Opiate detox and supervised withdrawal

It starts with an assessment. Staff ask what you have been taking, how much and when you last used. They check your pulse, blood pressure and general health, and may run blood or urine tests.

Then they treat the symptoms. Depending on the program, that may include:

• buprenorphine or methadone, which relieve withdrawal directly
• clonidine or lofexidine, which ease sweating, cramps, anxiety and restlessness
• medicines for nausea, vomiting and diarrhea
• help with sleep
• fluids and food as you can manage them

Good programs also check for depression and other mental health conditions, since treating them lowers the chance of returning to use.

Before you leave, staff should sit down with you and set up what comes next. If nobody raises it, ask.

Most stays last from a few days to a couple of weeks. The length depends on which opioids you used, for how long, and how your body responds.

Withdrawal from short-acting opioids such as heroin tends to start within about 12 hours of the last dose. With long-acting opioids such as methadone it can take 30 hours or so to begin, and it lasts longer. The withdrawal timeline walks through each stage.

The acute sickness passes first. Low mood, poor sleep and cravings can linger for weeks or months afterwards, which is one more reason to have support lined up.

Finishing detox feels like the finish line. It is closer to the starting line.

SAMHSA’s expert guidance does not recommend short-term supervised withdrawal as a stand-alone approach, because rates of return to opioid use are high. Detox clears the drug. It does not treat the cravings or the changes in the brain that drive them.

The bigger danger is overdose. After withdrawal, your tolerance is much lower than it was. An amount you used to take without trouble can now stop your breathing. MedlinePlus, from the National Library of Medicine, states that most opioid overdose deaths occur in people who have just detoxed.

So the days and weeks after detox are a high-risk time. The people around you should know that, and you should have naloxone within reach.

Call 911 if someone is not breathing or cannot be woken. For a crisis or thoughts of suicide, call or text 988. The SAMHSA National Helpline, 1-800-662-4357, offers free referrals 24 hours a day.

You have real choices here, and you can make them before detox begins.

• Stay on medication. If you are given buprenorphine or methadone for withdrawal, you can often keep taking it as ongoing treatment instead of tapering off. Ask about this on day one. Our medication treatment guide explains the options.
• Start the naltrexone shot. Once you have been opioid-free long enough, a monthly naltrexone injection can be given before discharge.
• Book the next level of care. That may be outpatient care or a residential program, with a set date and a named contact.
• Take naloxone home. Ask the program for it, or buy the nasal spray at a pharmacy.

Some people skip stand-alone detox altogether. They start buprenorphine or methadone as outpatients, and the medicine does the work of getting them through withdrawal. To compare programs near you, find treatment in your state.