It has been a really busy season at Coleman Addiction Medicine in Bergen County, New Jersey. We have improvised to figure out the best ways to protect patients and staff from COVID, manage holiday schedules, and help fight the tidal wave of people seeking treatment against various addictive substances. Covid has really complicated the lives of people struggling with addictions, since the stress and loneliness can trigger unhealthy behaviors.
Addiction Can Happen to Anyone
Our patients come from varied walks of life. People with Alcohol Use Disorder range from high flying executives to students who are just starting to form the adults they are meant to be.
The plurality of people we treat are seeking help getting off opioids—either street drugs like fentanyl, heroin or pills, or prescribed pain medications, such as oxycodone, hydrocodone, tramadol, and similar drugs. Some people have tried poppy seed tea or kratom.
Coleman Addiction Medicine offers Accelerated Detox Programs that target 2 large categories of Substance Use Disorder (SUD). There are few things as satisfying as working with these motivated people and seeing them crush the bonds of their addiction. But…for a person with a SUD to reach remission, he or she must give their brain a chance to heal. A brain that has a physical dependence on a substance is highly vulnerable.
While our detox programs are safe and proven, physical withdrawal from an addictive substance is just a first step. What a person does after his or her detox is critical, and our team members focus on helping our patients get into long-term recovery and stay there. With that in mind, here are 5 of the scariest things I’ve heard from my patients:
1. I can’t be in drug treatment; my employer would terminate me if they found out.Do not let this stop you from seeking treatment! Patient confidentiality is highly protected—by force of law. People undergoing treatment for substance use issues are shielded not only by HIPAA, but also by additional privacy regs like 42 CFR Part 2. Since our opioid detox program is accelerated, (that is, we safely speed up the withdrawal process to get patients off substances in 3-8 days in an outpatient setting), most patients only have to take a few days off work and can return within a couple of days after completion.
2. I barely use cocaine—it’s not a problem.Many of our patients could teach a high level seminar about drugs and dosages, so it’s no shock to them that many street drugs currently are adulterated with fentanyl. Fentanyl is a synthetic opioid 50-100 times stronger than morphine. When someone says they are ‘just an occasional benzo user’ or ‘only gets kratom or benzos when detoxing off heroin’, they are actually at high risk of overdosing since fentanyl is being blended into many other street drugs. The margin of error on fentanyl dosing is tiny, and these street drugs aren’t necessarily being blended in modern factories.
3. My partner is still using, but it’s no big deal since I’m using naltrexone.I have heard this way too many times during my career in addiction medicine. People wrap up their detox, get some long-acting naltrexone, and then, instead of changing the ‘people, places, and things’ in their life, they decide not to change relationships with family or friends that are still using these drugs. They rationalize that since they have naltrexone in their bodies, they are now ‘safe’ in these situations. Instead of using this window of protection to build a new safer world for themselves, they opt to linger in ‘dangerous territory’ holding a small shield: their naltrexone.
While it’s true that naltrexone will protect the opioid receptors in a person’s brain against opioids, they wear down over time and may eventually be pushed off. People who keep the same habits as before are missing the chance to create new neural pathways aren’t taking advantage of the biggest opportunity provided by naltrexone: a safe window in which to make the bigger, needed changes. Long-acting naltrexone provides some space to begin building healthier habits.
4. No thanks on the naltrexone…no way that I’d ever use opioids again!
Alas, success rates are low for people that have Opioid Use Disorder (OUD) and decline to utilize any evidence-based method of Medication Assisted Treatment (MAT). The Coleman Method for detoxing off opiates pushes opioid molecules off the brain’s receptors and replaces them with naltrexone, a pure non-addictive opiate blocker. People who choose our program are deciding to use a long-acting form of naltrexone for their MAT.
Until a person builds a strong support system and gives their brain time to heal, they are quite vulnerable. We never harshly judge people who relapse and return for more services, but we do carefully discuss with them what needs to change in order to have a better outcome this next time. That usually means adding in more intensive counseling or sober living, along with a stronger commitment to ongoing naltrexone therapy.
For other people, an Accelerated Opioid Detox is not an ideal fit, and MAT using buprenorphine products or methadone is a better choice. Both of these treatments can help people safely get stable and launch their long term recovery journey.
5. I’m in good shape since I only take it as prescribed.
Even though most people understand that certain substances can create physical dependence over time, patients regularly are surprised to learn that they have become physically dependent on their medicine even while taking it precisely as their physician prescribed. This can also happen with either pain medications or benzos.
Like I said before, I can’t envision working with a more inspiring or motivated group of patients. We understand their challenges and we celebrate their successes. Our founder Dr. Coleman has been in long-term recovery himself since 1984, so we fully embrace a nonjudgmental approach to addiction treatment.
Successful Recovery is Possible
As 2021 progresses we will all be facing unique personal issues. Do you need help to safely and effectively stop taking some type of drug or medicine? A wise Chinese proverb says that “The best time to plant a tree was twenty years ago, but the second best time is now.”
Joan Shepherd, FNP