The NESP Program FAQs

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What is the difference between dependence and addiction?

Most patients that have chronic pain are dependent on opioid painkillers but not necessarily addicted. However, the long-term consequences of dependence are just as grave as addiction. Patients that are dependent take painkillers because: i. they are in pain ii. to prevent withdrawal symptoms (sweats diarrhea, anxiety, etc.).

Patients that have true addiction may take painkillers for the same reasons but they also: i. will continue to take painkillers despite horrific consequences (loss of job, divorce, incarceration, etc.) ii. Will engage in risky behavior to obtain painkillers (theft, prostitution, etc.). Patients with true addiction will often need more long-term psychotherapy/cognitive behavioral therapy/medical hypnotherapy, etc. and other modalities such as  cranial (deep brain) stimulation to overcome the complex reasons for their behavior.

What is Suboxone/Subutex?

The active ingredient in both medications is buprenorphine. Buprenorphine is a partial agonist opioid. Medications such as OxyContin, Vicodin, Norco, and Dilaudid are full agonist opioids.

You can think of a full agonist (i.e. Vicodin) as a key and the opioid receptor in the nervous system as a lock. The key (full agonist) fits the lock perfectly and opens it unlocking a door that allows a rush of neurotransmitters into the cells that are responsible for pain relief but other substances enter that are associated with the development of addiction and other negative side effects. Suboxone/Subutex is a partial agonist  it is also a key that fits the lock and opens the door but the door only opens partially allowing enough of the neurotransmitters in for pain relief and to suppress drug cravings, but the door does not open wide enough (chain lock catches the door) to let some of the other substances in that are associated with addiction and negative side effects (note this is a simplistic version of what is really happening in your body).

Finally, there are antagonists (dummy key) that fits the lock (receptor) but does not open the door; it just sits on the receptors preventing them from being activated. These drugs (i.e. Naltrexone, Naloxone) can cause immediate withdrawal and NO pain relief but do have a place in treatment for some patients.

The NESP Program usually uses compounded buprenorphine to avoid the “inactive ingredients” found in mass-produced Suboxone and Subutex and other pharmaceutical buprenorphine medications that sometimes cause side effects or allergic reactions. However, most patients react well to Suboxone and Subutex we just feel from clinical experience that the compounded buprenorphine is more effective.

What is cranial electro Stimulation (CES) and why do I need to use it during the program?

CES is stimulation of the brain with microcurrents that helps patients not crave opioids. In addition, CES has been shown to be effective in reducing pain in chronic pain syndromes of various types and also treats depression and insomnia. You may be treated with this device on some or all of your treatment days.

Some patients may want to have one for home use and they can be purchased out of pocket. However, many insurance carriers will pay for the device. The small portable devices are relatively inexpensive and it is highly recommended that you obtain one for home use.

Other more advanced devices (achieves deep brain stimulation) used in the office are generally not affordable to the average person for home use. Both devices are painless but should be used while sitting or lying down since they can affect balance when standing.

How long does the detoxification process take?

This is very fast. In fact, on the first treatment day, you will be in a state of early withdrawal (you are told how to take your current medications in advance up until the day of treatment), which is an indication that many of your opioid receptors are unoccupied.

When buprenorphine is administered your prescription opioid is displaced and you are technically “detoxed” at that point. This, however, does not necessarily address your pain (although buprenorphine often provides great pain relief) or the psychological aspects of your dependence or addiction to the opioid, if you have any. This is why there is a maintenance part of the program. In addition, it takes time for your neurotransmitters (Dopamine, Serotonin, GABA, etc.) to become balanced.

This is why you will have a 3 to 10 day IV protocol to rapidly replace the building blocks of neurotransmitters into your nervous system. This is also achieved with many of the supplements you will be given to take.

Why do I have to stop taking my opioid pain medication the day before the treatment?

​This is the most important part of the detoxification process. You must refrain from taking opioids for 8-12 hours prior to treatment to insure that your opioid receptors in your nervous system will be available for buprenorphine to bind and take effect.

Patients on long-acting opioids such as. OxyContin, Duragesic (Fentanyl) patches, and Methadone will be converted to an equivalent dose of short-acting opioid 3-7 days prior to the scheduled start date to ensure these long-acting opioids are out of the system. Some patients have a lot of anxiety associated with early withdrawals and cannot handle abstaining from opioids for even 3-4 hours.

If this is the case for you it is mandatory that you notify the pain doctor before the treatment day so an alternative plan can be made for you (home healthcare nurse the night before and/or receiving anti-anxiety medication, you can take at home the day before your treatment day are a few examples of alternative plans).

What happens if I take my opiod medication the day of the treatment day and come in for detoxification anyway?

​This could potentially have disastrous effects on your body. It is possible to go into an acute withdrawal syndrome if you are given buprenorphine in the face of not abstaining from your opioid medication.

You will be evaluated (drug screen, Clinical Opioid Withdrawal Scale {COWS, and clinical evaluation) for evidence that you are indeed in early opioid withdrawals, if you are NOT, you will be sent home and given ONE make up appointment for treatment. If you fail to comply with the protocol on the next scheduled treatment day you will be subject to being expelled from the program and you will forfeit 50% of the cost of your program.

There are rare individuals that may have continued elevated blood or urine levels of opioid despite stopping the medication as instructed. This usually occurs in patients who have been on longer-acting opioids such as fentanyl patch and OxyContin or patients who are slow metabolizers of opioids (this will be picked up on DNA testing). In these cases; patients will be put on a special protocol to ensure proper preparation for detoxification.

Why do I have to take undergo multiple drug tests during the program?

​This is to document that you are being compliant with the program. In addition, it helps to document that the targeted substances that are being “detoxed” out of your system are indeed coming out of your system.

NOTE: anyone who tests positive for illegal substances such as cocaine or methamphetamine may be immediately expelled from the program and will forfeit a minimum of 50% and a maximum of 100% of the program fees depending on what stage of the program they are in.

Marijuana is usually acceptable since some patients are using medical marijuana or CBD or may even be prescribed this for pain/addiction during the program.

How long will I be on buprenorphine?

​This is determined on a case-by-case basis. Some patients can be rapidly tapered off in a matter of days to weeks; others may be on the drug indefinitely if they need it for pain relief and/or to prevent drug cravings. Drug cravings are usually a sign of neurotransmitter imbalance in the nervous system.

Supplements/nutraceuticals are used first line to achieve normal brain chemistry; if this fails or is inadequate several pharmaceuticals can be prescribed to help achieve brain chemistry balance. For patients taking it for pain, we can employ many Non- Opioid modalities for pain relief. Finally, a new technology called ODIN D1 is now being used to help patients discontinue buprenorphine.

The bottom line is how well a patient is functioning and the daily drug dose is what is most important. Our philosophy is that if you are functioning at a high level in all aspects of your life and you are on a low dose of buprenorphine (1-8 mg/24h) then being on this dose indefinitely is acceptable vs. not being on the medication and having bouts of relapse or significant pain.

Why do I need to see a nutritionist?

​The program is designed to target all aspects of pain and opioid dependence or addiction. Nutritional cleanse programs and custom programs to compensate for nutritional deficiencies are essential to becoming pain and addiction free and for overall good health. Patients can also be placed on anti-craving diets to help prevent relapse.

The vast majority of patients with opioid dependence or addiction have significant nutritional deficiencies that need to be addressed. In addition, patients in pain can be put on anti-inflammatory diets and be prescribed natural supplements that fight pain.

Finally, nutrition to support neurotransmitter imbalances can be extremely effective in controlling or even eliminating drug cravings and maintain normal mood and behavior.

Why do I need to see a medical hypnotherapist?

​This is optional, not all patients need this but since the inception of this program, we have found that medical hypnosis and cognitive behavioral therapy is a very important piece in the long-term success of the program. We have found it to be more effective than traditional 12 step programs and/or traditional psychotherapy.

This part of the program helps to identify and treat the psychological reasons and issues behind opioid dependence or addiction. In addition, it provides effective therapy for chronic pain. Eventually, patients will be taught self-hypnosis so they can continue to use the tools they have learned long after finishing the program.

What happens at the end of the program if I still have pain?

​Buprenorphine is a painkiller (as potent as morphine for some types of pain). You may be maintained on a dose of buprenorphine that controls your pain until the root cause of your pain is treated; recommendations and a long-term treatment plan (using several Non-Opioid modalities) will be outlined by the pain doctor. Once in balance, your body will begin to produce its own natural painkillers (Beta Endorphins); in addition, many supplements we employ will help to control chronic pain.

There are several other techniques and devices that can be used to control pain. Controlling and hopefully eliminating chronic pain WITHOUT habit-forming opioid medications is our specialty and is emphasized.

What can I do if I have an emergency after business hours?

If you are having a true acute life-threatening emergency you would call 911 or go directly to the emergency room. If you have an urgent problem you will be given an after-hours cell phone to call.

If you have an after-hours nurse (additional cost) assigned to your case we will also give you his/her cell phone number.

Does my insurance cover the program?

​Unfortunately, private insurance is very difficult to work with for non-conventional therapies so we no longer take insurance. We can provide you with itemized invoices for you to submit to your insurance for reimbursement. Another option is to pay for the program using a Health Spending Account (HSA) or Flexible Spending Account (FSA).

Patients who have HSA accounts are able to pay using pre-tax dollars.  We also offer short-term in-house financing and we work with several medical financing companies for long-term financing.

Are there any side effects to buprenorphine?

​The most common side effects are headache, nausea, and fatigue but these can be minimized by insuring that you are in early withdrawal prior to treatment (see FAQ 4 and 5). Most patients feel significantly better within hours of the initial treatment.

Remember you will have an intravenous line in for the first 3-10 days so side effects, if and when they occur can be treated rapidly.

What do I do if I have a dental or other procedure that requires me to take a opiod after I have undergone the program?

​Often pain associated with these types of procedures can be controlled with a non-opioid medication such as an anti-inflammatory or regional anesthesia. If the pain is too severe, patients can take a short course of an opioid for postoperative or acute pain. This should be done under the supervision of a pain physician and you should inform that physician of your history of doing this program. Most acute or postoperative pain is most severe within the first 24-72 hours after the painful event and at that point use of a non-opioid painkiller may be sufficient.

Anesthetic nerve blocks are another alternative for relief of acute and postoperative pain. These blocks can give excellent and even complete relief but usually need to be performed by a physician trained in regional anesthesia and or interventional pain management The best thing to do is to notify us in advance, so we can coordinate with your dentist/surgeon, etc. to get you through your procedure without risking a new addiction/dependence on prescription opioids.

Finally, here is where DNA testing (which for most is done prior to starting the program) is very useful. DNA can help identify which painkiller will work best for you in a post- surgery situation with the least risk of dependence or addiction.

What if I live out of town or state and want to do the program, where can I stay?

We have worked out special reduced rates for patients at some local hotels that can be offered to you. Another alternative is to stay with a host family. This is usually a former patient who has gone through the program. This situation offers the additional benefit of staying with someone “who has been through it” for increased support.

This option has to be scheduled and is based on availability. In addition, some patients may be eligible to complete some or even all of the program in their home depending on their condition and resources. This program is handled on a case by case basis and is significantly more expensive.

May I speak to former patients that have been through the program?

YES! Many of our former patients are so happy about the transformation in their lives that they want to help others. We can provide you with a list of former patients that would be willing to answer your questions.

Does this program work for smoking, alcohol or other drug addictions such as methamphetamines and cocaine?

​The short answer is maybe. This program is very specific for prescription opioids, however, it can also treat Heroin addiction since Heroin is an opioid. We focus on balancing brain chemistry and once this is done, anxiety, depression, and insomnia are often resolved partially or completely. In this regard, we try to detox patients off other prescription pills such as Valium, Xanax, muscle relaxants and Ambien.

All addictions have common denominators but also have unique characteristics so we focus on the opioids first. Therefore, if a patient is smoking we will usually not attempt to stop that habit while simultaneously detoxing the patient off opioids. For most patients, it is too much to deal with all at once. Therefore the focus is on prescription opioids.

Should I join a 12-step program or continue a 12-step program if I am already in one?

We do not require that you join a 12 step program such as Narcotic Anonymous (NA); however, we do not discourage it if you feel that this type of group support is helpful to you.

NA does not usually support the use of any drugs to help with abstaining from opioids. Obviously, we differ in philosophy on this point and allude to the fact that NA when used alone has a very low success rate and a relapse rate of 80-90%!

Will I need to be on medications for life?

This depends on many factors; however, our philosophy is to substitute as many if not all pharmaceuticals for scientifically proven nutritional supplements and nutraceuticals.

For example, a patient that has chronic depression; may respond to supplements such as 5 HTP instead of a pharmaceutical such as Prozac. Remember true addiction IS a disease not unlike diabetes. No one faults a patient for taking lifetime insulin to control their blood sugar from type I diabetes. The same is true here; you may need supplements or the combination of supplements and pharmaceuticals to control cravings which are the main reason for relapse.

The key here is how well a patient is functioning. A patient who requires a small dose of buprenorphine 1-8 mg per day indefinitely and is doing well in every area of their life and on no other habit-forming medications would be considered a success. Another example is a patient who is off all pharmaceuticals and is maintaining or a regimen of diet and nutritional supplements but occasionally has severe anxiety or even panic attacks. We believe in this situation the patient should be allowed to have a small supply of an anti-anxiety medication such as Valium for this purpose.

Most medications are not inherently bad it is the daily chronic use that is bad especially when the root cause of the problem is never sought out or corrected. Finally, CBD (cannabidiol) can be extremely useful for pain, anxiety, and insomnia and is often prescribed in lieu of prescription medications.