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January 23, 2019

Narcan Detox Guide

Narcan is a popular brand name version of naloxone— an opiate antagonist used to treat and reverse the symptoms associated with opiate overdose.  Although Narcan is considered a prescription medication, it is available without a prescription in many states and is therefore not considered a controlled substance by the Drug Enforcement Administration (DEA). Narcan is extremely potent and effective in those with opiates present in their system but has no effects whatsoever on those who do not.

Narcan is available as a fast-acting nasal spray or intravenous injection that kicks in almost immediately upon administration and lasts for up to an hour, part of an intentional chemical design that helps those suffering from opiate overdoses stabilize long enough to seek more intensive medical treatment. In this respect, Narcan represents a revolutionary advancement in the opiate treatment industry. In fact, many experts consider Narcan to be a light at the end of the dark tunnel created by America’s opiate epidemic. According to the Center for Disease Control and Prevention (CDC), in 2015 approximately 26,000 overdoses were reversed with the help of Narcan. 

NARCAN WITHDRAWAL SYMPTOMS

Narcan—an opiate antagonist—doesn’t typically result in severe or debilitating side effects when used as directed. In contrast to opiates, which exhibit a high potential for addiction and abuse, Narcan does not possess inherently addictive properties. Since it specifically targets opiate overdose symptoms, Narcan doesn’t release a surge of dopamine and artificially elevate the levels of other neurotransmitters— “feel good” chemicals associated with opiates that are both highly pleasurable and addictive. Physical and psychological side effects associated with Narcan withdrawal are not believed to be the result of the drug itself, but rather the acceleration and intensification of the opiate withdrawal (and overdose) symptoms it is used to treat.

Some withdrawal symptoms of Narcan include:

  • Fatigue
  • Anxiety
  • Disorientation
  • Stomach pain
  • Nausea
  • Fever
  • Body aches
  • Chills
  • Stomach pain
  • Hallucinations
  • Pulmonary edema
  • Seizures
  • Blackout
  • Coma
  • Erratic heartbeat
  • Respiratory depression

NARCAN WITHDRAWAL TIMELINE

Generally speaking, Narcan withdrawal follows the same basic pattern associated with opiate withdrawal, although the effects may be accelerated and may produce more severe symptoms.  The initial stages of opiate withdrawal usually take 7-10 days before gradually improving and eventually tapering off. The following schedule provides a more precise outline broken down into four specific stages and varies depending upon multiple factors including age, weight, height, gender, and whether or not Narcan has already been administered:

  • Stage 1: During the first one to three days following discontinuation of use, withdrawal symptoms usually reach peak intensity. This initial detox stage is extremely intense and uncomfortable and frequently characterized by nausea, vomiting, severe gastrointestinal distress, and anxiety. Many users relapse during this stage due to the extremely intense—even nightmarish—effects.
  • Stage 2: During days 4 through 7, users experience various physical and psychological symptoms including, chills, cramps, insomnia, and increased cravings. Although the effects of Stage 2 withdrawal are generally considered moderate, they can be debilitating, especially the intensifying cravings.
  • Stage 3: Following the first 7 to 10 days of detox, most users are ready to enter a treatment program. Although certain physical symptoms and cravings still linger, psychological symptoms, such as anxiety and depression, become the primary presenting issues.
  • Stage 4: Longer-term opiate users can expect lingering symptoms into the third and fourth week following initial detox. The heaviest, most chronic users may experience symptoms that persist for months or even years— a phenomenon known as post-acute withdrawal syndrome (PAWS).  

INPATIENT TREATMENT FOR OPIATES

Inpatient treatment for opiate addiction is a popular, evidence-based protocol in which clients live at a designated residential facility— usually for a month, but in some cases, as many as three.  During their stay, clients receive intensive clinical supervision and ongoing medication management.  Widely considered the “gold standard” for effective treatment, intensive inpatient is an excellent choice for clients battling opiate addiction— all of whom can benefit from the 24/7 staff monitoring, heightened security, enhanced camaraderie, and ancillary benefits and services.

Medication-Assisted Treatment

The cornerstone of MAT for opiate addiction is evidence-based, Food and Drug Administration (FDA)-approved interventions combined with behavioral and psychotherapy. The following medications are often considered the first line of treatment, in addition to whatever therapies are deemed appropriate by attending clinicians:

  • Vivitrol – an injectable prescription variety of naltrexone that helps control cravings and stabilize psychological and physiological processes. The drug is available in both pill and once-per-month injectable form and works by blocking opiate receptors in the brain, noticeably reducing the euphoric effects associated with opiates.
  • Suboxone – a combination of buprenorphine and naloxone—an opiate antagonist— frequently used early in symptom onset to help prevent intravenous buprenorphine abuse. This clinically proven medication for opiate dependence significantly lowers the risk of precipitated withdrawal. Suboxone activates the same neurological receptors as other opiates and is generally well-tolerated by a majority of clients.
  • Clonodine – an increasingly popular “anti-hypersensitive” medication that helps to minimize opiates withdrawal symptoms. Clonidine works by blocking the same brain chemicals that activate the sympathetic nervous system (SNS).
  • Narcan – a revolutionary medication used in treating opiate overdoses, now available over-the-counter and without a prescription in many states. Narcan is highly effective, but may accelerate opiate withdrawal symptoms and must be used cautiously and exactly as recommended. Among its numerous benefits, Narcan has been deemed effective in targeting opiate overdose symptoms even when other classes of drugs (including alcohol) are present in the system.

Dual Diagnosis Treatment

A broad range of anxiety, depression and trauma-related disorders are known to be precipitating factors involved in opiate addiction— and addiction in general. Treating these co-existing disorders is a critical aspect of detox (and inpatient treatment), and supplemental medications prescribed by the attending physician may include:

  • Gabapentin
  • Pregabalin
  • Buspirone
  • SSRIs

These medications help resolve the underlying psychological causes of addiction, so that optimal treatment outcomes may be achieved. Without their inclusion in the treatment protocol, clients may continue to suffer from the same issues that originally triggered their addiction and fail to respond favorably to treatment.

OUTPATIENT TREATMENT FOR OPIATES

Outpatient treatment is an affordable alternative to inpatient treatment that involves a non-residential level of care. Particularly attractive to clients with demanding personal and/or professional schedules, outpatient treatment offers many of the same services and benefits as inpatient treatment on a less comprehensive basis.  Although outpatient treatment may be insufficient following initial opiate detox, it represents an excellent choice as a transitional treatment method following successful completion of a residential program.  

CAN OPIATE DETOX BE DONE AT HOME?

Opiate detox should not be attempted at home. Self-guided detox is statistically proven to lead to unfavorable treatment outcomes and a greater likelihood of future relapse and exposes users to potentially deadly risks. Even casual, recreational users benefit from the assistance of an established treatment protocol within the context of medically managed detox.

TAPERED VS. COLD TURKEY

Quitting opiates cold turkey is considered extremely dangerous and can lead to devastating consequences including death—even if Narcan has already been administered to stop the effects of an opiate overdose. Tapering involves gradually weaning a user off opiates in diminishing doses (for a predetermined period of time). It is generally considered a safer and more effective detox option than quitting cold turkey.

CONSIDERATIONS/HOW TO DECIDE WHAT IS RIGHT FOR YOU

The decision to enroll in addiction treatment is a major step in the right direction, but it is also a complex and highly involved process. Financial considerations, facility location, reputation, and insurance coverage all represent critical factors in choosing an appropriate treatment program. Most reputable treatment facilities have experienced admissions staff on-hand to help facilitate the enrollment process. They will gladly help answer and resolve any questions or concerns related to insurance coverage and benefits, and help make the admissions process relatively stress-free.

RECOVERY SUCCESS AND AFTERCARE SERVICES FOR OPIATES

Simply completing medically managed detox is not sufficient to ensure long-term recovery success following opiate addiction. A key component of long-term abstinence and recovery involves implementing a multi-pronged approach.  Reputable inpatient facilities can help with strategizing and planning an optimal post-treatment regimen. This might include:

  • Involvement in Narcotic Anonymous (NA)
  • Ongoing medication management
  • One-on-one and group therapy
  • Life and job skills coaching (if necessary)
  • Regular physical activity
  • A healthy, nutritious diet and lifestyle decisions
  • Random drug testing
  • Continual sober peer support
  • Community involvement and a spiritual program

WHO NEEDS OPIATE DETOX?

Anyone, at any time, can find themselves addicted to opiates and in need of treatment— even those for whom substance abuse is not a known genetic tendency or those without a documented history of use. If you or someone you love are struggling with opiate addiction (or an untreated history of opiate abuse) and need help, contact a substance abuse professional today.

And remember, simultaneous opiate and Narcan abuse may result in an overdose, a life-threatening emergency requiring immediate medical attention. Although Narcan is extremely effective when used in treating opiate overdoses and can be administered multiple times, it is not a replacement for traditional emergency care services. If you are ever in a life-threatening situation involving an opiate overdose and the administration of Narcan, remember that seeking emergency medical help at a local hospital remains critically necessary.

For more about opiate addiction and recovery, check out these related articles:

  1. Choosing Between Inpatient and Outpatient Treatment
  2. 7 Benefits of Inpatient Rehab
  3. What is the Government Doing to Combat the Opioid Abuse Epidemic?
  4. Naltrexone Vs Narcan: What are They, and How are They used for Opiate Overdoses and Treatment?

Sources:

The New England Journal of Medicine. The Rising Price of Naloxone—Risks to Efforts to Stem Overdose Deaths. Dec, 2016.

Therapeutic Advancements in Drug Safety. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Feb, 2016.

Emergency Medicine Journal. Naloxone in opioid poisoning: walking the tightrope. September, 2005.

Annals of Emergency Medicine. 402 One-Year Mortality of Opioid Overdose Victims Who Received Naloxone by Emergency Medical Services. October, 2017.

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