1 Oxford Health NHS Foundation Trust A guide to Opioid Detoxification
2 If you re considering detox, congratulations.
3 You have obviously been visualising a drug free life and planning your future goals. Detox is a physical and psychological upheaval but with support we can help you to achieve abstinence. Here are some frequently asked questions. What is Opioid detox? For those who are physically dependent on opioids, detoxification is a process where opioids are safely and effectively discontinued whilst minimising withdrawal symptoms. Opioid withdrawal symptoms can include: Early symptoms: Agitation Increased tearing Anxiety Insomnia Muscle Aches Runny nose Sweating Yawning Late symptoms: Diarrhoea Nausea Dilated pupils Vomiting Abdominal cramping Goose bumps Opioid withdrawal can be very uncomfortable and unpleasant but it is NOT life threatening. What will happen? With opioids, detox can be achieved using the same medication you are already prescribed or an alternative opioid in gradually decreasing doses. Other medications can also be prescribed, in addition to opioids, to reduce specific withdrawal symptoms. Which regime is right for me? Your Keyworker or Addictions Nurse will assist you in deciding the most appropriate treatment plan for you. This may take into account the medication you are currently prescribed, how long/how much you have been using, any previous experiences of detox (successful or unsuccessful) and your preferred treatment option based on an informed choice to become abstinent. Other agencies involved in your care can be involved in this decision with your permission but it is essential that we communicate with your GP wherever medication is prescribed for you. OASIS will also help you to make informed decisions and will be there to support you through your detox. You and your keyworker will make a care plan that suits your needs and help you with other issues, e.g. housing, work, education. Your OASIS and SCAS keyworkers will work together throughout the process to make sure that you are supported in all life areas. 3
4 Who will do what to help? You will be working with both OASIS and SCAS throughout your detox. OASIS will help with motivation, setting life goals, support with other life issues (e.g. housing, employment), aftercare and relapse prevention. SCAS will be in charge of making sure you are prescribed the correct medication at the right time. They will also make sure you are as comfortable as possible throughout the detox whilst keeping an eye on any physical changes you may experience. How long is the detox? This can vary from person to person. Usually the medical detox will take between 4 and 12 weeks but may be longer or shorter in duration if appropriate. In addition, you will have time before the detox to prepare. This will include motivational work, making sure everything is in place and coming up with a care plan for when you are at home. Once you have completed the medical detox, you will be provided with a substantial amount of aftercare to help with relapse prevention, getting used to life without opiates and further assistance with housing, work and education. 4
5 What if I change my mind? If you have any concerns during your detox please contact the professionals involved in your treatment plan as soon as possible. Try not to deviate from your detox regime and negotiate with your keyworker if you want to slow down or move faster than planned. Remember, we are all aiming for your treatment to be successful but sometimes this does not happen on the first attempt. If your detox is not successful you will be able to access maintenance prescribing or other treatments as necessary. When should I consider detox? If you feel motivated and positive to stop taking your medication/drugs and be opioid free. When you feel committed to and informed about the process including the high risk of relapse and possible consequences of relapsing. When your social situation is stable and/ or supportive or if you are able to achieve this following detox. Following a period of stabilisation and/or reduction of your substitute medication. When ongoing relapse prevention support and aftercare treatment are in place to support you following your detox. 5
6 Do s and Don ts of detox Before Detox 6 Let your keyworker know if you might be pregnant or are breastfeeding as this may affect the medication you are prescribed or may mean detox is not recommended at this time. Please inform of us of any changes to medications your GP is prescribing, any over-the-counter medications or illicit drugs you are using or if you are drinking alcohol regularly. Don t forget to update us with any physical health or mental health problems which we may not be aware of already. Do attend all appointments as the keyworkers are here to help! Tell your keyworkers any concerns, problems or suggestions you may have as you are working together, for your benefit! Remember the goals: a life free from drugs, no more having to regularly pick up scripts, never having to be bound by opiates again! Prepare your own environment to be as stable as possible: purchase food/soft drinks in advance and stock up on things to occupy you such as magazines, DVD s etc. Let family and friends know what you will be going through and put useful contact numbers somewhere accessible. Try to reduce your daily responsibilities as much as possible. You may need to take time off work or make alternative childcare arrangements especially early on or towards the end. During detox Plan to take things easy for a few days after each reduction and keep as stress-free as possible. Look after yourself, eat well, drink fluids and stay warm. Remember to try and stay as positive and as relaxed as possible. Continue to use medication as prescribed. Store medication safely, as always, and preferably locked away high off the ground. Keep talking to the professionals involved in your treatment, family/ friends and other support networks about how you re feeling/coping. Keep your own record of medication taken, it s effect, your mood, any Opioid withdrawal symptoms you experience so you can discuss with your keyworker.
7 Don t use any other medication, over-the-counter remedies without informing your Addictions Nurse/GP. Do not use opioid medications such as Co-Dydramol, Dihydrocodeine, Co-Codamol etc as these may interact with opioids prescribed for detoxification and may not be the most appropriate treatment for physical pain at this time. Try not to use other drugs. Especially avoid using alcohol or other downers such as Benzodiazepines in large quantities. These can increase the risk of overdose in combination with opioids and replacing one drug for another can lead to further problems of physical/ psychological dependence. Do not drive or operate dangerous machinery. After detox: what is Naltrexone? Following opioid detox some people choose to be maintained on Naltrexone Hydrochloride for a period of time afterwards to aid abstinence. Naltrexone is an opioid antagonist which can be used as a deterrent from using opioids. If you decide to take any form of opioids Naltrexone will block any positive effects. Naltrexone is available as oral medication (tablet form) and would usually be prescribed by your GP. Your SCAS keyworker can liaise with your GP to start this once you are opioid free. In some instances you may be required to have physical investigations (usually blood test) prior to starting medication and at intervals of 6 or 12 months for the time you are prescribed Naltrexone. Don t worry if you get some opioid withdrawal symptoms or if you experience symptoms different from other people. Everyone is different. Contact your Addictions Nurse if you are concerned. If you are worried, anxious, scared or sad, please let us know! We are here to support you and help you through this tough time. Keep positive, remember your goals and think of the future. 7
8 Risk of Relapse/Overdose If you detox or stop using opioids or your script for a while your tolerance will reduce. If you lapse/relapse on top of a low dose of medication or return to using after a break you could easliy overdose on the amount you used to take. This risk increases if you use other downers (central nervous system depressants) such as alcohol/ benzodiazepines. You can reduce the risk of opioid overdose by not using drugs IV and not mixing Heroin with other drugs/ alcohol. If you feel the urge to use opioids during your detox please talk to the people who are suporting your treatment plan or visit OASIS drop-in for some immediate support if your workers are unavailable. It may be that talking through ways to manage urges will help, or slight adjustments to your medication can alleviate discomfort. However if the detox is not successful you will be able to access maintenance/other psychological treatments as appropriate. This is not a failure, you will have learnt what works and what doesn t, which can inform your treatment plan when you are ready to detox in the future! What other support is available? There will also be a pre-detox support group where individuals going through the detox can discuss their concerns and successes together. Each week will be different and people from other agencies may even come in to give extra support. During each stage of the detox, you are able to access other services at OASIS including acupuncture, drop-in, women s/ men s groups and anything else in which you are interested. This will enable you to gain support between appointments as well as provide structure and consistency throughout your detox. Once you have completed the detox, there will be a great deal of aftercare and relapse prevention provided. This is to help you make sure the changes you have made are long term and stable. Also, you may experience feelings of loss or emptiness once you have come off all drugs as it has been a big part of your life. We are here to help with this and can refer you onto counselling if you feel this is what you want. This is your detox and we are here to help. So please let us know how you are feeling, both mentally and physically, throughout the programme. If we know, we can change something to make it better for you. 8
9 Notes 9
12 Contact details Specialist Community Addiction Service High Wycombe Sefton House, Unit 5, The Valley Centre, Gordon Road, High Wycombe, HP13 6EQ Tel: Aylesbury Tindal Cottage, Bierton Road, Aylesbury, HP20 1EU Tel: Oasis Partnership High Wycombe Oasis House, George Street, High Wycombe, HP11 2RZ Tel: Aylesbury Unity House, 98 Walton Street, Aylesbury, HP21 7QP Tel: (www.oasispartnership.org) Oxford Health NHS Foundation Trust
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