I am going to share an interaction with a person who wrote to me about using the Naltrexone implant. I am always a bit suspicious about the motivations of people who want comments posted about a different type of treatment, or who come with pot-shots against Suboxone. I don’t go to methadone clinic sites or ads for rapid opiate detox and hound people for their choice of treatment—even though I don’t agree with their choices. But the point of my blog is to educate people (that better be the point, as it certainly isn’t a money-maker!), so I will share the material and let people decide what is right for themselves. I did make some comments at the end of the discussion—the owner of the blog gets the last word!– because there were some things written about Suboxone and Naltrexone that I don’t agree with, based in some cases on the literature, and in other cases on personal experience.
The message about Naltrexone:
I just wanted to add a thought to the doctor’s paragraph about Naltrexone and how it could be used as a tool to help in recovery but it can’t because it doesn’t last in the body for long. I want to tell everyone about the Naltrexone implant. It has been around for a long time but not many doctors have the knowledge of it. I detoxed off heroin six years ago and went onto the Naltrexone implant for twelve months. The implant lasts about 8 weeks and then you have to go back for another. I have to tell you that it was the best twelve months in my whole life. I wish everyone knew about it. I had a great doctor that was a recovering addict and really understood what it takes to be clean and stay clean. I would suggest ANYONE that wants to really be clean…STOP hiding behind Suboxone and get to a doctor that knows how to detox you and put you on something NON ADDICTING like the implant.
My Reply to the Writer:
Thank you for your comments. I will add your perspective, but will also discuss the problems with the Naltrexone implant that have kept it from becoming more popular. I’m glad it worked for you, but for many who have it implanted (usually as part of a rapid opiate detox weekend) there have been significant complications. There is the liver damage from Naltrexone of course, but that is not the only issue. I have met addicts who dug the implants from their belly or arm out of desperation to get ‘high’; there also have been several documented suicides in patients after rapid opiate detox and Naltrexone implantation.
As a board certified anesthesiologist, one of my initial plans after getting clean was to set up a rapid opiate detox place with a friend who was an internist. After research of the literature I learned that the medical community sees rapid detox mostly as a gimmick that pays well but that does little to ease the suffering of addicts.
I also take issue with your comment about ‘hiding behind Suboxone’. Most people would see the implantation of Naltrexone to be at least as significant an undertaking as taking a Suboxone tablet once per day. I’m not sure which person is actually ‘hiding’.
The Writer’s Response:
I completely understand your thoughts about the implant. I do know about these types of cases and they are unfortunate. However, because I took that step and did my best to use it correctly as a tool in my recovery, while working VERY VERY hard with a counselor, it worked for me. Since then, I have devoted a lot of time to speak with other addicts about it and have “sponsored” hundreds and hundreds through this option and I have seen more people stay in recovery longer because of it. I also was part of a Naltrexone implant study over the course of 12 months to see if people on the implant really achieve longer sobriety than someone on the oral form and even the injectable. As far as liver damage, case studies show no liver damage within the first 12 months of staying on Naltrexone. If that was the case, then I truly believe Vivitrol would not have been FDA approved for alcoholism (and they are more prone to have liver damage than an opiate addict).
I went through a rapid detox but with sedation….no anesthesia. I have been through both and the sedation detox was SO much easier and more comfortable process to go through. The doctor was great (he too was a board certified anesthesiologist) and I was awake through most of it to learn a lot about the process of which my brain and body was going through.
However…there are still several addiction specialists that can offer a detox (no anesthesia or sedation) on an outpatient basis and still complete it with the Naltrexone implant on the last day. There are usually several options to offer a patient to help them even get through the tough time.
And with the Suboxone…there are truly people who need to be on it; pain management, people who are NOT ready to be clean, etc. But there are some who did NOT know enough information about it, took the advice of their “MD” and then now are having a hard time getting off it and have no idea what to do. I am “sponsoring” a woman now who is a school teacher in AZ….she called me this week and is so upset that her MD keeps writing her scripts for Suboxone, then she talked with him and told him she wanted to stop, and he doesn’t know how to get her through it…..because is in NOT an addiction specialist. She is only on 2mg per day but she cannot get off of it. I sent her to a specialist who will detox her in 5-8 days comfortably and then put her on the Naltrexone implant……it will take away her cravings, temptations, and provide her that “safety net” during the first 2 months of her recovery. She knows it won’t be easy to be dependent for 2 years and all of a sudden not be dependent, but she is so excited to have the “opportunity” that she was never offered before.
I hope you will consider posting my blog…..it may help some and it may not. But, addiction is non-predictable anyway and there is never a guarantee. Thanks for the good work you are doing…..look forward to reading more stories.
My Last Word:
I appreciate the writer sticking with the discussion; too often a discussion will degenerate into name-calling, as I mentioned in my prior post.
I am not aware of anyone using the Naltrexone implant in my part of the country (the upper Midwest). I know that there are places in Florida that advertise heavily on the internet, and I do have one current patient who had rapid detox in Florida and the implant several years ago. He now takes Suboxone. I will admit to some real stupid behavior on my part, borne from desperation: on three occasions during my active using days I performed unmedicated rapid opiate detox… on myself! On one of the occasions I injected the contents of an unlabelled syringe– something that often results in a dead anesthesiologist– but which in this case resulted in an anesthesiologist who only felt dead. The unlabelled material turned out to be naloxone. It was when I recognized this level of addiction– and this level of dangerousness– that I decided to leave anesthesiology behind and do another residency.
The other two occasions were equally stupid. Again, understand that I hated being addicted to opiates from day one; I took naltrexone tablets (which unlike naloxone are active orally) thinking that the block would set me free. The first time, I was in a meeting with my partners after I took about 100 mg of naltrexone; by 60 minutes I had to run from the meeting, much like a disgusting scene in the movie Trainspotting (I won’t say more, but those of you who have seen the film likely know the scene I am referring to). The last time was late in my active addiction at a time when I was truly going crazy, and I don’t remember the event very well. Yuck.
Back to the writer’s comments– I don’t agree with the idea that Suboxone is for ‘pain patients’ and ‘people who are not ready to be clean’. People taking Suboxone are as ‘clean’ as a person on Naltrexone in my opinion; in both cases the person feels ‘normal’. There is no ‘high’ or any other subjective opiate effect associated with proper use of Suboxone. In fact, I have concerns when I start Suboxone in a patient having significant pain, knowing that the use of opiate agonists will be impossible on Suboxone and that tolerance develops to the agonist effects of buprenorphine.
As I have said in other posts, I see buprenorphine to be in line with Naltrexone, but an improvement upon it. I have not seen evidence that buprenorphine reduces opiate cravings; in my experience the cravings on Naltrexone were if anything more severe. Yes, Naltrexone reduces cravings for alcohol, but that is a completely separate effect. On the other hand, buprenorphine clearly does reduce opiate cravings, very effectively.
Everyone will have his/her own way of seeing things. Here is mine: Naltrexone provides assistance with sobriety by assuring the addict that use would not result in intoxication; the addict therefore can tell himself, as a last-resort measure to avoid use, that ‘even if I did use, nothing would happen’. In my model, ‘addiction’ consists of the mental obsession to use. Since Naltrexone doesn’t treat cravings, it doesn’t treat the ‘obsession’—it doesn’t treat ‘addiction’. So a person taking Naltrexone is truly in a ‘dry drunk’; the obsession to use is STILL there, and so active involvement in a 12-step program is necessary to regain a sense of freedom from substances. I think this is why rapid opiate detox and Naltrexone implantation has sometimes resulted in disaster; an addict stumbles out of a hotel after rapid detox, blocked from using, but still obsessed with opiates—without any exposure or experience with a recovery program (again, the steps are the ‘gold standard’ here). So the blocked addict is miserable—and sometimes digs out the implant, or worse.
ON THE OTHER HAND… and as I have written about many times, buprenorphine gets to the heart of addiction—the obsession to use. A person taking buprenorphine (in Suboxone) is relieved of the obsession, and so in my mind is not in a ‘dry drunk’. For that reason I see twelve step meetings as less of an issue in patients taking buprenorphine. This is a tough point, so I will word it another way: the meetings are necessary with Naltrexone implants in order to stop the obsession (which meetings stop through the adoption of powerlessness and a higher power); Buprenorphine ITSELF stops the obsession in patients taking Suboxone. This leads to my frequent caveat– if a person stops buprenorphine, he needs to take up meetings—or the cravings and obsession will eventually return.
One final comment: there are currently trials underway for a buprenorphine implant, Probuphine, owned by Titan Pharmaceuticals. I have tried to make contact with people at that company on a number of occasions but cannot get a response; if you have contacts with anyone there, please contact me at [email protected]boxonetalkzone.com.