Opiates
Naltrexone and Opiates
Opiates, including heroin, opium, morphine and codeine, work by binding to the opioid receptors in the brain. The opioid receptors also detect the body’s own naturally-occurring chemicals such as endorphins.
When a person regularly uses a drug like heroin or morphine, the opioid receptors in the brain become much less sensitive. When naltrexone is taken, it attaches to the opiate receptors in the brain. This stops opiate molecules being able to bind to the receptors and so the effects or ‘high’ associated with the opiate are eliminated. It also allows the opioid receptors to recover to their former sensitivity.
Opiate detoxification
Patients who are part of the naltrexone program will undergo detox as they come off opiates. This will be least severe for those who have managed to stop their opiates for 3 or 4 days beforehand. However this is not possible for many of our patients. It is more important to come for treatment than to try to detox at home.
Heroin users can choose to switch to buprenorphine (Subutex) for the 3 or 4 days before they get their implant. However many prefer to simply get on and have their implant with a view to getting better as quickly as possible. Detoxing off a normal dose of heroin will be rapid and uncomfortable so for this reason we tend to use light sedation for the first 24 to 48 hours.
Methadone is more difficult to detox from and we ask users to go through a 2-week process of changing to Suboxone or Subutex (buprenorphine). Users are encouraged to stop their methadone on a Tuesday and arrive at the clinic early the next day. We will then usually start them on buprenorphine for approximately 10 days. Fresh Start will organise the first day of buprenorphine in the clinic if the methadone dose has been more than 40 mg/day. The highest dose of methadone that we have detoxed patients from is more than 500 mg/day. At the end of 10 days of buprenorphine we usually arrange three days off all drugs before inserting an implant. This means two reasonably ‘gentle’ detoxes.
Nat decided she wanted to change during a holiday to Thailand. “As I sat in the poppy fields I was struck with how empty life was and how heroin was not worth it,” she says. Desperate to be drug-free she saw Dr George O’Neil in 1999 who prescribed oral naltrexone. “George treated me like a person and not a junkie,” says Nat. “He gave me a sense of hope when I felt like giving up.” Now drug-free for the past 10 years and loving life, Nat works in disability services, having completed a TAFE course, and has reconciled with her former husband — a recovering addict — who she plans to re-marry later this year.