Detox med protocol

Meriwhen, ASN, BSN, MSN, RN · Jun 14, 2012

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.

Topaz7 · Jun 18, 2012

That seems about right the couple of patients we have had on suboxone I think already came in on it or didn't get it unitl their 2nd/3rd day.

Meriwhen, ASN, BSN, MSN, RN · Jun 19, 2012

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.)

Topaz7 · Jun 20, 2012

Ty that was very informative. they used sub a lot before I started working and stopped. I know that the community mental health network doesn't like to send us their patients anymore because we don't use sub as much.

DebCRNBSN · Jun 22, 2012

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.

Meriwhen, ASN, BSN, MSN, RN · Jun 24, 2012

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.

Abdullahi · Jul 12, 2012

Good comments and informative, presently having the first experiance of having a patient on clonidine and diazepam in our Detox,i find your comments very educative. Thanks

kponderRN · Jul 15, 2012

I work on a telemetry unit and we will get our occasional detox patient that comes to us because they have some type of chest pain related to their detox process. I wish we had some kind of protocol because it is very dangerous for the patient to go cold turkey if they are used to having some kind of drug every single day. Hopefully one day someone will implement a detox program we can use on the floor

Topaz7 · Jul 18, 2012

You could bring it up to managers and see what they think. They might appreciate the input from you. We have different tiers based on how much the patient was drinking. It ends up fluctuating from 5-10mg of valium qid x8 then we titrate down to bid then none they also have prn valium available depending on ciwa scores. The clonidine is standing order for bp but also used for cina withdrawl symptoms. For opiate w/d we use what we call the blue light special valium clonidine and bentyl.

Meriwhen, ASN, BSN, MSN, RN · Jul 18, 2012

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.

Topaz7 · Jul 18, 2012

:) we call it blue light special because cina med protocol is on a blue sheet hehe. Yes we don't use valium if the pt is on suboxone either. Our docs try hard not to put ppl on sub though we di occassionally still get ppl on it. Also we use serax in pts with hx of liver damage/disease.