We’ve had an incredibly busy season across our physicians’ offices in the Coleman Network for Addiction Medicine. Everyone has been challenged to find the best ways to protect patients and staff from COVID, juggle holiday schedules, and help fight the avalanche of people seeking help against various addictive substances. If Covid wasn’t piling enough stress and anxiety onto people and driving some to consume more alcohol and/or opiates, the relative ease of finding these substances has made a troubling problem even worse.
Addiction Can Happen to Anyone
Our patients come from many walks of life. People with Alcohol Use Disorder range from business leaders to high school students who are just starting to become the adults they are meant to be.
Our patients grappling from addiction to benzodiazepines like Xanax® or Ativan® literally come from around the world, and over 3/4 of these patients are taking their medication exactly as prescribed by their doctors.
The largest number of people we treat are seeking help getting off opioids—either street drugs like fentanyl, heroin, or kratom, or prescribed pain medications, such as hydrocodone, tramadol, Percocet®, and similar drugs.
Give Your Brain Time to Heal
The doctors in the Coleman Network for Addiction Medicine offer Accelerated Detox Programs that target 3 main categories of Substance Use Disorder (SUD). There are few things as satisfying as working with these brave individuals and watching them shake loose the chains created by addiction. But…for a person with a SUD to achieve remission, he or she must give their brain a chance to heal. A brain which has developed a physical dependence on a substance is incredibly vulnerable.
Although our detox programs are effective and safe, physically withdrawing from a substance is just a first step. What someone does after his or her detox is crucial, and our team is focused on helping our patients achieve long-term success. With that in mind, here five of the scariest things I’ve heard from my patients:
1. I can’t go into treatment; I would get fired if my employer found out.
Please don’t let this stop you from seeking treatment!
Patient confidentiality is heavily protected and respected—by force of law. People undergoing treatment for substance use issues are protected not only by HIPAA, but also by additional privacy and security regulations like 42 CFR Part 2.
Since our opioid and benzodiazepine detox programs are accelerated, (that is, we safely speed up the withdrawal process to get patients off substances in 3-10 days in an outpatient setting), most patients are able to just take a few days off from work and return within 48 hours after completion.
2. I hardly ever use cocaine; it’s not a big deal at all.
A lot of my patients could teach advanced medical students about drugs, so it isn’t surprising to them that many street drugs contain fentanyl. Fentanyl is a synthetic opioid 50-100 times stronger than morphine. When someone calls themselves ‘just an occasional cocaine user’ or ‘strictly gets benzos when self-detoxing off heroin’, they are actually at high risk of overdosing since fentanyl is being blended into many other street drugs. It takes only a tiny amount of fentanyl to be fatal.
3. My housemate is still using, but I’m not worried because I’m on naltrexone.
I can’t count the number of times I’ve seen this in my career in addiction medicine. People finish their detox, get a long-acting naltrexone implant, and then, instead of changing the ‘people, places, and things’ in their life of drug use, they cling too tightly to friends or family members who are still using. They figure since they have naltrexone, a non-addictive opiate blocker on board, they are now ‘safe’ in these situations. However, instead of building a new safer world, they choose to stay in ‘hostile territory’ holding a small shield: their naltrexone.
While it’s true that naltrexone is sitting on the brain’s opioid receptors, and can prevent opioids from landing there, it can eventually be pushed off. People who maintain the same patterns as before are failing to build the new habits and neural pathways in their brain are missing out on the true opportunity provided by naltrexone. It provides some safe space to embrace these bigger, necessary changes. Long-acting naltrexone offers time to start building a new, better life.
4. I don’t need any naltrexone…there’s no way I will use opiates again!
Success rates are unfortunately low for people with Opioid Use Disorder (OUD) that refuse to participate in some form of Medication Assisted Treatment (MAT). The Coleman Method for detoxing nudges opioid molecules off the opiate receptors and replaces them with naltrexone, a pure blocker which is not addictive. People who opt into our program are essentially committing to use a long-acting form of naltrexone for their MAT.
Until a person builds a strong support system for sobriety and allows their brain time to heal, they are in a vulnerable space. We never harshly judge people who have relapsed and return for more treatment, but we do closely examine and discuss with them what needs to be different this next time in order to generate a better outcome. That often means adding in more intensive counseling or sober living, along with a firmer commitment to ongoing naltrexone therapy.
For other people, an Accelerated Opioid Detox is not the best fit, and MAT using buprenorphine products or methadone makes more sense. Both of these treatment choices can help a person safely stabilize and function as part of their long term recovery journey.
5. I am rock solid as long as I’m taking it just like my doctor prescribed.
Even though people realize that many drugs create physical dependence over time, patients regularly are surprised to learn that they have developed a physical dependence on their medication even while taking it precisely as their physician prescribed. This can also happen with pain medicine or benzodiazepines.
Many patients have been prescribed drug such as Ativan® (lorazepam) or Valium® (diazepam)—to treat conditions like anxiety or insomnia. These medications are meant to be used short term, at best.
These people are stunned to realize that they can’t just stop using these medications without facing serious side effects. People can slowly and safely taper their benzo use downward under their medical supervision, but it can be extremely challenged and take a long time.
The Coleman Method for Rapid Benzodiazepine Detox uses tiny doses of flumazenil to slowly push the benzos out of the brain and allow the healing process to begin. Medication is administered to help prevent seizures, and address possible issues such as sleeplessness.
Successful Recovery is Possible
As I said before, I can’t imagine working with a more diverse and motivated bunch of patients. We understand their challenges and we celebrate their success.
As 2021 unfolds, everyone will be facing their own personal issues. Do you need help to safely and efficiently stop taking some kind of drug or medicine? A wise Chinese proverb says that “The best time to plant a tree was 20 years ago, but the 2nd best time is now.”
Joan Shepherd, FNP