Outpatient Detoxification

Advances in treatment now allow people to be detoxified from alcohol and opioids safely and comfortably on an outpatient basis. Kolmac Clinic has pioneered in these developments. Patients spend one or two days at the Clinic receiving oral medication and being monitored by our medical staff. They participate simultaneously in the rehabilitation program. At the end of the day, they return home with a limited amount of medication for evening use. We do not perform “ultra rapid outpatient detoxification,” wherein patients are put under general anesthesia and detoxified from opioids in a few hours.

Alcohol

For detoxification from alcohol, the medication of choice for many years has been benzodiazepines. This class of medications can quickly relieve symptoms of anxiety, tremor, and insomnia. In addition, they can completely prevent serious withdrawal symptoms such as grand mal seizures or delirium tremens. We use the oldest of the benzodiazepines, Librium. It is long acting and provides a smoother transition to abstinence than do the shorter acting benzodiazepines, such as Xanax or Ativan. It is also less likely to cause cross-addiction than other benzodiazepines. We give Librium for two to three days, after which the body gradually eliminates it over a period of weeks.

In recent years, for mild to moderate withdrawal, we have also begun to use medications such as Tegretol and Neurontin, which were initially developed as anticonvulsants. These medications have the advantage of not being sedating and of having no potential for cross-addiction. They are given over a period of six days.

Opioids (prescription narcotics and heroin)

Our ability to relieve the discomfort of withdrawal from opioids has been dramatically improved by the availability of buprenorphine, marketed as Suboxone.  Patients place the medication under the tongue and usually experience a reduction of symptoms rapidly, often within an hour. Careful control of the dosing prevents unpleasant sedating effects. Although patients can be tapered comfortably off the buprenorphine over a period of days or weeks, we recommend that they remain on it for several months for a period of stabilization to prevent relapse.

Other Drugs

We are also able to detoxify people from tranquilizers such as Xanax and Ativan as well as sedative medications. Stimulants, such as cocaine and amphetamines, do not require formal detoxification.

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