• Bone pain
• Nausea or vomiting
• Stomach cramps
• Diarrhea
• Fever
• Excessive sweating
• Watery eyes and runny nose
• Yawning
• Piloerection, or goose bumps

Many of these withdrawal symptoms can be extremely distressing. Detoxing on your own at home could prove exquisitely difficult because of this unpleasant, potentially painful experience.

Detox Timeline

Every patient’s detox timeline varies depending on several factors, such as individual physiology, age, frequency and amount of use, typical mode of administration (e.g. injecting or snorting), as well as the specific opioid they are attempting to detox from. For example, the acute withdrawal syndrome associated with heroin and many of the opioid painkillers typically begins between 6–12 hours after the last heroin dose, with symptoms peaking within 1-3 days and subsiding within 5–7 days.²

The withdrawal timeline may be somewhat delayed for long-acting opioids, such as methadone. Withdrawal symptoms for methadone may emerge 2-4 days after the last dose and typically dissipate within several weeks.^2,3

While some people with opioid dependence can successfully detox at home, the support, medications, and monitoring provided in a formal detox program make the process much smoother and more comfortable.

Risks of Cold Turkey Opioid Detox

As mentioned, though the experience is often highly uncomfortable, opioid withdrawal is rarely immediately life-threatening. However, certain complications that may require medical attention could arise. These possible complications include:^1,3

• Aspiration (vomiting and breathing stomach contents into the lungs).
• Lung inflammation or infection secondary to aspiration.
• Severe gastrointestinal distress: diarrhea, nausea, and copious vomiting.
• Severe dehydration secondary to GI effects.
• Electrolyte disturbances and imbalances secondary to inadequate fluid and food intake.
• Exacerbation of cardiac illnesses due to increased blood pressure and pulse.
• Increased intensity of anxiety in those with anxiety disorders.
• Increased pain in people with chronic pain, due to a reduced pain threshold.

Relapse remains the most concerning risk associated with opioid withdrawal, as most overdose deaths occur in people who recently detoxed from opioids.¹ Any period of abstinence to occur during detox will result in a natural reduction of one’s opioid tolerance. Should an individual whose tolerance has decreased in this manner relapse with an opiate dose on par with what they were previously taking, they will be at increased risk of an overdose.¹

Even if overdose is avoided, the relapsing user will have reentered their previous destructive cycle of opioid abuse and will again be at risk of experiencing the adverse medical and psychosocial consequences of their now-reinforced compulsive opioid use.

How Can Professional Detox Help?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), comprehensive detoxification efforts must consist of 3 components:³

1. Evaluation
2. Stabilization
3. Encouraged advancement of patient into ongoing treatment

In the evaluation stage, toxicology screening takes place to detect any substances having been used. Treatment professionals will additionally assess for concurrent psychological and physical disorders. This stage includes a biopsychosocial assessment and creates the initial basis for appropriate treatment planning.³

The stabilization stage involves interventions that help guide a person through intoxication and withdrawal to get to a drug-free state. The detoxing patient may be administered select medications used to alleviate unpleasant withdrawal effects. Treatment professionals review treatment expectations with the patient and may work collaboratively with their family members, physician, or employer.³

The third stage of promoting additional, post-detox recovery efforts involves providing education about addiction treatment and emphasizing its importance on the continuum of substance abuse care. This means encouraging admittance into a treatment program to offset the risk of relapse after detox completion. Professionals may create a contract with the client to commit to a stable aftercare plan.³

Detox can occur in many locations, and the setting in which detoxification occurs should be appropriate for the individual patient. These settings are as follows:³

• Physician’s Office: This may be the first point of contact for a patient if they’ve been taking an opioid therapeutically and have developed a dependence. The physician may gradually taper them off the prescribed opioid. If the person is already exhibiting some of the more troublesome signs of an addiction, the physician may provide information regarding detox and substance abuse treatment options and refer the patient to an appropriate program. Additionally, some doctors are approved to dispense buprenorphine, a medication used during opioid detox and addiction treatment.
• Outpatient: Detox can also take place in outpatient detox centers. Patients attend outpatient programs during the day and then they return home at night. Outpatient programs may be a good fit for patients with relatively less severe opioid dependence issues and with a strong support system at home to better help them remain sober during this difficult time.
• Inpatient: Inpatient facilities require that the patient stay at the center for the duration of the detox program. Inpatient medical detox staff provide around-the-clock supervision and care to manage withdrawal and prevent and address complications, should they arise.
• Hospital: This may be the first point of contact for patients with significantly severe cases of physiological dependence who may be in florid, or severe, withdrawal or otherwise are experiencing an acute medical crisis. Acute hospital settings may not be equipped to provide substance abuse recovery care beyond detoxification. Instead, hospital professionals will work to stabilize the patient and then assess them for the appropriate level of addiction treatment to resume elsewhere.

Opioid Detox Medications

To alleviate or reduce some of the opioid withdrawal symptoms, patients may receive medication during their detox processes. Such medications are:³

• Methadone: This highly regulated medication is only available in specialty licensed programs, except when the patient is hospitalized. To date, methadone has been the most commonly used FDA-approved medication indicated for opioid dependence and detoxification. Methadone is a potent, long-acting, full opioid agonist that prevents the onset of opioid withdrawal and, additionally, will either displace or block the opioid receptor interaction of heroin and other abused opioids, should they be concurrently abused.
• Suboxone: This combination formula contains buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. The buprenorphine binds to opioid receptors to alleviate withdrawal symptoms while the naloxone helps to deter abuse of the detox medication. Suboxone can be dispensed at an approved physician’s office, making it more accessible than methadone treatment.
• Clonidine: This drug, although not approved by the FDA for opioid withdrawal, helps relieve some opioid withdrawal symptoms, such as anxiety, sweating, and high blood pressure, without producing opioid intoxication. That being said, it hasn’t proven effective in managing muscle aches, insomnia, or opioid cravings. It may be used in conjunction with other medications to provide comprehensive medical detox treatment.

Sources

1. U.S. National Library of Medicine. (2017). Opiate and Opioid Withdrawal.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, D.C: American Psychiatric Association.
3. Substance Abuse and Mental Health Services Administration. (2013). Detoxification and Substance Abuse Treatment.