I’m a medical professional in the substance use/addiction field. When I started in this business about 13 years ago, the most common situations our patients presented with were their struggles to get off methadone, prescribed pain medication, or heroin.

Nothing much has changed with our Accelerated Methadone Detox. This remains an eight-day outpatient process. Because of the long half-life of methadone, the Coleman method requires the extra time to ‘nudge’ the methadone from the receptors with daily micro-doses of naltrexone. This is similar to a person who wants to get off Suboxone® or other buprenorphine products.

What Is the Timeline for a Fentanyl Detox?

A person prescribed up to about 200mg daily of short-acting pain medication such as oxycodone, Roxicet®, or members of the hydrocodone family can generally expect to successfully complete a three day outpatient detox with us. The time is extended for people on higher doses or with certain medical comorbidities.

The same was true for heroin. Many of our patients turned to heroin when they could no longer get pain medication from their doctors, or their tolerance to the prescribed medication had become so high, they needed more and stronger drugs. Heroin was easy to find and relatively cheap, especially when compared to buying pills on the street. We regularly provided a three-day detox for people who wanted to get off heroin, and for the great majority of our patients, this time frame was the sweet spot.

The Heroin Impact on Fentanyl Detox

A few years ago things started to change. It started with reports of not just one person overdosing, but multiple people at the same time and place. People would come in for a detox off heroin, but their reactions to the micro-dose naltrexone was barely tolerable. The detoxes were becoming more and more difficult. We didn’t even know to test for fentanyl at that time, but that’s exactly what was going on. More and more, fentanyl was being cut into heroin, and our patients were suffering.

UNDERSTANDING ACCELERATED OPIOID DETOX


Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It was first used in the 1960’s as an intravenous anesthetic, and is still legally manufactured and distributed in the United States as a Schedule II prescription drug, used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.

Customized Regimen For Suspected Fentanyl Addiction

Although we did not see many people on clandestinely produced fentanyl as early as 2011, the DEA reports that is when the deaths from fatal overdoses started increasing. According to the Centers for Disease Control and Prevention, fentanyl analogues were involved in roughly 2,600 drug overdose deaths in 2011 and 2012. The years following this saw dramatic increases in these numbers. In 2018, 31,335 deaths were attributed to synthetic opioid and illicit fentanyl overdoses! This is completely consistent with what we were seeing at the Coleman Institute for Addiction Medicine.

As we became increasingly aware of the prevalence of fentanyl, our protocols evolved as well. Today we treat every patient with known or suspected fentanyl addiction with a bespoke regimen of multiple comfort medications and extended days to accomplish it. This keeps our patients both safe and as comfortable as possible.

If you or a loved one would like to learn more about a fentanyl detox at the Coleman Institute in Richmond, Virginia or Wellesley, Massachusetts, please give us a call at 877-773-3869.

Joan R. Shepherd, NP

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Learn More About Fentanyl Detox With Joan R. Shepherd, NP