The Coleman Institute Blog


Sep 16

September 27, 2016

Help for Chronic Pain Patients

By Peter R. Coleman, MD

A lot of the patients who come to us to be detoxed off opiates have never used street drugs. They are chronic pain patients who have become dependent on opiate pain medicine prescribed to them in a doctor’s office.

These are patients who started on narcotic pain medication for significant painful conditions, but they are now stuck on the medicine and unable to stop on their own. It can be a very cruel situation because they are taking chronic pain medicine, but they are still in a lot of pain. Sometimes, they become dependent on the opiate pain medicines because they had to take the medicine for such a long period of time. This caused their body to become very dependent on the painkiller medications.

Sometimes, they had a pre-disposition for addiction, so the opiate pain medicine very quickly set off a physical dependency. In other situations, they had a previous addiction to alcohol or other drugs, and now, they have been prescribed narcotic pain medicines and that quickly leads to them being becoming addicted to this new medicine.

When these opiate pain medicines are taken over a lengthy period of time, they change the brain and the body in ways that are not helpful. Chronic pain is quite different from acute pain. In an acute pain situation, like a broken bone, the brain responds well to the pain by making its own natural endorphins and any pain medicine works well to supplement relief. But, in a chronic pain situation, opiates are often taken over a prolonged period of time. When opiate medicines are taken over a protracted period, tolerance starts building up rapidly so that the same dose of medicine loses its effectiveness, and then, people need more and more in order to receive the same effect.



Sep 16

September 27, 2016

Post-Opioid Detox Peace

By Joan R. Shepherd, FNP

Patients who come to The Coleman Institute for a rapid opioid detox return every two months for their follow up naltrexone implants. I must admit it sometimes takes me a few minutes before I completely remember them.

There are a couple reasons for this. One: I’m getting older. Two: people look so different when they have been off these drugs for two months. They are happier and healthier. Those who had lost weight because of drug use have regained weight, and those who were bloated tend to lose weight. Eyes, hair and skin reflect the absence of the toxins.

However, there are those patients that are very easy to remember, from the first visit to the most current. Troy* is one of those.

On the first day of Troy’s detox, he was ebullient. He bounced off the walls with enthusiasm for his new chance at sobriety. He talked and talked and talked. Very funny, very charming, flashing his great smile at everyone who came in–kind of like a big kid, a little over the top, really.




Jul 16

July 24, 2016

New Suboxone Limits for Physicians

By Peter R. Coleman, MD

Recently, the U.S. Department of Health and Human Services decided to increase the number of patients that physicians can treat with Suboxone. Beginning around 2002, physicians who went to a training program have been allowed to prescribe Suboxone for up to one hundred patients. This has become an important treatment option for opiate-dependent patients and has undoubtedly led to many patients stabilizing their lives and committing to long-term recovery.

When determining rules for Suboxone treatment, the government intentionally chose a design that was different from methadone programs. Methadone was approved as a treatment for opiate addiction around 1970. Because it is an addictive and abused drug, it could only be given out in licensed clinics. Restrictive regulations were put in place, including required daily attendance at the clinic, and supervised consumption of medications. In some ways, the regulations contributed to the problem. It is difficult for patients on methadone to travel or hold a job, and they are regularly exposed to other actively using drug addicts. In order to avoid the same consequences, rules for Suboxone were designed to allow a physician in private practice to prescribe Suboxone type products for up to one month or longer. There were, however, no requirements for counseling, drug testing, or any other case management services.


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Jun 16

June 28, 2016

Medication-Assisted Treatment – MAT

By Peter R. Coleman, MD

Recently, the New York Times ran an article proposing that most opiate addicts should receive Medication Assisted Treatment (MAT). I couldn’t agree with them more.

Success rates for patients with opiate addiction who are not treated with any form of MAT are horrible. An important study I have quoted for many years made this abundantly clear. The study was out of Seattle. It followed 124 patients who went into a hospital to start their recovery from opiate addiction. About 26% were not even able to complete the detoxification. The others were all offered good treatment options – 28 day inpatient rehab, outpatient counseling, recovery residences, etc. After 3 months, there were only 4 successful patients. This equates to a success rate of only 3%. And, all of these patients were motivated. They went into a hospital to get clean. But, there is something about opiate addiction that makes relapse so much more likely than other addictions. Hence, the need for MAT.




May 16

May 26, 2016

Online Porn May Damage Teenage Brains

By Peter R. Coleman, MD

The internet is a marvelous thing. It can bring us information at lightning speed and help us learn things, get places, and entertain ourselves. Some of us older folks can remember life before the internet, but it is hard for anyone to imagine life now without the internet. But new inventions can have unintended consequences.

There have always been some people who enjoy sexual arousal and new inventions have often been used to feed that appetite. Soon after photographs were invented, some enterprising fellows began to make pornographic pictures. When moving pictures were invented around 1900, it was not long after that there were pornographic movies being made and watched. And, so it is with the internet. From the earliest days of the world-wide web enterprising people started to make money by providing pornography online.

There has been, and always will be, a ready market for pornography – it excites the Dopamine part of our brain that is biologically wired for sex and survival. We are born with a natural strong desire for sex, and anything that excites that part of our brain has a strong influence on us. Did you ever notice that beer and car TV commercials almost always involve seductively clad women? Online pornography has taken this to a new level. The numbers are staggering. In the US alone, there are over 100 million visitors to adult sites every month. It has been calculated, just in 2015, there were more hours spent on one particular pornography website than the number of hours that Homo Sapiens have been in existence!


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