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Detox Question about Vivitrol Shot Necessity/Effects in Outpatient Detox Research Program

Masemase

Greenlighter
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Aug 30, 2010
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Hi - so I have been on and off with oxycodone addiction for almost 10 years, having went through two separate suboxone detoxes that lasted a couple of months before I started again on the oxycodone 2 years ago, taking about 10mg or so total a day, split up into 3-4 doses.

Recently, I decided that I wanted to get off of it for good and researched local detox programs (after looking on this forum for advice on whether to go CT or Suboxone route and deciding on the former) I found an outpatient research study being conducted at Columbia university.

The study is to gauge the effectiveness of an outpatient course of LUCEMYRA (also called lofexidine) (the main drug being studied) to reduce withdrawals in a "remote" outpatient setting. I am also given klonapin and ambien for symptoms during the detox. At the end of the course of the detox (7-10 days) they administer a vivitrol shot and then another 4 weeks after that.

They said I should come in "comfortable" (ie not withdrawing) but that any bit of tapering leading up to it would be helpful. So the couple of days up to it I tapered down to about 5mg and on Monday I took just 4mg of oxycodone before my first appointment, so my last dose was now 72 hours ago.

I flushed my stash and went in this past Monday for them to observe my first dose of lofexidine in addition to their taking my vitals, etc and then once a day from home I do a urine test and blood pressure check over zoom with the doctor.

In terms of how I'm feeling: the WD hasn't been awful with the meds they've provided, as I think that the lofexidine is quite helpful, in addition to the fact that my habit wasn't too much. I also think tapering before was helpful, as I had some light WD symptoms those days as well. I do not think I'm through it at all, but I do think it will be tolerable.

Anyway, my two questions are specifically about the Vivitrol shot that they will be administering:

  1. I have read that one needs between 7-14 days of no opiates to fully avoid precipitated withdrawal from the Vivitrol shot. Initially, they had planned on giving me the shot after 10 days of detox, but now they are saying that they want to give it to me today (3 days in) or tomorrow (4 days in). My tests are clean for oxy now, but considering there is no real "harm" in waiting until the 10 days are up (since I have no oxy to take and if I do relapse then I am out of the program) then my question is: why would I rush to have the injection so quickly? Is this enough time to definitely avoid precipitated withdrawal or is it possible that this study is about getting the patient to the "end goal" (the Vivitrol shot) so they are rushing to get the shot into me before I relapse? The incentives here are confusing me so I am curious your thoughts here.
  2. I have read a bunch about Vivitrol now, and I am wondering whether it is sort of "too much" for my habit. Of course, I am not above anyone else in my potential to relapse, but I do have a very good outlook here, have no more connections for oxy, and am confident of riding this out to being fully clean. Some of the side effects of Vivitrol make me think that it might be "too much" for me and that it's possible that this course of action is more suited to a larger habit and that the researchers might, again, just be trying to get me to that "final goal" without taking into consideration that there are side effects to injecting someone with something that lasts for 30 days, whether they "need" it or not. What do you think?
I know this is a very long winded post, but the fact that this is not an actual detox program that I am paying for, I am suddenly unsure of who specifically they are looking out for and whether they consider the program's effectiveness over my health, so I am wondering whether I should use their meds to detox but not go in for the Vivitrol shot.

Any input here would be GREATLY appreciated; thanks so much in advance!
 
i'm afraid i can't answer your questions, but i will say vivitrol is not a magic bullet. i have a friend who was on it and he relapsed the second it wore off and just cross addicted onto different drugs while he was on it. unless you are getting therapy to deal with the underlying causes of your addiction while the shot is working, then i don't see how it is supposed to help.
 
You’re right @chinup , the underlying behaviors absolutely need to be addressed, but in my opinion, Vivitrol is a great option for people able to reach sobriety sooner and don’t need and/or want long term opioid maintenance medication.

The single biggest plus with naltrexone is it’s ability to reduce opioid tolerance, while also creating a barrier in the event the person relapses from not only being able to feel the drug (and thus, the reward is gone), but also from a potentially fatal overdose as well.

With that said, if the underlying behaviors aren’t dealt with first, it’s not a cure for opioid addiction.

why would I rush to have the injection so quickly? Is this enough time to definitely avoid precipitated withdrawal or is it possible that this study is about getting the patient to the "end goal" (the Vivitrol shot) so they are rushing to get the shot into me before I relapse?

Most likely a combination of protecting you from negative consequences of relapsing and also, the sooner you start the naltrexone, the sooner it will help reduce opioid tolerance.

I have read a bunch about Vivitrol now, and I am wondering whether it is sort of "too much" for my habit

Vivitrol is definitely the better option for you versus maintenance medication, if abstinence isn’t possible alone, considering your small doses of oxycodone usage. As far as it being too much, it’s not going to make you a bigger addict like if you were to go the buprenorphine or methadone route. Quite the opposite, in fact. Naloxone and naltrexone are prescribed for other things besides opioid treatment and to reverse overdoses, by the way.

So, I suppose it ultimately comes down to if you’ve addressed the underlying behaviors that fueled your addiction to begin with.
 
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