I just heard an incredibly disturbing report on National Public Radio (NPR) this morning. The report was called: Fentanyl-Laced Cocaine Becoming A Deadly Problem Among Drug Users. More and more people are dying from using cocaine laced with fentanyl. Already we are losing thousands in the United States to heroin laced with fentanyl. At the various Coleman Institute locations around the country, it is becoming more the rule than the exception that, when a person comes in to detox off heroin, he or she also tests positive for fentanyl. Sometimes they admit to knowing about the fentanyl and sometimes they are shocked to learn about it. The good news is that if they have shown up for a detox, it didn’t kill them. The NPR article states that more and more cases of cocaine laced with fentanyl are showing up; at least 10 states have reported finding the combination. Many people are able to use cocaine periodically because it does not create physical dependence. When it is laced with an opioid, however, and used regularly, physical dependence develops. A new customer is created because they will do whatever it takes to avoid the horrible symptoms of opioid withdrawal. At all of the Coleman Institute locations, we specialize in Accelerated Opioid Detox (AOD), to help get people off Percocet®, Vicodin®, Opana®, Dilaudid®, fentanyl, heroin, methadone, buprenorphine, etc. Some of our locations also have accelerated processes to get people off alcohol, as well as benzodiazepines such as Xanax®, Ativan®, and Valium®. For the opioid and alcohol program, we insert a naltrexone implant under the skin of the abdomen after the completion of the medically-supervised detoxification. The slow, steady release of naltrexone will occupy –thus blocking—opioid receptors for about two months in most patients. For people receiving naltrexone for alcohol, they experience less cravings, less impulse to drink, and less pleasure in drinking. However, naltrexone does nothing about blocking cocaine. When patients return to our offices for follow up naltrexone implants, we routinely do a urine drug screen (UDS) and catch up on how life without opioids is going. Needless to say, for the vast majority of these people, life is far better. Their energy, sleep, relationships, depression, anxiety, employment, and health are all improving. Most have clean urines and are engaging in some kind of counseling, treatment programs, or recovery meetings. Occasionally we find pot, benzos, or cocaine in the UDS. The presence of any of these drugs does not preclude receiving the naltrexone implant. Because naltrexone only affects the opioid receptors, it really does not help a person who chooses to use these other substances, nor is it dangerous to combine them with naltrexone. Our conversation with these patients will morph toward inviting them to become curious about why they continue to feel compelled to alter their reality. But rarely do we refuse the naltrexone implant. Now, however, with the news of cocaine laced with fentanyl, urging patients to avoid cocaine will become a greater priority. We encourage most of our patients to stay on naltrexone for at least a year, and during that time to engage in the most helpful treatment they can find to learn the coping skills it will take to live a life free from the bondage of altering their reality with drugs. It is concerning to think that a patient who has achieved the impressive feat of stopping opioid use may succumb because of a spontaneous, ill-planned, tryst with cocaine. Joan R. Shepherd, FNP

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