Supervised Withdrawal Opioid Use Disorder Treatments

Abstract Supervised opioid withdrawal (also referred to as detoxification or detox) is a medical treatment aimed at fully discontinuing opioid use in persons who are physically dependent on opioids. There is a long history of supervised withdrawal treatment programs in the United States, although the approach has varied wildly and to this day there is little guidance regarding best practices. Early approaches to supervised withdrawal favored an abrupt discontinuation of opioids rather than longer opioid tapers, though recent data support an extended approach. Withdrawal is a highly variable process with many decision points, including residential versus outpatient status, choice of withdrawal treatment and complementary/supportive interventions, duration of treatment, percent change in daily dose, and whether the withdrawal schedule is determined by the patient, provider, or both. Several treatments to help reduce withdrawal severity will be discussed. This chapter reviews the historical basis of withdrawal programs; the data supporting the aforementioned decision points; and the rationale, efficacy, and unique considerations for the different withdrawal methods. Outcomes following withdrawal programs, including resolution of medical comorbidities, overdose risk, and linkage to aftercare are also reviewed. Since the United States now has a formal indication of opioid withdrawal, this chapter also includes a discussion of important considerations for empirical trials of medications and/or other interventions for opioid withdrawal management. Future efforts to maximize the efficacy of withdrawal treatment, and importantly, to link individuals to long-term care (preferably with a medication for OUD) are important directions for future research and practice.