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Detox Nightmares

Beyond Nightmares: Detox Options

'The Man With the Golden Arm' movie poster. Detox need not be a nightmare. But it is much more likely to be so if one enters treatment blindly. There is much to know; the addict who has decided to kick dope has a dizzying number of choices. And despite what many (especially those in the legal system) would have you believe, detox efficacy is highly idiosyncratic; what worked well for your best friend may be the worst choice for you.

Choices, Choices...

Despite much talk of new treatments for heroin withdrawal symptoms, there really are only four methods. These are listed below:

Cold Turkey
This is the default method. By doing nothing, a junkie checks himself into a cold turkey detox. This is also the kind of treatment that one gets when using a bogus treatment method.
Medicated
This kind of detox involves treating the symptoms of withdrawal with non-opioid medications. The two most common medications are clonidine and any of the benzodiazapine family of drugs. Therapies such as Ibogaine also fall into this category, although the effectiveness of ibogaine is unclear.
Opioid Substitution
Opioid substitution is a way of weening heroin users--less and less of the opioid substitute is given over time. Using a long-acting opioid such as methadone makes it easier to gradually reduce the dosage. Drugs such as buprenorphine fall into this category.
Antagonist
This kind of therapy is just the opposite of opioid substitution. Instead of making withdrawal last a long time at a low level, antagonist therapy makes it last a short time at an extremely high level.

Myths

There are a few myths that surround detox that should be kept in mind. One should always make detox decisions based upon fact rather than rumor. Avoid the following.

  1. Substituting one opioid for another does not detox the body. This does not mean doing so is useless, however. Detox from methadone is less intense than detox from heroin, for example. Thus, gradually reducing one's methadone use is that much easier than doing so with heroin.
  2. Buprenorphine is just an opioid substitute. It is not possible to substitute it for heroin and then simply stop using the buprenorphine without going through withdrawal.
  3. The effectiveness of ibogaine for stopping withdrawal symptoms is not clear. Great care must be taken when using it for withdrawal. In addition, claims that it "cures" addiction are simply fantasy. Compulsive drug use is a complex behavior that cannot be cured by taking a drug.

Choosing how to get off heroin is an important decision that should not be approached casually. Research any form of treatment that you are interested in. Also, be very skeptical of claims that seem too good to be true; as the saying goes, "Things that sound too good to be true usually are."

by Dr. H © 2001
Last Modified: 12 January 2004


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