Speaking from my own experience, I know how frightening going to detox can be. The fear of withdrawal is overwhelming. I was addicted to IV heroin, shooting up as soon as I woke up and throughout the night. The thought of quitting made me sick. There were times I did not have money, or couldn’t find my drug of choice, and felt the full effects of heroin withdrawal. I had no tapers or comfort medications to relieve my agony.
Before I went to detox, I had no idea what it would entail, or what “comfort medications” were. I thought it would be the worst week of my life and I was not sure if I would be able to do it. I had used suboxone before and knew what methadone was, but those were the only medications that came to mind when I thought of detox. I thought of not being able to sleep and dreaded feeling like garbage. This is mostly why I had avoided detox for so long. Little did I know that a variety of medications are used in detox centers to assist with withdrawal.
What to expect in detox
Suboxone was used only as a “taper”, or a drug to slowly wean me off opiates. This slows down the withdrawal process and makes it a little bit more bearable. This drug is only used for opioid detox. Even though it is a taper, Suboxone still acts as one of the many comfort medications used for opioid withdrawal.
One of the first drugs I was given in detox was a non-narcotic blood pressure medicine called clonidine. Clonidine lowers blood pressure to assist with anxiety, restlessness, irritability, and sleep. This is a common drug in detox and used for various drug or alcohol withdrawal symptoms.
The addict that I was, I was not expecting much from a non-narcotic drug. I had had my fair share of “anxiety medication” and clonidine was not one I had ever heard of…But, to my surprise, clonidine helped me greatly with sleep and restless legs specifically. It also made me significantly less anxious compared to when I was facing opiate withdrawal on my own.
The next drug I was given was Phenobarbital. Phenobarbital is a barbiturate (yes they are not extinct). This was one of the drugs I was more shocked to hear about because I did not think barbiturates were widely used anymore, but come to find out, they actually still used today in many detox centers for sleep and anxiety. I was given a very small dose but it was enough to allow me to sleep despite the opiate withdrawal symptoms I was facing. Sometimes benzodiazepines are used in place of barbiturates. Benzos are used for the same reasons because they are very similar drugs but benzos are easier to manage and widely considered safer.
In alcohol and benzo withdrawal, benzodiazepines are almost always used in detox. This is because it acts as an anticonvulsant which can mitigate tremors and the risk of seizures. Benzos are also used as a tapering drug similar to how suboxone is used for heroin addiction. Benzodiazepines are safer than barbiturates in higher doses, and the effects are more predictable.
Benzos are also common in stimulant drug detox. This is because anxiety and depression are very severe following heavy stimulant abuse. The benzos promote sleep and greatly reduce anxiety. There is also no taper that exists for stimulant detox so this is another reason benzodiazepines are commonly used.
I also was also given various comfort medications to assist with nausea and vomiting. Promethazine and cola-syrup are the most common and are used for drugs as well as alcohol detox.
List of Comfort Medications and What They Are Used For
- Buprenorphine (Suboxone/Subutex): most common opioid taper
- Methadone: Less common opioid taper
- Benzodiazepines (Librium, Ativan): sleep, anxiety, restlessness
- Clonidine (Catapres patch or pill): Restless legs, anxiety, sleep
- Barbiturates: sleep, anxiety, restlessness
- Promethazine: nausea, vomiting
- Cola syrup: nausea, vomiting
- Antidepressants: depression
The combination of these medications makes for a much more bearable withdrawal process. Much of the anxiety and fear is reduced to a level of stability.
Each patient is evaluated on an individual basis. Doctors and nurses will be sure to make sure that the detox is as comfortable as possible. Of course, some symptoms will be felt, but not nearly to the extent of detoxing on one’s own or quitting “cold turkey.” Detox makes for a safe withdrawal, given that substances like alcohol and benzodiazepines can be very dangerous. Vital signs will be monitored and medication administered as symptoms arise.
The presence of medical professionals paired with comfort medications provides a feeling of safety. It allows one to remain optimistic and focused on their path to recovery. If detoxing at home, it is can be easy to have a panic attack due to the overwhelming pain and fear of withdrawal. Feeling safe and secure provides an extra cushion for an already difficult process. Sometimes on one’s own, the cravings and symptoms can trigger one to give up. They may feel that their symptoms will not go away, or are only getting worse. They will not have the reassurance of medical professionals that they will soon feel better. That on its own is a priceless perk of medical detox.