Detoxing from Fentanyl at Home

Millions of people use drugs to cope with physical and emotional problems. According to the National Survey on Drug Use and Health, 20.8 million adults, or nearly 9 percent of the U.S. adult population, were suffering from substance use disorders in 2015. Despite the need, only 11 percent of them received treatment at a specialized facility. 

Traditional addiction treatment begins with a process called detox, which is meant to filter drugs from the body while managing withdrawal symptoms. During this time, which can last anywhere from a few days to several weeks, the patient may receive medications such as methadone and buprenorphine to minimize drug cravings and withdrawal symptoms. 

The problem with detox is—it isn’t enough. According to the National Institute on Drug Abuse, detox alone does little to change long-term drug use. In fact, it increases patients’ risk of death from overdose if they do not transition to substance abuse treatment after discharge. While the assumption is that all patients will transition from detox into an outpatient or residential treatment program, the reality is that few patients do. A 2012 study of more than 200,000 individuals in California found that less than 11 percent of detox admissions were followed by admission into maintenance treatment within 14 days. 

In short, there is no quick fix for addiction. Detoxing your body of harmful and addictive substances, whether that’s alcohol, opiates, or even junk food, is only the beginning of a long and arduous recovery process. You will need social and emotional support, and to acknowledge the complex underlying factors that led to these behaviors in the first place. 

Home or Ambulatory Detox 

Most people identify the home setting as the preferred option for supervised detoxification and many might be more willing to undertake detox if they do not require hospitalization. The option to detoxify at home might be especially appealing to psychostimulant users who are often reluctant to access mainstream treatment services. In addition, as the withdrawals from psychostimulants may be protracted, a hospital setting may be impractical for many individuals. 

During home detoxification, the person is supervised in their home by a caregiver and receives daily visits from a registered nurse or a general practitioner. With ambulatory (or outpatient) detoxification, the person attends the local drug treatment service or the local hospital (in some regional areas) daily or sees his/her general practitioner daily or every other day. 

The detoxification process should be monitored and appropriate interventions undertaken. The aim of ambulatory or home-based detoxification is to: 

• manage the symptoms of withdrawal in a supportive environment 
• monitor the person’s mood 
• provide an opportunity for early intervention if adverse consequences arise 
• educate people about the course of withdrawal and the likelihood of enduring symptoms 
• maintain commitment to withdrawal 
• plan for and co-ordinate aftercare. 

Ambulatory or home detoxification treatment can be considered suitable ONLY if the following criteria are met: 

• no severe or complicated withdrawal is anticipated 

• no medical complications requiring close observation or treatment in a hospital setting are evident 
• psychiatric symptoms such as psychosis or depression can be safely managed in a community setting 
• the patient has strong social supports (family members and caregivers require education and support themselves) 
• the home environment is drug-free, supportive and stable
• the patient has not previously failed detoxification, and is committed to withdrawal. 

Community residential setting 

When the home environment is not supportive of detoxification, or where one or more previous attempts at ambulatory or home detoxification have been unsuccessful, the person can be referred to a community residential setting for detoxification. This setting is suitable for persons who meet the criteria outlined below: 

• no severe or complicated withdrawal is anticipated 
• no medical complications requiring close observation or treatment in a hospital setting are evident; and 
• psychiatric symptoms such as psychosis or depression can be safely managed in a community residential setting. 

Hospital or specialist detox setting 

Admission to a hospital or a specialist detoxification unit may be less warranted for fentanyl than for other drug types, such as alcohol or benzodiazepines. There is also considerable variation in criteria for admission among specialist detoxification settings. The following criteria are intended as a guide only: 

• simultaneous dependence on alcohol or other drugs that would satisfy criteria for hospital admission 
• severe dependence such that complicated withdrawal is anticipated 
• serious medical complications requiring close observation or treatment in a hospital setting are evident 
• significant psychiatric complications, specifically psychotic symptoms or severe depression and/or suicidal ideation that pose significant risk to the person or others and cannot be adequately or safely managed in a community setting 
• has an unfavorable home environment or homeless 
• the person has had multiple previously failed attempts at ambulatory detoxification