What meds are used to detox off of heroin? Suboxone is the most common, but there are others, too. Sometimes, Suboxone fails to sufficiently suppress withdrawal symptoms and drug cravings and other medications become necessary. This can include methadone, clonidine, muscle relaxants, benzodiazepines and certain hypnotics. This article will provide an overview of heroin, its withdrawal symptoms and the drugs most commonly used to ease those symptoms.
Heroin, also known by street names like black, tar, China White and smack, is a semi-synthetic chemical cousin of morphine. Although it’s converted back into morphine once in the body, heroin crosses the blood-brain barrier membrane much faster than morphine does. This produces a much stronger high. Heroin was once legally sold in general stores, drugstores and even through mail order as a cough suppressant, sedative and pain reliever. Heroin works poorly when taken by mouth, with an average BA of around 30 percent. This is terrible. BA means bioavailability, which refers to the percentage of the ingested dose that actually reaches the brain. Morphine’s oral BA is pretty bad, too, but at around a little under 50 percent it’s better than heroin’s.
This low BA is why people inject, snort or smoke the substance instead of swallowing it. Smoking heroin is also called chasing the dragon. This metaphor refers to the appearance of the heroin vapors as they rise off the smoking device, usually tin foil or some kind of pipe. These vapors may look somewhat like the outline of a dragon hence the expression. These routes avoid the first-pass effect and increase the amount of drug that reaches the brain’s opioid receptors. All oral drugs, with a few exceptions, must pass through the liver before going anywhere else. The liver then detoxifies as much of the drug as it can. If the substance is repeatedly ingested, the liver becomes better and better at breaking it down. This is part of the tolerance process whereby someone must take more and more of a drug to get the same effect or even any effect at all. People who take opioids only rarely will not have this tolerance, and that’s why heroin was once sold as oral patent medicine. People with no opioid tolerance would be able to get the drug’s intended effects even when taken orally. For people who abuse it, this is not an option, at least not a practical one.
Heroin Withdrawal Symptoms
Heroin, like all opioids, produces a miserable withdrawal syndrome when suddenly stopped. This can include:
- Nausea
- Vomiting
- Diarrhea
- Hot flashes and cold chills
- Sweating
- Insomnia
- Drug cravings
- Stomach, bone and muscle pain
- Headache
- Restless leg syndrome
- Anxiety and depression
- Intense drug cravings
Although heroin withdrawal tends to be shorter when compared to certain other opioids like oxycodone, the symptoms are intense and many people find them to be intolerable. Medical detox centers can do amazing things when it comes to relieving this nightmare of heroin withdrawal by using certain medications:
- Suboxone
Suboxone contains two synthetic opioids called buprenorphine and naloxone. Buprenorphine is a partial agonist with activity on the brain’s opioid receptors. Most of its ability to relieve opioid withdrawal comes from its activity on the MOR or mu receptor. The mu is most associated with euphoria, sedation and tolerance and is strongly involved in the tolerance process within the brain. A brain used to the presence of heroin will become unable to function without it. It stops producing its own natural, and much weaker, opioids called endorphins. It also grows extra opioid receptors. Buprenorphine binds with the mu just enough to relieve withdrawal symptoms without causing a high of its own. The naloxone is included to prevent intravenous abuse of the buprenorphine.
- Methadone
Although Suboxone is effective for many people who try it, it won’t work for everyone. This could be due to a very high tolerance level of a super-strong opioid like fentanyl or merely to differences in biochemistry among individuals. Methadone is a full agonist synthetic opioid acting very much like heroin does on the mu receptor. However, it tends to produce far less euphoria.
- Clonidine
This is a beta blocker normally used for high blood pressure and certain heart conditions. It’s used off-label for relief of part of the heroin withdrawal syndrome, but it may not be enough when used alone.
- Muscle relaxants, benzodiazepines and hypnotics
Suboxone will often provide sufficient withdrawal relief by itself. Methadone nearly always does and requires no further medications. However, if restless leg syndrome, anxiety and insomnia are still present after medication with Suboxone, the above medications will help to relieve it. They are typically used only for the short-term because they may have addictive risks of their own.
If you Need Help
There is no reason to be afraid of heroin withdrawal at a modern medical detox center. You will not be in any kind of significant discomfort if your medications are properly managed. Let us help you find a great detox near you. Just call us anytime at 833-846-5669. Our professional counselors look forward to your call.