The Revolving Door of Opioid Detox and Relapse: Breaking the Cycle
The ‘revolving door of opioid detox and relapse’ has been a concern for as long as there have been treatment programs. Many studies have been performed but a recent study had shed new light on the issue.
In a first-ever randomized trial, patients at a short-term inpatient program began long-term outpatient treatment with buprenorphine before discharge, with better outcomes than detox patients.
Three out of four people who complete an inpatient opioid withdrawal management program — commonly known as “detox” — relapse within a month, leading to a “revolving door” effect. Few successfully transition from the inpatient setting to long-term treatment with proven medications such as buprenorphine, methadone, or naltrexone to prevent overdose.
This is one of the reasons that we constantly assert that the revolving door’of opioid detox and relapse will continue without aftercare. Aftercare includes outpatient treatment programs and sober living.
The study found that patients who start long-term buprenorphine treatment at a detox program, instead of going through detox and getting a referral for such treatment at discharge, are less likely to use opioids illicitly over the following six months, and more likely to keep up treatment, according to a first-of-its-kind study led by a Boston University School of Public Health (BUSPH) researcher and published in the journal Addiction.
“The idea of detox — getting inpatient treatment for a few days and expecting to quit opioids — has always been magical thinking,” says study lead author Dr. Michael Stein, professor and chair of health law, policy & management at BUSPH. “We’ve quantified here for the first time how successful we can be if we use short-term inpatient programs as starting grounds for long-term treatment.”
This process is referred to as “Medication Assisted Treatment.” We began our own MAT program in 2019 and we’re big believers that for many patients, this increases the chances of long term sobriety significantly.
In the randomized trial, 59 patients at the Stanley Street Treatment and Resources program (SSTAR) in Fall River, Mass., went through a standard buprenorphine-assisted detox program (including then tapering off buprenorphine). Another 56 patients received the typical first-day buprenorphine treatment, then went on to a daily dose of buprenorphine, and were discharged as already-established patients at SSTAR’s nearby primary healthcare center, with an outpatient appointment for the following week and a prescription to be able to continue taking their daily dose of buprenorphine until then.
The researchers found that these participants were more likely to be taking buprenorphine up to six months after discharge than the patients who had gone through standard detox. They were also less likely to use illicit opioids, “thereby lowering the overdose risk that comes from use of fentanyl and other lethal opioids,” Stein says.
The revolving door of opioid detox and relapse
When we talk about a revolving door, what we’re really saying is that patients who only go through Rehab or Detox are at a much, much higher of relapse within the first year. Patients who seek “aftercare” or continuing treatment such as outpatient treatment or sober living facilities have a much better chance at sobriety. The longer a patient is in active treatment, the better their chances.
This makes perfect sense. Addicition doesn’t happen overnight. It takes many other influences such as environment, mental health issues, depression, physical pain, peer pressure to drive someone to addiction. This process happens over many years.
In our group and one-on-one therapy sessions, we hear the stories of how people turned to substances to escape something – whether it was emotional distress, physical pain, self esteem issues or anything else – that all comes out in long term therapy. Such therapy is vital to the success of addiction treatment.
This type of treatment is only offered on very limited basis in Rehab/Detox programs. All wounds will not be healed in 1-3 months (the average Rehab program length). As such, while a patient might leave Rehab “clean,” without continuing treatment, the revolving door of opioid detox and relapse will continue.
Medication assisted treatment has shown promise for some time. One challenge has been that some insurance providers have been reluctant to fully fund such treatment. Independent studies have shown solid results and those treatment providers who offer such treatment hold a distinct advantage over those that don’t.
In fact, most treatment programs will warn patients that unless they stick to the program, the revolving door of opioid detox and relapse becomes a very real threat to their recovery.
Choosing the right treatment program
It takes desperation, frustration and sometimes even a medical emergency before a person will admit they need help. The fear and anxiety of living in reality, with no substance-provided escape, is petrifying. But asking for help takes something else: bravery. To get to this point, it might’ve taken years or decades, so why would anyone want to go through the revolving door of opioid detox and relapse? You want to do it right and do it only once.
We strongly recommend that you talk to different recovery treatment providers to see if their program is a good fit for you. Ask them if they have an MAT program (if that interests you) and meet with them, if possible.
Materials provided by Boston University School of Medicine. Note: Content may be edited for style and length.