These were not my words, but the words of a patient who completed a 5-day opioid detox with us a few weeks ago. A couple of years ago, his detox would probably have been 3 days—he believed he was using a gram or a gram and a half of heroin a day—but when fentanyl was discovered in his urine, the length of his outpatient detox was increased.

This is both for his comfort and his safety.

At the Coleman Institute for Addiction Medicine, we have been getting people off opioids safely and comfortably for over twenty years, and the recent ubiquitous presence of fentanyl has definitely caused a change in our protocols. I am always curious about how a patient finds us. Was it word-of-mouth? Or an online search? Tony (not his real name) said he had searched "the easiest and fastest way to detox off opioids" and "the most painless way to get off opioids" in Google.

Is the Fastest Way to Detox the Right Way to Detox?

Some years ago Dr. Coleman, like a handful of other doctors, was performing Ultra-Rapid Opiate Detoxes (UROD or URD) for people on the path to freedom from their Substance Use Disorder. This entailed a stay in the hospital and having all the opioids removed from their respective receptors while the patient was under general anesthesia. There is no doubt that flooding a person with naloxone and/or naltrexone will eliminate opioids “ultra-rapidly.”

However, this abrupt method is far from gentle or comfortable. Patients waking up from being anesthetized experienced all the profound withdrawal one might expect. Plus, using general anesthesia adds another layer of complexity and potential complications.

Outpatient Detox is a Better Treatment Experience

After seriously considering all the pros and cons of doing Ultra-Rapid Detoxes in a hospital setting, Dr. Coleman came to the conclusion that an outpatient procedure just made more sense. It accomplishes the same result—helping people get off pain killers and other opioids—but in a more comfortable, safer, and more affordable way. Furthermore, the outpatient detox experience allows for dialogue between the patient, the patient’s support person, and our knowledgeable staff. Not much conversation happens when a person is under anesthesia.

While the opioid withdrawal process is accelerated from a 7-10 day cold turkey experience (or much longer in the case of buprenorphine or methadone), I am reluctant to tell an inquiring patient that our detox is easy. That being said, we do all we can to make it is the most comfortable experience possible for people desiring to get off drugs like Percocet®, Vicodin®, Fentanyl, Opana®, Roxicodone®, Dilaudid®, Tramadol, Methadone, Suboxone, heroin…and now, more and more, kratom.

Finding the Right Detox Treatment For You

Tony himself was an extremely satisfied customer. Having detoxed cold turkey on several occasions in the past, he couldn’t bear the thought of doing it again that way. These past painful memories kept him locked into continued use. He had tried kratom and Suboxone bought off the street to detox himself but just couldn’t make it last. Finally, in desperation, typing the search words into the computer, he found the Coleman Institute.

I don’t want to say Tony "breezed through" his detox, but I will say, it was one of the smoothest detoxes I have worked with, and I’ve been doing this for over thirteen years. (Dr. Coleman has been doing this for over 25 years.) We tell our patients to expect to feel a couple of hours of relative discomfort and then about twenty to twenty-two hours of feeling okay.


UNDERSTANDING ACCELERATED OPIOID DETOX


The Dangers of Going Cold Turkey

Retching, vomiting, diarrhea, severe stomach and muscular cramping are the usual consequences of abrupt opioid withdrawal. Is it actually dangerous?

Perhaps people with comorbidities who suffer extreme dehydration and potential electrolyte imbalances from the gastrointestinal effects of a cold-turkey opioid withdrawal are at risk for serious medical consequences. But for most people, opioid withdrawal is simply unbearable—and terrifying. I think this is what prevents so many from discontinuing their opioid use or abuse. Patients who use opioids recreationally and come to the Coleman Institute for Addiction Medicine quickly acknowledge that they are not having fun or getting high any longer; they are simply loathed to stop using these substances because of the excruciating physical discomfort.

How an Outpatient Detox Using The Coleman Method Works

Our process is to use micro-doses of naltrexone each day to displace the opioid from the receptor. The naltrexone is the workhorse of the operation and it is not snake oil—as the naltrexone takes the place of the opioid on the receptor, patients are likely to experience some withdrawal symptoms.

Tony and his support person’s first day at the office involved completing paperwork and being educated by our staff on the details of administering comfort medications. We also do blood work and get an EKG at the initial visit. Tony received his first micro-dose of naltrexone prior to leaving.

At each subsequent visit, we met with Tony and his father to hear how things went, review and adjust the comfort medication as needed, and administer ever-increasing micro-doses of naltrexone. An accelerated detox off methadone or buprenorphine products is usually an eight-day procedure. Short-acting opioid detoxes are generally scheduled to last for five days. The final day is the longest, as we hang an IV and remove any traces of opioids that might be left on the receptors before placing a long-acting naltrexone implant.

Comfort During an Accelerated Opioid Detox

Because the micro-dose naltrexone has been bumping the drugs off the brain’s receptors incrementally each day—and the body has been naturally eliminating the drug—the final day is usually pretty comfortable. (We always offer our support person a nice meal from a menu of great local take-out places, because we anticipate they will be with us through lunchtime and finish up in the afternoon).

Sometimes I suggest that patients visualize a huge boulder being pushed out of a hole and being replaced with a beautiful tree. By the end of one of our Accelerated Opioid Detoxes, a "forest" of naltrexone populates the receptors, leaving no empty spaces for opioids to land.

In Tony’s case, he had never before had five comfort medications offered during a detox. (His father, the chosen support person who stayed with him throughout the entire process, admitted he had once purchased 2 fifths of vodka to get his son through a tough detox in the past). Tony’s worst detox symptoms were chills and a jerking sensation in his arms and shoulders. Again, these did not last more than two hours, nor were they debilitating. The medication and several warm showers helped greatly with his symptoms. Plus, our staff is available 24/7 if either the patient or the support person is concerned or has questions.

Finding The Right Detox Treatment Facility

Finding a reputable place to help someone responsibly and safely get through an extremely difficult process is even more challenging. The Coleman Institute started with a single office in Richmond, Virginia, and because of its unique approach—providing an accelerated, outpatient process using naltrexone as its main MAT (medication-assisted treatment)—we have grown to train providers in 12 different states.

Perhaps your search will end here, as well. We promise a highly-skilled, compassionate staff that will provide you with what is likely the safest and most comfortable—opioid detox on the market. Please call or schedule a callback if we can answer any questions.

Joan R. Shepherd FNP


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