Detox Programs - ULTRAM 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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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 pain killers) 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:

Cold Turkey: Using no drugs and doing it on your own is called cold turkey and as mentioned that this is so uncomfortable that most patients are unable to tolerate it and it is not successful. Sometimes people are pushed into cold turkey by being put in jail or in another situation where the drug is not available.
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.
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.
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.
Outpatient Ultram detoxification is a 4-5 day process that is comfortable, cheaper and yet still successful at getting patients onto Naltrexone (blocking) therapy

3. What is the Ultram Outpatient Detoxification program?
A five-day outpatient detoxification program by using Ultram at the start of the treatment and then giving other drugs including Valium and Clonidine. Symptoms are minimized that are associated with withdrawal from Heroin and other opiates. Patients attend the clinic with a support person for five days. On the first day, the patient will receive a thorough evaluation, Ultram, and a number of other medications. At each subsequent visit the exact amount of medicine needed to relieve the withdrawal symptoms are determined. Usually patients have no diarrhea and are able to eat and sleep during the detoxification process. At the end of the treatment, the patient will start Naltrexone therapy, usually with the implantation of a Naltrexone pellet.

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 detox seems to be the most comfortable and therefore successful 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 Ultram Detox Program Work?
The Ultram Detox Program is a four to five day program performed on an outpatient basis 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. They are seen and evaluated on a daily basis until their detox is complete with the understanding and the goal being that they will be put on Naltrexone Therapy as soon as detox is complete. We highly recommend the Naltrexone Implant as the preferred form of Naltrexone therapy. At the beginning 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. During the program, patients are seen daily. They are required to have a support person who stays with them during the entire program. Patients are not allowed to drive and have to be monitored at all times. Doses of medicines that we use are prescribed to get people through the detox safely and as comfortably as possible. During the detox, patients and support persons receive counseling, education and case management. These are designed to facilitate the transfer into appropriate rehabilitation. At the end of the detox, patients are put on Naltrexone. There may be some discomfort associated with this, but this is usually mild and easily tolerated.

8. Who is eligible for the Ultram 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 Ultram 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, 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 Ultram outpatient detoxification for seven months and to date 75% of patients who followed the guidelines were successfully detoxed and put onto Naltrexone therapy.

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 clinic, or take more medicine than intended, then there could potentially be problems with overdose and accidents. There are some risks associated with the Naltrexone pellet as mentioned above. There is some risk of taking the Naltrexone Therapy before the detoxification is complete. If taken too early, Naltrexone will push people into a complete withdrawal state and if the detoxification is not completely over, then there will be some withdrawal symptoms. If done too early, these can be severe. The timing of the Naltrexone Therapy is discussed in detail with each patient individually. It is to be expected that patients will feel some withdrawal symptoms but our treatment program should minimize these.

11. 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.

12. 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.

13. What is the risk of overdosing following treatment?
Studies show that there have been patients who have died following periods of abstinence from narcotics. This appears to be caused by 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. 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 and be extremely careful if they do relapse back to narcotic use. In my experience, the fatal overdoses that we are aware of have usually not happened on 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.

14. 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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