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High-Dose Methadone Detox: How Novus Medical Detox Center Does What Most Other Detox Centers Can't Do, An Interview with Kent Runyon
An interview with Kent Runyon of Novus Medical Detox Center
The prescription opioid called methadone has been used for decades to treat opioid addiction, most commonly for heroin. Hundreds of thousands of such patients have become dependent on methadone because of such treatment. And this opioid replacement use recently gained even more support from officialdom as high up as the White House.
Methadone-replacement patients normally receive their methadone from a licensed methadone clinic. The clear advantage is that they are no longer threatened by the inherent dangers of street heroin – the crime, communicable diseases and the ever-present potential of a fatal overdose.
The disadvantage is that methadone itself is an addictive narcotic. Methadone-replacement patients remain dependent on an opiate and tethered to their local clinic. However, considering the alternatives, many patients consider it an acceptable trade-off.
The use of methadone as a painkiller has also expanded over the past 15 or 20 years. Because of the addictive nature of methadone, this unfortunately has added to the growing number of methadone-dependent Americans.
A substantial sub-population of methadone-dependent patients has emerged whose daily methadone dosages have crept inexorably higher over time, reaching levels far exceeding the recommended dosages for pain or addiction treatment. How this happens can only be explained on a patient-by-patient basis.
The important factor here is this: When one of these high-dose patients decides it’s time to get off methadone, they usually encounter two critical factors hampering their quest for recovery:
- Most detox clinics cannot safely or successfully treat high-dose methadone dependence. Patients receive instructions to come back after they’ve reduced their dosage to original treatment levels.
- But because of the crushing withdrawal symptoms, it can be very difficult to reduce or get off methadone on their own. They need professional help, it’s not widely available, so essentially they’re trapped.
Fortunately, a few detox clinics do accept and successfully handle high-dose methadone-dependent patients. One in particular, Florida’s widely-respected Novus Medical Detox Center, famously pioneered new medical protocols for successful high-dose methadone detox.
We asked Kent Runyon, Vice President of Community Relations for Novus Medical Detox Center to explain why methadone is so difficult to deal with. And we also wanted to know how Novus sets patient after patient free from their methadone prisons. Here is the substance of that interview:
Q: Why do most detox centers refuse to accept high-dose methadone patients?
Kent Runyon: Methadone by nature is possibly the most difficult substance to detox from, as far as the comfort perspective goes. I’ve heard methadone patients describe feeling the ache and pain of withdrawal in their very bones when they’ve tried it on their own or elsewhere. Many detox centers don’t want to deal with high-dose methadone patients because they have found it too difficult to get people all the way down and off in a way that’s reasonably comfortable for the patient. Most detox centers don’t have medical protocols or strategies in effect that keep patients comfortable and prevent patients from going into precipitated withdrawal in the process. They don’t know how to avoid making patients too uncomfortable to continue before they can start on a Suboxone or buprenorphine type of therapy. That’s been the challenge for a lot of detox centers.
Q: Can you tell us how you make it more comfortable for patients? Without giving away any trade secrets of course.
KR: I should say that methadone is our longest detox protocol, and we invest all the time necessary to get patients to the finish line. We’re not rushing to get there, we take all the time it needs to make them successful. It’s a combination of the medical protocol that’s been developed over nearly 10 years, and refined through experience over that decade – a balance of medication with natural alternatives that blend with the medications that make the patient more comfortable. I think the credit goes to Dr. Agin’s expertise and the protocols that he’s developed, and implementation of the protocols by our skilled and experienced nursing team.
[Note: Dr. Brent Agin is Medical Director and the developer of the successful medical detox protocols used at Novus.]
Dr. Agin pays a lot of attention to how long the person has been off methadone before we start them on certain regimens. For example, he’s very attentive to the half-life of methadone and making sure we have them at the right point before we start them on the next step of the protocol.
[Half-life refers to how long it takes for 50 percent of a drug to be expelled from your body after the last dose. Methadone’s half-life is extensive compared to other opioids – from about a day or so for longer-term methadone users, to two or three or even more days for shorter-term users.]
Q: What do you mean by ‘steps’ of the protocol?
KR: Our methadone detoxification process is applied in what you might call steps, requiring close attention to patient response and making midstream adjustments when necessary. Methadone detox is one of our more complicated protocols, and it’s a highly individualized protocol that can change day by day, based on how patients are responding to care. That can be driven by their metabolism, their age, what dosage they’ve been on, how long they’ve been on methadone – one year? five years? All these things affect how they respond to care and how the doctor approaches their individualized protocol.
Q: What is the first step, and what is it’s endpoint?
KR: During the first step the patient is no longer on any methadone, and our protocol includes treatment to reduce symptoms. The endpoint comes when the doctor knows he can begin the transition onto buprenorphine – the next step – without inducing a precipitated withdrawal.
[Buprenorphine is an opioid medication that helps replace the missing methadone, thus relieving its withdrawal symptoms. Unlike methadone, which must be prescribed by a doctor registered with the DEA in a licensed narcotic treatment program, buprenorphine can only be administered by credentialed physicians in their office – or in this case, at Novus Medical Detox Center. Dr. Agin is one of only 3 percent of physicians in the U.S. certified to do so.]
Q: Can you tell us a little more about this step?
KR: We begin by transitioning the patient onto buprenorphine, and then titrating them [stepping down] off the buprenorphine. Our goal is always to use as little buprenorphine as possible to stabilize the patient and then get them off it as quickly as we can because buprenorphine in and of itself is addictive.
Q: What is the next step?
KR: The next step, after they’ve been withdrawn completely from the buprenorphine, could be called the stabilization period. The goal here really is for the patient at this point to have symptoms that are manageable without medications and that can be handled with our natural remedies. We know that some patients may have symptoms for some period of time as their body heals and re-orients to life without methadone. But we want to set them up for success and be able to manage any of these on-going symptoms without the use of any addictive medication. They could get to their final dose of buprenorphine on a Friday, and then stay with us Saturday and Sunday while they continue to get our Novus IVs and natural supplements.
Q: Now they’re done. They can go home or to rehab.
KR: We and the patient need to see how they’re doing with no medication at all, because their goal after they leave here is to go on to the next step in their recovery. They need to be able to manage their care at home or in rehab without medication. When they can leave with confidence, we can discharge them with confidence.
Q: So it’s never, ‘OK you’re done, you can leave now.’ They help make that decision.
KR: Correct. We monitor basic vitals multiple times daily throughout the program – heart rate, blood pressure, oxygen level, temperature and so on. During those final few days when they’re not on meds of any kind, and before they’re discharged, our nursing staff completes a final assessment. And we talk to them: How are you doing? How are you feeling? Do you have any symptoms at all? Is there anything we need to talk about? We fully assess the patient before we make a determination that this person is safe and stable and ready to move on. Patients know they’ve been through at least two days with no medication and no unmanageable symptoms. “I’ve had no methadone, no buprenorphine and no other medications, and it was manageable. I can do this!”
Q: Is there anything else you’d like to add?
KR: I do want to state that I believe that methadone and methadone clinics have their place in the continuum of care of persons struggling with addiction. For some people this is not the case. Some heroin addicts are ready for a life change, and the best recommendation for them would be to come straight into detox, get free from heroin dependence in detox, get into long-term treatment and get drug-free, get sober and move on with your life. I hear from too many of our patients “If I only knew how hard methadone was going to be I would have gone straight to detox.”
What’s really important is that we should make sure that methadone clinics are all operating in a professional and ethical manner, where patients are fully informed up-front that methadone is addictive, and that you may find that you’ll need some assistance to get off methadone because it often presents challenging withdrawal symptoms.
Every patient going into a methadone clinic should be on a timeline of getting off it. “Now that you’re on it, let’s talk about your next life chapter, the one of becoming drug-free” kind of thing. Not leaving someone on it with no plan in place to get off. The plan to be drug-free and the counseling to help that happen – these are the professional and ethical aspects that should and must be part of every methadone replacement program when used.
Q: Mr. Runyon, thanks so much for your time and for sharing this vital information.
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