Detoxification Programs - Accelerated Detox - Commonwealth Addiction Treatment Center, L.L.C.

204 Hamilton Street, Suite #4 Richmond, VA 23221
(804) 353-1230 fax:(804) 353-3342 tollfree: 877-77DETOX

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877-77DETOX
(or 877-773-3869)

Questions & Answers

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 rapidly 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 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 narcotics?
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 and as mentioned this is so uncomfortable that most patients are unable to tolerate it and it is not successful.
B. Inpatient detoxification: 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. The most common method of detoxification is to use Methadone in an approved clinic and slowly taper the patient down from his usual dose to zero over a period of approximately 21 days. Unfortunately, the success rate is not particularly high because the withdrawal is still uncomfortable and patient usually uses drugs during the withdrawal period.
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 there are some risks associated with it.
E. Outpatient Ultram detoxification is a 4-5 day process that is comfortable, cheaper and yet still successful at getting patients onto Naltrexone (blocking) therapy.
F. Accelerated Detoxification is a modification of the URD by using sedative medicines that allow us to usually complete the detoxification in an office setting without the risks and costs of general anesthesia.

3. What is the Accelerated Detoxification program?
This is an outpatient detoxification program where we use Ultram on the first day of the treatment, and give other drugs including Valium and Clonidine. On the second day the patient takes heavy doses of sedatives by mouth and attends the clinic all day. Over the next 6-8 hour period, 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 Ultram?
Ultram is a drug that has some opiate properties and therefore relieves withdrawal symptoms. It attaches to the endorphin or opiate receptors in the brain and stimulates them and is therefore like an agonist. However, at higher doses, it seems to attach to the same receptors and actually blocks the effects, similar to Naltrexone, and is therefore termed a partial antagonist. Ultram also has a very long duration of action and therefore weans itself slowly out of the body. For that reason, Ultram seems to be an effective medicine to start the detoxification and it almost seems like it prepares the brain for full detoxification.

5. 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. 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. Then in a short period of time they go back to using Heroin. 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. 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.

6. What is the Naltrexone implant?
This 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 is so 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 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.

7. How Does the Accelerated Detox ProgramWork?
The Accelerated Detox is an outpatient detoxification performed at our office at 204 North Hamilton Street, Richmond, Virginia. 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 narcotics for 8-16 hours so that they arrive for their H&P and are in moderate withdrawal. On the first day of the detox program, a very large dose of Ultram is given. Other drugs including Clonidine and Valium are used to help with the withdrawal symptoms. Patients are then released. The next days, 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 patient is monitored intensely. Over a 6-8 hour period the patient is sedated as needed and narcotic antagonists are gradually introduced until full blockage is tolerated. 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 during the first day. 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.

8. Who is eligible for the Accelerated Detox Program?
Patients eligible for the program are those addicted to opiates or narcotics including Heroin, Percocet or other prescription narcotics. Patients are eligible if they are using less than $200.00 per day of Heroin or less than 400 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 two weeks. Patients will need to be in good general health, be willing to attend on a daily basis, stay in the local area, and agree to not drive, and agree to be fully supervised by someone during the treatment program until the Naltrexone Therapy has begun.

9. What has been your success rate?
We have been performing the Accelerated Detoxification since mid 2001 and to date 100% of patients have been successfully detoxed and put onto Naltrexone therapy.

10. 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 dose Oxycontin in a fairly comfortable manner.

11. 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 clinic, or take more medicine than intended, and then there could potentially be problems with overdose and accidents. We have not experienced any problems to date. There are some risks associated with the Naltrexone pellet as mentioned above. Frequently the first day when the Ultram is 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 problem. Sometimes patients make some poor judgements and so it is essential that the support person be careful to keep them safe.

12. How do patients feel during the detox?
On the screening day, patients will be in mild to moderate withdrawal but meds we give will help this considerably. The Ultram we give in the clinic may increase withdrawal symptoms for a short while. On the 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 sleepy also. 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 have the post-acute withdrawal which varies a lot from person to person.

13. 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 after- care. 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. They will also need to be involved with a physician who specializes in substance abuse.

14. 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, little energy, and other depressive symptoms. This is very variable but is sometimes difficult for patients to tolerate. Unfortunately medications have only 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.

15. How long should I be on Naltrexone therapy?
We believe strongly that patients should be on Naltrexone therapy 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 at least two Naltrexone implants and then switching to oral Naltrexone for the balance of 12 months. 16. What is the risk of overdosing following treatment?
Studies show that it is common for patients to die following periods of abstinence from narcotics. 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 a 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. 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 narcotic use. It is important to know also that the combination of heroin and sedatives including alcohol can be particularly lethal. In my experience, the fatal overdoses that we are aware 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.

17. 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 and feel free to call us anytime and we will try to respond as soon as possible.

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