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Day-by-day guide to our opiate detox
Monday - Assessment Day (Day 1)
People are invited to attend for an assessment and the process of assessment is followed as on our Assessment page. Once the assessments are completed, the person says goodbye to their family/ worker and the medication is introduced.
It is easier to begin the sedation before the person starts to withdraw from opiates. For that reason they are encouraged to continue using opiates as normal on the day of admission. However, they are not allowed to use drugs on the unit. All people admitted are made aware that all illicit substances will be confiscated and destroyed.
Tuesday & Wednesday - Sedation Days (Days 2 and 3)
Clients are kept in a sedated state throughout days two and three. This means that their sedation level is maintained somewhere between the semi-conscious and pain-free but wakeful. Throughout this period their vital signs will be recorded every three hours at least and they will have at least three litres of oral fluids per 24 hours.
They are observed around the clock by the detox staff to monitor the level of sedation and to maintain their safety. Sedative medication is discontinued at midnight on day three and only symptomatic control used thereafter. There is usually enough sedation in their system to maintain a pain free sleep until the morning of day four.
Thursday - Challenge Day (Day 4)
The challenge dose of Naltrexone (25mg, half a tablet) is given when the nurse in charge thinks that the client is ready for it. Generally, the person is awake and orientated and steady on their feet. It is not uncommon for the person to suffer from nausea and vomiting following the introduction of naltrexone; if so, anti-emetics are used. Diarrhoea is a common effect but only anti-spasmodic drugs are used for this as constipation, a common side effect of opiate abuse, will be compounded.
Some experience what we call rebound sedation following the challenge dose of Naltrexone. This will generally wear off throughout the afternoon.
Telephone calls are then allowed with the people identified on admission day only. Relatives are made aware that the person may sound confused and/or slurred but are reassured that these symptoms are transient.
Clients stay in their rooms until 8pm for infection control reasons mainly. Afterwards they can meet in the lounge area and socialise with each other.
Vital signs are measured every four hours and diet is introduced. The high fluid intake and round the clock supervision is continued.
Friday - Discharge Day (Day 5)
Clients are reviewed by the Consultant Psychiatrist in his ward round prior to discharge. This may be on Thursday or Friday of the week.
On day five a whole Naltrexone tablet (50mg) is given. The person is now opiate-free and this dose starts the blockade that will help to protect them from relapsing. We recommend that they take Naltrexone for at least twelve months. Some elect to have their Naltrexone via implant. This takes place in a minor surgery unit within the hospital grounds.
On discharge day the person does not always feel 100% fit. They may complain of feeling weak and cold, lack of appetite, abdominal cramps and widespread body pain. Sometimes they think that they are still withdrawing but this is not the case as they have been opiate-free since the evening of day four. At this point the body is starting to work without opiates and is starting to get used to them not being there.
The opiates have affected every one of the body’s systems, e.g. they have caused the temperature to drop below normal levels and the large bowel to become severely constipated. Poor diet and exercise, as well as the opiate abuse, allows their bodies to become compromised. It can take several days for the body to deal with these changes. Friends and family need to give lots of emotional support and diversional activities as well as tender loving care until the patient feels stronger.
Vital signs are recorded every four hours; diet and fluids are encouraged and assessments are carried out to make sure the client is fit for discharge.
They are reviewed by the Medical Officer and need to be alert and orientated as well as independently mobile before they can leave. They should be adequately hydrated and have vital signs within normal limits before they can be discharged into the care of their supervisor. They receive a comprehensive discharge brief, an information pack and take home medications before they leave.
So glad that I had the implants and came to Detox 5. I'm finally getting my life on track.