“Please, Ms. Shepherd,” my patient begged, “please remove this naltrexone implant. I don’t want it anymore…”

Evelyn is a 42-year-old high school teacher in New Jersey, and quite frankly, had one hell of a year in 2020. While all teachers deserve medals for Resilience and Creativity in the Educating-During-A-Pandemic realm, Evelyn’s job was further challenging because she works with special needs children. Her high school students have learning disabilities, many with limited access to internet services.

In addition to trying to keep her students engaged and learning, on a personal level, Evelyn was devastated. Her mother had died from Covid and of course, neither Evelyn nor her siblings were allowed to be with her in the hospital.

Like so many others, Evelyn and her family were robbed from celebrating her mother’s life with a meaningful funeral service. Evelyn found that her mind was racing with thoughts and anxieties she had no power to stop.

A History With Opioids Became A Crutch

In her twenties, Evelyn had briefly dabbled with opioids. She snorted heroin a couple times, was caught, and her parents intervened. But last year, as she found herself in a state of deepening anxiety and emotional pain, an old and astonishingly strong memory of the obliteration of feelings that came with her brief dalliance with street pills and heroin, she began to obsess over finding that peace again.

It was easier to find opioids than she thought. ‘Respectable’ people hooked her up. And she justified to herself that it was pills, not heroin. Buying them on the streets kept her out of the doctor’s office and minimized her own possible exposure to the dreaded Coronavirus.

Dealing With Opioid Cravings and a Career

Within several months of taking these pills, Evelyn couldn’t lie to herself. She experienced withdrawal if she didn’t have a pill within four to five hours. Stacked on top of each other like a batch of ten-ton hotcakes were the responsibilities and challenges of her career, dealing with the loss of her beloved mom, and now, a very real addiction to street pills.

Evelyn’s career in the education world with special needs children involved motivating and inspiring these young people. She could barely lift herself to seek help, feeling like such a hypocrite. How could she ever expect her students to do the right thing when she herself had succumbed to such depths? How ashamed her mother would be. She tortured herself with these dark thoughts. Her depression deepened.

Family Support To Strengthen Outpatient Detox Treatment

Evelyn has family near Richmond who acted immediately when she reached out, swaddling her with support. They helped her look for treatment options and, after eliminating Methadone and Buprenorphine as her preferred form of Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD), she chose to come to the Coleman Institute for Addiction Medicine and have an Outpatient Accelerated Opioid Detox. The Coleman Method has focused on using this 3rd form of MAT to treat OUD for over 20 years: long-acting naltrexone.

Upon arrival, Evelyn’s urine revealed that what she thought was oxycodone was actually pure fentanyl. She was surprised.

(We weren’t. Fentanyl is in everything bought on the street.)


UNDERSTANDING ACCELERATED OPIOID DETOX


Naltrexone Therapy for Recovery Support

Evelyn had some of the usual side effects one might see during an opioid detox, especially detoxing off fentanyl, but with several comfort medications and 24/7 support from our knowledgeable staff, she got through it in five days. We placed a naltrexone implant, and Evelyn went back to stay with her family for a few days before returning to her home and resuming teaching.

About a week after the detox, Evelyn called the office. She was supposed to go back to work in two days, and she could barely drag herself out of bed. She had no energy, no appetite, and she still felt queasy. She had other issues that were not typically seen as part of a post-detox package. She was convinced these symptoms were the side effects of naltrexone.

It's true that any medication has side effects, and naltrexone is no exception. The things she was feeling could have been attributed to naltrexone and Evelyn was desperate to feel good-- certainly to feel good enough to return to her challenging job.

“I just need you to take this implant out,” she said.

Low Energy After an Opioid Detox

Because opioids flood our brain with more dopamine than it was ever meant to have, most people who stop opioids, whether prescription medication from a doctor or drugs bought off the street, will feel a great loss of energy, especially in the early part of the brain’s recovery.

How Long Does Low Energy Last After Stopping Opioids?

I am asked this question frequently, and I still don’t have a single one-size-fits-all answer. I always tell my patients to expect low energy after their opioid detox. When our patients return for follow up or we have a virtual follow up, it’s one of the first questions I ask. How is your energy? Are you starting to feel normal again? How are you sleeping? How is your appetite, your ability to concentrate?

And the answers are all across the board.

One of my patients who’d been on opioid pain medication supplemented by street fentanyl said he felt better precisely at “four weeks and three days”. I just followed up with a CEO of a thriving business who started taking pills for energy. She felt better in the time it took to remove her sutures, about 12 days later.

Others experience a more amorphous return to normal—they suddenly realize one day that they haven’t had the thought, “how will I get through this day? I’m exhausted…” But I think the most common experience our patients have is the ‘wave pattern’. People will experience a ‘wave’ of Post-Acute Withdrawal Symptoms (PAWS) and then have an interval of feeling pretty good. Then another wave, another interval, and so on. Ultimately the waves lose their amplitude and the intervals between the PAWS gets longer and longer.

Do The Side Effects of Naltrexone Mimic Opioid Withdrawal?

But Evelyn struggled more than our usual patient. She extended her time off from work for more than a week. She was convinced her symptoms were coming from the naltrexone. She had researched this online and was gathering evidence to support her growing belief. Listening carefully to her concerns, I suggested she follow up with her primary care provider rather than jump to the conclusion that everything she was experiencing was caused by PAWS and naltrexone side effects. Some things just weren’t adding up.

Therefore, I was unsurprised when I heard from Evelyn last week that, indeed, her blood work revealed an iron deficiency and a thyroid problem, and both were now being addressed. She was feeling good. She was talking to a therapist. She was attending 12-step recovery meetings via Zoom. And then she asked me, “Do I need to schedule my next implant, or will someone call me?”

I stopped my answer in mid-sentence. “Evelyn, did you just hear yourself? Do you remember when you were begging to have the implant removed? And here we are, talking about scheduling your next one!!” She laughed—it was the first time I’d heard her laugh and it was a beautiful sound.

Removing Opioids From Your Brain is a Process

Getting off opioids is difficult but it’s not impossible. The Coleman Institute for Addiction Medicine can get you safely started by removing the opioids from your receptors and replacing the receptors with naltrexone. Low energy and mild side effects are to be expected temporarily, but our patients agree: the reward of finally—safely—being in recovery is well worth it.

If you have any questions, please schedule a callback with one of our Care Advocates. We are here to help.

Joan R. Shepherd, FNP


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