Accelerated Detox Medically Supervised Detox Ultra-Rapid Detox Buprenex Suboxone

Questions & Answers

1. What is Opiate Dependence?
   Opiate dependence is a medical condition where the patient has been taking opiates (Narcotics, Heroin, Methadone, or other painkillers) and the patient’s body has become physically dependent on these drugs. Drug dependence can happen as rapidly as 1-2 weeks after starting use since tolerance builds up rapidly. After tolerance is developed, if opiates are not taken, the patient will go through a very painful withdrawal. Usually withdrawal takes 5-10 days and is characterized by extreme discomfort and pain, diarrhea, sweats, sleeplessness and abdominal cramps. Most people are unable to tolerate it without help.

2. What are the different ways to detoxify from opiates?
   There are a number of ways to detoxify from narcotics.
   
   A. Cold Turkey: Using no drugs and doing it on your own is called cold turkey. As mentioned before, the withdrawal process is so uncomfortable that most patients are unable to tolerate it therefore cold turkey has a very low success rate.
   
   B. Inpatient detoxification: Patients are checked into an overnight care facility and detoxed with therapy and/or medications. This process can be expensive and is still painful unless other drugs are given. Usually insurance companies will not pay for people to stay in inpatient long enough to be fully detoxified.
   
   C. Methadone: The most common method of detoxification is to use Methadone in an approved clinic and slowly taper the patient down from his usual dose of illegal opiates to zero over a period of approximately 21 days. Unfortunately, the success rate is not particularly high because the withdrawal is still uncomfortable and patients usually use drugs during the withdrawal period. Methadone has also been shown to be addictive.
   
   D. Ultra Rapid Detoxification (URD): involves putting patients under anesthesia and while asleep, giving them a drug called Naltrexone which blocks all of their endorphin receptors and pushes them into 100% detoxification within a 5-30 minute period. This is an extremely painful process but under anesthesia, it is tolerable. The success rate of Ultra Rapid Detoxification is 100% but its drawbacks include a high cost and extreme medical risks including death have been associated with it.
   
   E. Buprenex: newly approved by the FDA, Buprenex can be administered on an outpatient basis by physicians. However, using Buprenex, the detox takes 7-14 days which many patients find intolerable.
   
   F. Accelerated Detoxification Technique (ADT): The Coleman Institute’s advanced technique is a modification of the URD which uses sedative medicines that allow us to complete the detoxification in an office setting in a 3-day period without the risks and costs of general anesthesia. Furthermore, the ADT can detox Methadone patients over 8 days.
   
   G. Medically Supervised Detox: Outpatient Ultram detoxification is a 4-5 day process that is comfortable and useful for light users of Heroin or Narcotics.

3. What is the Accelerated Detoxification Technique?
   ADT is a 3-day outpatient detoxification program where we use several medications on the first day of the treatment. On the second day, the patient takes heavy doses of sedatives by mouth and attends the clinic all day. On the third and final day, the patient is sedated, monitored, and slowly all the remaining narcotics are removed from the brain. At the end of the day Naltrexone therapy is begun.

4. What is Naltrexone Therapy and why is it important?
   We believe that the ultimate goal of the detoxification program is to have patients on Naltrexone. Naltrexone is a pure opiate antagonist. That is, it attaches to the endorphin or opiate receptors in the brain and completely blocks them. This means that if someone tries to use any kind of opiate while they are on Naltrexone, they feel no effect because all of the receptors are completely blocked. While Naltrexone is in the body, it is virtually impossible to relapse. Naltrexone has been available as an oral tablet since the late 1970s. However, it only has duration of action of around 24 to 48 hours and in practice, it has been found that most patients either forget or purposefully choose not to take their medicine. Unfortunately in a short period of time many oral Naltrexone users go back to using the Opiates. Higher success rates have been achieved when patients are forced to take their medicine, either by concerned family members or by a court system such as probation or parole. For this reason, we strongly recommend the Naltrexone implant which releases the Naltrexone over a 6-10 week period. We believe that Naltrexone therapy should be given for 12 months giving the patient a chance to have their brain physically recover from the damage from the opiates. The implant also gives the patient an excellent chance to begin on the road to recovery.

5. What is the Naltrexone implant?
   The Implant is a special formulation of Naltrexone which is designed to release slowly over a 6-10 week period. It is placed under the patient’s skin and so it is effective and does not allow the patient to forget or skip their medicine. We highly recommend it because it has proven to be very effective. There are some potential side effects with the Naltrexone Implant including infection, irritation or inflammation and sometimes even some skin breakdown over the implant site. The implant contains a small dose of corticosteroids to try to minimize the side effects. A licensed pharmacist in New Jersey manufactures the implant for The Coleman Institute. While the Naltrexone implant has not yet been submitted to the FDA for approval, the medications it contains are fully approved by the FDA.

6. How Does the Accelerated Detox Technique Work?
   The Accelerated Detox is an outpatient detoxification performed at our offices located in Virginia and in California. Patients are screened and if found to be eligible, they have a history and physical performed and sign a treatment contract. Before patients arrive they are screened and they stay off their opiates for 8-16 hours so that they arrive for their history & physical in moderate withdrawal. On the first day of the detox program, a very large dose of pain relieving medication is given to help with the withdrawal symptoms. Patients are then released. On the second day, meds are given to stabilize the patient while the opiates continue to be flushed from the system. On the final day, the patient will fast after midnight, take a large dose of sedatives and arrive at the clinic about 8:30am. An IV line is inserted and the patient is monitored intensely. Over a 6-8 hour period the patient is sedated as needed and opiate antagonists are gradually introduced until full blockage is tolerated. The patient will be released on Naltrexone therapy, usually with the Naltrexone implant. Each patient is required to have a support person who stays with him or her during the entire detox. Patients are not allowed to drive and have to be monitored at all times. There will be some discomfort associated with this detox but this is usually well tolerated.

7. Who is eligible for the Accelerated Detox Technique?
   Patients eligible for the program are those addicted to opiates including Heroin, Oxycontin, Vicodin, Percodan or other prescription narcotics. Patients are eligible if they are using less than $300.00 per day of Heroin or less than 1000 mg per day of Oxycodone. Patients using doses higher than this or who are on Methadone may be eligible for an extended form of the Accelerated Detox which will take closer to 8 days. Patients will need to be in good general health, be willing to attend on a daily basis, stay in the local area, agree to not drive and agree to be fully supervised by someone during the treatment program until the Naltrexone Therapy has begun.

8. What has been your success rate?
   We have been performing the Accelerated Detoxification since mid 2001 and to date 99% of patients have been successfully detoxed and put onto Naltrexone therapy.

9. Can this detox method be used for Methadone?
   We have found that this detox works particularly well for Methadone provided we pre-treat the patient for about one week before the actual detox. For patients who are able to stay in the area for 7-10 days, we are able to get them off Methadone or high doses of Oxycontin in a fairly comfortable manner.

10. Are there any risks and side effects?
    As with any medical procedure, there are some risks and potential problems. If patients do not follow through with instructions, do not attend the clinic, or take more medicine than intended, potential problems with overdose and accidents could arise. However, we have not experienced any major problems to date. There are some risks associated with the Naltrexone implant as mentioned above. Frequently the first day when the pain relieving medications are given, the patient can have some discomfort especially if the patient is not in sufficient withdrawal. During the procedure and afterwards the patient may be affected by the detoxification procedure and by the medicines we prescribe. There may be some emotional instability and some behavioral problems. Sometimes patients make some poor judgments and so it is essential that the support person be careful to keep them safe.
    

11. How do patients feel during the detox?
    On Day 1, patients will be in mild to moderate withdrawal but meds will help these symptoms considerably. The pain relieving medications we give in the clinic may increase withdrawal symptoms for a short while but again is tolerated with meds. On the final day of detox, patients will be quite sedated and frequently they don’t remember anything about the whole day. They usually appear agitated but are also sleepy. By the time they leave, they can walk and talk coherently. The rest of the evening they are usually quite sleepy, a little agitated and have mild withdrawal. They sometimes vomit and have diarrhea. By the next day they are feeling a lot better and they continue to get better all the time. Following the detox they experience the post-acute withdrawal which varies a lot from person to person and is described in Question 14 below.

12. What happens after detoxification?
    We believe strongly that detoxification without appropriate follow-up and treatment is almost always unsuccessful. Therefore, we insist that all of our patients be willing to participate in an appropriate treatment program as part of their aftercare. A good aftercare program should include 12-step programs and professional therapy. We expect that all patients will identify and begin therapy with an appropriate substance abuse treatment facility in their area as soon as possible following the detoxification. They will also need to be involved with a physician who specializes in substance abuse.

13. What is the post acute withdrawal syndrome?
    We have found that following opiate detox, there are two periods of protracted withdrawal. The first (or sub-acute withdrawal) lasts 2-8 weeks and patients describe moderate to severe insomnia and fatigue, low energy, and other depressive symptoms. This is quite variable but is sometimes difficult for patients to tolerate. Unfortunately medications have only a limited effect. However the symptoms always go away with time as the brain heals and restores itself to its natural state. The second phase is very mild and is easily tolerated because by this stage the patients feel so much better than when they were using drugs.

14. How long should I be on Naltrexone therapy?
    We highly recommend 12 months of Naltrexone therapy (six implants total.) Please ask us about our 12-month Freedom Plan.

15. What is the risk of overdosing following treatment?
    Studies show that patients can die if they use opiates following periods of abstinence. Overdose can happen easily due to a lack of tolerance following a period of abstinence. Naltrexone is extremely good at making people abstinent but when the Naltrexone wears off, patients have a very low tolerance for opiates. Following any Naltrexone therapy it is extremely easy for patients to use too much Heroin and have an overdose which can be fatal. Patients need to understand this clearly. It is actually safer for patients to be on Methadone then to try to be abstinent. If patients choose abstinence they need to be extremely careful if they do relapse back to opiate use. It is important to know also that the combination of heroin and sedatives including alcohol can be particularly lethal. In our experience, the fatal overdoses that we are aware of can happen after the first time of using and so patients need to be very careful for at least the first month. It is also may be possible to overdose if the patients try to override their Naltrexone therapy.

16. Follow up with our practice: We will be contacting you on a regular basis to check on your progress to see if we can offer any assistance. Feel free to call us anytime and we will respond as soon as possible.