Patients who face the disease of addiction to painkillers have a few options to choose from. I will briefly touch on most of them but will focus on the 2 modalities that are mentioned above.
In my view the treatment options are divided into 3 main categories: 1-medically monitered withdrawal (i.e. detox), 2-maintenance therapy, 3-non-medicated recovery.
The latter approach utilizes spiritual recovery through NA meeting and other psychosocial rehabilitation options without the use of medications. This is usually associated with sever withdrawal symptoms and we feel that this can be avoided by the use of Suboxone (see below).
Maintenance therapy, where the patients are maintained on a long acting opiate medication for months or years, can be carried out using Methadone or the newer medication called Buprenorphine (generic for Suboxone and Sututex). The former is a stronger opiate medication that has been utilized for decades to treat opiate addiction. It is very effective in treating sever cases of heroin addiction but carries the porential for overdose that can lead to death. we can talk about methadone for hours but this is beyound the scope of this article.
Buprenorphine is a safer medication which lead the FDA to approve it for outpatient treatment of opiate addiction. After recieving a waiver from the DEA Physicians can prescribe or dispense it out of their regular offices without the need for a methadone clinic.
Many patients however choose to detx completely off opiates using the shortest but least painfull methods. Detox can vary in duration from few days, which I think is to fast and can be painful with more chance of relapse, up to few weeks. Traditionally has been done in hospitals and drug rehabs untill Suboxone became available in the US few years ago. Detox is the first step of a long recovery journey and need to be followed by long term spychosocial rehabilitation.
Now lets talk about the main topic; detox in a drug rehab or outpatient.
Drug rehab facilities have a great role in the treatment of Substance abuse and alcoholism but in the case of dependence on prescription pain killers, at-home detox can be as effective.
The difference: When patients are admitted to a drug rehabilitation facility they are secluded from all the surrounding triggers and hence can stay clean with no effort. When they are discharged they start to face the same circumstances that led them to develop the drug dependence in the first place. Without adherence to the after-care plan designed for them many patients relapse within 90 days of their discharge date. Outpatient/at-home program help patients to recover in face of those triggers and coach them through those urges to minimize the chance of relapse.
Privacy: At-home recovery provides a much more private environment than any other form of treatment. This helps patients avoid stigmatization which can have a tremendous hindrance on recovery. Clinicians help patients regain their self esteem and encourage reentry into the society.
A great value of in home recovery is that clinicians get to examine first hand the surrounding triggers and initiate a plan to reduce and eliminate those.
Functioning: With Outpatient/at-home programs there is no or minimal interruption of your life cycle with the ability to become productive and independent while you are recovering. An advantage that cannot be accomplished in a drug rehab.
Cost:Outpatient/at-home programs cost a fraction of the prices of private drug rehabs which can reach up to $30,000.
Family support: families should be engaged at the onset and through out the treatment period. The convenience of having recovery at home makes this option easy to establish.