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I recently attended a conference where participants were challenged to surrender their electronics, tobacco products, alcohol, sugar, caffeine, gum, any medications or supplements not prescribed by a medical provider, and between-meal snacks for the duration of the event, which lasted a little longer than a week.

The tension in the room was palpable. Lots of murmuring. Hands went up in the air to get clarification. Questions were raised about exceptions to this situation or that situation. I suspect every brain in the room was in overdrive anticipating what the absence of these things would mean. I myself was agonizing about turning over the sack of organic mixed nuts I had brought to the conference, precisely so that I would have healthy snacks. I was also very ambivalent about giving up the eight-dollar bag of peanut M&Ms I’d not been able to resist from that wretched temptress: the minibar refrigerator.

Once those of us who chose to participate in this exercise gave up our electronics and other items, the experience was surprisingly easier than I’d expected. As our teacher so aptly said, “No Decision, No Fear.”

It was true. Once the agreement had been made and the option to begin the morning with a cup of coffee or snack between meals was gone, my brain and its noisy Team of Thoughts became quiet…at least about those situations.

This exercise is a great example of how using long-acting naltrexone as a Medication-Assisted Treatment for opioid dependency can work. It takes the decision of whether or not to use opioids (pain medications, heroin, fentanyl, etc.) off the table entirely. Because naltrexone is a pure opiate antagonist, it actually sits on the opioid receptors, thus blocking them from any other opiate that may be introduced.

For a person struggling with opioid addiction, the freedom to wake up in the morning and not need to chase the drug to keep from being sick is nothing short of miraculous.

No Decision, No Fear.

Although there are always some exceptions, most of our patients are astonished at how quickly the cravings are absolutely gone. I have heard this over and over again from our patients.

There are a couple of options for long-acting naltrexone. It comes in the form of a monthly injection under the trade name of Vivitrol®. The injection goes into the large gluteal muscle and the medication is slowly released for about a month. Many insurance companies will cover the cost of Vivitrol®. Naltrexone implants are another option, and The Coleman Institute has been a national leader in the use of them for over fifteen years. This implant, or pellet, is placed in the fatty tissue of the abdomen. It’s about the size of a vitamin tablet. We make a half-inch incision and close it with 3 stitches. Once it heals, it leaves a small scar similar to what you might see from a laser gallbladder removal. Our implants bathe the opioid receptors with naltrexone for about 8 weeks.

Some patients have told me they opted to come to The Coleman Institute for an Accelerated Outpatient Opioid Detox “instead of going to therapy”. Very importantly, these are not mutually exclusive, and our belief is that patients benefit from both. With the recognition of the enormous opioid epidemic our country is experiencing, the options for therapy after detox are numerous and increasing daily. But it often makes sense to detox before going into therapy so that your brain can better begin to absorb the skills necessary for sustained recovery.

A one month injection of Vivitrol® provides our patients with about 28 days of No Decision, No Fear; an implant even longer.

Let us help you to sift through some of the overwhelming choices that become urgent for families in crisis. Freedom from opioids is possible.

Joan R. Shepherd, FNP

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