Accelerated Detox Technique

Questions & Answers

1. What is Narcotic dependence?
2. What are the different ways to detoxify from narcotics?
3. What is Naltrexone Therapy and why is it important?
4. What is the Naltrexone implant?
5. How Does the Accelerated Opiate Detox Program Work?
6. What has been your success rate?
7. Can this detox method be used for Methadone, Suboxone, and Subutex?
8. Are there any risks and side effects?
9. How do patients feel during the detox?
10. What happens after the detoxification?
11. How long should I be on Naltrexone Therapy?
12. What is the risk of overdosing following treatment?
13. What is the follow up with your facility?
14. What is the cost?

1. What is Narcotic dependence?

   Narcotic dependence is a medical condition where the patient has been taking narcotic drugs (Opiates, Heroin, Methadone, or other painkillers) and the patient's body has become physically dependent on these drugs. Drug dependence can happen as quickly as 1-2 weeks after starting use, since tolerance builds up rapidly. After tolerance is developed, if narcotics are not taken the patient will go through a very painful withdrawal. Usually withdrawal takes about 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 narcotics?

   There are a number of ways to detoxify from narcotics.

   1. Cold Turkey:Using no drugs and doing it on your own is called cold turkey and as mentioned, this is so uncomfortable that most patients are unable to tolerate it and it is not successful.

   2. Inpatient detoxification can be expensive and is still difficult even when some drugs are given. Usually insurance companies will not pay for people to stay in inpatient long enough to be fully detoxified. They do not offer the Naltrexone implant or heavy sedation.

   3. The most common method of detoxification is to use Methadone or Suboxone in an approved clinic and slowly taper the patient down from his usual dose to zero over a period of approximately 21 days. Both of these medications are opiates and are highly addictive. Unfortunately, the success rate is very low because the withdrawal is still uncomfortable and the patient usually uses drugs during the withdrawal period.

   4. Ultra Rapid Detoxification (URD) involves putting patients under anesthesia and while asleep, giving them a drug called Naltrexone, which blocks all of the 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 completion rate of Ultra Rapid Detoxification is 100% but its drawbacks include a high cost, and there are significant medical risks associated with it.

   5. Accelerated Opiate Detoxification is a modification of the URD by using sedative medicines that allow us to complete the detoxification in an office setting without the risks and costs of general anesthesia.

3. 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 narcotic 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. It can also help significantly with cravings which often occur after detox.

   Naltrexone has been available as an oral tablet since the late 1970's. However, oral Naltrexone only has a duration 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. Then in a short period of time they go back to using opiates. For this reason, we strongly recommend the Naltrexone implant.

   We believe that Naltrexone therapy should be given for 12 months. This gives the patient a chance to have their brain physically recover from the damage from the narcotics. It also gives the patient an excellent chance to begin on the road to recovery.

4. What is the Naltrexone implant?

   This is a special formulation of Naltrexone, which is designed to release slowly over an eight week period. It is placed under the patient's skin and does not allow the patient to forget or skip their medicine. After the eight weeks, the Naltrexone will have completely dissolved and therefore nothing will need to be removed. We highly recommend it because it is so effective. There are some potential side effects with the Naltrexone Implant including infection, irritation or inflammation. Licensed pharmacists manufacture the implants for us. While the Naltrexone implant has not yet been submitted to the FDA for approval, the medications it contains are fully approved by the FDA.

5. How Does the Accelerated Opiate Detox Program Work?

   The Accelerated Opiate Detox is an outpatient detoxification performed in a medical office. Before patients arrive, they are medically screened over the phone. Blood work and an EKG will also be performed on the first day of treatment. Patients are required to stay off their narcotics for 8-16 hours so that they arrive for their initial appointment in moderate withdrawal. During the entire detox, medicines are given to help with the withdrawal symptoms. On the completion day, the patient will fast after midnight, take a dose of sedatives and arrive at the clinic in the morning. The patient will stay in a private room with a bed where an IV line is inserted and the patient is monitored closely. Over a 6-8 hour period, narcotic antagonists are gradually introduced until full blockage is tolerated and the patient is completely clean of all opiates. Then 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 throughout the duration of the detox and 48 hours after their detox. Patients are not allowed to drive and must be monitored at all times. There will be a small amount of discomfort associated with this detox but this is usually well tolerated.

6. What has been your success rate?

   We have been performing the Accelerated Detoxification since mid 2001. To date, over 98% of patients have been successfully detoxed and placed onto Naltrexone Therapy.

7. Can this detox method be used for Methadone, Suboxone, and Subutex?

   We have found that this detox works particularly well for Methadone, Suboxone and Subutex provided we extend the accelerated Detox program to eight days. We are able to detox patients off of even very high doses of these long acting opiates in a comfortable manner.

8. Are there any risks and side effects?

   As with any medical procedure, there are some possible risks. If patients do not follow through with the physician's instructions, do not come in for their scheduled appointments, or take more medicine than prescribed, then there could potentially be problems. Most Ultra Rapid Detox facilities have had fatalities whereas the Accelerated Opiate Detox procedure is extremely safe.

9. How do patients feel during the detox?

   On the initial detox day, patients will be in mild to moderate withdrawal but medications we give will help this dramatically. Throughout the rest of the detox, patients usually will sleep a lot, eat well, have mild amnesia and report feeling quite comfortable. Following the detox, they may have some post-acute withdrawal symptoms (PAWS). This is the recuperation period after detox while the brain receptors are healing and endorphin levels are rising back to a normal level. No matter which route a patient chooses to detox, there will always be a post-acute withdrawal phase. These vary a lot from person to person but tend to only last a few weeks. If a patient is having difficulty with post-acute withdrawal, our physicians can call in medications to help.

10. What happens after the detoxification?

    We believe strongly that detoxification without appropriate follow-up and treatment is almost always unsuccessful. Therefore, we strongly encourage all of our patients to participate in an appropriate treatment program. This 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. If any of our patients require assistance with finding an aftercare treatment program, we have an Aftercare Coordinator who will be able to assist.

11. How long should I be on Naltrexone Therapy?

    We believe strongly that patients should be on Naltrexone implants for at least twelve months. This prevents them from relapsing back to narcotic use and gives the patients a chance to start making changes in their lives and building up a support program. We highly recommend Naltrexone implants for at least 12 months and then switching to oral Naltrexone.

12. What is the risk of overdosing following treatment?

    Studies show that it is common for patients to overdose and even die following periods of abstinence from narcotics. This commonly happens after patients are released from jail. This appears to be caused by lack of tolerance following a period of abstinence so that overdose can easily happen. Naltrexone is extremely good at making people abstinent but when the Naltrexone wears off, patients have very low tolerance. Following any Naltrexone therapy, it is extremely easy for them to use too much heroin and have an overdose which can be fatal. It is not the Naltrexone itself which is causing the low tolerance, but instead the length of abstinence. Patients need to understand this clearly. If patients choose abstinence they need to be extremely careful if they do relapse back to narcotic use.

13. What is the follow up with your facility?

    We will be contacting you on a regular basis to check on your progress and to see if we can offer any assistance. Feel free to call us anytime and we will try to respond as soon as possible.

14. What is the cost?

    Pricing is based on the specific type of opiate the patient is using and which TCI location. Please call for exact pricing. Financing is available if needed and we also accept all major credit cards. Worker's Compensation may also cover the cost of this treatment.

Indiana and Virginia offices are company owned. All other medical offices are independently owned and operated.