Almost 25 million American adults (aged 12 or older), or close to 10 percent of the adult population in the United States, were classified by the National Survey on Drug Use and Health (NSDUH) as current illicit drug users, meaning that they had used drugs in the month before the 2013 survey. More than 4 million Americans, according to NSDUH, were considered to be dependent on or have problematic drug abuse issues in 2013, and another almost 3 million were dependent on or abusing both alcohol and drugs within the previous year.
When someone abuses a drug, such as heroin, cocaine, methamphetamine, marijuana, other illegal drugs, or prescription medications, brain chemistry is altered. Neurotransmitters, which are the brain’s messengers, are interfered with, and levels of dopamine, serotonin, or norepinephrine may be temporarily increased, creating the sense of euphoria, or “high,” that may be desired.
If drugs are regularly introduced, the brain’s natural production of these pleasure-inducing messengers may be disrupted. An individual who abuses drugs continuously may develop a tolerance to them and need more and higher doses each time in order to keep feeling the their effects. Over a period of time, a chemical dependency to drugs may form. The brain may now depend on the drugs to produce pleasure, and natural stimuli may no longer be enough. Drugs act on the parts of the brain that help to regulate a person’s moods, control impulses, and make good decisions. Once a dependency on drugs has formed, individuals may have difficulties functioning normally without them.
When drug abuse becomes compulsive, and the individual no longer has control over usage, it may be a sign of drug addiction. The American Society of Addiction Medicine (ASAM) defines addiction as a brain disease that is chronic, relapsing, and complex, and that involves a dysfunction in parts of the brain related to memory, reward, and motivation. A potential side effect of both drug dependency and addiction is drug withdrawal, and this is best managed through medical detox. Medical detox involves the removal of drugs from the brain and body in a safe manner, often with the use of medications or other methods to ease withdrawal symptoms. The National Institute on Drug Abuse (NIDA) reports that medical detox is the management of acute physical withdrawal symptoms and commonly the first step in drug abuse or addiction treatment.
Withdrawal symptoms may vary and start at different rates, depending on the type of drug abused as well as the method of abuse. Injecting or smoking drugs may send them straight across the barrier between the brain and the blood, creating an intense and rapid-onset high. But the drug’s effects also wear off more quickly when abused this way, meaning that an individual may be tempted to take more drugs quickly in succession to prolong the high, often called binge use. This can be a fast path toward dependency and addiction, as the brain may become more rapidly reliant on the drugs and their interaction in the body.
The type of drug also makes a difference as to when withdrawal symptoms may start, as different drugs will have variable half-lives – the amount of time it takes for half of the drug’s strength to leave the body. As a general rule, withdrawal symptoms often begin when the drug’s effects wear off. Withdrawal symptoms are likely to start within the following timeframes for specific drugs:
- Cocaine: within a few hours of last dose (National Highway Traffic Safety Administration, NHTSA)
- Heroin and most prescription opioid drugs: Between 6-12 hours of last dose (NHTSA)
- Methamphetamine: between 8-12 hours or up to three days after stopping use (NHTSA)
- Short-acting benzodiazepines, such as Xanax (alprazolam) and Ativan (lorazepam): between 12 and 24 hours of last use (Vancouver Acute)
- Longer-acting benzodiazepines, like Valium (diazepam) and Librium (chlordiazepoxide): around 24 hours to one day after last use (Vancouver Acute)
- Marijuana: about a day after last use (National Cannabis Prevention and Information Centre, NCPIC).
- Methadone: within 30 hours of last use (National Library of Medicine, NLM)
The timeline for detox will vary depending on various factors and may not be the same for every person. The following things may dictate when withdrawal may start, how intense the symptoms are, and how long withdrawal may last:
- Type of drug abused
- Method of abuse
- Abuse of more than one substance or drug (poly-drug abuse)
- Length of time abusing the drug
- Dosage amount
- Personal biology
- Genetic factors and family history of addiction
- Environmental contributors
- Potential underlying medical or mental health condition
As a general rule, detox usually lasts 5-7 days to stabilize an individual physically before moving on to the other components of a drug abuse treatment plan.
Side Effects of Drug Withdrawal during Detox
The main goal of detox is to help a person become physically stable so that all aspects of drug abuse and dependence, including social, behavioral, and emotional factors, can be identified. These factors are then addressed through a comprehensive treatment model that may include both medical and mental health professionals working in tandem to foster long-term recovery.
Even though physical stabilization is the main goal of detox, emotional needs need to be taken care of as well since individuals may experience both psychological and physical withdrawal symptoms that can be very powerful. Since reaching a healthy balance is the primary goal of detox, it is important to understand what may occur both physically and psychologically during detox. Different types of drugs may have variable withdrawal symptoms that are highlighted below.
Heroin and prescription opioid drugs like OxyContin (oxycodone), Vicodin (hydrocodone combination product), methadone, and fentanyl are CNS depressant drugs that slow down the bodily functions that stimulant drugs increase. Prescription opioid drugs block pain sensations. The Office of National Drug Control Policy (ONDCP) reports that these are some of the most frequently diverted, abused, and addictive prescription medications in the United States.
Detox from an opioid drug has both physical and psychological symptoms. During the early stages of withdrawal, an individual may have muscle aches, a runny nose, overactive tear glands, sweat excessively, feel anxious and agitated, yawn a lot, and suffer from insomnia. Major withdrawal symptoms are likely to peak within 2-3 days, according to NHTSA, and may include abdominal cramps, nausea, vomiting, diarrhea, chills or goosebumps, raised and irregular heart rate, increased blood pressure, depression, irritability, tremors, muscle spasms, and drug cravings. Opioid withdrawal, in the physical sense, if often likened to a bad case of the flu. Physical symptoms may typically dissipate within a week or so and are be best managed with medical detox. The emotional symptoms of opioid withdrawal may be optimally handled with behavioral therapeutic methods beyond detox and into recovery.
Valium (alprazolam), Xanax (diazepam), Klonopin (clonazepam), and Ativan (lorazepam) are benzodiazepines, or benzos, which are anxiety, seizure, and insomnia treatment medications. These drugs may be commonly abused for the high they may produce when used recreationally and also for their stress-dampening and sedative effects.
Benzos act on the neurotransmitter gamma-aminobutyric acid, or GABA, in the brain and along the CNS. GABA is a kind of natural tranquilizer that calms nerve firings in the brain that are related to the fight-or-flight reaction that occurs when a person feels stressed. Bodily functions involved in the stress response, such as heart rate, body temperature, respiration, and blood pressure, are also suppressed by benzodiazepine medications.
The U.S. Food and Drug Administration (FDA) reports that even using a drug like Xanax as directed may cause tolerance and dependency, and individuals taking it in higher doses for three months or more may experience severe withdrawal symptoms when stopping the drug. Benzos should not be stopped suddenly, or “cold turkey,” because of the intense and potentially dangerous withdrawal side effects that may occur once the CNS functions that have been being suppressed by the drug are suddenly released. A rebound may occur as the brain struggles to regain balance.
Seizures, psychosis that possibly includes hallucinations, sweating, anxiety, restlessness, depression, anxiety, paranoia, delirium, nausea and vomiting, increased blood pressure, irregular heart rate, confusion, hyperthermia, panic attacks, dizziness, headaches, trouble feeling pleasure, muscle stiffness, insomnia, difficulties concentrating, and weight loss may be side effects of benzodiazepine withdrawal. Benzodiazepine withdrawal is potentially hazardous, and can even be life-threatening. Professional medical supervision is required for benzo withdrawal.
Safety of Medical Detox
Detox can help a person regain a healthy balance and help the brain begin to recover from the negative effects of drugs. Withdrawal from drugs like opioids and benzodiazepines may bring intense physical and emotional symptoms, so it’s not recommended to stop these substances suddenly without medical intervention. Medical detox is often considered the safest and most comfortable way to detox from drugs of any kind, as it provides the safety and security of around-the-clock medical monitoring and supervision, as well as the use of pharmaceuticals, in many cases, to help manage the side effects of withdrawal.
Sometimes a longer-acting version of the same type of drug may be used to taper the dosage down in a slow and controlled fashion until none of the drug is left in the system. This weaning method can help to reduce the intensity of potentially dangerous withdrawal symptoms.
Medications are also often used during medical detox to minimize withdrawal symptoms from many drugs. Some examples of detox medications include:
- Buprenorphine (Subutex): This long-acting partial opioid agonist has been approved by the FDA to treat opioid dependence. It fills opioid receptors to prevent withdrawal symptoms, but it doesn’t initiate the same euphoria-producing effects as heroin or prescription painkillers..
- Methadone: This opioid has a long half-life and may be used as a substitute for shorter-acting opioids during detox. Due to its potential for abuse and dependence, it should be used with caution under direct medical supervision.
- Flumazenil: This drug may act as a benzodiazepine antagonist to reverse sedation from benzodiazepines. The British Journal of Clinical Pharmacology (BJCP) reports that in low doses it may be effective in reducing withdrawal symptoms during benzo detox and dependency treatment.
- Propranolol: This beta blocker may reduce anxiety and drug cravings associated with cocaine withdrawal, according to studies published in Psychiatry.
- Benzodiazepines: Long-acting benzodiazepines may be substituted for shorter-acting ones during benzo detox, or benzodiazepines may be useful as mood stabilizers, anti-anxiety medications, or sleep aids during detox. They are prescribed with caution and for short-term use only due to their high potential for dependency and abuse.
- Antidepressants: These medications may help to reduce suicidal thoughts and powerful emotional withdrawal symptoms during detox.
- Muscle relaxants: These medications can help to reduce muscle-related pain during detox.
Other vitamins and supplements may be used during detox at the discretion of medical professionals to help with specific symptoms of withdrawal. For example, anti-nausea medications may be used to treat vomiting and nausea. Many of the above drugs are approved by the FDA for use in addiction treatment and specifically designed for use during detox and substance abuse treatment. Others are actually marketed to treat other medical or mental health conditions, but research has shown their potential effectiveness for off-label use during detox, addiction treatment, and recovery. Medications are meant to be used in tandem with therapy, counseling, and support group services during substance abuse treatment and not as standalone methods of treatment.
The withdrawal process can be made more comfortable and run more smoothly with medical detox. In medical detox, substance abuse, medical, and mental health professionals all work together to help clients achieve stability in order to build a strong foundation for continuing treatment. With medical detox and comprehensive addiction treatment, individuals struggling with drug addiction can go on to enjoy long-term recovery.