I had the pleasure of seeing my patient Isabel (not her real name, but I love this name) in the office today for her regular monthly Vivitrol® injection. Vivitrol® is a long-acting, injectable form of naltrexone. Naltrexone is an opiate blocker, also called an opiate antagonist. When naltrexone is present in the system, there is “no room at the inn” for opioids. The receptors are blocked and opiates have nowhere to rest, so they simply leave. It also non-addictive. This is why naltrexone is gaining more and more popularity as a form of Medication Assisted Treatment (MAT) for people with Opioid Use Disorder.
Back to Isabel.
Isabel came to our office for a detox off methadone two years ago—in the winter of 2015. She was on 100 mg/day of methadone, which was treatment for her previous addiction to 400mg/day of oxycodone. Some people find it ironic that the most common way of dealing with an opiate addiction is to put people on opiates. The difference of course, is that the opioid of choice—methadone--is a very long-acting drug. And if you are getting it at the clinic, it is legal. Instead of needing to take pills (or heroin)—gotten legally or illegally—several times a day, the methadone stays in the system for over 24 hours. Some of the drawbacks that patients have described to me include:
- Having to go to the clinic daily, which can make it very difficult to hold down a job, especially if there is significant travel time to the methadone clinic.
- Not being able to take a vacation; it's tough to travel very far when you need to be at your clinic every single day, and unless you are a well-known and trusted patient, it's hard to get 'take-homes'.
And yet, for many people, a methadone clinic provides needed structure, a place to go that is consistent, and people to connect with.
Isabel had been a patient at her methadone clinic for 4 years when she just wanted to be free of the restrictive lifestyle this demanded.
She was a single mom; a dental hygienist who had lost her position, but was working closely with the regulatory board to someday get her license back. She was active in recovery meetings and—although she loved her parents dearly, was tired of living with them.
Her Accelerated Opiate Detox (AOD) off methadone at the Coleman Institute’s Richmond office took 8 days. Because it is an outpatient procedure, Isabel was able to return home after her daily check-ins with us. She opted for a naltrexone implant and then began the process of rebuilding her life.
Isabel said when she contemplated getting off methadone and ‘being in recovery’, she really thought nothing good was ever going to happen for her. Then, at about three months clean, she said it was like springtime came to her: “I felt like I could take a full breath. I looked around and things seemed new. I got hired again and started paying down my debts. When I begrudged paying a bill, I would remind myself how easily I spent the same amount on two days worth of drugs in the past.” She paid off bills, she bought a new car, she was promoted at her job, and she even took her first vacation in years.
Isabel’s big news today was that she had just finished signing a stack of papers and, for the first time ever in her life, she is purchasing a house. She and her son are moving out of her parents’ home at last.
Methadone as a form of MAT can be a good choice for many people, and although some people stay on it for a lifetime, others may be ready for an opioid-free form Medication Assisted Treatment (MAT). The Coleman Institute can successfully bridge people from methadone to naltrexone in 8 days, the same period that it takes us to treat patients on buprenorphine, another long-lasting opioid used as a form of MAT. If you have any questions about switching from buprenorphine or methadone to the long-acting opioid-blocker, naltrexone, feel free to give me a call.
Joan R. Shepherd, FNP