Fred, a former patient at the Coleman Institute, was prescribed opioids for roughly 14 years. When a specialist treated this with Suboxone, he found himself needing treatment to detox off of Buprenorphine. Find out how the Coleman Institute helped Fred detox comfortably and quickly.
Many individuals are prescribed opioid pain medication for their pain conditions. When their specialist stops prescribing their medication, they might need additional treatment for their physical dependence on these medications. In many cases, addiction specialists will treat this with Suboxone. However, this medication (along with other Buprenorphine medications) can lead to an entirely new dependency.
Pain Patient Asks Himself: What If I’d Never Stopped?
Fred, age 68, is a financial advisor in a neighboring state who had a follow up appointment with me to refill his oral naltrexone.
Several years ago, in the midst of the US Opioid Crisis — but before anyone was truly connecting the dots and recognizing the alarming patterns of physical dependence and Substance Use Disorder that were emerging — Fred was being treated by his primary care provider (PCP) for multiple areas of pain in his body, especially low back and shoulders.
He had always been active and connected some of his back issues to football injuries sustained when he played in high school and two years of college. As an adult he became enamored with golf and took private lessons to improve his game and minimize back and shoulder problems. He had used a variety of different non-steroidal anti-inflammatories over the years, and there was some concern about the side effects of these medications. Eventually at a routine physical his PCP started him on Oxycontin, assuring him that as long as the pain was real, he could not become "addicted."
The Doctor Stops Prescribing Pain Medication
For almost 14 years Fred was prescribed oxycodone. As his body built a tolerance to the medication, the dose continued to increase. At some point, short-acting ‘breakthrough’ pain medications were added. At his highest dosing, Fred was taking about 400mg daily of combined long and short-acting oxycodone products.
One day Fred received a recorded message from his doctor’s office stating that all further appointments would have to be canceled and that patients needed to seek alternative providers. Fred was outraged and terrified. Although he had never run out of or lost his medications (he guarded them like a hawk), he knew how he felt physically when he experimented with cutting his dose down or waiting a little longer than scheduled to take his medication. Not good.
His frantic search to find another prescriber ultimately led him to the office of an addiction psychiatrist not too far from his home. This doctor introduced Fred to the concept of Suboxone; a medication that would allow Fred to reduce his medication to only once or twice daily while even helping with Fred’s back pain.
Fred transitioned to Suboxone (buprenorphine/naloxone) and was impressed with how well it worked. It didn’t make him as sleepy as the other medication. He felt good about this decision.
Treatment Can Become A New Dependence
Like many people who have switched to Suboxone or other buprenorphine products, he didn’t quite understand that it might be difficult to stop taking it. As time went on, Fred began to recognize the complications associated with being on this medication.
Although he could stretch doses out longer, he still experienced withdrawal if he missed a dose. He felt trapped. Even though he still had pain issues, he no longer wanted to be tied down by medication. His wife was also very concerned about his seeming obsession with his meds.
UNDERSTANDING ACCELERATED OPIOID DETOX
Fred found the Coleman Institute for Addiction Medicine in Richmond, Virginia and signed up for a detox off of buprenorphine. He only did this after multiple attempts at stopping the medication himself and not being able to tolerate the symptoms of withdrawal: stomach cramping, muscle aches, sleeplessness, and other disturbing flu-like symptoms.
Safe, Comfortable Detox with Naltrexone Therapy
The procedure to detox off Suboxone at the Coleman Institute is very straightforward. On Day One the patient and his support person come to the office and receive instructions for the next several days. These include when and how much comfort medication to take. The comfort meds are provided as well. The patient will meet with their assigned case manager to determine what other types of services will be most beneficial to their continued recovery after the medical detox is completed. Different people require different levels of aftercare, and our skilled staff collaborate with each patient to meet their unique needs.
Before leaving the office, a micro-dose of naltrexone will be administered to our patient. This will begin the process of removing the buprenorphine from the opioid receptors. Buprenorphine is very ‘clingy’ on opioid receptors and rather than a several weeks cold-turkey detox, the Accelerated Opioid Detox process reduces the time to about 8-10 days.
The micro-dosing of naltrexone continues on each of the following days until the final day when some form of long- acting naltrexone is given. A naltrexone implant, which is available at the Richmond office, will typically last about eight weeks. Other offices utilize an injectable form of naltrexone, which lasts for about a month.
Because naltrexone occupies the same receptors that buprenorphine and other opioids (such as heroin, fentanyl, Percocet, morphine, hydrocodone, tramadol, Dilaudid, etc.) occupy, patients no longer experience cravings for the opioid they had been using.
Increased Quality of Life and Ongoing Treatment
Fred completed his detox about two years ago. The period after a detox is generally associated with some Post-Acute Withdrawal Symptoms or PAWS, and for Fred the worst of it was getting his sleep back to normal along with his energy levels.
By about two months, he was astonished at how good he felt. He returned to our clinic for naltrexone implants every two months for a year, then switched to monthly Vivitrol injections for about six months before--after much discussion--we began to prescribe oral naltrexone, which he now takes daily. (This is not recommended for people early on in their recovery; long-acting forms of naltrexone are associated with much higher levels of success.
As Fred and I talked, he expressed how profound the decision to get off pain medication has been in his life. Not everyone is as articulate as Fred, and I grabbed a pen while he spoke and asked if I could quote him in a blog.
He said, “Time is precious; we don’t own it, but we can spend it…and I often wonder, what if I hadn’t done this? My work, my marriage, my relationship with my children….would all look so different now. I don’t want to have regrets; I want to be awake to experience all life has to give me.”
I can’t say it better than that.
If you or a loved one is wrestling with the idea of getting off pain medication or illicit opioids, you are so not alone. It is not necessarily an easy process, but it is simple. The conviction to change is the most important attribute you need. Especially now since many insurance companies are recognizing the value of helping to pay for an opioid detox.
If you have further questions, our experienced and kind staff are available to talk. Schedule a callback below.
Joan Shepherd FNP
