Opiate and Opioid Withdrawal
At Novus Medical Detox Center, an increasing number of our patients are coming to us for assistance in withdrawing from narcotic painkillers. Most of these patients have attempted to withdraw from narcotic painkillers or heroin on their own. But a "cold turkey" withdrawal can be extremely uncomfortable, painful and sometimes even medically dangerous. Most who try to withdraw on their own are unable to finish and are driven back to taking the drug to which they are addicted.
There are some definitions that are helpful.
Dependent vs. Addicted to Opiates and Opioids
The term dependent is used to describe the phenomenon of a person who has been taking narcotic painkillers and experiences withdrawal symptoms when they try to stop taking the drugs. People can become dependent because they were given painkillers but took them for too long a period, and often these people may not need to go for further treatment because they are not addicted.
The term addicted is used when a person continues taking the narcotic painkillers not just because they fear the pain of withdrawal, which they will experience if they quit taking them, but because of the way the painkillers make them feel. Many describe this as a feeling of euphoria, and the addicted person may still have pain but primarily now craves the feeling and will do anything to obtain the painkillers.
If the addicted person does not receive further treatment after a medical detox, most studies estimate that only five percent will not get back on the painkillers.
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Of course, if a person has a work-related injury and the pain is still there after they have successfully withdrawn from the painkillers, it is important that alternative non-narcotic methods of dealing with the pain are used. Otherwise, they will be driven to resume the use of narcotics.
Many of our patients who were injured and still had pain after their withdrawal have experienced relief from therapists and non-drug pain management doctors. We regularly work with some very good ones and send our patients to see them. Some patients state that they are now "pain-free" while others just say that it provided them with real relief and greatly lessened their pain.
Opiate vs. Opioid – What Is The Difference?
Opiate refers to drugs derived from the opium plant. Some examples of opiates are morphine and codeine. Heroin is made from the opium plant.
An opioid is a synthetic chemical substance made by the drug companies that has similar action in the body as that of opiates. Examples of opioids are: methadone, Percodan/Percocet, Lorcet, Lortab, Demerol, Vicodin, OxyContin, Suboxone, Subutex and Dilaudid.
Endorphins as Pain Blockers
The human body produces endorphins, natural hormones that the body uses to block pain signals from the nervous system which relieves pain. The word "endorphin" was created by combining endogenous (something originating in an organism) and morphine. Endorphins are protein molecules that bind with receptors located in your brain, spinal cord, and other nerve endings.
Everyone wants to experience pleasure and not feel pain. This is normal. The endorphins increase the feeling of pleasure or at least a feeling of relief from pain.
Endorphins are naturally produced by a variety of activities such as running, swimming, cycling, skiing, deep breathing, and even laughter. Because of our different DNA and metabolisms, the amount of endorphins produced by us and what activity is required for their production varies. For some people, they may start to feel "high" after exercising for ten minutes, but others may not get a similar feeling until they have exercised for 20 minutes or even longer.
Narcotic painkiller receptors are molecules on the surfaces of cells to which the narcotic painkillers attach and activate the receptors to produce endorphins. Different types of narcotic painkiller receptors are present in the brain. The receptor most relevant to narcotic painkillers has been named the "mu" receptor. (Receptors were named with the first letter of the substance found to bind with them. Morphine was the first substance so they named it M but then changed it to Mu which is the 12th letter of the Greek alphabet.) It is now believed that through activation of the mu receptor, painkillers exert their analgesic and addictive effects and their feelings of euphoria. The roles of other types of opioid receptors in the brain (that is, non-mu opioid receptors, e.g. the kappa receptors) in the addictive process are not as well-defined.
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The Opiate/Opioid Withdrawal Procedure
If operated properly, a medical detox facility can greatly ease the discomfort of withdrawal from narcotic painkillers.
DNA / METABOLISM
At Novus we recognize that each of us has different DNA and that our metabolisms are not the same. We know that all narcotic painkillers and most everything else we eat and drink are metabolized through the P450 pathway in the liver. We know that most narcotic painkillers are metabolized with the CYP2D6 enzyme.
We know that as many as 10% of the population doesn't even have this enzyme. We also know that as many as 50% of the population metabolize these painkillers either more slowly than others or faster than normal. We also know that the painkillers are substitutes for the body's natural activities. For example, the painkillers stimulate the receptors to produce more endorphins. Most people produce less of their own endorphins while taking these painkillers.
Part of the withdrawal process is the time it takes the patient to again produce endorphins naturally, which is dictated by the individual's DNA and is something which we carefully monitor.
We know that people withdraw from all drugs differently, and we modify our withdrawal protocols for each person.
HYDRATION and NUTRITION
Between 60% and 70% of our body is composed of water. All of our organs are composed of cells which are largely fluid. At Novus we find that most of our patients who are dependent or addicted to painkillers are dehydrated and are suffering from vitamin deficiencies. We ensure that our patients are hydrated properly and this, along with individually designed withdrawal protocols, is a major reason that our patients, who have detoxed before, comment that their Novus detox was not only much faster but much more comfortable.
SUBOXONE®
One of the medications that Novus uses is Suboxone®, which was approved by the Food and Drug Administration in 2002 and is administered in tablet form. Only doctors approved by the Substance Abuse and Mental Health Services Administration, a department in the United States Department of Health and Human Services, are allowed to dispense Suboxone®.
Suboxone® contains buprenorphine, an opioid that triggers a response in the body similar to the response triggered by heroin, oxycodone, and morphine. However, unlike heroin, OxyContin® and other frequently abused narcotic painkillers, buprenorphine increases endorphin production only to a certain point and then no longer adds to the effect no matter how large the dose.
An example would be entering an elevator of a ten-story building. The elevator requires you to press a code to go to each floor. Oxycodone and heroin can take you to the tenth floor. Suboxone will only take you to the fourth floor-no matter how much you take.
Suboxone® also contains naloxone which slows or prevents the triggering of the receptors. If Suboxone® is not taken under the tongue but crushed and injected into the bloodstream, the naloxone will prevent the buprenorphine from activating the narcotic painkiller receptors and almost certainly cause the person to quickly go into a painful withdrawal.
However, if the Suboxone® tablet is placed under the tongue and allowed to dissolve gradually, the buprenorphine effect predominates, and very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine and an increase in endorphin production.
Suboxone® comes in two dosage forms: 2 mg buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2 mg naloxone. The Suboxone® drug label is available on the FDA Web site at: http://www.fda.gov/cder/drug/infopage/subutex_suboxone/default.htm
The medical staff must determine when the opiate-addicted individual is ready for the first dose of Suboxone® to be administered. Here is the reason. If someone who is dependent/addicted to painkillers is not in withdrawal, this means that the painkillers are still activating the receptors in the brain and causing it to produce endorphins.
If you were to take Suboxone® at this time it would go to the brain, seek out the painkillers that were producing a certain amount of endorphins, expel them from the receptors and activate the receptors but to a much lower degree than the painkillers. This results in a drastic drop in endorphin production and is like falling from the tenth floor to the fourth floor. This drop in endorphins is what starts the withdrawal.
The Result of the Novus Withdrawal Protocol
At Novus, using hydration, natural supplements, good food and a withdrawal protocol designed specifically for each person, we ensure that the Suboxone® dose is properly tapered so that the person's natural production of endorphins increases as the Suboxone® is tapered down. Our patients experience a much milder and more comfortable withdrawal than at many other medical detox centers. When they leave Novus Medical Detox Center, they are off all unnecessary drugs.
If a patient is dependent only and if we are able to help them address any remaining pain, then the patient will likely be able to resume their life without narcotic painkillers. If a patient is addicted, then detox is only the first step. 95% of the addicted people who don't get further treatment resume taking their addicted substance or one like it.
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Our counselors are available 24 hours a day, 7 days a week. We can help you arrange a safer, more comfortable medically-supervised opiate / opioid detox as the first step toward ending opiate / opioid addiction, dependency and abuse.