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Drug Detox: Process, Medications & Treatment Options

Last Updated: October 21, 2022

A medically supervised detox can ease withdrawal symptoms, making the first steps of addiction recovery safer, more comfortable and easier to achieve.

Quitting an addictive substance can seem like an overwhelming challenge. Fortunately, with the dangers of addiction becoming more widely known, there is more medical support than ever for people determined to stop their substance use. 

Typically, the process of addiction treatment and recovery starts with a detox period. Drug detox refers to the initial stages of stopping or weaning off a substance. This is often completed in a medical setting and is known as medical detox.

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When Is Detox Necessary?

Detox is necessary when a person wants to quit a substance they have become physically or psychologically dependent on. Because the body and mind have become reliant on the presence of the substance to function normally, quitting the substance can lead to a variety of physical and mental withdrawal symptoms. These withdrawal symptoms vary widely depending on the substance the person is quitting.

Withdrawal symptoms can be uncomfortable and even dangerous in some situations. For this reason, one of the safest ways for a person to detox is in a medically supervised inpatient setting. In these medical detox facilities, clients receive around-the-clock care from doctors and nurses who can address any withdrawal symptoms and complications as they arise.

In case of a substance-related medical emergency, such as an overdose or uncontrolled withdrawal symptoms, call 911 immediately. If you suspect a person may be overdosing on an opioid, administer the opioid reversal drug naloxone if possible and then call 911.

Dangers of Detoxing From Drugs at Home

Some people attempt to end substance use at home without help. This can be difficult for a variety of reasons. Because withdrawal symptoms can be intense and overpowering, a person might get discouraged and abandon their detox efforts. If they have stopped taking the substance but suddenly start again due to difficult withdrawal symptoms, their body may no longer be used to the substance. This can cause a potentially deadly overdose.

Further, some withdrawal symptoms, such as hallucinations or uncontrolled vomiting, can be dangerous and lead to medical complications.

Medical Detox for Drug Addiction

Medical detox is a safe way to stop substance use. Experts recommend medical detox for many people, including those who have underlying medical conditions, mental health problems, severe addictions or addictions to multiple substances.

What Is Medical Detox?

In medical detox, a person stops or is slowly weaned off a substance while in inpatient care at a specialized detox facility. Doctors and nurses provide around-the-clock medical support while the person’s body is cleansed of the substance.

The Detox Process

When someone is admitted to a medical detox center, the medical team takes their full medical history. This allows any underlying medical or nutritional needs to be addressed as the person is weaned off the substance. The medical team then determines the best way for the person to stop the substance and monitors them until they are ready for the next level of care, which is typically a rehab setting.

Detox Medications & Medication
Assisted Treatment

Medications are often used during the detox process to treat withdrawal symptoms as necessary. Certain medications that help a person stay sober may also be prescribed either during detox or rehab. Prescriptions can vary depending on the withdrawal symptoms that arise and the type of substance that is being abused.

Acamprosate (Campral)

Acamprosate is an FDA-approved medication used to help people overcome alcohol. The drug helps people stay sober by reducing the levels of glutamate in the brain. Glutamate is the brain’s excitatory neurotransmitter, and it spikes when a person stops drinking. This can make it hard for a person to stay away from alcohol. By lowering the brain’s glutamate, acamprosate helps a person not need alcohol.

Anticonvulsants

In some cases, when a person quits alcohol or benzodiazepines, seizures can be a potential withdrawal symptom. Other times, seizures can result from medical complications like dehydration from withdrawal-induced vomiting or diarrhea. Anticonvulsants can be prescribed as add-on medications to treat people in withdrawal who are at risk of seizures or have had a seizure before. Many different anticonvulsants exist, ranging from benzodiazepines like diazepam (Valium) to antiepileptic medications like levetiracetam (Keppra).

Antidepressants

Mood changes like anxiety and depression are common when a person struggles with addiction, and they can be worsened during the withdrawal process. Antidepressants may be prescribed to help a person overcome these feelings, setting them up for a better mental health space to meet the challenges of detox and rehab.

Antidiarrheal Medications

Withdrawal can often cause changes in bowel habits, with diarrhea and abdominal cramping being especially common. If untreated, diarrhea can lead to complications like dehydration, which can be dangerous. Antidiarrheal medications like loperamide (Imodium) are commonly prescribed to help prevent diarrhea.

Anti-Nausea Medication

Nausea and vomiting are unpleasant but common side effects of withdrawal. Antiemetics, or medications that fight nausea and vomiting, are commonly prescribed to people undergoing withdrawal. These medications include prochlorperazine.

Antipsychotics

Serious psychological side effects like hallucinations and psychosis can occur during withdrawal from stimulants and certain substances, especially methamphetamine. This can make the person a danger to themselves or others. Antipsychotics can help to ease dangerous psychological side effects of withdrawal. Many antipsychotics exist, including quetiapine (Seroquel).

Benzodiazepines

Benzodiazepines can be drugs of abuse. In certain circumstances, however, they can be very helpful for managing withdrawal symptoms of other substances when the benefit outweighs the risk. For example, during the most intensive stages of alcohol detox, benzodiazepines are considered the gold standard for helping to fend off potentially dangerous withdrawal symptoms like seizures.

Buprenorphine (Suboxone, Subutex)

Buprenorphine-based products like Suboxone are among the first-line medications used to treat opioid use disorder. Buprenorphine has less abuse potential than many other opioids, and it can be taken both during the detox period as well as over the long term as medication-assisted treatment (MAT). The medication helps prevent withdrawal symptoms and lessen cravings, and it also reduces the chances of overdose if a person relapses and takes an opioid.

Clonidine (Kapvay)

Clonidine is a medication that has been prescribed off-label for more than 25 years to treat opioid withdrawal symptoms. Although methadone and buprenorphine are more effective at treating opioid withdrawal symptoms, clonidine may be prescribed in cases where those gold standard treatments are not an option.

Disulfiram (Antabuse) 

Disulfiram is a medication that can help a person stay sober from drinking once they have quit alcohol. The medication is not intended to treat alcohol withdrawal symptoms. Instead, it works as a deterrent. Disulfiram blocks the pleasant effects that occur with drinking and also makes people feel sick if they drink alcohol.

Methadone (Dolophine, Methadose)

Along with buprenorphine, methadone is an FDA-approved first-line treatment for opioid use disorder. A long-acting opioid itself, the drug can help ease withdrawal symptoms in people weaning off opioids. It can also be taken long-term to help people avoid opioid cravings and prevent unintended overdose in the event of a relapse.

Naltrexone (ReVia, Vivitrol)

Naltrexone can be prescribed for both alcohol and opioid use disorders. However, because a person should be completely sober from alcohol and opioids before starting naltrexone, the drug is rarely used during detox. Further, unlike methadone and buprenorphine products, it is not a first-line treatment for opioid use disorder. Naltrexone works by interfering with the brain’s production of dopamine, a feel-good chemical that plays a large role in addiction. 

Non-addictive Pain Medication

Physical aches and pains, including cramps and headaches, are common during withdrawal. Non-addictive pain medications like acetaminophen (Tylenol), ibuprofen (Motrin) or naproxen (Aleve) are often prescribed to help ease these symptoms.

Sources

Bartter, T & Gooberman, L L. “Rapid opiate detoxification.” The American Journal of Drug and Alcohol Abuse. November 1996. Accessed June 21, 2023.

Legarda, Juan J. “Ultra-rapid opiate detoxification under anaesthesia (UROD).” The Lancet Journal. May 16, 1998. Accessed June 21, 2023.

American Society of Anesthesiologists. “General Anesthesia.” 2023. Accessed June 21, 2023.

US Centers for Disease Control and Prevention. “Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012.” September 27, 2013. Accessed June 21, 2023.

Shah, Mansi & Huecker, Martin R. “Opioid Withdrawal.” StatPearls. April 29, 2023. Accessed June 21, 2023.

Singh, J. & Basu, Debasish. “Ultra-Rapid Opioid Detoxification: Current Status and Controversies.” Journal of Postgraduate Medicine. 2004. Accessed June 21, 2023.

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