Heroin addiction is one of the most difficult addictions to overcome. The heroin abuser ’s nervous system becomes accustomed to accommodating chronic exposure to the drug, which is an opioid. Therefore, during heroin detoxification excruciating withdrawal symptoms are ubiquitous.
Withdrawal symptoms begin within 12 hours of not using and peak after two to four days. The symptoms include:
- Abdominal pain
Even though there have been improvements in medically supervised heroin detoxification, patient discomfort and high dropout rates exist today. This has led to the growth of ultra-rapid, anesthesia-assisted opioid withdrawal procedures, which have been publicized as a fast, painless way to withdraw from opioid.
Studies have also shown however, that the procedure can lead to risk of death, psychosis, increased stress, delirium, attempted suicide, abnormal heart rhythm and acute renal failure. The anesthesia method comes at a high price between $5,000 and $15,000.
Francis Moraes wrote in The Little Book of Heroin, that there are three important brain chemicals or neurotransmitters that relate to heroin. First, dopamine helps to control human appetites for both food and sex. If a person has large quantities of dopamine they are considered out-going and exuberant. Persons who suffer with Parkinson’s disease and depression are said to have too little dopamine. On the other hand, people suffering from schizophrenia have too much.
First, heroin causes a release of dopamine. Second, norepinephrine controls the sympathetic nervous system: nerves of the body that cannot be voluntarily controlled. This neurotransmitter stabilizes blood pressure so that it does not get too low. The brain’s release of norepinephrine stimulates the fight or flight response. But heroin suppresses the middle part of the brain called the locus coeruleus and therefore provides the user with feelings of safety and contentment. Third, endorphines, which are morphine-like chemicals, used by the body to modulate mood, promote pleasure, and manage reactions to stress. These three chemicals are exaggerated or heightened by heroin use.
There are several forms of heroin detoxification including opioid agonist drugs, such as Methadone, Levo-Alpha-Acetylmethadol (LAAM), or Buprenorphine; Clonidine, which blocks some withdrawal symptoms; ultra-rapid opioid detox under anesthesia; and an experimental method using the drug Lofexidine. Opioid agonist drugs act like heroin but do not provide the same high and are administered in gradually decreasing doses. Since these medications act like heroin there are no withdrawal symptoms.
Clonidine can be administered by a transdermal patch, which gives the drug constantly over a seven- day period. Patients using the patch should also take Clonidine orally for the first two days since the transdermal medications takes two days to reach a steady effectiveness. Clonidine causes hypotension and sedation and therefore blood pressure monitoring is essential.
Ultra-rapid detox is done under general anesthesia with intubations for six to eight hours. During this time a combination of drugs, usually naltrexone and Clonidine are administered. Lofexidine, a non-addictive drug brought to the market in 1992, is a centrally acting alpha-2 adrenergic agonist targeted for relief of opiate withdrawal symptoms.
Withdrawal symptoms continue to be the greatest obstacle in heroin detoxification treatment. Studies concur that there is no proof that one detoxification treatment is better than another. Relapses continue to occur in numerous cases around the world therefore making heroin detoxification a monster of an addiction. Statistics show that the average heroin addict will stop and start detox 10 to 25 times in their lifetime relapsing to heroin use every time.
Heroin Detoxification Involves:
- Admitting there is a problem
- Seeking medical help
- Staying focused on the goal
- Treatment through a continuing program.
All facts conclude that there is no easy cure nor guarantee that relapse will not occur. The determination of the patient and support through family, friends, physicians or other sources must accompany the detoxification process. Long-term treatments that are drug-free or use medications as part of the treatment are useful in detoxification. Solutions for Recovery Sights, “the best-documented drug-free treatments are the therapeutic community residential programs lasting at least 3 to 6 months.”
Many times, although not physically dependent on heroin, psychological cravings will overcome the former user throwing him or her into relapse. Overseas studies have proven that detoxification does not work alone in the treatment process.
- Columbia University Medical Center and New York State Psychiatric Institute. Researchers illustrate severe risk in popular procedure, identify safer procedure. Study finds rapid heroin detoxification procedure under anesthesia does not work and can result in death. Journal of American Medical Association (JAMA) 24 August 2005.
- Moraes, Francis. The Little Book of Heroin Berkeley, CA: RONIN Publishers, 2000.
- Rabinowitz, Jonathan, Hagit Cohen and Moshe Kotler. Outcomes of ultrarapid opiate detoxification combined with naltrexone maintenance and counseling. Psychiatr Serv 49:831-833, June 1998.
- Health Matters, ABC, 2006.