Richard Rohr, author of Breathing Under Water, Spirituality and the Twelve Steps, writes in his newsletter about how it is so much easier for many people to have a relationship with a process or a substance than with a person. Unlike objects, people are so unpredictable!
Turning to a drink, a purchase, a drug, or a device can quickly change our superficial mood. We don’t have to sit with our boredom, discomfort, or anger. This does, however, short-circuit our ability to grow up and move beyond whatever is in our way.
In Denial and Justifying Opioid Use
Maya sought help at the Coleman Institute for Addiction Medicine when she had had enough of justifying her opioid use to herself. She was quite good at being in denial about taking pills because she was a recovered alcoholic, abstinent for the last 22 years. She told herself how strong her recovery was as she continued to attend meetings, share with others, live in gratitude for her sobriety from alcohol, and consume approximately 160mg daily of various opioids — some prescribed and some bought from “friends.”
Maya had suffered with severe sciatica pain down her left leg. This led to back surgery about 6 years ago. Prior to that, she was medicated by her primary care provider with a combination of Tramadol and a hydrocodone product. She took them exactly as prescribed, but was also aware of how much she loved the feeling in her mind and body as the opioids did their work. As her body developed a tolerance to these medications, her doctor dropped the Tramadol and switched her to a hydrocodone/oxycodone regimen.
From Innocent Prescription to Substance Use Disorder
After surgery she left the hospital with Dilaudid® and a feeling of deep relief that the shooting pain down her left leg was gone. But the opioids had their clutches deeply entrenched on her opioid receptors. Stopping was not going to be an easy option.
"And to be perfectly honest, there was a part of me that really didn’t want to stop anyway," she told me. She liked the energy she got when she took the medication.
For several months — and this was a surprise to Maya — it was fairly easy to get refills of the Dilaudid® from her surgeon’s office. She simply called and asked, then picked up the scripts from her pharmacy. Finally, he stopped refilling the scripts and then it became a real battle to have her primary care provider resume prescribing for her. She described her fear of withdrawal and the PCP reluctantly put her back on oxycodone with the forewarning that there would be an intentional and precise taper to get her off completely. She gratefully agreed to his terms, but any time the subject of the taper came up, Maya was able to persuade her providers (the practice was large enough that she saw physician’s assistants, nurse practitioners, and doctors) that this dose was reasonable and kept her functioning and pain free.
The Physician’s Dilemma of Opioid Prescriptions
Because of the opioid crisis and the trail of misery and destruction that overprescribing has produced, physicians and other medical providers have been re-educated about using narcotics for pain management. This has created a backlash and many providers have made the decision to stop including pain management as part of their practices at all.
I cannot tell you the number of patients who have contacted the Coleman Institute in desperation because they have received a call or simply a recording from their opioid prescriber, abruptly announcing that these services are no longer being offered. Time and again I hear frustrated people tell me, “The people who abuse these medications are ruining it for those of us who truly need it, who are experiencing real pain.”
Withdrawal Symptoms and Detoxing Off of Opioids
Maya had been around enough people in recovery to have heard horror stories about withdrawal. She started quietly making inquiries and found other sources of pain medication. It was quite expensive, but she told herself she wasn’t hurting anybody, she had a good job, and she could use her money as she pleased.
Maya continued living this fragmented lifestyle for several years, compartmentalizing her image of herself as a woman in recovery from alcohol, sponsoring others and attending meetings alongside the other Maya who, in her mind, deserved and needed pain medication and had to take the initiative to care for herself, which meant supplementing prescriptions with illegally purchased drugs.
UNDERSTANDING ACCELERATED OPIOID DETOX
Dr. Peter Coleman, our founder and National Medical Director, tells of a time when he was in treatment, still not quite convinced he truly had a problem with drugs. As a young doctor, he felt that much of his drug use was really a scientific inquiry into understanding the effects of these medications. He was challenged with a paragraph from the Big Book, Chapter Five: “Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.” It got his attention.
Notably, this same passage was being discussed at the meeting where Maya finally allowed her denial to dissolve.
Safe and Effective Method for Accelerated Opioid Detox
She knew about the Coleman Institute for Addiction Medicine in Richmond, Virginia; she had actually referred many people to us for safe, medical outpatient alcohol detoxes over the years. Now, she knew, she needed our help.
Getting off opioid pain medications is difficult. When a physically dependent person is denied their medication, the body rages against it with nausea, vomiting, diarrhea, body aches, ‘kicks’, and more. These symptoms are even worse when a person has turned to street drugs such as the — sadly — extremely affordable and accessible, fentanyl.
The Coleman Method for withdrawal management (also known as detox) provides a compassionate solution for those who find themselves in the grip of this situation. Our outpatient Accelerated Opioid Detox includes a minimum of five different comfort meds to mitigate the symptoms of withdrawal. Each patient brings the support person of their choice. Over a three-to-eight-day period, depending on what medication is being stopped (methadone and buprenorphine products require the longer timeframes for successful accelerated detoxing), the opioids residing on the receptors are replaced with naltrexone, a non-addictive opioid antagonist that will essentially block other drugs in this class.
Naltrexone Gives the Best Chance for Lasting Success
Using long-acting naltrexone at the completion of the detox affords the brain the opportunity to begin the healing process, producing its own dopamine stores again, and allowing the patient to begin building a drug-free life. Coupled with the medical aspect of our program is the support provided by our Case Management team, who work with every patient to find the most successful treatment regimen going forward. The treatment will look different from patient to patient, as we recognize how difficult it can sometimes be to navigate those waters without help.
Maya checked in for her second naltrexone implant last week, opioid-free for two months. Humbled to her core, she talked about the relief she felt not having to live her double life. She opted to attend an IOP (Intensive Outpatient Program) which we helped her locate. Her energy and sleep have returned to normal, although the first two weeks were challenging.
There are very few programs that help people get off opioids — whether pharmaceutical grade medications or street drugs — and onto long-acting forms of naltrexone. The FDA has provided guidelines to prescribers to help them taper patients off this type of medication, but in most cases, it is a lengthy and drawn-out process. For people who prefer an Accelerated Detox in an outpatient setting rather than months of tapering, the Coleman Method may be the right fit. Several insurance companies, including Blue Cross Blue Shield, Humana, Tufts, and Optima/Sentara, have recognized the importance of this option and cover the cost on an in-network basis.
Schedule a callback below to speak with one of our Care Advocates and start your path to freedom from addiction.
Joan Shepherd FNP
