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Typical scenario at the Coleman Institute:

A patient and their support person arrive at the office to begin an accelerated opioid detox from heroin, fentanyl, Dilaudid®, Percocet®, Vicodin®, etc. Many patients also seek our help to come off long-acting MAT (Medication-Assisted Treatment) methadone or buprenorphine products.

The patient is nervous. He or she is in the early stages of withdrawal. Many have been through withdrawal before and they are terrified to experience the grueling physical symptoms: chills, sweats, muscle pain, abdominal pain, vomiting, diarrhea…to name a few. If our patient has followed our guidelines--that they can use until 6:00 pm the evening prior to starting our program—their withdrawal symptoms are generally around a 3-4 out of 10. Not horrible, but the fear of the future they are imagining, based on the past they have experienced, can catapult a patient from a 3 to a 9 pretty quickly.

Because the Coleman Institute’s providers throughout the country are leading experts in using naltrexone to treat opioid addiction, we are well prepared to address these concerns.

Upon arrival the patient will settle up at the Front Desk and complete final paperwork and consent forms. Our Coleman Institute patients are our priority, and we want them out of discomfort as much as they want it, so we move them quickly to the ‘clinical’ side.

After vital signs, EKG, and blood-work are taken, a provider—either a nurse practitioner or a doctor will meet the patient and his/her support person. The screening form is reviewed and a brief physical assessment is performed. Medications are given which are specifically chosen to mitigate all the previously mentioned withdrawal symptoms.

It is not unusual for patients to say things like, “You don’t understand—I have a really high tolerance to medications. These aren’t going to touch my symptoms.” And every blue moon, they are right. If that’s the case, we’ve got some other tricks up our sleeves. Most often, however, when we return to their room to discuss medications with the support person, our patient has fallen asleep.

During the daily visits throughout the detoxification process, our providers not only assess the objective findings, but also do a thorough assessment of the subjective symptoms our patient may be experiencing. Based on how each patient is individually responding to his/her medication regimen, we will adjust the protocol

At each visit we give a micro-dose of naltrexone to accelerate the body’s natural process of eliminating opioids and allow the brain to begin to heal. It is precisely because the amounts of naltrexone we use are so small, that this elegant detox can be done in an outpatient setting.

Many patients report a couple hours of discomfort, but state that the medication and a hot shower get them through it. They generally report about 22 hours of feeling reasonably comfortable.

We welcome questions from the support people and our patients! We all know that this is not the kind of doctor’s visit when you go in for a cold or sore throat, or even to get a physical or be started on blood pressure medication. The practice of addiction medicine is a unique area of specialization, and we love to field questions and have discussions throughout—and following—a detox at the Coleman Institute, for any concerns that may arise later. There is no stupid question when it comes to finding the right way to detox!!

Please give a call if we can address any general or specific questions as you gather data to find your best strategy for an opioid-free life.

Joan R. Shepherd, FNP

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