#15 Detox

When people involved in opioid misuse are ready to stop using, they often enter into recovery/treatment/rehab.  The next few articles will discuss the stages of recovery: detox, treatment and long-term recovery.  Recovery is defined as living life without the addictive substances.  Treatment is the initial stage of that process.  With many addictive drugs including opioids, the first step is detox.
Once a person has developed physical dependence/addiction to opioids, stopping opioids will cause a condition called withdrawal. Some people compare substance withdrawal to ‘the worst flu in your life’ but that does not accurately captures the agony, depression, hopelessness, pain and despair. Symptoms start with anxiety, yawning, sweating, eyes tearing, goosebumps, runny nose, and  hot/cold flashes, the progress to nausea, vomiting, diarrhea, restlessness, muscle and bone pain, and may even include hallucinations, delirium, seizures,  altered sensory perceptions, psychosis, suicidal thoughts and more. Specific symptoms and severity differ for each individual. But, withdrawal and fear of withdrawal are definitely reasons why some people continue to use opioids despite wanting to stop. https://www.smartrecovery.org
Detox is the process of ridding the body of the addictive substances.  It is painful and can be dangerous. The purpose of detox is to safely manage the withdrawal symptoms and stabilize the individual to proceed to further treatment. 
Detox looks different depending on the drug used.  Benzodiazepines and alcohol require medical supervision to safely detox as seizures, severe dehydration and death can occur.  Detox from opioids is generally not life-threatening, but the anguish and misery of the symptoms make it difficult to do ‘cold turkey.’ Under medical supervision, the worst of the symptoms can be minimized.
Detox can take days, weeks, or months depending the substance used, length of use, severity of the addiction and underlying medical conditions.  Even after the physical withdrawal is over, psychological desire for the substance continues.  It can take up to a year for the person to recover brain function and overcome the effects of addiction. Because addiction is both psychological and physical, patients benefit from therapy and counseling to address the i changes made in the brain resulting from substance abuse. Detox alone might help the patient to stop abusing drugs and alcohol in the short term, but without follow-up care and therapy, the risk of relapse back into substance misuse increases greatly.
Travis Reider, research scholar at Johns Hopkins' Berman Institute of Bioethics, recently shared his experience of  opioid withdrawal in a Ted Talk.  He describes the physical and mental anguish of withdrawal and the struggle of getting accurate medical advice and treatment.  It is an interesting view offering insight into the difficulty of untreated withdrawal. https://www.ted.com/talks/travis_rieder_the_agony_of_opioid_withdrawal_and_what_doctors_should_tell_patients_about_it?language=en
​