Opioid Detox: Medication From the First Hours, and a Plan for What Follows

Opioid withdrawal is rarely dangerous and almost always unbearable, which is why so few people get through it alone and why the overdose that follows a failed attempt is the real risk. Briarwood runs medically supervised opioid detox in Austin and Houston for fentanyl, heroin, oxycodone, hydrocodone, methadone and the other opioids, with medication started early rather than after a wait, and the step after detox arranged before you leave. This page covers who needs it, what happens, how long it takes, and what comes next.

Opioid detox at Briarwood is a medical assessment on arrival, medication for withdrawal started as soon as the symptoms that allow it appear, comfort medication for everything else, and nursing checks around the clock.

The assessment covers what you have been using, how much, how recently, whether fentanyl is involved, what else you take, and your medical and psychiatric history. Buprenorphine, a partial opioid agonist, relieves withdrawal without producing the high, but its label is specific that it must be started once withdrawal has begun, because given too early it can precipitate a worse withdrawal rather than relieve one. Timing that dose is a nursing judgment, not a schedule, which is one reason it belongs in a supervised setting.

Around the buprenorphine, medication is given for the symptoms that come through: clonidine for the sweating, agitation and cramping, and other medications for nausea, diarrhea and sleep. Vital signs are checked at intervals through the day and night. A detox counselor meets with you individually and in group, and the clinical team begins arranging the step after the stay from the first day. The what to expect page covers the rooms, the routine and what to bring.

Source: SUBOXONE (buprenorphine and naloxone) prescribing information, DailyMed, National Library of Medicine.

The opioid withdrawal timeline begins 6 to 12 hours after a short-acting opioid, or 1 to 2 days after a long-acting one, peaks around day three, and has mostly receded by day five to seven.

The National Library of Medicine puts onset within 12 hours of the last heroin use and within 30 hours of the last methadone dose, which is the short-acting and long-acting ends of the range. Symptoms typically peak around the third day, with nausea, vomiting, cramping, diarrhea and strong cravings, and have mostly receded by days five to seven, though some people have lingering nausea, anxiety and trouble eating. Federal guidance gives the acute phase as four to ten days for most opioids and fourteen to twenty-one for methadone.

After the acute phase, the same guidance describes anxiety, depression and sleep disturbance that can last weeks or months and gradually subside with continued abstinence. That is post-acute withdrawal, and it is a reason treatment continues after detox rather than a reason to doubt that detox worked.

Source: Protracted Withdrawal, Substance Abuse Treatment Advisory, Substance Abuse and Mental Health Services Administration, 2010.

Opioid detox uses buprenorphine to relieve withdrawal, clonidine and other comfort medications for the symptoms it does not cover, and, where it fits, a plan to continue medication for opioid use disorder after discharge.

Buprenorphine is the center of it: a partial agonist that occupies the opioid receptors enough to stop withdrawal without the high, and that can be continued as long-term treatment. Clonidine reduces the anxiety, agitation, muscle aches, sweating and cramping but does not touch cravings. Anti-nausea, anti-diarrheal and sleep medications cover the rest. Naltrexone, an opioid blocker, is an option after detox to help prevent relapse, but it cannot be started while opioids are still in the system because it precipitates withdrawal; the timing of a first naltrexone dose is another decision that belongs in a supervised setting.

What Briarwood does not do is anesthesia-assisted rapid detox. The Centers for Disease Control and Prevention documented two deaths and five hospitalizations among 75 patients at one clinic offering it, with no better symptom relief than standard methods, and the rapid detox explainer sets out why it is not offered here.

Briarwood does inpatient opioid detox in Austin and in Houston, and outpatient detox with scheduled medical visits in San Antonio for people whose situation allows it.

Both inpatient centers run the same medical protocol, and which one you go to is usually a matter of where you are and which has a bed. Houston serves the Houston area, including Spring, The Woodlands and Katy; Austin serves Central Texas. The San Antonio outpatient detox page describes the outpatient option, which suits moderate use with a stable home and no heavy alcohol or benzodiazepine use alongside. Combining opioids with alcohol or benzodiazepines changes the medical picture considerably: the buprenorphine label warns of life-threatening respiratory depression with other central nervous system depressants, and the withdrawal from the other substance may be the dangerous one. Say so on the first call.