Opioids Can narcan be used to shorten detox time?

[tarman]

Hello,

I've tried and failed to find user experiences with narcan (naloxone HCL). The threads I've found haven't really been focused on what the actual experience is like of taking naloxone. I'm sure it's dependent on how much opiate one is ingesting per day. In any case, I've been reading up on rapid detox. Y'know, where they knock you out for 24 hours and somehow accelerate the detox process. It seems like all they're doing is giving a constant, relatively high dose of naloxone. So let's say one were to get a bunch of naloxone nasal sprays from the local health clinic. Could they be used to accelerate the detox process? I know it would be very unpleasant. But it seems like maybe the naloxone really cleans up the receptors in such a way that one might be able to make more efficient use of their time if they were to cold turkey opiates. So the idea would be to repeatedly administer naloxone for a day or so, and that would be equivalent to 5 or 6 days or normal cold turkeying. I'm just spitballing ideas here.

In any case, any thoughts welcome. I'm sure there will be some harsh criticism. But hey, go for it.

TL;DR: Anyone tried using naloxone to rapid detox? Anyone simply had naloxone administered and care to share their experience?

 

[Zonxx]

Gosh thats one way to use it... if you wish to be in very harsh withdrawal with full symptoms i suppose.. but i dont really reccomend this route. It works by blocking any opiates in the brain nearly 100% and by doing so sending the person into extreme withdrawal upon administration.

 

[Nicomorphinist]

The method you are mentioning is used to compress the detoxification into hours rather than days, but it is done under general anaesthesia because the patient would not be able to stand it and be at a rather high risk of heart attack and stroke of apoplexy . . . it was invented in 1985 or so; they call it Rapid Opioid Detox or something similar. It is falling out of favour as it is still very hard on the system and it has a 0.1 to 0.2 per cent fatality rate . . .

 

[Foreigner]

It's my understanding that narcan only provides a temporary blockade that lasts approximately 90 minutes. For example it doesn't truly save people from overdoses, it simply stops the opioid receptors from having an interaction with the opiate until the opiate clears the system. This gives people time to get to a hospital where they can receive continuous narcan. Functionally, this behaves as a detox.

If you have a long-term opiate dependency, narcan will trigger immediate withdrawal. You're thinking of just the opiate receptors and how narcan speeds up their clearance, but not about what the body's somatic responses will look like when suddenly there is no opiate to be found. You would need supportive therapy.

 

[OpiateKiller]

In my personal opinion, no it won't make a difference. Maybe the initial wave of withdrawal would be instantaneous but the prolonged parts of withdrawal would still need to take place. I don't think the instant action of putting one self into full blown withdrawal is worth any gain, and it would be incredibly painful. Every time I've been narcan'd out of an overdose I awoke to literally shaking uncontrollably and the worst headache of my life, it's not fun and I wouldn't wish it on the devil. I don't think naloxone would speed up the healing of receptors / the brain, and it would all still be the same. However, if you believe it could help and need to get off opiates, please do share your results if you try I'd be curious to see what you say

 

[Foreigner]

I was just thinking too... you could take low dose naltrexone, 4.5mg or less around bed time. It provides a gentle temporary blockade that encourages recovery of the receptors along with the endogenous opioid system. I do this.

 

[Nicomorphinist]

What is the thinking about how long or how tightly something would need to block an opioid receptor before there is a risk of burning out the receptor or causing some kind of down-regulation? Naloxone and nalorphine are ideal life-saving drugs, one just needs to make sure there is a big bottle of it because many opioids last longer than the antagonists, but is naltrexone really the panacea some folks seem to think it is? Ultra-low dose -- I would say, yes, actually it is starting to look that way . . . but especially in cases where a fully naltrexonised patient in recovery from opioid or alcohol dependence is in some horrible accident or has a heart attack and requires morphine or the like . . . is the blockade idea really the best for all cases? It actually seems extreme, like Antabuse times three, when one considers that a narcotic relapse is a physiological symptom which is not a moral failure, it doesn't cancel out the prior work done in recovery, it is the beginning of the next step of recovery, and patients and the people helping them could be trained to treat it more like this . . .

 

[Nicomorphinist]

It's my understanding that narcan only provides a temporary blockade that lasts approximately 90 minutes. For example it doesn't truly save people from overdoses, it simply stops the opioid receptors from having an interaction with the opiate until the opiate clears the system. This gives people time to get to a hospital where they can receive continuous narcan. Functionally, this behaves as a detox.

If you have a long-term opiate dependency, narcan will trigger immediate withdrawal. You're thinking of just the opiate receptors and how narcan speeds up their clearance, but not about what the body's somatic responses will look like when suddenly there is no opiate to be found. You would need supportive therapy.

Folks I know who have gone through the rapid detoxification protocol and had little or no assistance with the after effects couldn't even find the words in any of a number of languages to describe how awful the after-effects felt . . .. Plus, if explosive diarrhoea is a common symptom in this kind of thing, even the index symptom and sign of completing the detox, I have to imagine all the other systems are out of control too, including cardiac, pulmonary, and circulatory, and the entire nervous system. Organic looseness of the bowels, for whatever cause, is not trivial -- what do people think kills cholera victims? Beyond a certain point, Irritable Bowel Syndrome has to be treated with codeine, dihydrocodeine, or whole opium products, so imagine how dangerous the out of control effects after narcotic antagonists are . . . and the dirty little secret is that when one's bowels are completely out of control, even high-dose difenoxin has its limits -- in extreme cases sometimes whole opium products like paregoric, laudanum, or others, in combination with belladonna products or similar anticholinergics, kicked off with a shot of morphine are indicated.

The doctors and pharmacologists who came up with ultra-rapid detox in Vienna in the 1980s and the people around the world doing the detoxes generally were suggesting all manner of supportive measures like clonidine, anticholinergics, anti-motility agents, anticonvulsants, analgesics from paracetamol to nefopam, benzodiazepines, barbiturates and similar sedative-hypnotics, parenteral nutrition, and other methods of mitigating this, with some of the early thinking on ketamine in opioid maintenance and detoxification coming from this and other sources . . .