Wednesday, August 22, 2007

They tried to make me go to rehab

I get a lot of calls from people who want to go to detox, or who want their family members to go to detox. Often they are legitimate candidates for immediate, do-not-pass-go-do-not-collect-$200 detox. For example, they've decided to go cold turkey from alcohol and now are tremulous and sweating. Or they've been quadrupling their Xanax and their psychiatrist won't write another prescription. Withdrawal from alcohol or benzodiazepines can be fatal; and detox is a medical procedure which (hopefully) keeps the withdrawal process safe. I can't begin to count the number of alcohol- or benzo-dependent people I've had to convince to go to the hospital immediately... not tomorrow, not the next day, not next week when they already have time off from work. I've found "Withdrawal can kill you" to be a fairly effective tactic.

Opiate detox is another story. Opiate withdrawal is highly unpleasant, to say the least; but it is not necessarily dangerous. Managed care does not always cover opiate detox, especially of the inpatient sort. I have no idea why. But if I get a call from someone who wants to detox from Vicodin, I tell them to go to the hospital immediately. Some will ask whether withdrawal will kill them. I reply, "At the very least, if you try to do it yourself, it will be extraordinarily uncomfortable."

But then I have some people who want to detox from cocaine. There is no medical detox procedure for cocaine. Cocaine is rapidly eliminated from the body; so even if there were a way to do cocaine detox, it would have to be done very quickly. When people ask me for cocaine detox referrals, I tell them to go to the ER right away if they have any unpleasant physical symptoms or pre-existing cardiac problems. But unless they are suicidal, homicidal, or using alcohol or benzos with their cocaine, they can most likely wait until the next day for an assessment for some other level of care.

My favorite callers, though, are the parents who want their teenagers to go to marijuana detox. (Oddly, no one ever seems to call for detox for their own pot habit.) Again, there is no medical detox for marijuana. Marijuana hangs out in the body for a while, but there's really nothing to do about it--and no real need to do anything, either. I am often tempted to tell these folks that marijuana detox is a home procedure involving a couple bags of potato chips administered over the course of a few hours. But I don't, as this would be poor customer service.


Lavender said...

Detox is a very scary thing to have to treat. Alcoholics in particular, though the cocaine cases can get rowdy as well. I haven't had a benzo yet, but only a matter of time I suppose...

I like your suggestion for pot. It doesn't do much except make you hungry, so why not give them food? They get cranky if you don't anyway. :-)

frog said...

I just went through withdrawal from Percocet. It sucked more than anything else I've ever done.

Bless you for suggesting that people not do that without help. I did it, but wouldn't recommend it and hope never to do it again. if nothing else, I know, now, to TAPER.

Anonymous said...

I have to say, my detox from benzos was one of the most scary and painful experiences of my life. This was the result of poor medical guidance on how to wean myself off gradually. The solution my health care provider gave me in the apex of my discomfort was to give me another full bottle of the stuff.