Understanding the Opiate Detox Process

You can feel it coming on like a hurricane.

It has been a while since the urge to use has been this intense. Lying there with the fan blasting, sweat pouring down your forehead, television on silent and your mind racing like a horse—this is it—rock bottom. “Where in the hell is he!?”

Your patience has finally run its course.

Anger seeps in.

“How could he possibly ignore?” He said he was only two hours away. Then he called me just a few minutes ago and told me, “Don’t pass out (!), I’m on the highway only a few miles away.”

How could your drug dealer bail on you like this? After all, you have to be one of his most loyal customers.

You tell yourself, “This is the worst moment of my life.”

But, didn’t you say that a few days ago when your drug dealer came late again? Didn’t you make a promise with yourself to get help, delete his number and tell him never to call you again?

Didn’t you tell yourself that one day you would have children, teach them how to strum the guitar, play hide-and-go-seek with you and watch them grow up?

Didn’t you look at your mom’s crying face for the last time, devastated at what her child had become, only to lie to yourself hours later, as you called your drug dealer, and got your fix?

As an opiate addict, moments like this consume your every waking move.

Even when you’re lucky enough to get a few hours of sleep, your subconscious mind is awoken by those vicious, unapologetic cravings.

However, something you were never prepared your entire happened today.

Your drug dealer no longer answers your calls. Your doctor said she was no longer going to prescribe opiates to you; your opiate-addicted network of friends suddenly no longer answer your phone calls or text; your “hook-ups” are dryer than the Sahara Desert.

You no longer have access to opiates.

But, perhaps, this curse is actually a blessing. Sure, right now life is a living, breathing, sweltering pile of sh*t, but perhaps something good will come out of this

Because right now, you’re not high—you’re as sober as a rock in the park.

Right now, you’re in detox.

Right now, in this painful, dreadful and seemingly unbearable moment, could be your last chance at survival? And right now, you have a choice.

Which path will you choose? 

What is Detox?

Detoxification is a relatively simple concept; however, the side effects experienced during detoxification from opiates is anything but. Detoxification implies that your body is in its natural state of cleansing.

The brain, blood, nervous system, intestines, liver, lungs, etc., have all become so accustom to external (i.e., non-natural) administration of opiates, that it takes a certain amount of time to cleanse (“purify”) the body from toxins (i.e., opiates).

There is no specific amount of time you can accurately measure how long detox will last. Usually, successful completion of detox only lasts a couple of day, however, the withdrawal effects are only just beginning. 

What Happens to your Brain When You’re in Detox?

When you go through detoxification from opiates, your brain essentially panics. It no longer knows what to do because, for so long, you were controlling what the brain was supposed to do (i.e., get you high by releasing dopamine into the nervous system, blood and brain).

You’ve essentially trained the brain to act as your slave, dictating how to feel, when to feel it, and how long you are going to feel it.

The opiate detox process essentially “reboots” the brain back into its natural rhythm and distribution of chemicals and neurotransmitters.

Take for example, when you’re attempting to learn another language, such as Spanish. Becoming fluent takes willpower, dedication and consistency if you want your brain to retain the muscle memory to use it whenever you wish.

It a skill that doesn’t happen overnight.

However, after one year of practicing Spanish every single day, you suddenly decide to stop practicing and take a break for six months. Well, by the time six months come around, you’re not going to be able to pick up right from where you left off.

You’re going to have to start from square.

Sure, you might remember a little bit from what you learned, but overall, your brain needs for you to start over and go back to the basics.

That is what is essentially happening you suddenly stop taking opiates.

Your brain simply doesn’t remember how to act before you started using. It is going to take a certain amount of time, or “practice,” to regain where it left off.

Side Effects of Post-Acute Withdrawal

• Restlessness
• Difficulty concentrating
• Difficulty talking with others
• Vomiting
• Volatile mood swings (possibly dangerous)
• Intense cravings; fear of not having opiates
• Depression and anxiety (due to the brain’s inability to release chemicals normally)
• Insomnia; night terrors
• Trouble getting out of bed
• Trouble urinating
• Constipation
• Sweating
• Low sex drive
• Fever
• Muscle soreness; muscle fatigue

Craving After Detoxification

Your brain is going to be too happy when you go through detox. Cravings are most severe during the initial 48 hours after your dose, and can anywhere between a couple to a couple months.

In fact, your body may not fully get over its cravings, however, the intensity will slowly decrease over time. Curbing your dose, or taking lower amounts of opiates it day, is an effective method for decreasing the strength of your cravings.

Stopping “cold turkey” essentially forces the brain to overreact, and do everything in its power to manipulate you into using opiates again.

Factors That Affect the Length of Detox:

Administration – Opiates can be externally administered into the body in several different ways; for example, snorting, smoking intravenous injection, anal administration, oral administration, and even drinking, are all ways opiates can be dispensed into the brain.

Metabolism – The body’s metabolism (i.e., how the body breakdowns calories and converts them into energy), determines a significant amount of information into how long detox will take. Things that determine metabolism:

• Genetics—the body’s natural chemical makeup; genes that are naturally passed by generation; physical characteristics that are shared with individuals of the same bloodline. Genetics are incontrollable and cannot be altered.

• Height—Height is in fact related to genetics, however, the shorter the body is, the more is has to work (i.e., initiate energy) to cover the same distance as taller people; therefore, shorter people tend to have faster metabolisms.

• Age—The older you become, the slower your metabolism is. That’s because as the body ages, the harder it is for your body to create and sustain muscle mass. The slower production in muscle results in increase production of body fat. The more body fat the individual has, the slower it takes foods to be metabolized.

• Current Physical Condition—The better condition your body is in, the faster your metabolism will be. When you’re in better shape, your body has more muscle and less fat, which makes the food-to-energy process more efficient.

• Sex—Women tend to develop less muscle mass than men, and at a slower rate, which slows down the body’s metabolism.

• Exercising—Whether it’s going on a 10-mile bike ride or simply walking to the store down the block, the more you move, the faster your metabolism will be.

• Environment—For people who endure colder weather conditions (such as in the Midwest or East coast), their metabolisms are usually faster than in warmer climates.

That’s because the colder it is, the harder/faster the heart beats, thus creating the body to breath more heavily; inhale more oxygen, which is then distributed throughout the body/brain. This process burns calories faster—thus creating a faster metabolism. However, people that reside in colder climates also stay in doors more and don’t exercise as frequently as individuals in warmer areas. The less exercise, the slower the body converts calories into energy.

Opiate Potency – Heroin, when measured in the same dose, is more potent than hydrocodone. Although both drugs are opiates, their potency levels are very much different; consequentially, the higher the potency of the opiate, the longer it takes to detoxify.

Consistency in usage – An individual with five years of opiate abuse versus someone abusing the drug only once a month will endure the detoxification process longer. That’s because the more the brain becomes familiar with chemicals, the more it interprets it as essential. When the brain no longer receives those chemicals, the harder it works to conserve opiates.

Methods of Opiate Detoxification

Medical Detoxification: It is very common for patients going through opiate withdrawal to alleviate the uncomfortable side effects via medically assisted treatment. This is especially true for individuals who have used the drug over a long period of time. Inpatient medical detoxification implies that patients receive around-the-clock care in additional medications that mitigate negative side effects, thus making the detoxification process more manageable.

Rapid Detoxification: The objective of this process focuses on the “rapidness” recovery. Rapid detoxification, also known as the “businessman’s method of recovery,” implies that patients undergo general anesthesia to bypass the negative side effects of withdrawal unconsciously. This inpatient, invasive procedure is practiced via the addition of intravenous injection with opiate blockers. After approx. 4 to 8 hours, the procedure is over; however, patients are usually hospitalized for at least two days for further evaluation.

Ultra Rapid Detoxification: This painful, expensive method of detoxification treatment involves general anesthesia via Naltrexone, which blocks all dopamine receptors. By doing this, patients are able to bypass detoxification extremely quickly (only a few minutes), while accelerates the withdrawal process dramatically.

Methadone: “Tapering off” opiate use with the addition of Methadone is one of the most widely practiced methods in detoxification treatment. Usually conducted in a safe, inpatient environment, methadone (i.e., opiate-antagonist) is methodically provided to patients based on potency, and time length of abuse. Although Methadone itself is a semisynthetic opioid, it counts the euphoric effects associated with opiates.

Outpatient Detoxification: Outpatient detoxification is a widely used alternative method in the treatment of opiate withdrawal for patients with mild to moderate abuse of opiates. Patients that have: long-term abuse of opiates, trouble relapsing, additional medical and/or mental issues, etc., are discouraged to resort to outpatient care due to its high potential of relapse. However, outpatient treatment does have many advantages such as lower cost, easy accessibility to medical care, ability to continue work and/or sustain an income, etc.

Tips on Successful Opiate Detoxification

Listen and talk with family: Although it may be hard, communicating with family members during this sensitive time is crucial to your confidence, wellbeing and overall potential of recovery. Listen and talk with family members in a peaceful, calm state-of-mind. The more relaxed you are, the more relaxed they will be.

Don’t Procrastinate: Once you’ve signed up for treatment, don’t allow yourself additional time to think about the decision. Procrastination is one of the biggest reasons why abusers stay addicted. Indecision and fear of no longer having access to opiates is hard, but the outcome is well worth it. When you go, go! Don’t think, don’t delay, and don’t ponder—just get help.

Set yourself up for success: Great, you’ve successfully detoxed, but you didn’t prepare what to do next. Often times, this leads right back into abuse. Whether it’s getting involved with a 12-step program, eliminating certain friend(s), moving, getting a new job, having transportation, etc., do what you needs to do before, then get help.

Meditate: Find a peaceful place (preferably somewhere quiet outdoors) and practice deep breathing exercises. Take a deep breath through the nose for three seconds, expand your tummy with the fresh air, then your chest—hold for three seconds—then slowly exhale through the mouth for five seconds. Try it (!) it will change your life for the better.

Diet: You are what you eat. Stay away from genetically altered foods, gluten, sugar, diary, alcohol and processed foods. Eats foods rich in fiber, protein, calcium, zinc, fatty-acids, etc., and become a beautiful (new) source of energy.

Sources:

“Understanding Drug Abuse and Addiction: What Science Says.” NIDA. 15 Mar. 2019. https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification

“Opiate Withdrawal and Detox.” Addiction Centers. 15 Mar. 2019. https://www.addictioncenter.com/opiates/withdrawal-detox/

“Opiate Withdrawal & Detox.” The Recovery Village. 15 Mar. 2019. https://georgiadrugdetox.com/resources/opiate-detox-process/