For a rapid detox (6hrs) they put you in a drug induce coma and give you a cocktail of drugs to flush the opiod out of your system (I’m guessing naloxone or naltrexone will be in there somewhere, but I don’t know for sure). After that they wake you up, then keep you in hospital a couple of days to make sure your OK. They’ll probably also insert a naltrexone implant to try to prevent relapses as well as outpatient treatment.
I did this in a hospital. They gave me Subutex which is buprenorphine and diazepam for four days starting at four doses the first day, three doses the second day, two doses the third, and one dose the fourth day. From there you could be put on Suboxone which is buprenorphine and the opiod antagonist naloxone for maintenance. Maintenance like suboxone and methadone suck. They are just another monkey. Tough it out, wean down, and just be sick for a few days.
I use clonidine for some some of the wd sx. If the pt is taking very high doses, I may use a little methadone.
low dose lorazepam for some of the anxiety
ibuprofen for the associated aches and pains
zofran for the nausea
frequent vital sign checks
attention to nutrition and encourage oral fluids, of whatever variety the patient likes best and that we have available in the hospital.
If the pt is overdosed on opiates, I use narcan.
If the pt is chronic pain, I do my best to find a way to control the pain.