My patients, the struggles they have endured, and the efforts they have made to achieve sobriety inspire many of my blogs. But yesterday at work, I have to say, I was moved so much by my coworkers.

A young man was with us for a simple accelerated opioid detox. He is under 20 and he has been on opioids since about the age of 16. He has overdosed a couple of times and he has tried to stop on his own multiple times.

We have a pretty elegant detox process to get opioids safely and relatively comfortably off the opioid receptors, and Greg was already at this point.


He was on his last (3rd day) of our detox. As the end of the treatment approached, his father came to us, concerned and said, “Greg says he doesn’t want to get the naltrexone implant.”

Naltrexone is one of the three Medication-Assisted Treatments (MAT) available and approved by the FDA in combination with counseling and behavioral therapies used to treat opioid use disorder. (Methadone and buprenorphine are the others). Naltrexone occupies and effectively blocks the same opioid receptors that would otherwise be available to opioids such as heroin, fentanyl, Oxycontin®, hydromorphone, oxymorphone, hydrocodone, tramadol, (increasingly) kratom. The Coleman Institute for Addiction Medicine has been using naltrexone as the mainstay of its treatment regimen for over twenty years.

Our protocols include using naltrexone in a long-acting formulation, either as an implant, which reliably lasts for about 8 weeks, or an injectable form of naltrexone which lasts for about 30 days. We believe it is extremely important to use a long-acting formulation of naltrexone, rather than a daily oral tablet, especially in the early stages of recovery when the temptation to relapse can be overwhelming.

This is why all of us working with Greg rallied around to urge him to reconsider.


For the rest of the day, various staff members went into Greg’s room.

Our nurse, Kim had bonded with him during her weekend shift. She has raised 2 sons and loves boys. She walked outside with Greg so he could have a smoke. She listened to his concerns and expressed hers.

Johnnelle and Alona spent time sitting with and joking with him.

Bridget offered sage advice from her years of working in the field.

Dr. Coleman and Erin, one of our amazing nurse practitioners, came in, sat down, and spent time with Greg and his Dad, having frank discussions about the pros and cons of getting the implant.

This boy had gotten under our skin and we just didn’t want to see him become another statistic.

In the end, Greg chose not to get the long-acting naltrexone. We supplied him with daily oral naltrexone tablets and a prescription for emergency naloxone in case of overdose. He and his dad were assured that if he changed his mind, we would schedule him in a heartbeat to get the implant.

Statistically, the numbers are bleak for people with Opioid Use Disorder (OUD) who don’t use some form of MAT, whether it is naltrexone, buprenorphine, or methadone.

Patients who choose the Coleman Institute for an accelerated opioid detox often do so in order to take advantage of the long-acting naltrexone, which can only be used when all opioids are out of the body. It is a process that Dr. Coleman and the colleagues he has trained and worked with for decades have perfected and continue to improve. And, while having state of the art protocols and years of experience are reason enough to come to us for an accelerated opioid or alcohol detox---over and over again I have to hand it to the people I work with. They all, to a number, care deeply and individually about our patients.

If you or a loved one would like to ask some questions about what to expect from an accelerated opioid or alcohol detox at the Coleman Institute in Richmond, Virginia or one of our many affiliate offices around the country, please give us a call at 877-773-3869.

Joan Shepherd, FNP