All week long our staff has had the pleasure of working with Juliette who came to us for a dual detox off alcohol and buprenorphine. She couldn’t have chosen a better support person, her Aunt Leila, who is tough, wise, and adores Jules.

When I opened the door to get her started on the last day of her 8-day accelerated opioid detox off Suboxone®, Juliette and her aunt were quietly listening to a song on her phone. Their eyes were moist. I sat down and Juliette began to fill in her story for me.

Juliette is in her early thirties and, like her brother Jimmy, started playing around with drugs at an early age. There was definitely a family history of addiction. Her father was an alcoholic and was addicted to pain medication. Although he ultimately got sober, he was never able to re-connect well with his family.

Is Addiction a Genetic Disease?

Years of family drama made Jimmy and Jules very close; they were everything to each other. He was the one who turned her on to pot, and when they partied with others, he was always protective of her, especially around his friends. As Jimmy moved on to harder drugs, he began to put some distance between himself and Jules. He did not want her to tread down the same path. Eventually his drug use led to a conviction and Jimmy ended up in jail.

Meanwhile Juliette--beautiful, talented, and ambitious, completed studies and internships to become a head chef. By now, she had a baby boy and a tenuous relationship with his father. She visited Jimmy when she could, called, and described in detail the delicacies she would prepare for him when he got out.

During this time, except while pregnant, Jules’s drinking became a regular habit. She found the people she worked with in the service and restaurant industry loved to try different cocktail recipes and good wine. After a long shift, hanging out with coworkers was relaxing and satisfying. She was living with her mom and knew her son, JoJo, was safe. Lots of the staff used drugs and every once in a while, Juliette would take the random pill offered to her. She liked the way the pills made her feel, but after seeing what happened with Jimmy, Jules was careful not to let the pill use be more than occasional.


UNDERSTANDING ACCELERATED OPIOID DETOX


From Recovery to Relapse to Overdose

When Jimmy was released from prison, the reunion was as sweet as Juliette had imagined. No one could make JoJo laugh like Uncle Jimmy. His energy was contagious, and best of all, he came out of prison clean—and intended to stay that way. It wasn’t long before he found a construction job and was quickly moved to the position of a supervisor.

As the rest of the story began to unfold, Juliette struggled. “I don’t really know what happened…Jimmy had been out of prison and clean for two years. At some point, he started using heroin again.” He tried to hide it from her, but she knew something had changed. He didn’t come around as often as he used to, and when he did, he “wasn’t all there.” She and her mom tried to talk to him, imploring him to get help.

The last time Juliette saw Jimmy alive, he was almost like his old self she remembers. He enthusiastically had both Jules and their mom listen to his ‘new favorite song’, Where Rainbows Never Die by The SteelDrivers.

A week later, it was the song they played at his funeral.

From Downward Spiral to Detox

Jimmy’s overdose sent Juliette into a downward spiral. In spite of her successful position as head chef and her responsibilities as a mom, the loss of the most important person in her life was too much to bear. It wasn’t hard to find pills and heroin, which of course were mostly comprised of fentanyl. For two years, this is how Juliette managed her grief.

Over the years, I have often been moved by the stories of an intervening boss. In Jules’s case, the owner of the restaurant quietly offered her support. Jules accepted, and began to see a doctor for Suboxone. The street drugs stopped, although the binge drinking continued. When Juliette reached out to the Coleman Institute last month, she was finally prepared to stop both the drinking and the Suboxone.

At the Coleman Institute for Addiction Medicine, we help people get off street drugs like heroin, fentanyl, pressed pills, and kratom, as well as prescribed pain medications such as Percocet®. (Generics include oxycodone, hydrocodone, hydromorphone, morphine, etc.) We also offer outpatient alcohol detox and—in Richmond, Virginia—a Rapid Benzodiazepine Detox using flumazenil.

How Our Accelerated Opioid Detox Works

The format of our Accelerated Opioid Detox treatment is to ‘bump’ off the opioids in a safe and efficient timeframe and in an outpatient setting. This allows our patients to stay with their own support person in their own home, or if out of town, in a local AirBnB or hotel. Our patients come daily for micro-doses of naltrexone, based on the particular drug we are eliminating, and at the completion of the detox, we insert a long-acting naltrexone implant (in Richmond) or inject Vivitrol (in Wellesley). The long-acting naltrexone occupies the receptors where the opioids used to be.

The naltrexone implant dissolves over approximately a two month period and effectively blocks the use of other opioids. We encourage our patients to consider staying on a long acting form of naltrexone for at least a year.

A Safe and Comfortable Detox

Because Juliette had a dual Substance Use Disorder which included both Alcohol and Opioids, her detox was extended one day so we could safely address her stopping the alcohol without dangerous medical complications.

She completed both detoxes beautifully and is very excited to return to her work as head chef next week. As part of her treatment program, our Case Manager has also set Juliette up with a grief counselor.

While we were talking, I wrote down the name of the song on my hand, and have spent quite a while this morning listening to it. The phrase that is “riffing” through my heart right now is this one:

I will make my way across the fields of cotton
And wade through muddy waters one last time
And in my dreams I come out clean
When I reach the other side.

Schedule a callback below if we can help you or a loved one safely detox off an addictive substance that has taken over your life.

Joan R. Shepherd, FNP


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