Patients who are making the decision to stop using opioids have a few choices. They can go cold turkey. Difficult and painful, but doable. For some people this happens when they are in jail, for others it happens because their pain management doctor is no longer willing or able to continue to prescribe narcotic pain medication.
Patients can also choose Medication Assisted Treatment (MAT). The top three medications used are some type of buprenorphine product such as Suboxone® or Subutex®, methadone, or naltrexone. Both buprenorphine and methadone are highly controlled substances, which require special licensing by the prescribing providers. While they keep the cravings for opioids at bay, they also create profound physical dependence. If the person using buprenorphine or methadone decides some day to stop using this form of MAT, they must go through an extensive weaning period that can last for several uncomfortable months.
Naltrexone is a completely different alternative for using medical treatment to get off opioids. Whereas the previous medications actually ‘turn on’ the opioid receptors, naltrexone simply occupies the receptors, effectively blocking them from any possible action from opioids. The Coleman Institute has been the leader in using naltrexone for over twenty years to help patients get off opioids.
Following are the main reasons patients tell us they have chosen naltrexone therapy to detox from Vicodin®, Percocet®, morphine, heroin, Dilaudid®, and—yes—methadone and buprenorphine at our offices.
- RELEASE THE BALL AND CHAIN
Our patients are tired of being physically dependent on a substance, whether it is prescribed legitimately by a health care provider or procured by less than legit means. Both buprenorphine products and methadone as mentioned earlier create physical dependence and are highly controlled. People tell me they have sacrificed going on vacations because of the hassle of finding a ‘guest clinic’ in another city and the fear of losing their medications while traveling. Many people have had to actually give up jobs because the distance they have to travel and the time they must spend at the clinic to receive their daily methadone makes holding down a job impossible. By the time a patient seeks our help, they are not having fun with their drug. They are simply trying not to be sick.
- FAST AND EFFECTIVE
Depending on the amount and type of substance a patient is using, we can detox him or her in 3 to 8 days. A person on relatively low doses of pain medications without significant medical problems can be completely detoxed in three days. A person getting off high doses of methadone or Suboxone® can complete our detox in eight days, a process at the methadone clinic that would take several months. For our patients and their support people who do not have the luxury of limited time off from work, this feature is a godsend.
Dr. Coleman’s passion for helping free people from their addictions began with his own recovery beginning in 1986 and then blossomed within a small but busy practice in Richmond, Virginia. As people in the community grew to know Dr. Coleman’s commitment and compassion, his reputation grew. It wasn’t long before people sought his help from all around the country, and even from other countries.
As his unique approach received more and more recognition, Dr. Coleman invited other doctors to come to Richmond for training. This growth has resulted in several clinics around the country with all the providers trained in the protocols of the Coleman Institute. Currently we have offices in 12 major cities across the United States.
The convenience isn’t just about the multiple locations, however. The accelerated or rapid opioid detox program operates on an outpatient basis. This is one of the features our patients and their families appreciate most. The support people are able to work a quick visit into the clinic and are able to spend their day with their loved one. They can prepare their own meals, stay nearby in hotels or an Airbnb, or if local, in their own homes. I have seen many patients over the years turn the detox into an extended vacation of sorts, traveling to museums, beaches, and near-by historical sites.
- SAFE AND (RELATIVELY) EASY
Unlike other rapid opioid detox programs, the Coleman Institute does not use general anesthesia to put a person ‘under’. The complications of anesthetizing a patient increase dramatically with such a procedure, and it goes without saying, the patient must be in the hospital for such treatment. With a program like this, the person is completely sedated and all opioids removed at once. Rather than bring immediate relief and comfort, the patient actually experiences all the wrath of precipitated withdrawal upon waking from the anesthesia.
At the Coleman Institute, the patient’s support person is given medication and instructed in detail on how to keep their loved one comfortable. Many of our patients will sleep for several hours during the days of their detox; it’s not unusual that they come to us exhausted, and report finally being able to rest.
We are careful to manage our patients’ expectations, however. The way naltrexone works is to replace the opioids. This means each day a patient will receive a very small, calculated dose of naltrexone to push the opioid off the receptor so the naltrexone can begin to populate it. We ask our patients to be prepared to experience a couple hours of discomfort, but about twenty-two hours of relative comfort on most days of their detox. As I mentioned in Number 1, our patients are highly motivated.
We work with our patients to help create the right treatment program for them. We recognize that everyone has specific needs and situations, and our staff works to steer the patient into the most appropriate constellation of therapies available, keeping in mind financial and transportation constraints, familial and social obligations, and physical and mental health challenges.
During the early part of recovery and for at least a year, we strongly urge our patients to continue with long-acting naltrexone therapy. Patients are more vulnerable to relapse during this tender time. Coupled with the best possible counseling from an addiction-proficient therapist and working to restore the body’s health physically by incorporating good self-care (see an earlier blog article on restoring energy after detox here.) helps to set the groundwork for long-term sobriety.
At some point, patients will want to discuss the appropriateness of discontinuing their naltrexone. It is a conversation that warrants serious reflection on each patient’s level of commitment to their own recovery program, and our providers are well positioned to be an integral part of this decision process.
The real beauty of naltrexone is that when a person is truly ready to stop, there are absolutely no physical withdrawal symptoms.
To all our patients—past, present, and those yet to experience freedom from opioid addiction using naltrexone therapy-the staff of the Coleman Institute sincerely thanks you for choosing to work with us. We grow from each encounter with every one of you.
Joan R. Shepherd, FNP