Scott came to our office yesterday for a naltrexone implant. He had detoxed off street fentanyl ten weeks ago. He was a few days late for his scheduled naltrexone implant, and he started getting restless as the time for his appointment approached.
Scott’s wife has understandably had a hard time trusting him lately. They had an argument that caused Scott to adopt a “f*%@ it” attitude. He dug out an old contact, purchased some crack and heroin, and for the first time in a few months, used opiates.
Naltrexone Therapy To Block Relapse
Scott suspected that the naltrexone was still blocking his opiate receptors, and he viewed this as a mixed bag. During the argument with his wife, he realized that he was getting ready to use. It was like watching a scene play out on a TV: provoking his wife so he could blame her for misunderstanding him, stomping out of the house, texting someone he only contacts when he wanted to use — a person who agreed with everything he said about his wife. Scott said it was like being caught in an endless loop, and one that he didn’t want to break out of in that moment.
He wasn’t totally surprised that he didn’t get high. The long-acting naltrexone was still blocking his opioid receptors. At that point, he started to feel fairly stupid and disappointed with his recent decision-making.
When Scott came into our office for his implant, he tested positive for THC, cocaine, and fentanyl. Since he’d only used once and the naltrexone was clearly still effective, we were able to give him his implant without any worry about sending him into precipitated withdrawal.
Relapsing Is Not Failing
I was really happy that Scott came back to see us. Our entire team appreciated his swagger and sense of humor during his detox. His wife clearly adored him, although she occasionally rolled her eyes at his jokes. Scott used heroin for a few years in his youth, before enjoying an opiate-free period of over 10 years.
Unfortunately, after a back injury 3 years ago, he was prescribed opiates again, which sent him into a spiral towards daily usage and getting drugs from a dealer. Although he hid it as long as he could, his wife and daughter eventually figured it out and encouraged him to seek treatment with their support. He called us and came in 3 days later to start his detox.
Coleman Addiction Medicine’s outpatient opioid detox helps people to stop using not only street drugs like heroin, but also prescription pain medications like hydrocodone, Oxycontin®, Percocet®, tramadol, or Dilaudid®. We know it is challenging. Our unique detox program allows our patients to quickly and safely get off addictive substances and transition to naltrexone.
Little To No Withdrawal When Stopping Naltrexone
Unlike Suboxone® or methadone, naltrexone is a non-addictive blocker. While the other 2 substances are also proven treatments for Opioid Use Disorder, naltrexone is the only one that does not cause physical dependence. When someone wants to stop using naltrexone, there is no withdrawal.
Dr. Coleman’s team has specialized in using long-acting naltrexone treatment for over 20 years. Among the many reasons to use long-acting naltrexone, and even more compelling as the world adjusts itself to life during a pandemic, is the elimination of daily clinic visits for methadone and weekly or bi-weekly clinic visits for buprenorphine products.
Dedicated to Recovery
Scott received his implant and promised to come back in 2 months. He also decided that he would take advantage of our social worker’s offer to help him find a local therapist to work with. I couldn’t help but think about a quote I’d just seen about Kintsugi, the Japanese art of putting broken pottery pieces back together with gold — which espouses the view that you can create an even stronger and more beautiful piece of art by embracing the imperfections in an object.
As Andrea Montovani has written, “The kintsugi approach makes the most of what already is, highlights the beauty of what we do have, flaws and all, rather than leaving us eternally grasping for more, different, other, better. In other words, the experiences you have, and the person you already are, suffice. You may occasionally chip and break and need repairs. And that’s fine. But the reality is the best and most abundant material on the planet, available to anyone, comes for free, and we can all use what we already have — including our flaws — to be even more beautiful.”
Joan Shepherd, FNP