I had the great pleasure of seeing Pam last week at the Richmond office of the Coleman Institute for Addiction Medicine. Pam detoxed off Suboxone® two months ago through our accelerated outpatient detox process. With long-acting opioids, such as methadone and buprenorphine, the outpatient withdrawal management process is 8 days.

However, many individuals like Pam are always curious which treatment is best - Suboxone or Naltrexone, when it comes to completing a drug detox.

For many, opioid use disorder (OUD) is common and it is a disorder that millions of Americans suffer from. Whether you are detoxing off opioid substances such as Percocet, Roxicet, Vicodin, and heroin, or fentanyl it generally takes 3-5 days, depending on a few different factors; one being the treatment method.

While the most common and effective FDA-approved medications are Suboxone and Naltrexone, they both tend to differ vastly in terms of how they work, their effects, withdrawal symptoms, and the potential for overdose.

What is Naltrexone

Naltrexone is a common medication that has been used for many years when it comes to treating opioid use disorder. The way that Naltrexone works is that it trains the brain to treat dependence for opioids, it blocks the effects of opioid receptors and in turn decreases cravings and urges to use again. With Naltrexone, it comes in two forms - pill or injectable and once taken typically begins working within one hour of dose.

For many patients, the ability to take Naltrexone as a pill is oftentimes convenient as you can take the prescription from home and not have to worry about disruption in day-to-day life activities. Additionally, Naltrexone is typically recommended for individuals who haven't taken opioids for at least 7-14 days and have no history of liver disease, kidney disease, or hemophilia.

At the Coleman Institute, we find our patients that use Naltrexone Therapy as a detox "freed" of intense cravings with the ability to look beyond their physical symptoms in order to focus on a healthier tomorrow. We offer two specially formulated Naltrexone options for patients depending on their unique circumstances and both give patients weeks of support at a time.

For the best chance in a lifelong recovery from opiate addiction, we recommend that most patients continue with Naltrexone therapy for a year after completing detox to give them enough time to develop new, healthy habits.


UNDERSTANDING ACCELERATED OPIOID DETOX


What is Suboxone?

Suboxone is a detox treatment option that has two main ingredients which are Naloxone and Buprenorphine. Buprenorphine is a partial opioid antagonist that blocks opiate receptors and reduces cravings. Naloxone is the second portion which counters the direct effects of opioids. Combined, these two work together to alleviate the withdrawal symptoms that are so common with opioid addiction.

For those that are using Suboxone therapy, the medication is typically only available as a film that melts in your mouth in order to pass to your bloodstream. This medicine works very quickly by attaching to the same brain receptors that opioids would. It is important to note however, unlike Naltrexone, Suboxone does have the ability to cause physical or psychological dependence if taken for an extended period of time.

At the Coleman Institute, we have an Accelerated Opioid Detox program that is available for patients who are ready to come off of buprenorphine. Because each Suboxone treatment also stays in the body for weeks at a time, traditional detox from this drug itself can cause pain, anxiety, and fatigue. The treatment for Suboxone detox typically takes eight days instead of the usual three days.

To provide further perspective, our patient Pam, chose to use Naltrexone therapy. She lives about two hours outside of Richmond and had traveled with her mom and her dog to get her second dose of three naltrexone implants as part of her early stage treatment process. Pam smoked pot and drank in high school. It was not until after high school she started to use pills from time to time. At some point, she had the horrible realization that she had developed a physical dependency on the pills. She was so ashamed, she did not tell her parents why she was dropping out of college. She got a job in the service industry and went on to have a very expensive pill habit. She stayed abstinent from opiates for six years without being on any Medication-Assisted Treatment (MAT). Then she started dating a guy in recovery who relapsed.

After impulsively taking "just one" 10mg oxycodone from this guy’s stash, she was full blown using again after just one week. She didn't let this go on for long before she moved back home with her parents, found a reputable clinic, and went onto Suboxone (buprenorphine/naloxone).

She didn’t let this go on for long before she moved back home with her parents, found a reputable clinic, and went onto Suboxone® (buprenorphine/naloxone). Buprenorphine, methadone and naltrexone are the 3 evidence-based approaches of Medication-Assisted Treatment (MAT) for opioid use disorder.

I asked about her choice to go on Suboxone® when she returned to live with her parents in the town where she’d grown up. Even though Pam had been opiate-free for six years without the help of MAT, her relapse completely unnerved her. “I really thought I was no longer vulnerable”, she told me. “I had become complacent, I guess…but truthfully, I didn’t think I needed the support of recovery groups. I felt like I was doing a pretty good job staying clean by hanging out with good people, working, and being very physically active. I thought I was done with that phase of my life. Clearly, I wasn’t. "Suboxone® was right for me at that time. I was able to get off the oxycodone pretty easily, although part of me was reluctant to start on Suboxone®.


UNDERSTANDING ACCELERATED OPIOID DETOX


Owning to the high risk of relapse in opioid-dependent individuals, the most commonly prescribed treatment is maintenance treatment in which opioids with longer absorption times and half-lives are prescribed, such as methadone or the partial agonist buprenorphine, such as found in Suboxone and other products. Pam had been taking Suboxone 8mg/2mgday for two years and weaned to 2mg/0.5 daily when she came to our office for help with a detox. (many people don't know that stopping Suboxone abruptly can precipitate severe withdrawal).

Although the buprenorphine was a good fit for Pam in many ways, she was quite anxious when she anticipated stopping; by then she'd heard horror stories from people who had tried to get off on their own. She discussed this extensively with the counselors and the addiction physician at the clinic and they told her about naltrexone. Naltrexone (our specialty at the Coleman Institute for Addiction Medicine for over twenty years) is a pure opioid antagonist - also called a blocker. It sits on the opioid receptors leaving no room for opioids to inhabit. And although it is available as a daily oral dose, compliance is obviously significantly better if taken in an extended release formulation such as a slowly dissolving implant or a monthly Vivitrol injection. Naltrexone sounds like a great way to transition from Suboxone to ultimate abstinence. Pam liked the fact that it was a pure blocker, and didn't create either physical dependence or tolerance."

“When I told my counselors I was interested in going forward with this, there was a bit of an issue. They told me I would have to have the Suboxone® completely out of my system before I started the naltrexone. I was weaned from 8mg to 2mg/day over the course of several months, which was not easy, but I was motivated. But when it came time to drop down below 2mg a day, I just couldn’t tolerate it. I was working at a day-care center at the time, and I was so irritable. I wasn’t sleeping, my bowels were a mess, and my anxiety was through the roof. I googled around looking for solutions and that’s when I heard about the Coleman Institute.”

Accelerated Opioid Detox

At the Coleman Institute, we care about providing our patients with a positive, safer, and faster way to start their journey towards recovery. As you can see from our patient Pam, there are both pros and cons to using various Medication-Assisted Treatment in order to treat opioid use disorder and every patient's situation should be evaluated uniquely.

If you or a loved one is suffering from opioid addiction, it's important to remember that you are not alone. Opioid addiction can be treated and with an outpatient detox program you can be on your way to a healthier lifestyle in as little as three days.

if you would like to discuss the options, please give us a call.


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Joan R. Shepherd, FNP

Learn more about our accelerated opioid detox process from Dr. Peter Coleman.

 
 
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