I heard from Ken (not his real name) yesterday. Ken completed an Accelerated Opiate Detox with us about 5 weeks ago. The burden lifted from his shoulders is immense, he told me. He wakes up with the freedom of knowing he can be like a “normal” human: drink coffee, take a shower, snuggle his kids, read his mail…with absolutely no need to compromise his integrity or his wallet by buying pills.
Ken was using high dose opiates. He admitted to taking as much as 24mg-36mg of dilaudid (hydromorphone) plus 25-50 mcg of fentanyl together on most days. It all depended on what his dealer could find. Ken could afford to purchase pretty much whatever he wanted.
His opiate use a few years ago was very occasional.
Until it wasn’t.
In the last 10 years or so, we have embarked on a big experiment in this country - by allowing much easier access to marijuana.
There are many reasons this has happened. We have come to believe that marijuana is not really that dangerous - a lot safer than alcohol, which of course is legal and quite available. We have also come to believe we could cut out the black market if pot became legal, and we could even generate significant tax dollars if it were legal. Finally, we believe that anyone who wants to get pot will already get it, so legalization won’t really encourage anyone to use it who wasn’t going to use it anyway - and that overall consumption levels will stay the same.
This is a very controversial topic and there are very strong opinions on both sides, so I was a little nervous writing a newsletter article on this topic. Upfront, let me give a couple of my opinions.
At The Coleman Institute, we continue to assist people with a medical withdrawal from short acting opiates, but we have a growing number of patients who are seeking our services to help get off of buprenorphine products like Suboxone® or Subutex®.
In an earnest attempt to stop using short acting opiates, we hear from many people who are turning to doctors that prescribe buprenorphine to help them escape the wretched cycle into which addiction to prescription opioids or heroin has sucked them.
It is a huge relief when you are in withdrawal—chills, nausea, perhaps vomiting and/or diarrhea, severe leg kicks and spasms—to receive a simple strip, dissolvable under the tongue in minutes, to absolutely halt these physical symptoms. Many people intend this to be a ‘quick-fix’ and plan never to use an opioid again, but what often happens is the patient continues to be prescribed Suboxone® indefinitely. Patients tell us they frequently hear from these prescribers that they may need to stay on Suboxone® for the rest of their lives.
Why do people love coming to The Coleman Institute?
Partly it’s because our method of Rapid Non-Addictive, Medically Assisted Withdrawal from opioids just plain makes the experience tolerable. Our patients are generally highly motivated; they are exhausted from a life of dependence on pills or heroin or alcohol. They desperately want to stop, even though this desire is often coupled with overwhelming fear, anxiety and shame.
For patients and family members, this can be a terrifying time. Parents fear their child will be the next in the brutal statistics of unintended opioid overdoes. They wonder what they’ve done wrong and what they could have/should have done differently. Spouses wonder if their partners will ever be clean and trustworthy again. Friends want their friends back. Patients are uncomfortable. Many must be wondering, “Is this snake oil? We’ve tried so many things before, how do we know this will work?”
And from the moment they arrive, the fear, anxiety, and shame begin to dissolve.
The fact is, we care, and our patients feel it.
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.