Drug detoxification
Drug detoxification (informally, detox) is variously the intervention in a case of physical dependence to a drug; the process and experience of a withdrawal syndrome; and any of various treatments for acute drug overdose.
A detoxification program for physical dependence does not necessarily address the precedents of addiction, social factors, psychological addiction, or the often-complex behavioral issues that intermingle with addiction.
Process
The United States Department of Health and Human Services acknowledges three steps in a drug detoxification process:
- Evaluation: Upon beginning drug detoxification, a patient is first tested to see which specific substances are presently circulating in their bloodstream and the amount. Clinicians also evaluate the patient for potential co-occurring disorders, dual diagnosis, and mental/behavioral issues.
- Stabilization: In this stage, the patient is guided through the process of detoxification. This may be done with or without the use of medications but for the most part the former is more common. Also part of stabilization is explaining to the patient what to expect during treatment and the recovery process. Where appropriate, people close to the addict are brought in at this time to become involved and show support.
- Guiding Patient into Treatment: The last step of the detoxification process is to ready the patient for the actual recovery process. As drug detoxification only deals with the physical dependency and addiction to drugs, it does not address the psychological aspects of drug addiction. This stage entails obtaining agreement from the patient to complete the process by enrolling in a drug rehabilitation program.
Rapid detoxification
Richard B. Resnick MD was the first scientist to investigate the idea of accelerated detox under anesthesia. In 1977, he published a paper detailing the first procedures using Naloxone and clonidine. Shortly afterward, physicians began discussing anesthesia to reduce pain during rapid detox. Norbert Loimer, MD, Ph.D. published a paper in the '80s outlining the success of opiate detoxification under general anesthesia. Dr. Resnick and Dr. Loimer's early research served as the foundation for all forms of detoxification under sedation procedures used today. While physicians' protocols significantly differ, they still adhere to the principles described in the early publications. The combined use of clonidine and naltrexone was found to be a rapid, safe, and effective treatment for abrupt withdrawal from methadone, as detailed in a paper published in The American Journal of Psychiatry in 1986. The early efforts of these brilliant minds were the beginning of the true history of rapid detox.
Since then, numerous clinics around the world, including the renowned Waismann Method in the United States, have implemented detoxification under sedation procedures to assist patients in overcoming opioid use disorder. These procedures involve the administration of anesthesia and other medications to facilitate rapid detoxification of the body, effectively reducing the painful and uncomfortable symptoms of withdrawal. While the effectiveness of rapid detox has been a subject of debate, it remains a popular treatment option for certain individuals grappling with opioid addiction. The pioneering efforts of Dr. Resnick and Dr. Loimer have paved the way for ongoing research and advancements in this field, ultimately aiding more individuals on their journey to recovery.
Etymology
The concept of "detoxification" comes from the discredited autotoxin theory of George E. Pettey and others. David F. Musto says that "according to Pettey, opiates stimulated the production of toxins in the intestines, which had the physiological effect associated with withdrawal phenomena. [...] Therefore treatment would consist of purging the body of toxins and any lurking morphine that might remain to stimulate toxin production in the future."
Rapid detox controversy
Naltrexone therapy, which critics claim lacks long-term efficacy and can actually be detrimental to a patient's long-term recovery, has led to controversy. Additionally, there have been many questions raised about the ethics as well as safety of rapid detox following a number of deaths resulting from the procedure.
Some researchers say that relapses to injection use of illicit opioids during or following repeated detoxification episodes carry the substantial potential for injury associated with uncontrolled drug use and include drug overdose, infections, and death.