FEAR OF WITHDRAWAL & TREATMENT OPTIONS

Statement from ariticle 
https://www.ndtv.com/health/bidding-goodbye-to-addiction-1662311

"The patient’s fear of withdrawal perpetuates dependency or makes it more permanent. For the late stage opiate addicted individual, fear of the pain from withdrawal can be the single factor that continues their dependency" 

This is so TRUE! That is the biggest excuse of why a person with substance use disorder did not start treatment earlier. The fear of being in withdrawal. Most people with substance use disorder hear horror stories of others who started treatment and were so sick they couldn't work.  Well, that is in the "old days" or maybe at a different type of program where they only detox you, roughly. It is different now. There are new medications and different modes of delivery being used. Plus, with the Opioid Crisis, programs are being scrutinized and held to certain standards. Programs are changing according to the needs of the crisis. Treatment plans are individualized according to the patients needs and the patients goals! Counties and other communities are being given grants to hire more professionals to meet the needs of society and this crisis. So if the program you are looking into is short staffed or is not being somewhat flexible to your needs (within reason) then move on to one who received a grant and is hiring and training more professionals. Not every clinic received a grant. But all must follow the DEA, Federal, State Pharmacy and State rules and regulations according to the type of license they hold. Private companies that did not receive a grant will become more competitive, hire and train staff and find ways to attract and retain their patients; to better meet the patient's needs.

Of course the biggest attraction to a treatment program is the ease of transition due to the fear of withdrawal. Treatment varies according to the treatment program in which you enroll, and that depends on the insurance, funds you have or money you can borrow. There is, Ultra Rapid Opiate Detoxification without Anesthesia where a patient is place under light sedation and rapidly detoxed. Nothing is felt.  Naltrexone, (which is similar to naloxone) is then implanted. Once fully awake, the withdrawal symptoms are gone! Similar to naloxone, Naltrexone blocks any opiates and the implant lasts anywhere from 3-12 months. I am not sure if it takes care of cravings but that is another reason why addiction counseling is so important. It is not offered everywhere and I am not sure of the cost or insurance coverage.

There is Suboxone treatment which can be administered at a clinic or a certified physician's office along with mandatory addiction counseling or groups. With suboxone, a person MUST have very small to no opioids in their system in order to begin (NO use in 24+ hours). You must be in moderate withdrawals before you take your first suboxone dose. It is the nature of the medication. Suboxone's properties are strong, meaning that once taken, it kicks out any opioid you previously took; it kicks it out from the opioid receptor site and takes its place. The first dose of suboxone is not enough to fully fill the receptor site as much as the opioid you had in your system, therefore you are in withdrawals quite quickly. So, it is better to be in withdrawals before your first dose, and within 1-2 hours after a couple small doses of suboxone, you feel fine....normal. That "normal" state will last for 24 hours!  But. if you use 24 hours or less before your first dose of suboxone, then you will make yourself sick and won't feel better until the next day's dose of suboxone. It would work on that second day, since this second day of suboxone would be 24+ hours after your drug use and the opioids would be out of your system. It would be successful and you would feel better within minutes to an hour of that dose and remain symptom free by taking that therapeutic suboxone dose every day to every other day depending on the program. Stay off of any opioids, marijuana, benzodiazepine and alcohol and you could get take home doses and go only once a week for your addiction group and medication and live a normal life!

Methadone treatment can be started right away at a small dose and that dose is slowly increased until you feel normal. This takes some time. I discussed how methadone programs work in previous blogs.  Don't expect to suddenly stop opioids with your first methadone dose. How do you start methadone and not be in withdrawals or sedated? By being honest about your use and listening to the doctor and nurses treating you. Don't go to your admitting appointment sedated or tired looking or you might be denied or started on a smaller than normal dose, for medical safety. The unspoken rule is: Do not use after 8 pm the night before. Go to your admitting appointment in mild to moderate withdrawals. The doctor will do a physical and order your first dose of methadone which is anywhere from 20 mg to 30 mg. Will that be enough? No. But it is the only way to begin. Too large a dose at the beginning could make you sedated. It has to be done slowly. The day before your assessment and increase day (they will remind you), decrease your drug use to prepare for that increase. If you do it that way: slowly cut down your opioid use as your methadone increases, you will slowly transition to only methadone. You will have periods of withdrawal that will lessen and improve as you learn how to cut down your use and time it wisely. Listen to the nurses dispensing your dose. Talk to one with experience, then ask questions! An experienced methadone nurse can tell you exactly how to transition smoothly and can even estimate what dose will have you feeling "normal". Unfortunately, due to the long action of the medication and the potential for overdose with this medication, the rules for methadone take homes are very strict and it takes longer to earn take home medication doses.

There are other medications being trialed for alcohol and cocaine use. So far, for opioid misuse, the Naltrexone implant sounds like the smoothest transition. Hopefully they will make it affordable and more accessible in the near future.