It happened again.

The office phones had just transitioned to the answering service for the evening when a call came through from a patient who had completed an accelerated opioid detox (not to be confused with ultra-rapid (anesthesia-using), hospital-based detox) three days earlier.

Jimmy (not his real name) is a 40-something, big, strong, smart man in the construction business. He works on high-end projects in the Richmond area and he was not feeling good.

“I’ve got no energy. I’m dragging myself to work, but I don’t remember ever feeling this tired. Is there anything you can prescribe or anything I can take over the counter?” He was almost pleading.

One of the calls we field the most and one of the topics we address during the detox is how a person will feel after they complete their own rapid detox off opioids. Whether the opioid is heroin, fentanyl, oxycodone, hydromorphone, oxymorphone, hydrocodone, tramadol, (increasingly) kratom, methadone, or buprenorphine (to name a few), it is simply going to take some time before the brain’s dopamine is restored and the energy returns.


Although I can’t be specific about each particular person’s recovery time, a patient can usually count on the toughest phase to last from 2 weeks to 2 months. During this time, lack of energy, appetite, and sleep are the norm. I base this statement on my almost twelve years of working with people recovering from opioid dependence.

Patients who continue to follow up with us and stay on naltrexone, one of the three evidence-based options for Medication-Assisted Treatment (MAT) for Opioid Use Disorder, continue to feel better and better, with improvements in energy, sleep, appetite, and anxiety.

I spent a few minutes reminding Jimmy about the image we had looked at together of how the brain’s dopamine is depleted when opioids are stopped after extensive use. I suggested he stay incredibly well hydrated and use medication we provided to help him sleep in the short term. I also suggested—with a little hesitation—because I guess I have some stereotypes about big strong construction workers journaling, that Jimmy keep written track of a few markers of his progress, both physically and emotionally. Things like:

  • Creating good sleep hygiene habits
  • Having at least two meals of his day be something good for his body and not overly processed, high fat and carb food
  • Close attention to how much water he’s drinking
  • Doing one thing specifically for his recovery—attend a meeting, read some inspiring recovery literature, connect with a sponsor, listen to a podcast to reinforce his decision to get off opioids

To my great surprise, he said, “That sounds like a great idea.”

The other stereotype Jimmy kind of crushed for me happened when his voice wavered and he told me that we had ‘saved his life’. That ever since he became dependent on opioids, he had been trying to stop using them and nothing else had worked for him. He said he had absolutely no cravings. He couldn’t believe it.

No bravado, no ego, no machismo…just gratitude and humility.

Perhaps this is why I have never worked in another setting for as long as I have practiced at the Coleman Institute for Addiction Medicine. I am truly touched by my patients every day.

Call us at 877-773-3869 when you are ready to stop. You will get through to the other side of freedom.

Joan Shepherd, FNP



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