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Which Drugs are Safe for Outpatient Detox?

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Outpatient detox is beneficial and safe for people addicted to certain drugs, including marijuana, hallucinogens, stimulants, ecstasy, and others. People who struggle with an addiction to alcohol, benzodiazepines, or opioids may be safer and more comfortable in an inpatient detox program.

What Does Outpatient Detox Entail?

The goal of a professional detox program is to help you withdraw from drugs and alcohol safely and comfortably and to achieve a medically stable, drug-free state. Detox can occur in a number of settings, with the two main types being inpatient and outpatient. Inpatient detox programs offer 24/7 care and supervision in the event that withdrawal complications arise. Outpatient detox programs are different because patients live at home and travel to the facility during the day to receive detox services.

Options for outpatient detox.

Outpatient detox is a good fit for substance abusers at relatively lower risk of relapse and unlikely to experience medical complications, either at the detox center or when they return home in the evening.1

Many detox programs provide medication assistance, which can ease the symptoms of withdrawal. Medication-assisted detox programs help reduce cravings and manage uncomfortable withdrawal symptoms, like anxiety and nausea. In certain types of outpatient programs, you can meet regularly with medical staff to receive medications, such as methadone, which is commonly used for the management of opioid withdrawal.1

Outpatient detox treatment varies in intensity. Common outpatient detox options include the following:1

  • Doctor’s office: Many people with a relatively low-risk of severe withdrawal choose to rely on their family physician or psychiatrist. Meeting one or more times per week, your doctor can prescribe medications that help reduce uncomfortable symptoms and prevent cravings. They can also help you taper off prescription medications.
  • Partial hospitalization program (PHP): This type of outpatient program allows people to come in for several hours per day, for 5-7 days per week for substance abuse counseling and therapy sessions, and provides access to medical and mental health services, if needed.
  • Intensive outpatient treatment (IOP): This option is similar to the partial hospitalization programs in that they provide more time intensive detox treatment than standard outpatient visits. Unlike PHPs, there may be limited or no access to medical staff and services in an IOP.

Your outpatient detox experience will be influenced by what substance you are addicted to, your physical health, your mental health, your individual physiology, your past withdrawal experiences, and your social supports. Typically, detox lasts anywhere from several days to a few weeks.

Although every outpatient detox program is different, common interventions used may include:1

  • Medications, such as methadone or Suboxone.
  • Individual therapy.
  • Group counseling.
  • Peer support.
  • Medical care from nurses or doctors.

No matter what level of detox treatment you’re receiving, staff members should treat you with compassion, empathy, and understanding during this emotionally trying time. They understand what you’re going through and are there to help you each step of the way.

The ultimate goal of any detox program is to stabilize you and then prepare you to enter addiction treatment.

Detoxification is only the first step on a continuum of substance abuse recovery services. Addiction treatment requires a longer commitment to therapy or support programs that can help you maintain sobriety and prevent relapse.

What are the Risks?

Safety is the major concern of any detoxification program. The withdrawal experience is different for everyone, but some acute substance withdrawal syndromes are much riskier than others.

Substances that pose a major risk to your health include:1,2,3

  • Alcohol: Alcohol withdrawal can cause life-threatening seizures, hallucinations, tremors, and a dangerous condition known as delirium tremens. Alcohol withdrawal can be fatal.
  • Benzodiazepines (Xanax, Ativan, Klonopin, Valium): Benzodiazepine withdrawal can result in complications including seizures, delirium, and a recurrence of psychological symptoms, such as severe panic in those prone to it.
  • Barbiturates (phenobarbital, secobarbital, butalbital): Barbiturate withdrawal syndrome can lead to multiple seizures, delirium, psychosis, and hallucinations. It can be life-threatening.
  • Gamma-hydroxybutyrate (GHB): GHB withdrawal symptoms are similar to benzodiazepine and alcohol withdrawal and may include delirium, confusion, and psychosis lasting several days.

What an opioid withdrawal feels like.

Having an addiction to any of the abovementioned substances is a contraindication for outpatient treatment. It is safer to detox in an inpatient facility in which staff members provide patients with around-the-clock care.1

While opioid detox is not typically dangerous or life-threatening, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that opioid abusers also receive 24-hour detox treatment. This is because opioid withdrawal can be extremely uncomfortable and distressing, which may cause people to relapse in attempts to alleviate the symptoms. Inpatient facilities can provide around-the-clock medication management to help ease withdrawal symptoms and cravings.1

Some substances are generally considered safe for outpatient detox treatment. Drugs that do not typically have dangerous withdrawal symptoms include:1,2

  • Marijuana: Withdrawal is typically mild and may include depression, anxiety, and irritability.
  • Hallucinogens: Withdrawal from hallucinogenic drugs is mild.
  • Stimulants: Stimulants, such as amphetamines and cocaine, typically don’t cause immediately risky withdrawal symptoms. In some cases, however, people may experience severe and prolonged depression, anxiety, and paranoia.
  • Inhalants: Commonly abused inhalants, like aerosols and cleaning supplies, do not have a characteristic withdrawal syndrome. In rare cases they may cause tremors, irritability, anxiety, and seizures. Withdrawal from toluene, a specific chemical in glues and other products, could possibly lead to delirium tremens.
  • Steroids: Steroid withdrawal syndrome can occur with heavy steroid use and may include depression, fatigue, and insomnia.
  • Ecstasy: MDMA is not commonly associated with any serious withdrawal symptoms. Most complications are a result of intoxication or overdose.
  • Ketamine and PCP: Withdrawal symptoms may include excessive sleep, depression, and cravings.

The drugs listed above are typically safe for outpatient detox, but not always. Certain people have an increased risk of complications and would be better suited for constant medical supervision.

Outpatient detox may be contraindicated for people with any of the following conditions or concerns:1 

  • Polydrug abuse
  • Dual diagnosis (i.e., mental health issues in addition to substance abuse)
  • A history of complicated withdrawal
  • Serious physical health conditions
  • Suicidal ideation or past suicide attempts
  • Pregnancy

Choosing the right treatment option for you.If you are struggling with a substance addiction, there are many places to find help. Detox doesn’t have to be as hard as you may think. Finding the right type of detox program will make it easier to withdraw safely and comfortably so that you can then enter an addiction treatment program and begin your new life of sobriety. Reach out today.

Sources

  1. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment.
  2. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
  3. Sellers EM. (1988). Alcohol, barbiturate and benzodiazepine withdrawal syndromes: clinical management. CMAJ: Canadian Medical Association Journal. 1988;139(2):113-120.

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