Home
Detoxification for Heroin
Jennifer
Rosewood
ref:
September 99 Heroinsight
FAMILIES
ARE BEING INVOLVED in supervising home detoxification
of heroin more and more. This is a very stressful
project but maybe some extra basic information
about the medications used will assist. Researchers
have established that patient detoxification
does not benefit the user or the community to
the extent other services might. This has resulted
in the closure of many detoxification beds,
putting the support role onto families.
Trying
to catch up with the changing fashions of drug
use and the increased acceptance of illicit
drugs by young people, the drug and alcohol
professionals are constantly trying to improve
services with `evidence-based practice' rather
than the established assumptions usually based
on moral attitudes. We are changing from `leave
them alone, they have to hit rock bottom' to
`they have to do it themselves' and as with
any challenge, support from family or friends
is an accepted part of any personal achievement.
As
families take on the carer role for a home detox
they are being given the job of supervising
meditations that are traditionally associated
with observations by nursing staff. This is
for good reason as Clonidine was developed for
use as an anti-hypertensive; it lowers blood
pressure. Sedatives of the Benzodiazapine group
also lower blood pressure and respiratory function.
They were developed to treat anxiety and insomnia
for short periods.
A
good place to start is a planned detox through
the local Community Health Centre. This may
take a couple of weeks to set up by the time
an appointment is available, a supportive GP
found or time off work arranged. If a more immediate
detox is attempted, a GP may be the only medical
support person available. It is good to use
the motivation to give up while it is there.
Home detoxes are not a new thing but using some
of the medications outside an in-patient detox
is, which is why some GPs may be unfamiliar
with meditation regimes. The choice to assist
a home detox has to be weighted between expediency
and not setting the addict up to fail by attempting
too much without establishing outside support
for you and them. Immediate gratification is
part of the addiction lifestyle; it is not helpful.
And planning a home detox may give a better
outcome.
A
heroin detox should take between 48 and 72 hours
and varies in severity and discomfort. It is
not a life-threatening situation but it is important
to take fluids to prevent hydration. Use of
some meditations can be dangerous, especially
if used in association with continued heroin
use. The meditations used to maintain symptomatic
relief does not eliminate them and cravings
will occur.
Most
of these medications require a prescription.
Clonidine
is used to ease anxiety and flu-like symptoms.
Dose:
maximum 150 micrograms = 1 tablet 6th hourly
for 48 to 72 hours.
It
is most effective when used continuously but
it does drop the blood pressure and should be
used with medical supervision handy. Easy-to-use
Sphygmomanometers can be hired and you can test
a person's blood pressure by their ability to
stand up. Dizziness and fainting is an indication
the blood pressure is low and the body is stressed
to supply enough blood to the brain. An average
normal blood pressure is 140 on 80.
BenzodiazapinesÄa
sedative which ends in `pam', e.g. diazapam;
its brand name is Valium. These pills help insomnia
and anxiety.
Dose:
1-2 tablets at night for up to three days.
Dependence
on benzodiazapines is common now and complicates
the use of Clonidine for detox. Benzodiazapines
can depress the respiratory function and should
be used sparingly. A tolerance for Benzodiazapines
can be developed by regular use and because
someone with developed tolerance can take a
handful, it does not mean it is safe for someone
without developed tolerance to take more than
prescribed. If in doubt, don't use them.
Quinine
is used for leg cramps.
Dose:
300mgs 6th hourly for symptomatic relief no
more.
Lomatil
is for diarrhoea.
Dose:
1 tablet after each bowel action.
Paracetamol,
Panadol is a brand name, and is for pain and
to help sleep.
Dose:
2 tablets every four hours for 48 hours.
It
can be toxic to the liver if used more excessively.
Check whether the person has a healthy liver,
as Hep C is a problem for many injecting drug
users.
Buscopan
is used for stomach cramps.
Dose:
10-20mgs 6th hourly.
Maxalon
or Stemital is given for nausea and vomiting.
Dose:
10mgs 6th hourly for 48 hours. No more without
medical advice.
A
side effect is a tightening of the muscles in
the jaw which can be easily stopped with another
medication (Cogentin).
Other
Helpful Remedies
Hot
showers and baths help aches and pains, anxiety
and insomnia. Relaxation tapes, distractions,
entertainment, conversation, TV, videos (Trainspotting
is not recommended), radio. Phone others, supporting
friends, counsellor, NA or Lifeline. Company
is important, but it is not a good time to talk
to other users even if they appear supportive.
The
substance use which causes the most complications
for a heroin home detox is associated use of
Benzodiazapines or alcohol, especially if dependence
is established. Perhaps an in-patient detox
is more suitable.
A
bit of planning may make the experience far
less traumatic for everyone.
Highly
recommended is a small booklet, Getting Through
Heroin Withdrawal, published by Turning Point
