Executive Home Detox has been providing physician supervised alcohol home detox and opiate* home detox for the past six years. EHD always works with a prescribing physician. There are a number of options we use to access physician services when working with a client.
- Current Physician: We work with the client’s current physician. This is an opportunity to work closely with a doctor that knows the client and an opportunity to begin the process of supporting all the team members the client will use post detox. There are times the client requests we not contact or work with the current physician. He or she may be personal friends or the client may have felt “judged” by the physician in the past. We prefer to work with the client’s current physician but will consider other options.
- An Alternative Physician: If the client doesn’t have a physician or the client wants us to access a physician other than their current physician, we seek an expert in the field. EHD already knows many expert physicians throughout the US and often accesses these experts to work with new clients. Additionally, EHD seeks out physicians who are American Society of Addiction Medicine (ASAM) certified or a member of the ASAM. Lastly, if we cannot access a physician from the ASAM, we seek out physicians who have demonstrated an interest in addiction medicine through publication or through noted treatment programs in the area.
Alcohol and opiate detoxification is usually managed without incident however it is important to have a knowledgeable physician available and prescribing in the event an incident begins to surface. Having a knowledgeable physician decreases the likelihood there will be a medical incident.
*Opiate Detox includes: Heroin, Oxycodone, Oxycontin, Percocet, Roxicet, Roxies, Roxy’s, Oxy’s, Dilaudid, Hydromorphone, Opana, Hydrocodone, Vicodan, Lortabs, Fentanyl, Fentora and others.
A 60 year old woman dependent on alcohol contacted Executive Home Detox and requested EHD assist her with detoxification in the comfort of her home. She was drinking daily for 5-6 weeks and her overall health was being seriously impacted by her daily alcohol consumption. EHD has a long history of providing highly individual and specialized services to women and thus, was able to help this client.
This client (we will refer to her as Michelle) had recently been to a detox and rehab. She has a history of attending multiple rehabs. She realized she needed help but was adamant to friends that she would not enter another inpatient program. She contacted EHD in the hopes we could detox her from her alcohol dependence and addiction and begin an aftercare program suited to her needs.
Michelle required a medical professional to monitor her throughout her alcohol detox. She was physically compromised with obvious weakness, hypertension, mild confusion, and and malnourishment. She had multiple signs of withdrawal. Her risk of injury was great. A nurse, expert in the area of medical detox and addictions treatment, resided with Michelle and her family from the beginning of the home detox to the end of the detox process. The nurse monitored her blood pressure, provided medication ordered by her physician, and assisted with meals to strengthen this client.
A five day alcohol detox was required. The client received alcohol detox medications to counter the alcohol withdrawal and to make her as comfortable as possible. Michelle had a say in her medications and felt a part of the detox process. An aftercare plan was negotiated that would sustain Michelle’s sobriety. She has, to date, followed this aftercare plan. Michelle and her family are cautiously optimistic she will sustain her sobriety and are thankful for this treatment model that allowed Michelle to stay at home and receive treatment.
Executive Home Detox has the ability to tailor a program for women in need of services.
Executive Home Detox recently received a referral from a pre-eminent physician. A woman 35-40 years old had relapsed on Oxycodone*, had become drug dependent, and wanted help but did not want to go back into the hospital.
The client, we’ll call Laura, is an active, independent, strong willed woman. She has a number of responsibilites; including being a mother. Laura did not want to take an extended period of time away from her child or her other responsibilities. EHD proposed a number of possible detox protocols and, along with her physician, Laura chose to proceed with the shortest possible opiate / Oxycodone detox.
Unfortunately, a female nurse was not available to assist with the home detox so a male nurse was used and Laura’s female friend was on-site for the duration of the home detox. The private duty nurse was on-site twenty-four hours per day monitoring and supervising the medical detox. Laura and the nurse had daily contact and two face to face visits with Laura’s physician. Laura was also able to continue with her therapist during this period of time.
Five days from commencement, Laura was fully detoxed. She continued to have some Post Acute Withdrawal Syndrome, some malaise, however she was medically detoxed from the Oxycontin in her system.
Laura is doing quite well. She is active in her community and active with her family. She continues to see her physician and her therapist. Laura and a representative from EHD speak on the phone periodically.
EHD was created for people like Laura. People who want help but feel they cannot take the time off to go to a hospital for intense treatment. EHD is staffed with Certified Addictions Registered Nurses (CARN) and we provide one private duty nurse 24/7 for as long as the medical detox requires.
EHD is available for a Boston Home Detox and is available to travel anywhere in the United States and beyond to provide a Private Duty Home Detox experience.
*Oxycodone is an opiate found in Oxycontin, Oxys, Percocet, Percs, Roxicet, Roxies, and other formulations. It is closely related to Vicodin, Lortabs, Vikes, and Hydrocodone.
Executive Home Detox has recently completed two opiate home detoxes. Both of these recent detoxes were “cold turkey” type detoxes with the assistance of comfort medications.
There are a number of ways to detox from short acting opiates*. Executive Home Detox uses two effective protocols to detox a client dependent on opiates. A 7-10 day tapering Suboxone detox is fairly comfortable and effective. We also assist the client with a five day “cold turkey” detox in which comfort medications are used.
The five – 5 day “cold turkey” detox does include discomfort, but it is shorter than a Suboxone detox and in 4-5 days the opiate is completely out of your system. The comfort medications include Clonidine, Bentyl (Dicyclomine), Motrin and/ or Tylenol, and other medications (possibly including short term benzodiazepine use).
The most difficult period of time for this detox is days two and three. Very unpleasant withdrawal symptoms occur during this time and those dependent on opiates frequently elect to resume using during days two and three.
Executive Home Detox monitors the opiate detox from beginning to end. A certified addictions registered nurse lives with the client and makes every attempt to make the client comfortable while still managing an effective opiate detox.
Short acting opiates include:Heroin, Oxycodone, Oxycontin, Percocet, Roxicet, Roxies, Roxy’s, Oxy’s, Dilaudid, Hydromorphone, Opana, Hydrocodone, Vicodan, Lortabs, Fentanyl, Fentora and others.
The New York Times has an article in it’s July 29th issue titled: “South America Sees Drug Path to Legalization”. It talks primarily about Marijuana but also includes other potential drugs that may get legalized.
Here is the link: http://www.nytimes.com/2012/07/30/world/americas/uruguay-considers-legalizing-marijuana-to-stop-traffickers.html?_r=1&pagewanted=all
The crux of the article is the country of Uruguay is considering legalizing Marijuana in an effort to decrease the violence associated with the control of Marijuana. Here is a quote from the article:
“It’s a profound change in approach,” said Sebastián Sabini, one of the lawmakers working on the contentious proposal unveiled by President José Mujica on June 20. “We want to separate the market: users from traffickers, marijuana from other drugs like heroin.”
There is an evolution of thought, some consider it a revolution, that legalizing MJ will not affect adolescent and adult use and it will add to the governments coffers in the form of taxes and decrease violence. I suspect the process of legalization will continue to evolve throughout the US and the world.
Executive Home Detox often gets questions related to MJ use. Here are a few thoughts:
1. Some people can use MJ responsibly, just as some people use alcohol responsibly. However there are those that are profoundly affected by MJ in a negative way. Those affected in such a negative way may require assistance and support to cease it’s use.
2. The use of MJ as an adjunct in the process of detox from other substances must be cleared by the prescribing physician and the client’s personal physician. The preference is to have the client get off anything addictive or can be abused, however EHD will work with the client in a manner designed to reduce risk.
EHD travels to the client to assist in the home detox of alcohol, opiates, and other substances (benzodiazepines / Ambien …). The treatment model is unique in that one expert nurse lives with the client for as long as the medical detox requires.
A group of highly reputable physicians, including Dr. Stuart Gitlow, who have petitioned the Food and Drug Administration (FDA) to regulate the prescription practice of opiate use for non-cancer patients. This petition, in my opinion, stems from the gross overprescribing of opiates and irresponsible practice of many practitioners in their prescribing habits.
There are those that will decry the request for more regulation as insensitive to those suffering from chronic pain. To those, I suggest you read the petition. It is contained in a previous blog post.
Here are are few recent examples of the need for this regulation:
- A 21 yo female, suffering from physical and emotional pain was prescribed a 100 mcg Fentanyl patch and Fentora 400mcg every four hours for breakthrough pain. She was on 2000 mcg of Fentora for an extended period of time. Prior to this she was on the potent Dilaudid. Once detoxed from this extraordinary amount of opiate, she has required a total of six doses of opiate in the past year.
- A 24 yo male, post op from a simple appendectomy, received 70 Percocets for pain. He used a total of six percocets. He was in the high risk category for abusing or selling the Percocets.
The pendulum has swung wildly with the irresponsible marketing, irresponsible prescribing habits, irresponsible abuse of opiates in the past two decades. We have an epidemic on our hands. The pendulum has swung so far in one direction that it may need to swing too far in the conservative direction to bring the industry back into a healthy compliance.
Executive Home Detox has worked with many clients that have been prescribed, and then overprescribed opiates. We have seen countless individuals who have had their opiate addiction resumed due to irresponsible prescribing habits of physicians and due to the client’s lack of accountability for their addiction condition.
EHD provides a unique opiate home detox treatment model to clients who prefer privacy or convenience. We live with our client’s 24/7 in the comfort of their home. We travel to the client and supervise the medical detox one on one for as long as required.
Executive Home Detox recently completed a New York Home Detox in NYC. The client was in need of a medical detox from Alcohol and also had been using Cocaine. The client is, and was, highly motivated for ongoing treatment and we sought out an Intensive Outpatient Program (IOP) at the Freedom Institute.
The Freedom Institute, located in Midtown on Madison Avenue, presents as a comfortable treatment setting. The staff were professional and caring and the client and EHD were hopeful. Unfortunately, the Freedom Institute refused the client. The client is on a benzodiazepine and a muscle relaxer and the Freedom Institute wanted the client off these medications.
Many programs talk about “individuating” or “individualizing” programs for clients but most are incapable of really doing so. It is understandable that the Freedom Institute question any client on a benzodiazepine or muscle relaxant and assess the medication’s relevancy to the client. Unfortunately the Freedom Institute decided against treating the client because he was on these medications.
EHD is very cautious about treating clients with benzodiazepines and muscle relaxants due to their abuse potential. Caution should always be exercised in placing clients on these medications or continuing clients on these medications. However, a carte blanche approach that demands all clients be off these medications does not take into consideration the rare, but legitimate, client that needs addiction outpatient treatment and needs to stay on these medications.
I will not hesitate to consider the Freedom Institute for clients in the future, however I will not refer any challenging clients that require highly individualized medication management. EHD promotes abstinence, but also supports Risk Reduction for those clients in the process of address their dependence and addiction.
EHD provides private and confidential in-home detox to clients in the New York City area, as well as clients throughout the United States. EHD specializes in Alcohol Home Detox and Opiate Home Detox. Additionally EHD is qualified to assist with Benzodiazepine Home Detox.
Updated January 5, 2013
When should Phenobarbital be used for detox?
How safe is Phenobarbital when it is used for detox?
Executive Home Detox recently had reason to use Phenobarbital for a medical detox. A middle aged male recently contacted Executive Home Detox. He had decided to quit drinking alcohol and used benzodiazepines* to assist with his withdrawal. However he soon became dependent on benzodiazepines as well.
Benzodiazepine withdrawal can be difficult, very uncomfortable and can also be dangerous. The abrupt discontinuation of benzodiazepines can cause seizures.
Consideration was given to the use of long acting benzodiazepines to manage withdrawal symptoms from his benzodiazepine dependency, however there were questions about exactly how much benzodiazepine he was taking. A decision was made to use Phenobarbital as a detox agent. Phenobarbital is a barbiturate that will assist with withdrawal symptoms (anxiety, tachycardia, agitation, sleeplessness) and is also a very effective anti-seizure medication.
The danger of using Phenobarbital is primarily respiratory depression. The use of Phenobarbital as a detox agent in an outpatient setting has to be supervised. In this case, a qualified nurse provided 1:1 on site supervision. The nurse administered the Phenobarbital per a qualified physician’s order and then assessed the efficacy of the dose of Phenobarbital. The nurse also monitored the pulse, blood pressure, and respirations of the client. The nurse made the use of Phenobarbital safe.
This Benzodiazepine home detox was a nine day detox. The length of time for a Benzodiazepine detox can vary greatly and is partially dependent on how quickly the client wants the detox to occur. Generally a Phenobarbital managed medical detox will take up to fifteen days.
Executive Home Detox also assisted the client to create and follow through with an aftercare plan that increased the likelihood of sustaining sobriety from alcohol and benzodiazepines.
Benzodiazepines include: Xanax (Alprazolam), Ativan (Lorazepam), Clonopin, Klonopin (Clonazepam), Valium (Diazepam) and many others.
Home Detox for Alcohol:
Executive Home Detox provides in-home detox support to clients primarily interested in medical detox from alcohol or opiates*. Approximately 60% of our clients detox from Alcohol and about 40% detox from opiates.
Why consider a home detox for alcohol? I thought a small review of the reasons previous EHD clients requested a supervised at-home detox from alcohol may help others to make a decision to consider at home detox versus inpatient detox. All clients below demonstrated withdrawal symptoms that necessitated medication assisted detoxification.
Tom: Age 44 years. Retired executive. Alcohol Home Detox. Preferred privacy and convenience. Tom preferred having some control over his environment.
Gino: Age 55 years. Stock Exchange Trader. Alcohol and Opiate Home Detox. Confidentiality was a primary concern.
Allan: Age 62 years. Bank Executive. Alcohol Home Detox. Privacy and convenience were the determining factors. Allan also is used to a high level of service. EHD is a concierge level service with a high degree of clinical competence.
Maura: Age 50 years. Retired rancher. Alcohol Home Detox. Maura has disturbing memories of previous forced treatment. She also has specific medical issues that she was worried would not be addressed in an inpatient setting. Lastly, she did not want to leave her beloved cats.
[EHD is focused on privacy and confidentiality, identifying information is doctored to preserve a client's identity]
EHD is an alternative for many clients who would benefit from a 1:1 Nurse Supervised in home detox for alcohol. EHD supports inpatient treatments and inpatient rehab but recognize that for some, inpatient treatment is not an option.
EHD is happy to provide free consultation to determine if a supervised outpatient treatment model is a possibility for you or your loved one.
Opiates include: Heroin, Oxycodone, Oxycontin, Percocet, Roxicet, Roxies, Roxy’s, Oxy’s, Dilaudid, Hydromorphone, Opana, Hydrocodone, Vicodan, Lortabs, Fentanyl, Fentora and others.
Home detox for alcohol
The Wall Street Journal (WSJ) has an interesting video in it’s week-end digital edition. Mark Kleiman, a professor of public policy at UCLA makes a number of suggestions and points related to the way we, as a society, manage our war on drugs. Much of his focus is on alcohol misuse and the incarceration of those violating our laws geared toward drunk driving and illicit drug dealing.
Professor Kleiman cites programs that do not jail DUI offenders. Rather they offer the person a choice of jail versus breathylizer monitoring twice a day. Those that choose the breathylizer option and remain sober do not go to jail. This is a lower cost to society and allows the individual to remain a functioning member of our society…. and it helps the individual to practice living a sober lifestyle.
Another program targets the non-violent drug pusher / dealer. It also gives the drug pusher an option to avoid jail by closing down shop and answering to the community. Of course further infractions will result in jail time.
The above examples demonstrate “thinking outside the box”. Executive Home Detox was created by thinking outside the box as well. EHD offers an alternative to inpatient medical detox. We travel to the client and assist in the alcohol or opiate medical detox in the home. This home detox is uniqe. We actually live with our clients 24/7 for as long as the detox requires.