For those battling substance use disorder, the path to recovery is different for everyone and not easy. Often the person must go through a period of detoxification — the process of clearing their body of the drugs or alcohol — before they are able to focus on treatment, classes or therapy.
Dr. Kyle John, a psychiatrist, has been with Mercy for 16 years and currently serves as Medical Director of Behavioral Health East Region & Mercy Virtual. John was happy to talk about the ins and outs of detox with the Springfield Daily Citizen, explaining that he moonlighted with a detox program when he was a resident at the Mayo Clinic from 1993 to 1998.
“We’re talking 25 years ago,” John said. “They had a community detox program, and it served like 12 counties. So instead of those patients going to the emergency departments for medical detox, they came to the crisis receiving unit. It’s a different approach to it.
“And my point in telling you that is this: This is an old issue,” he added. “I mean, we’ve been detoxing people for a long time.”
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What is detox?
People often think of substances like alcohol or heroin when they hear the word “detox,” but people detox from a lot of substances including nicotine and sugar.
On the weekends, for example, John said he avoids caffeine. That usually means he gets a headache around noon on Saturdays. The Springfield doctor is withdrawing — or detoxing — from caffeine.
There are some substances that if a person has been using in large amounts for long periods of time, they very likely would need to have medical supervision if they tried to stop. These substances include alcohol, benzodiazepines and, in some cases, opioids.
Of those, only alcohol and benzodiazepines (Xanax, Ativan, etc.) can cause death when a person tries to detox on their own. Detoxing from those substances can induce seizures, which can cause a person to vomit and aspirate, John said.
“In other words, you can only die from withdrawing from a couple of substances,” John said. “I sometimes jokingly say you may feel like you’ll want to die, but you’re not going to die if you are detoxing from opioids.”
If a patient comes to Mercy seeking help with detox, they usually come through the emergency department where they are evaluated and determined if they are medically at risk. From there, they could be sent a few different places to detox, John said.
“They may just sit there in the (emergency department) for 24 hours or 26 hours and get a bag full of fluids and nutrients,” he said. “They affectionately call it a banana bag, because it’s got all the things that you need to not have bad things happen to your brain and body when you’re withdrawing.”
The patient might be admitted to a medical floor or into the intensive care unit to be closely monitored, particularly if the person has other medical problems.
“We’ve got (emergency department) docs that do withdrawal detox. We’ve got hospitalists. We have intensivists all managing detox,” he said. “Or if you have a comorbid psychiatric issue and you could get admitted right over to the Marion Center, then you might be detoxed there by a psychiatrist. So a lot of folks can do detox. It’s not just one specialty that’s got the market cornered.”
According to John, patients often rely on their primary care physician to help them with an outpatient detox.
“If you were struggling with alcohol dependence, but you were healthy and not at risk for any bad outcome, your doctor wouldn’t send you to the hospital to detox,” John said. “They would say, ‘OK, we’re going to decrease your drinking over time. You drank 12 beers yesterday. Today, you’re going to drink 11. Tomorrow, you’re going to drink 10.’ That’s not very common, but you could do that. Or more likely, what they would say is: ‘Let me give you a medicine that does the same thing in your brain as alcohol and will bring your brain off that substance without it getting too excited, which could cause a seizure.’”
The length of time a person needs to detox varies, John said, but 24 to 48 hours is pretty typical.
It might be longer for people who have a serious and long history of substance use.
Someone who’s been drinking heavily for 30 years, for example, and has a history of seizures might need medication administered for three or four days to safely detox, John said. And for someone who has been using benzodiazepines for 30 years, it could take up to a year of gradually tapering the dosage to detox.
“I always encourage people, if you are not in crisis, talk to your primary care provider,” John said. “That goes for mental health issues, too, not just substance use disorders. They’re a great resource, a great place to get screened and started in treatment.”
John said he’d love to see the creation of a sobering center in Springfield like Preferred Family Healthcare’s Dunnica Sobering Center that opened in St. Louis in 2021.
That facility has 12 beds where folks can be medically monitored as they detox. The goal is to give police a place to bring people who are intoxicated other than jails and hospitals.
According to a news report, the Dunnica Sobering Center is expected to serve more than 4,000 people a year, freeing up both police officers and health care workers.
“It’s a great example of a lower-cost environment, but it’s the exact same concept that I was involved in 25 years ago,” John said. “It wasn’t my idea. I was just a poor medical resident that needed to make money to pay my loans. And I’m like, ‘Hey, this is great.’”
What detox options are available in Springfield?
In Springfield, there are two types of detox programs available: medical detox and social-setting detox.
Medical detox happens in a hospital and is supervised by physicians and nurses. Sometimes the patient is treated with medicine. According to spokespersons from both CoxHealth and Mercy, any inpatient hospital bed can be used for medical detox.
However, unless a person has a serious medical condition that could complicate the detox, there are really only two substances for which a medical detox might be necessary: alcohol and benzodiazepines.
Patients are usually assessed in the emergency department and if they meet the criteria for medical detox, they are admitted. Some patients begin withdrawing/detoxing after coming in for another injury or illness, so it’s difficult to determine the exact number of patients who went through “medical detox” in local hospitals.
Medicaid pays for medical detox, but typically only pays about 75 percent to 85 percent of the actual cost of providing care, explained Mercy spokesperson Sonya Kullman.
At Mercy, if the patient qualifies for Medicaid, then they will qualify for a presumptive charity write-off of any balance for detox, Kullman said. CoxHealth, too, will take care of the balance for Medicaid patients so that they will not receive a bill for detox services.
People who are detoxing from other substances like methamphetamine and opioids (and in some cases, alcohol) can benefit from what’s called a social-setting detox, where they are monitored by SUD (Substance-Use Disorder) Techs. These are Burrell employees with medication training and a program supervisor typically oversees social-setting detox. They also have the ability to consult with a nurse on-site when needed.
“With alcohol and benzos, it’s life-threatening,” said Sally Gibson, vice president of recovery services for Burrell Behavioral Health. “They could go into seizures and die without it being monitored or having medication.
“With things like methamphetamine or opioids, it is very uncomfortable. They are sick while they’re going through it,” Gibson said. “(With a social setting detox) someone is there checking blood pressure, making sure everything is going okay, making sure that they are staying stable and they are not at risk.”
Some private in-patient treatment centers offer social-setting detox with their programs. But for those who cannot afford private treatment, Burrell’s Behavioral Crisis Center currently has 12 social detox beds that are funded by a grant from the Department of Mental Health. (The center had 18 beds but is running at reduced capacity due to the pandemic.)
If those 12 beds are full, patients could be put in Burrell’s Rapid Access Unit for up to 23-hours while they wait for a social-setting detox bed to become available.
Gibson said that while a person is going through the social-setting detox at Burrell, staff talks to them about treatment options including Burrell Recovery Services inpatient program.
If someone feels they are in need of a detoxification program, Gibson said they can either go to an emergency room where they will be either admitted into a medical detox bed or be medically cleared to go into a social-setting detox program.
They could also walk into Burrell’s Behavioral Crisis Center at 800 S. Park St. in Springfield or call Burrell’s detox unit at 417-893-7722.