Methadone Detoxification Treatments

The term detoxification, implies a clearing of toxins. However, for individuals with physiologic substance dependence/addiction, detox is usually related to withdrawal syndrome, that is, the predictable constellation of signs and symptoms following abrupt discontinuation of, or rapid decrease in, intake of a substance that has been used consistently for a period of time.

In fact, the withdrawal syndrome is the main obstacle for a recovery of addiction to methadone. That is because for persons who are severely dependent on methadone, abrupt, untreated cessation of consumption may result in severe discomfort. But risks are not limited to the severity of the patient's physical disturbance, particularly when the methadone detoxification is conducted in an outpatient setting. Outpatients experiencing withdrawal symptoms give up treatment more often, may self-medicate, and the interaction between prescribed medication and self-administered drugs may result in an overdose or brain damage.

Signs and symptoms of withdrawal from long-acting opiates (such as methadone) begin 24 to 48 hours after the patient's last dose, peak on or after the third day, and gradually subside over several weeks.

Once the user stops using methadone, which can prove very difficult for a regular or chronic user, they will very quickly start to feel tired, panicky, exhausted and unable to sleep, often causing extreme emotional and physical distress. Many former heroin users have claimed that the horrors of heroin withdrawal were far less painful and difficult than withdrawal from methadone. Methadone detoxification withdrawal symptoms include but are not limited to sneezing, yawning, tearing of eyes, runny nose, excessive perspiration, fever, dilated pupils, abdominal cramps, nausea, body aches, tremors, irritability. Many chronic users are well aware of these symptoms, some of them ubearable for many, and, in an attempt to avoid them as well as ensuing fatigue, are very reluctant to stop its use.

For these reasons, methadone detoxification treatment without an appropriate medical management and level of care constitutes a great health risk for patients. On the other hand, the harshness of the methadone withdrawal syndrome leads to a very high risk of relapse during the early withdrawal period, in part because drug craving is easily triggered by encounters with or thinking of drug-associated stimuli.

To avoid brain damage risk: ultra rapid detox without withdrawal

As it has been mentioned, the withdrawal symptoms are a fundamental obstacle for methadone detox treatment. This is because withdrawal from consumption of methadone is not sufficient to eliminate the serious alterations that methadone produces in brain cells. Moreover, current medications used in detox treatment do not restore damaged areas, but mask symptoms.

Once in the brain, methadone affects chemicals called neurotransmitters. These are the chemicals that control the flow of information within the brain between the neurons or brain cells, forming a synapse. Neurotransmitters also alter people's moods and feelings.

Opiates like methadone stimulate a "pleasure system" in the brain. This system involves neurons in the midbrain that use the neurotransmitter called "dopamine." These midbrain dopamine neurons project to another structure called the nucleus accumbens which then projects to the cerebral cortex. This system is responsible for the pleasurable effects of methadone and for the addictive power of the drug. Other neurotransmitter systems, such as those related to endorphins, are also likely to be involved with withdrawal from and tolerance to methadone.

Therefore, to avoid the withdrawal syndrome, it is necessary to restore brain systems and functions that have been damaged by the methadone addiction. But this is not possible just with detox. Neurons must be recovered. Only a pharmacological intervention, to recover the normal neural functioning of the brain structures harmed by methadone, allows a detox without withdrawal symptoms and without craving. Moreover, it allows the recovery of higher cognitive and affective processes as attention, reading abilities, conciousness or serenity.

Because there is a risk of serious adverse consequences for most patients who undergo withdrawal, it is necessary an advanced pharmacological treatment in a medically-monitored inpatient detox. This is an organized service delivered by medical and nursing professionals, which provides for 24-hour medically supervised evaluation and recovery management in a permanent facility with inpatient beds. Services are delivered under a defined set of physician-approved policies and physician-monitored procedures or clinical protocols.

Advantages of inpatient detox are that (1) the patient is in a protected setting where access to substances of abuse is restricted, (2) the management and monitoring of neural recovery eliminates craving, and allows a methadone detoxification without withdrawal, and (3) detox can be accomplished more rapidly than it can in an outpatient setting. Besides, detox with hospitalization prepares the patient for ongoing treatment of his or her addiction on methadone. During detoxification, patients may form therapeutic relationships with treatment staff or other patients, and may become aware of alternatives to a drug-using lifestyle. Detox is an opportunity to offer patients information and to motivate them for longer-term treatment.

According to these needs, methadone detoxification involves several procedures

First, treatment of patients who are under the influence of, or experiencing withdrawal from, substance-related disorders requires an understanding of the natural history and variants of such syndromes; a complete assessment of the patient's individual medical, psychiatric, and social issues. Detailed clinical exploration is necessary, as well as psycho-diagnostic and psychopathological examinations, to establish the characteristics of the addiction and its intensity, the existence of associated psychological illnesses, and the repercussions on the patient family, work, and friendships. This medical assessment is important in order to determine the need for medication and medical management, and the patient assessment should identify coexisting medical and psychiatric conditions and methadone-related medical complications. Besides, this information is necessary to design the psychotherapeutic strategy during hospitalization which is later continued on an out-patient basis after the patient's release.

Afterwards, oral and intravenous pharmacological interventions are performed to recuperate the normal neural functioning of the brain structures harmed by methadone. The goal of pharmacologic management is to provide the amount of medication necessary to ensure safe and comfortable methadone detoxification, as these interventions allow a detox without withdrawal symptoms and without craving; by increasing the ability of the treated neurons to take advantage of available oxygen, neural membrane functions are normalized in a short period of time.

General management also includes maintaining adequate fluid balance, correction of electrolyte deficiencies, and attendance to the patient's nutritional needs. Brain nutrition involves enriching the patient's diet with salts, oligo-elements, and amino acids essential for neural recuperation and correcting nutritional deficiencies which frequently accompany this illness.

At the same time, a personalized psychotherapy action plan is design, based on the psycho-diagnostic examinations, to restore the harmony between personal and familial psychological functioning, clarify erroneous concepts regarding the illness, and promote attitude and lifestyle changes, all of which incorporate the patient as an active participant in his/her own rehabilitation process. This psychotherapy, as well as pharmacological control, are process of ambulatory follow-up phase, after the patient leaves hospital.

Under these conditions, the methadone detoxification has four immediate goals:(1) to provide a safe withdrawal from methadone dependence and enable the patient to become free of non-prescribed medications; (2) to provide a withdrawal that is humane and that protects the patient's dignity; (3) to provide a recovery of higher cognitive and affective processes, and (4) to prepare the patient for ongoing treatment of his or her new life.

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