Detox med protocol

Depends on what they're detoxing from. For ETOH: usually Librium or Ativan PRN based on w/d symptoms, or a taper if they have a seizure history or very bad withdrawal. Benzos: long-term Valium taper. Meth: long-acting benzos. Crack and cocaine: comfort care, maybe a benzo here and there. Pain meds, heroin, methadone and other opiates: either phenobarbital or valium, clonidine and Bentyl.

You can't use Suboxone for detox because if a person takes it while there's still opiates in their system, they're going to go through rapid withdrawal. Suboxone is more for a longer term weaning and recovery...if we do use it, it would be started 2-3 days after admission.

Buprenorphine (Suboxone) has a far stronger affinity with the receptors than opiates, even in a person who has recently used opiates. The problem is that after Suboxone is done yanking the opiates off of the receptors, there may not be enough Suboxone left over to fill the now empty receptors...hence, an accelerated withdrawal.

That's why we wait until they're in active withdrawal, so there's more than enough Suboxone to go around the receptors :) Until then, it's mostly comfort care (Bentyl, clonidine, non-narcotic pain relief, etc.)

W e have had this year an increase in pregnant addicted patients on our High Risk OB unit. They are using Methodone to treat them for there addiction. They state for a few days until they can be placed into a treatment center. I don't know if any of the drugs stated in previous posts are better or if they are used during pregnancy.

Problem with pregnant detoxing patients is that the benzos that may be used to help them taper or prevent seizures, DTs, etc., are all category D (fetal harm is very possible) or X (fetal harm definite). Granted, the fact that mom used drugs while pregnant didn't do the kid any favors...however, that doesn't mean it'd automatically be OK for us to administer medications whose risks to the fetus can/do outweigh the benefits to the mom. That'd have to be a decision between mom and doctor, taking into account the risks of the mom during detox and what could happen if she did or didn't get the medications.

Methadone is as least a category C (the big grey area of "could be harmful but we're really not sure").

When we get the occasional pregnant detox-er, we try to use as little medication as possible; we'll do what we can to prevent the serious problems but we won't go overboard with the comfort meds.

For opiate w/d we use what we call the blue light special valium clonidine and bentyl.

I like that...blue light special :)

We would often use phenobarb in place of the Valium, particularly if the patient is to start suboxone down the road. Benzos and Suboxone are a nasty combination because they can cause severe respiratory depression. If buprenorphine definitely wasn't in their future, then we'd go with Valium.

Yes, some doctors use benzos and Suboxone in combination, but that should strictly be under a doctor's close supervision. IMO it should be discouraged, since research has shown that many of the fatalities associated with mixing Suboxone and benzos came from patients attempting to self-medicate.