So we’ve talked about how relationships can be bad for the success of your opiate detox, and we’ve talked about how opiate detox can be bad for relationships (not that drug addiction is good for relationships, but you know what I mean). Some people have asked me about casual relationships, both sexual in nature and platonic. So here’s what I think…

Sex-Only Relationships During Opiate Detox

Dangerous. Your time in opiate detox is uncomfortable to say the least. Many are uncomfortable with themselves in this vulnerable state, physically and emotionally. Getting involved with someone in a purely physical relationship is just too risky for this time in your life. What if you start to have feelings for this person? Or they start to feel for you? Especially if these feelings are unrequited in either situation, you’ve got yourself a problem.

You may or may not even really know yourself that well anymore, depending on how long you spent actively in your addiction. Sometimes people move too quickly into physical relationships because they are unsure of themselves, maybe don’t feel that they don’t have anything else to offer. Of course, this isn’t to say that this applies across the board or forever, but when you’re just starting out in recovery, it’s my opinion that you should find your entertainment in something more substantial.

Platonic Relationships During Opiate Detox

Is it okay to date or have a relationship that isn’t physical in nature? Yes and no. If there are feelings between you and someone else that go beyond friendship and you’re choosing to spend time together without taking it to a serious physical level, then you’re doing the right thing. Just make sure that you aren’t spending all your time with this person, making decisions about your future or opportunities that become open to you based on what this person thinks or wants or with an eye toward maintaining the relationship first. This is called codependency and it’s a common problem among those new to opiate detox and opiate addiction treatment.

Whatever you decide to do, take it slow. Make sure that you have a support system that extends beyond this relationship in your life. You want to give yourself every opportunity to succeed, not set yourself up to fail.

What about you? Do you have any experiences or thoughts on platonic relationships or casual relationships that are only physical in nature during opiate detox and recovery?

US WorldMeds is a Kentucky-based specialty pharmaceutical company and they have recently completed Phase III clinical trials of lofexidine hydrochloride (Lofexidine) in the treatment of opiate addiction. More specifically, Lofexidine would treat the withdrawal symptoms associated with opiate detox just like buprenorphine and methadone. So is there a new treatment in the world of opiate addiction? According to Medical News Today, “opiate-dependent patients taking the drug experienced a significant reduction in withdrawal symptoms at the anticipated peak of withdrawal and stayed longer in detoxification treatment as compared to patients taking placebo.”

The Hope of a New Option for Opiate Addiction

Paul Breckinridge “Breck” Jones is the CEO of US WorldMeds. He says, “The debilitating withdrawal symptoms associated with opiate detoxification are a major reason people struggling with heroin or prescription drug addiction avoid or leave treatment. These trial results are impressive and confirm our expectations for Lofexidine. Lofexidine promises to be an important new tool for treating opiate addiction here in the US.”

The Difference Between Lofexidine and Buprenorphine

From what I can tell, the biggest difference is that Lofexidine is non-addictive and non-narcotic, unlike buprenorphine which works because it is an opiate with a high affinity for the opiate receptors that require constant engagement when you are an opiate addict. So Lofexidine is more of a treatment for the withdrawal symptoms than it is for the addiction. It eases the vomiting and nausea, stomach and muscle cramps, cold sweats and insomnia.

What This Could Mean to Opiate Addiction Treatment

Lofexidine is not yet approved by the US Food and Drug Administration (FDA) so this is purely speculation, but if the drug were to be approved, it would be the only non-narcotic treatment available for treating opiate withdrawal symptoms. According to Medical News Today,

“Lofexidine has been approved for use for 15 years in the United Kingdom (UK) to manage the often debilitating withdrawal symptoms that occur during opiate detoxification.

“Given the encouraging initial results of the Phase III clinical trial, US WorldMeds intends to submit a new drug application (NDA) for Lofexidine with the FDA for US approval. The NDA will be filed after the complete dataset from the trial, including additional efficacy and safety measures, is analyzed, and additional required studies are completed.”

What do you think?

I can’t stop thinking about it. The other day we talked about a guy on buprenorphine who saved up his pills and tried to return to maintenance after a heroin relapse by taking 11 8-milligram pills only to find himself smack in the middle of a nasty opiate withdrawal.

If he took Suboxone—a combination of buprenorphine and naloxone—without waiting for withdrawal symptoms to kick in first, then that makes sense. When you’re already strung out on prescription painkillers or heroin and are ready to detox, the doctor will most likely start you on Subutex first or wait for withdrawal to start before switching you over to Suboxone with the express purpose of helping you avoid an onslaught of withdrawal symptoms. According to the Associated Press article, this man continued to take buprenorphine after the first handful of pills and yet the symptoms still did not subside.

What The Experts Have to Say

In the article, they have this comment:

“When buprenorphine is taken soon after opiates with less opiate-receptor affinity, such as heroin and methadone, it displaces them from the receptors. Since buprenorphine is only a partial agonist, this causes a drop in the level of overall opiate activity and is experienced as opiate withdrawal. While we are aware of only three other reported cases of buprenorphine-precipitated withdrawal after heroin use, it is common in methadone patients transferring to buprenorphine therapy, particularly with higher doses of methadone (> 40 mg), a short time between the last methadone dose and the first buprenorphine dose and when higher initial buprenorphine doses are used. Withdrawal symptoms typically commence within 1–3 hours of the first buprenorphine dose and can last for several days.”

What This Case Shows About Buprenorphine

First, it shows that you can take 88 milligrams of the drug and not die. The highest dose prescribed is 32 milligrams, so that’s almost three times as much, and there was no respiratory depression to speak of. Considering that’s the problem with opiate overdose, that’s good news for those on buprenorphine who can’t be rescued from respiratory depression by naloxone. So here’s more evidence on the ceiling effect of buprenorphine, that you don’t “feel it” per se even when you increase your dose. I’ve heard people say that it doesn’t feel like they’re taking anything at all, no matter what dose they’re at.

This case also shows that repeated doses of buprenorphine doesn’t help matters any, since his withdrawal symptoms didn’t subside with multiple doses. Maybe his dose of heroin was too high. And his initial dose of buprenorphine was definitely too high. But this, too, is an interesting fact to ponder.

Okay…. Discuss!