A recent publication by Health and Human Services (HSS) reports that opioid prescriptions in the US peaked at 255 million in 2012 and decreased to 191 million in 2017.

Prescribers—and the rest of the world—have become well aware of the unanticipated consequences of over-prescribing opioid pain medications. And although we know escalating the dose of a patient’s opioid pain medication can cause harm, so too, can quickly reducing a patient’s long-term opioid analgesics.

The Coleman Institute for Addiction Medicine has heard from many people who have been prescribed opioid pain medications for years. These medications include, but are not limited to: Oxycontin®, Opana®, Vicodin®, Roxicet®, morphine, fentanyl, and methadone. These people have been caught in the sometimes knee-jerk reaction as their doctors, interpreting the message to reduce long-term opioid analgesics, have tapered their patients too quickly or abruptly stopped prescribing.

What happens When You Discontinue Your Meds Too Quickly?

The recent HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics lists the risks of rapid opioid taper:

  • Significant withdrawal: Feelings of exhaustion, anxiety, trouble sleeping, and irritability spike during a rapid taper off of opioids. These feelings pose a risk for relapse and therefore should be mitigated with the help of a medical professional.
  • Exacerbation of pain: Opioids cause the body to produce excess endorphins and dopamine, causing an irregularity in these naturally occurring processes. When the opioids no longer over-aid this process, the body feels pain until the brain heals and can self regulate these chemicals once again. Forcing yourself to do this too quickly can be physically excruciating.
  • Serious psychological distress: Withdrawal symptoms are intense for anyone to deal with alone. Bringing on too many too quickly can take a toll on one’s psychological health. Feelings of isolation and constant stress can occur when moving too quickly through a tapering process.
  • Thoughts of suicide: Thoughts of suicide are an especially insidious symptom of withdrawal. The combination of physical dependence and emotions returning to the surface rapidly of one’s mind can be overwhelming. If you are having thoughts of suicide it is vital to speak with someone immediately. The National Suicide Prevention Lifeline can help 24 hours a day by calling 800-273-8255.
  • Seeking illicit opioids as a way to treat their pain or withdrawal symptoms: Unfortunately, it is common for those looking to treat their withdrawal symptoms by trading in one substance use disorder for another to help cope with the loss of the previous substance. Being kind to yourself is helpful by not forcing a recovery process too quickly.

Therefore, “unless there are indications of a life-threatening issue, such as warning signs of impending overdose, HHS does not recommend abrupt opioid dose reduction or discontinuation.”

They suggest several reasons for prescribers to continue tapering to a reduced opioid dosage or discontinuing altogether. These include the patient requesting their medications be reduced or discontinued, pain and function are not noticeably improved on the medication regimen, or the patient is receiving higher opioid doses without evidence of benefit from the increased amount.


UNDERSTANDING ACCELERATED OPIOID DETOX


These tend to be the main reasons patients seek the expertise of the Coleman Institute. While we also serve people who have become addicted to illegal or street drugs, a large percentage of our patients have been taking their medications exactly as prescribed (with maybe a few exceptions) and are ready to stop.

How Does an Outpatient Opioid Detox Work?

Gone are the days of detoxing alone in a clinic, with your life passing you by. Our outpatient opioid detox means you don’t have to put your life on hold or let responsibilities go awry.

With an outpatient opioid detox at the Coleman Institute, you are able to come into one of our locations, bringing your support person with you, for your treatment. Treatments typically last an hour but will be dependent on your specific situation. Once your treatment is completed, you return to the comfort of your own home or hotel! No uncomfortable overnight stay in a stale, cold clinic.

Can You Detox From Opioids in 3 Days?

The Accelerated Opioid Detox using the Coleman Method helps people shorten the opioid detox process. Each patient has their support person with them 24-7 so we are able to administer plenty of comfort medications as the opioids leave the body. This outpatient approach uses a sedative medicine and Naltrexone to help patients detox in as few as three days. This is also dependent upon the health and age of the patient and the amount of medication a patient has been taking.

For specific patients, the longer end of the range is for people desiring to get off long-acting opioids such as methadone or buprenorphine. This accelerated detoxification can be between 3-8 days, respectively.

Are You a Candidate for a 3 day Opioid Detox?

Recognizing opioid addiction can be difficult at times for patients. Opioid addiction is often characterized as a powerful, compulsive urge to use opioid medication, even when a patient generally is no longer required medically. Many patients also realize that opioids can have a great potential for causing addiction yet still be unaware in predicting if they are vulnerable or abusing the drug. In many cases, even when the medication is prescribed appropriately and taken as directed it can still cause intense craving and feel like something you can't live without.

Because opioids trigger the release of endorphins, your brain also may feel-good and distract from the specific perception of pain, yet when the opioid wears off you can find yourself "craving" as soon as possible. Hence, safe choices that are made available such as accelerated detoxification.

Importantly, this method, which Dr. Coleman has taught to providers around the country, is an outpatient procedure. Our patients are able to stay in the comfort of their homes, local hotel or Airbnb®, with their family during the entire detox procedure. Time in our office is spent reviewing medications, answering questions, and meeting with aftercare staff to plan out the next steps upon returning home.

If you are questioning your need to be on long-term opioid analgesics, please give our office a call. You may find, as most of our patients do, that your body is able to handle pain far better than you ever thought, or that the pain is actually far less than when opioids were first prescribed.

My colleagues and I look forward to working with you or answering any questions. You can reach us at 877-773-3869 for information on our programs.

Joan R. Shepherd, FNP

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