What is an opiate detox like in a drug rehab clinic?

Opiate addiction includes addiction to ‘respectable’ prescription medication. It includes codeine addiction and problems stopping Tramadol, as well addiction to street drugs such as methadone and heroin. It is difficult to stop taking any of these drugs and to detox comfortably from them. Therefore, if affordable, many people opt for a medically assisted detox in a safe environment such as in a residential drug rehab.


Heroin detox

Heroin can either be injected or smoked and the downward life spiral can be very rapid. At The Haynes Clinic we will often get alcoholics in their 60’s seeking help, but with heroin, due to its impact on the body, users do not usually live to an old age, so we usually admit younger people with a heroin addiction who are desperate to get their lives back.

Initially, people will have sought help through their local drug and alcohol team and there is one in every county throughout the UK.  Due to budget restraints and lack of staff due to returning from work following Covid, there is limited help and certainly not the ability to be offered a full heroin detox, within the foreseeable future. However, what the NHS local drug and alcohol team can offer though is a needle exchange, counselling, and also work out a treatment programme with you that will probably involve the prescribing of a heroin substitute, Methadone.

Methadone detox

Methadone is a manmade opioid which has the same effect as heroin. If it is prescribed it is taken daily and can be taken in liquid form or a pill. This will then reduce the cravings and withdrawal from heroin. The benefits of Methadone are that it is safer to use as it is not injected so there is no need for a syringe. It is of a known purity unlike heroin which can be cut with anything.  There is no need to keep in contact with a dealer. There is no need to go stealing goods to sell to buy heroin.   

The disadvantages of Methadone are that it is equally addictive, the body can become tolerant to the dose, and so the prescribed dose may have to be increased. There is also a real risk that even though the Methadone is prescribed that heroin will also be used daily on top of the Methadone dose which could run the risk of an overdose.  People can be kept on a maintenance dose for years because it does not damage any of the major organs or systems of the body.

Many people seeking help for a heroin detox at The Haynes Clinic are also taking prescribed Methadone and they are also using additional heroin, as well, on a daily basis. Certain clinics or rehabs will insist that the amount of Methadone being taken on a daily basis is reduced down before they will consider a residential detox treatment programme. This is not usually the case at The Haynes Clinic.

At The Haynes Clinic we will usually manage your reduction on Methadone prior to switching you to a more comfortable detox on Subutex (generically known as buprenorphine). This is a ‘blocker’ meaning that withdrawal symptoms are managed and limited.

This is because a full Methadone detox can be very uncomfortable – particularly at the tail end when the doses are minimal and the effects of the drug are still very much in the body.

How will the opiate detox be prescribed?

On an agreed admission date, the individual will be seen by the clinic’s or rehab’s doctor and prescribed Subutex which is the recognised medication to detox off any Opiate. Like Methadone, Subutex is a controlled drug so obtaining it and using it is strictly monitored. This is the same even if you want to detox off a prescription medication such as Tramadol, or opiate medication obtained over the counter such as codeine: a Tramadol detox or codeine detox can be made a lot more comfortable if Subutex is used for it.

Subutex tablets contain the ingredient Buprenorphine Hydrochloride which helps with the withdrawal effects when stopping taking Methadone, Heroin or any other opiate such as Tramadol and Codeine. The detox should start usually 12 plus hours after the last time an opiate was used and just as the user is going into withdrawal. The longer the individual can wait, the more effective the Subutex will be. 

To start with, sometimes a small dose of Subutex is given and if withdrawal does not continue then the dose is increased. The doctor will determine how best to administer and the amount of the first dose, depending on the individual user. Few people need more than 8 mg as a starting dose and some are comfortable on less. Subutex tablets should be placed under the tongue and allowed to dissolve, as they will not work if they are chewed or swallowed.

The dose of Subutex medication is then reduced, on a daily or two daily basis. It is taken once a day and the prescribed medication will end after about 10 days.   It is important to drink a lot of water or fluids during the treatment period and after about 24 hours an appetite will return. The dosage of prescribed medication during the opiate detox keeps you on an even level and not high, so you are able to have normal conversations and participate within the therapy programme.

Relapse risk

Interestingly, if there is a relapse it is a reverse situation to alcohol: to suddenly stop consuming alcohol can result in dangerous and severe seizures but stopping taking heroin will result in severe abdominal cramps and vomiting and diarrhoea but the physical risk is not as severe as withdrawing from alcohol.

However, if an alcoholic relapses, when they have left treatment, then they quickly start drinking the amounts they used to drink plus more.  If a heroin user relapses, they could actually die from an overdose as their body has not been used to the drug for some time and a relapse can be highly dangerous. 

In summary, a heroin or opiate detox taken within a residential drug rehab is completely safe and in essence what is trying to be achieved is to reduce any form of withdrawal symptoms to a minimum to make the experience as comfortable as possible