Rate and Predictors of Severe Withdrawal Symptoms in an Accelerated Opioid Detoxification Program

Abstract

Background: Opioid addicts usually quit treatment due to the severe withdrawal symptoms associated with it. Accelerated opioid detoxification programs were launched with the aim of making the detoxification process easier to complete for opioid patients and to improve compliance to the treatment. However, there is limited information on the prevalence of severe withdrawal symptoms and on the risk factors which may lead to such symptoms in accelerated opioid detoxification. The objective of this study, therefore, is to determine the frequency of severe withdrawal symptoms in accelerated detoxification programs and the factors responsible for this. Methods: A total of 191 participants were included in the study. All the participants had been diagnosed with opioid addiction and admitted to Moodist Hospital, where they underwent the Accelerated Detoxification Program (ADP) between November 2018 – July 2019. A naltrexone implant was applied to the participants subsequent to the treatment. The Addiction Profile Index Clinic Form (API-CF) and the Clinical Opiate Withdrawal Symptoms Scale (COWS) were administered to participants during the study process. Results: The Naltrexone implant was applied to all participants at the end of the detoxification treatment. It was found that 9.4% of the people in the ADP treatment process had severe withdrawal symptoms. Furthermore, the presence of severe withdrawal symptoms on the first day was seen to be a factor determining the severity of withdrawal symptoms in the following days. The mean COWS scores and standard deviation of the participants who experienced severe withdrawal symptoms subsequent to the first, second, third, fourth and fifth days of the treatment were 6.64±2.53, 5.47±2.99, 8.14±5.51, 6.13±3.52 and 6.27±2.08, respectively. Another factor that was shown to affect severe withdrawal symptoms was previous outpatient treatments, that is, 80% of the participants who had undergone outpatient treatment before experienced severe withdrawal symptoms, whereas 46% of the participants who had never undergone outpatient treatment before had severe withdrawal symptoms. The mean anxiety score was found to be another factor having an influence on severe withdrawal symptoms. Participants who experienced severe withdrawal symptoms had higher mean anxiety scores; the average anxiety score of those without severe withdrawal symptoms was 0.68, while for those participants with severe withdrawal symptoms, it was 1.07. Conclusions: The rate of completion of the accelerated detoxification program was very high in the study. The higher completion rate takes on particular importance considering the fact that the treatment program was only 5 days. The low rate of confusion, which is one of the major complications associated with accelerated programs, is significant insofar as it demonstrates the aptness of such programs.