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9 - Detoxification: How Do We Get Ourselves Off Opioids?

from Part III - The Treatment Plan

Published online by Cambridge University Press:  07 October 2023

Ethan O. Bryson
Affiliation:
Icahn School of Medicine at Mount Sinai, New York
Christine E. Boxhorn
Affiliation:
Medical College of Wisconsin, Milwaukee
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Summary

When an individual has been consuming opioids for an extended period, a phenomenon known as physical dependence occurs. Because of physical dependence, when the opioids are discontinued abruptly, or the dosage is dropped significantly, the individual experiences withdrawal through the process of detoxification. Historically, people were forced to endure withdrawal symptoms without medical treatment in jail cells, drunk tanks, or compulsory treatment centers. Nowadays, withdrawal management includes education, treatment of withdrawal symptoms, and referrals for further care, which is almost always required for individuals to achieve long-term sobriety. Inpatient and residential treatment are two options for care after detoxification, and various individual factors must be considered when choosing the best type of treatment for that person.

Type
Chapter
Information
The Opioid Epidemic
Origins, Current State and Potential Solutions
, pp. 107 - 122
Publisher: Cambridge University Press
Print publication year: 2023

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References

References and Further Reading

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington, DC: American Psychiatric Association.Google Scholar
Alharbi, FF, Alsubaie, EG, Al-Surimi, K (2021). Substance abuse in Arab world: Does it matter and where are we? In Laher, I. (ed.) Handbook of Healthcare in the Arab World. Cham: Springer, pp. 23712398.CrossRefGoogle Scholar
Beletsky, L, Tomansini-Joshi, D (2019). ‘Treatment facilities’ aren’t what you think they are. New York Times, September 3.Google Scholar
Center for Substance Abuse Treatment (2006). Detoxification and Substance Abuse Treatment.Treatment Improvement Protocol (TIP) Series. No. 45. HHS Publication No. (SMA) 154131. Rockville, MD: Center for Substance Abuse Treatment.Google Scholar
Collins, ED, Kleber, HD, Whittington, RA, Heitler, NE (2005). Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: A randomized trial.JAMA 294(8): 903913.CrossRefGoogle ScholarPubMed
Connery, HS, McHugh, RK, Reilly, M, Shin, S, Greenfield, SF (2020). Substance use disorders in global mental health delivery: Epidemiology, treatment gap, and implementation of evidence-based treatments. Harvard Review of Psychiatry 28(5): 316–327.CrossRefGoogle ScholarPubMed
European Monitoring Centre for Drugs and Drug Addiction (2014). Residential treatment for drug use in Europe, EMCDDA Papers. Luxembourg: Publications Office of the European Union.Google Scholar
Forozeshfard, M, Hosseinzadeh Zoroufchi, B, Saberi Zafarghandi, MB, Bandari, R, Foroutan, B (2014). Six-month follow-up study of ultrarapid opiate detoxification with naltrexone. International Journal of High Risk Behaviors & Addiction 3(4):e20944.Google ScholarPubMed
Harm Reduction International (2018). Regional overview of the Middle East and North Africa. www.hri.global/files/2018/12/10/MiddleEastNorthAfrica-harm-reduction.pdfGoogle Scholar
Ivers, JH, Zgaga, L, Sweeney, B, et al. (2018). A naturalistic longitudinal analysis of post-detoxification outcomes in opioid-dependent patients. Drug and Alcohol Dependence 37(Suppl. 1): S339S347.Google Scholar
McCorry, F, Garnick, GW, Bartlett, J, Cotter, F, Chalk, M (2000). Developing performance measures for alcohol and other drug services in managed care plans. Washington Circle Group. Joint Commission Journal on Quality Improvement 26(11): 633643.Google ScholarPubMed
Mee-Lee, D, Shulman, GD, Fishman, MJ, Gastfriend, DR, Miller, MM (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, 3rd ed. Carson City, NV: The Change Companies.Google Scholar
O’Malley, GF and O’Malley, R (2020). Opioid toxicity and withdrawal. Merck manual, professional version. www.msdmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/opioid-toxicity-and-withdrawal/?autoredirectid=20985Google Scholar
Olsen, JP, Walden, L (2008). The Narcotic Farm [Video]. King Love Films and the Independent Television Service. https://vimeo.com/91392115Google Scholar
Reif, S, George, P, Braude, L (2014). Residential treatment for individuals with substance use disorder: Assessing the evidence. Psychological Services 65(3): 301312.CrossRefGoogle ScholarPubMed
Substance Abuse and Mental Health Services Administration (2021). National Survey of Substance Abuse Treatment Services (N-SSATS): 2020. Data on Substance Abuse Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
Turner, A (2015). Alternatives to criminalizing public intoxication: Case study of a sobering centre in Calgary, AB. SPP Research Papers 1–8(27).Google Scholar
United Nations Office on Drugs and Crime (2022). Compulsory Drug Treatment and Rehabilitation in East and Southeast Asia: Executive Summary. Bangkok, Thailand: UNODC Regional Office for Southeast Asia and the Pacific.Google Scholar
Wesson, DR, Ling, W (2003). The clinical opiate withdrawal scale. Journal of Psychoactive Drugs 35(2): 253259.Google Scholar
World Health Organization and United Nations Office on Drugs and Crime (2020). International Standards for the Treatment of Drug Use Disorders: Revised Edition Incorporating Results of Field-Testing. Geneva, Switzerland: WHO and UNODC.Google Scholar
Wright, TM, Cluver, JS, Myrick, H (2014). Management of intoxication and withdrawal: General principles. In Ries, RK, Fiellin, DA, Miller, SC, Saitz, R (eds.) The ASAM Principles of Addiction Medicine, 5th ed. Philadelphia, PA: Wolters Kluwer, pp. 625634.Google Scholar
Yassini Ardekani, SM, Yassini Ardekani, S (2013). Ultrarapid opioid detoxification: Current status in Iran and controversies. International Journal of High Risk Behaviors & Addiction 2(3): 9699. https://doi.org/10.5812/ijhrba.13140Google Scholar

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