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Most people who get into recovery do so when the pain of their using and the pain of their lifestyle is greater than the fear of stopping and trying a new way of life. Usually, this requires a crisis - like a health scare, legal problems, a threatened divorce or something similar.

But lately, I have been wondering how much the scare of dying from an overdose will actually cause someone to stop using heroin and get into treatment. The risk of dying from using street drugs has never been higher. Just this week we heard about four fatalities in Petersburg, Virginia and another 16 overdoses. These overdoses seem to have been caused by one batch of carfentanil. Heroin use has always been very dangerous with a high overdose fatality rate. Every heroin user knows there is a significant risk every time they use heroin. But now, with the new drugs coming in from China and Mexico, the risk has gone through the roof. Fentanyl is 50 times stronger than heroin and carfentanil is 5,000 times stronger! (See my "Ask the Doctor" column for more info about carfentanil.) The drugs are cheap to make and easy to import into the U.S. There are reports of drug dealers bringing in massive quantities of fentanyl from China and pressing it into tablets that look like Percocet, except they have enough fentanyl in them to cause instant death. Anytime someone buys what they think is heroin, or even look alike prescription drugs on the street, they are taking an incredible risk.

Earlier this month we worked with a family from South Carolina at our Richmond Coleman Institute office. Accompanied by his parents and younger sister, Tim (not his real name), a 27-year-old college educated young man who works in the finance world, came to us for a Medically Assisted Withdrawal off Suboxone®.

Four years earlier, after struggling to stop using prescription pain pills (Roxicodone®, Percocet, and Opana), he easily found a doctor who was quick to prescribe Suboxone®. Indeed, with the buprenorphine and naloxone provided by the Suboxone®, his cravings for short-acting pain pills was gone. The doctor saw him each month and regularly prescribed him 30-60 8/2mg sublingual strips. He told him to use one or two a day, as needed.

We just helped a gentleman with a Medically Assisted Treatment (MAT) to get off Opana® (oxymorphone). He was injecting about 40mg/day, often supplemented with oxycodone.

When a patient contacts The Coleman Institute for information about how to detox off Opana®, we usually add an extra day or so to the procedure. This is one tough drug to stop using. In fact, this is the opening line of an article I read this morning:

For the first time ever, the Food and Drug Administration has told a drug company to pull a painkiller off the market because it has such a high potential for abuse.

They are, of course, referring to Opana®. Here’s the link to the full article: http://nbcnews.to/2saKnw7

Raphael (I don’t use patients real names, so I thought this would be a fun one) came to the office recently to have his monthly Vivitrol® injection. Vivitrol® is the trade name for a long acting formulation of naltrexone, which is a pure opiate antagonist or blocker.

Raph completed a rapid opioid detox with The Coleman Institute several months ago. Prior to that he used heroin and assorted pills for almost a decade. He has a small, but growing construction company. He used to work for someone but had to create his own business because of a felony charge for possession some years ago.

He told me that a couple weeks before this office visit he was looking for something inside the toolbox on the back of his truck when he found a small bag of heroin. Raph said it was like time was suspended; he held the bag in his hand, staring at it as if an alien had started growing up out of his palm. He felt shock, disbelief, and—interestingly-- most strongly, he says he felt fierce anger.

We have seen an increase in patients coming to The Coleman Institute (TCI) for rapid detox from Roxicodone (also known as Roxycodone). Roxicodone is a strong prescription pain medicine that contains an opioid (narcotic) used to manage pain severe enough to require an opioid pain medicine, when other pain treatments such as non-opioid pain medicines do not treat pain well enough or a person cannot tolerate them. It is another pain medicine that can put a person at risk for overdose and death. Even if taken as prescribed a person is at risk for opioid addiction, abuse, and misuse that can lead to death.

If someone is buying these pills on the street, they are commonly called Blues, Roxies, Roxys, or thirties--descriptors of the color and usual milligrams.

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