Procedure for Detoxification (Medically Supervised Withdrawal)
Detoxification, or medically supervised withdrawal (MSW), involves using a medication to take a patient from an opioid-dependent to an opioid-free state. Patients who want to stop using opioids but not want to be maintained on buprenorphine may request MSW. Conducting MSW involves inducting the patient onto buprenorphine following the standard induction protocol and then tapering the patient back off of buprenorphine. The buprenorphine/naloxone combination formulation should be used in most cases.
Risks of MSW
Relapse is a significant concern when conducting MSW. It is extremely common and, in some cases, can lead to overdose. The implications of relapse and possible risk of overdose should be carefully explained to patients who are requesting MSW. Also, the benefits of maintenance therapy should be discussed.
During detoxification, the patient should be closely monitored, offered appropriate psychosocial support, and offered medication maintenance treatment if they become unstable during the detoxification process. Detoxification is often conducted in an inpatient setting.
There is no absolute standard for how fast or slow to detoxify a patient using buprenorphine, but the general guideline is to detoxify as gradually as possible to minimize symptoms of acute opioid withdrawal.
Dosing Schedule for Medically Supervised Withdrawal:
In some instances the MSW process can be completed in a week:
- Induction on days 1 to 3
- Tapering on days 4 to 7
However, a slower taper is recommended for most patients to reduce the severity of withdrawal symptoms and monitor their psychosocial situation. In all instances, you should work closely with the patient to determine a realistic time frame for conducting MSW.