Detoxing from Prescription Drugs

If you have ever suffered from severe pain, ADHD, or anxiety, you can appreciate the necessity of prescription medications. Unfortunately, these drugs have a high incidence of abuse. Many are psychoactive, or mind-altering, and can lead to dependence or addiction.

People are often under the false impression that since these drugs came from a doctor and are found in a medicine cabinet instead of on the street, that they are safe. Anytime a prescription medication is used for nonmedical purposes, it is considered substance abuse.

The cycle of dependence can be difficult to break and often requires professional assistance. The first step in most recovery programs is typically detox. Detox refers to the process by which toxins are purged from the body. The detox process may vary depending on the type of drug abused, length of time abused, and the severity of the dependence.

Prescription drugs fall into three main classes: opioid pain relievers, stimulants, and central nervous system depressants. Each type of drug can create a physical and chemical dependence, making changes in the brain that take time to reverse. Withdrawal occurs when the drug use is stopped or quantities are decreased. Withdrawal symptoms can range from mild to severe, and they can even be life-threatening if not managed correctly and safely.

Opioid Withdrawal

Opioid pain relievers are one of the most heavily abused prescription medications with over two million people in America estimated to suffer from an opioid substance abuse disorder, as published by the National Institute on Drug Abuse. Opioid drugs are derived from the opium poppy plant and include morphine, hydromorphone, codeine, methadone, and oxycodone to name a few. Opioids bind to receptor sites in the body and brain producing euphoria, reducing anxiety, and masking pain.

Neurotransmitters, the brain’s chemical messengers, and receptor sites are altered, and natural production is inhibited the longer the drugs are present in the system. When the drugs are removed, these receptors and neurotransmitters no longer function properly, causing withdrawal symptoms to start.

Withdrawal from opioids is not usually life-threatening but can be very uncomfortable and intense.

Withdrawal symptoms can become dangerous if vomit is breathed into the lungs, causing aspiration, choking, or a lung infection. Dehydration due to vomiting and diarrhea can also occur. The detox process for opioid dependency often includes the use of a medication like buprenorphine, clonidine, or a lower dose of an opioid or an opioid agonist to help counteract or relieve withdrawal symptoms.

Partial opioid agonists work to fill opioid receptors at lower levels than the abused drug. They also have a definitive ceiling meaning that no matter how much of the drug you try to take, its effects will plateau at a certain level. A medical professional should administer these agonists and partial agonists.

Rapid detox is also performed under direct medical supervision using an opioid antagonist like naloxone, which blocks opioid receptor sites in the brain from receiving any more of the drug. Opioid antagonists generally are fast-acting and can be used to reverse the effects of an overdose as well as in a rapid detox program.

It is important to understand that these antagonists do not relieve withdrawal symptoms, and withdrawal will start immediately upon purging the opioid from the body. Generally, rapid detox is not recommended due to the increased health risks involved.

Stimulant Withdrawal Symptoms

Medications for attention deficit hyperactivity disorder (ADHD) include Concerta, Ritalin, and Adderall, which fall into the stimulant category of prescription drugs. This class of drugs generally includes either amphetamines or methylphenidates.

Stimulants work to improve focus and attention, promote wakefulness, and suppress appetite. Stimulants also increase the production of dopamine in the brain, which is responsible for pleasure. These drugs are often abused not only for the high feeling but also as a sort of so-called “smart drug” or cognitive enhancer. The National Alliance on Mental Illness (NAMI) estimates that each month around 900,000 people in the United States use these medications for non-medical reasons.

Detoxing from stimulants can be dangerous as well as uncomfortable. Withdrawal symptoms range from trouble sleeping, anxiety, and depressed appetite to sweating, tremors, muscle pain, mood swings, and depression. Severe symptoms can include suicidal thoughts and behaviors, which require immediate medical intervention.

At this point, there are no approved pharmaceutical detox protocols for stimulants; however, antidepressants are often used to help stabilize mood during withdrawal and detox.

Detox should be performed in a safe and secure environment under supervision of medical professionals.

Central Nervous System Depressant Detox

The class of drugs responsible for slowing brain activity, often considered sedatives or tranquilizers, is central nervous system (CNS) depressants. Examples of CNS depressants include benzodiazepines like Valium and Xanax, sleep medications like Ambien, and barbiturates including Nembutal and Mebaral. CNS depressants are often prescribed for anxiety and sleep disorders due to their calming and drowsy effect promoted by the increase of the neurotransmitter gamma-aminobutyric acid, GABA.

Detoxing from CNS depressant drugs should be done under direct medical supervision as the withdrawal symptoms can be very serious and even life-threatening. Since these drugs work to depress brain activity, sudden removal of them can cause the brain to rebound, which can lead to seizures, coma, or even death. Withdrawal symptoms can often mimic those of alcohol withdrawal, including delirium tremens (DTs), which can be fatal.

In some cases, withdrawal from CNS depressant drugs can also lead to psychosis, and symptoms may persist for several weeks without proper treatment. Depending on the type of drug and amount taken, withdrawal symptoms may not progress immediately, but rather reach their peak a few days or even weeks later. Often the detox protocol will include tapering off the drug in order to decrease the intensity of the withdrawal symptoms; this process should be closely monitored.

Safe Detox

Drug abuse is a common issue in America, and according to the National Institute on Drug Abuse (NIDA), the abuse of prescription and over-the-counter drugs is second only to marijuana abuse. Levels of physical and chemical dependence can be directly correlated with the severity and intensity of withdrawal symptoms during detox.

Since all prescription medications include some type of withdrawal symptoms and health concerns, you should not attempt to detox on your own. Detox should be medically supervised and the first step in a rehabilitation program. Detox should never be the only step in the recovery process, as addiction and dependency are not merely physical but contain an emotional aspect as well.

Many times someone suffering from mental illness will turn to drugs as a coping mechanism, just as someone abusing drugs may experience exacerbated mental illness symptoms. When substance abuse and mental illness occur at the same time in the same individual, dual diagnosis treatment is necessary. Professional staff members trained in dual diagnosis treatment methods are in tune to individual needs and strive to provide a safe and nurturing environment for recovery.

Offering supervised and safe medical detox as well as therapies and emotional support, dual diagnosis treatment can be the answer you are searching for

David W. Newton

David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.

Reviewed by: Kim Chin and Marian Newton