A couple weeks ago I attended the funeral of an amazing woman who died at the age of 67 from Lou Gehrig’s Disease, or ALS. She had decided early on to make her dying process a gift to her loved ones. Printed on her memorial card was the question, “What does love require of me today?”

Ann completely embodied this notion as she lived her life to the absolute fullest extent. As her body diminished, her already robust spirit flourished even more.

So this question was very present in my mind as I witnessed the concept personified while working with Elliot and his mother the same week as Ann’s funeral.

Prescribed Suboxone® for Curbing Addiction

Elliot, now 37, started playing around with drugs when he was in high school. He tried everything, but his true love was opioids. A smart guy, he killed it in college, even with an active addiction to pills that ultimately morphed into a heroin habit.

Elliot met a girl and wanted to get straight and start a life with her. He went to a treatment program and was prescribed Suboxone® (a combination of buprenorphine and naloxone). At first he was on 8mg three times a day, which is not an unusual starting dose.

Suboxone® and a Recovery Lifestyle

Besides using a form of Medication-Assisted Treatment (MAT) for his Opioid Use Disorder, Elliot truly embraced a recovery lifestyle. He attended 12 step meetings and had a sponsor. He didn’t drink alcohol, smoke pot, or use cocaine. He maintained a daily meditation habit. He and the girl married and had a daughter. After eight years on Suboxone® and with their second child on the way, Elliot was ready to be off all medication.

Self-Detoxing Off Suboxone®

Elliot tried to work with the doctor at his treatment center, but was not really encouraged to stop taking the Suboxone®; in fact, the doctor actively discouraged him, basically telling him that his addiction was a life-long affliction, and he should probably continue to take this for the rest of his life, for his own good.

Elliot, now a little frightened that he didn’t have his doctor’s support to stop this medication, began to do some research about stopping it himself. Worried about letting his doctor know how determined he was to stop using buprenorphine because he was afraid they might oust him from the clinic, he was put in an awkward position of lying to the providers at the treatment program, who continued to prescribe ninety 8mg films a month. Elliot was able to quickly taper himself down to 8mg daily. He was surprised at how easy it was to do this and told me he experienced no side effects.

UNDERSTANDING ACCELERATED OPIOID DETOX


Trading One Drug for Another

In one to two week increments, Elliot reduced his Suboxone®, eventually getting himself down to 3mg daily. This is when the side effects started. Regardless of how slowly he continued his taper, Elliot found himself in a perpetual state of withdrawal.

This is one of the most common scenarios we encounter at the Coleman Institute for Addiction Medicine. Buprenorphine, the component of Suboxone® that occupies the opioid receptor, is a tenacious rascal. That’s why it is a powerful part of many people’s successful opioid use disorder treatment…but it’s also why it is so difficult to stop taking it.

The Coleman Method

Our program dislodges the buprenorphine from the opioid receptors in tiny increments over about a week, requiring brief daily visits from the patient and the support person. When the buprenorphine is off the receptors, the patient can then begin using naltrexone, which is a pure opioid blocker. We use long-acting naltrexone in the form of a small implant, which is placed under the skin in the abdominal area.

Our implant lasts approximately two months and slowly dissolves, completely populating the opioid receptors, therefore, alleviating physical craving for the drug.

Free From Suboxone®

Elliot’s detox wasn’t easy. Even with our comfort medication, booting the buprenorphine off the receptors caused some withdrawal symptoms. But Elliot was determined to be free from this medication that, while providing escape from all the complications of being addicted to heroin, ultimately ensnared him in a completely different kind of cage.

This detox asks a lot of the support person, and it was always gratifying to be with Elliot and his mom, who was ‘boots on the ground’ all the way. Elliot had timed his detox during his paternity leave, and his mother in law was back home helping with her new grandson and Elliot and his wife’s first child. It was truly a love story with multiple plots, with each participant fully responding to the mandate, “What does love require of me today?”

If you or a loved one is ready to embrace a life free from opioids such as heroin, fentanyl, oxycodone, hydrocodone, or tramadol (or even kratom or loperamide), please request a callback today.

Joan Shepherd, FNP

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