Ken Starr MD on Precipitated Withdrawal

Hey, Dr. Ken Starr with the Wellness Group in Arroyo Grande. I wanted to take a minute to fully explain, what is precipitated withdrawal? You’ve probably heard about precipitated withdrawal, maybe you’ve experienced it. Here’s what precipitated withdrawal is. Buprenorphine or trade name or brand name Suboxone, has a higher binding efficiency, it’s a stronger magnet at that opiate receptor in the brain than any other opiate for the most part. So if you have any other opiates in your system, whether it’s fentanyl, heroin, pain pills, whatever, there’s anything down to that receptor and you take Suboxone, boom, it pulls it off. (more…)

An opioid vaccine, new drugs for chronic pain, yet alcohol use disorder not a priority for NIH HEAL Initiative?

A week ago, I was drinking my morning cup of tea while reading several ‘addiction news’ articles
(as this is part of my morning routine) when I came across something novel. I saw a press
release on an opioid vaccine that targets fentanyl, which is being developed by the National
Institutes of Health (NIH) Helping to End Addiction Long-Term Initiative.

According to Heal.NIH.Gov, “The Helping to End Addiction Long-Term Initiative, or NIH HEAL
Initiative is an aggressive, trans-agency effort to speed scientific solutions to stem the national
opioid crisis. Almost every NIH Institute and Center is accelerating research to address this
public health emergency from all angles.”

The main goals of the NIH HEAL Initiative are to improve prevention and treatment for opioid
misuse and addiction and enhancing pain management. It aims to create new medications (for
opioid withdrawal, cravings, relapse prevention, overdose, pain management, and more) and
optimize treatment and treatment outcomes.

This is a big deal for individuals with opioid use disorder (OUD) and/or chronic pain, however,
alcohol use disorder (AUD) treatment appears to get no love in the NIH HEAL Initiative’s 6-point
plan that is estimated to take 5-6 years.

Why The Massive Initiative?

On average, 130 people die from opioid overdose daily. Worse still, rates of opioid use disorder
and opioid overdose deaths spiked drastically in 2020 and continue to rise at alarming rates. In
2018, the Centers for Disease Control and Prevention (CDC) documented that it was the first
year in decades overdose deaths were finally decreasing. Unfortunately, that trend has not

A combination of the covid pandemic and massive amounts of black-market pills and heroin
being cut with fentanyl is no doubt two major contributors to these elevated rates of opioid
addiction and overdose deaths.

Fentanyl is a synthetic opioid up to 50-100x more powerful than heroin, so if a person doesn’t
know the heroin, oxycodone, etc. they bought from a drug dealer is laced with fentanyl, they are
in serious jeopardy of overdosing. Black market opioids cut with fentanyl have been so
devastating that the CDC has named it the deadliest drug in America.

Fortunately, innovations in medicines for preventing opioid overdose and for treating opioid
addiction are in the works. The most interesting of these medicines (to me at least) is an opioid

How Will The Opioid Vaccine Work?

The vaccine being studied by the NIH HEAL Initiative is an adjuvant opioid use disorder
vaccine. An adjuvant molecule boosts the immune system’s response to vaccines, a critical
component of the effectiveness of anti-addiction vaccines.

adjuvant (noun) – a substance that enhances the body’s immune response to an antigen.

The vaccine targets fentanyl and it protects the brain and nervous system by stimulating the
body to create powerful antibodies that target and bind to opioid molecules.

Next, it sequesters the opioid molecules in the blood in a peripheral area. This prevents opioids from crossing
the blood-brain barrier (BBB) and reaching the central nervous system (CNS).

Since it blocks opioids from reaching the brain, it also prevents the massive respiratory
depression caused by opioids getting into the brain, and that’s why it’s so beneficial for
preventing opioid overdose.

When Will The Opioid Vaccine Be Available?

It would be extraordinary if the NIH HEAL Initiative’s anti-opioid vaccine and other medicines it’s
working on for the prevention and treatment of opioid addiction were available now, however,
these things take time. The process of getting FDA approval for a new vaccine or drug is long
and costly.

Fortunately, the NIH HEAL Initiative appears to be more than capable of developing, studying,
and getting FDA approval for these drugs… medicines that will help with damage control of the
opioid epidemic that keeps raging on amidst the covid pandemic.

More Drugs for Opioid Addiction, Non-Addictive Drugs for Pain, Yet No
Alcohol Treatment Innovations?

I’m very excited to track the development of the opioid vaccine and the other opioid addiction
and chronic pain treatment solutions the NIH HEAL Initiative is working on, however, after
reading the entire NIH HEAL Initiative Research Plan and not seeing alcohol addiction treatment
in their overall strategies, I felt sad for that population. Why?

6% of adults in the U.S. have alcohol use disorder. 15… million… people. 88,000 people in
America die every year as a result of alcohol. It’s estimated that approximately 2.1 million
Americans have opioid use disorder.

Thus, there are over 700% more Americans with AUD than there are with OUD.
Fortunately, even though the NIH HEAL Initiative appears to be focusing its efforts on
preventing overdose deaths, opioid addiction, and chronic pain, people like Chris Scott, an
Alcohol Recovery Coach and founder of Fit Recovery, and Ken Star, M.D., a board-certified
addiction physician and founder of Ken Starr MD Wellness Group, are leading the way for
biochemical innovations in AUD treatment like customized alcohol detox supplement protocols,
neuro-nutrient therapy, nutrigenomics, and much more.


Rates of substance use disorders, as well as behavioral addictions like gambling and others,
are all rising across the board. America is undergoing a ‘Twindemic’ of addiction/overdose and
covid and these are both synergistic with each other. The covid pandemic is causing elevated
rates of substance use disorders and, according to the CDC, people with a substance use
disorder are more susceptible to catching covid and having negative outcomes with covid

The NIH HEAL Initiative is actively combating the addiction/overdose issue. Will its work pay
off? Only time will tell. I have high hopes for it to achieve all of the goals it has set out to
accomplish. It may not be focusing on alcohol use disorder treatment, but then again, one has
to start somewhere.

According to the NIH HEAL Research Plan, the first 2-3 years will be focused on chronic pain
and the next couple of years will be focused on opioid addiction. Perhaps alcohol treatment will
be next on the list? Yet again… only time will tell.

Mistakes To Avoid When Helping Someone Recover From Drug Addiction


Drug addiction may be a treatable condition, but addiction recovery is a lifelong process that
requires all hands on deck to improve its chances of success.
When you’re helping a friend or a loved one recover from drug addiction, you’re bound to run into
more than a few challenges.
Sometimes, we make mistakes when helping a drug-addicted family member or friend. Some of
these mistakes could deeply hurt a recovering addict’s feelings. Others may even push them to
begin using again.
No one would ever want to see friends or loved ones get involved in situations like getting arrested
for DUI prescription drugs or worse, overdosing on any addictive substance.
If you really want to help them recover from drug addiction, you must avoid committing the
following mistakes:

Not Educating Yourself About Addiction

You cannot possibly help anyone struggling with drug addiction if you know little to nothing about
You would be in a much better position to help a friend or loved one recover from addiction if you
understand the causes of addiction, the symptoms associated with it, and the treatment options
By educating yourself about addiction, you will come to understand better what your friend or
relative is going through. The more you know about the condition, the more you will be able to help
them overcome it.

Not Watching What You Say

We all should keep in mind that a friend or relative facing drug addiction struggles may tend to be a
a bit more insecure, emotional, and sensitive about their current situation.
You might be close to that person, but you still have to be careful about what you say to or around

You may mean well when you say something like, “I know what you’re going through.”
However, unless you’ve struggled with drug addiction yourself and managed to overcome it, those
words will ring empty.
Better say that you’re sorry and that you’re there to support them than mouthing off about knowing
what they’re going through when you actually don’t.
If possible, avoid cracking jokes at their expense, even when you’re bosom buddies with the
recovering addict.
They might be smiling or laughing with you when you’re making light of their situation, but there’s
no way we would know if they’re really okay with the jokes.
To be on the safe side, keep your jokes away from anything resembling their current state.

Making Decisions For Them

It’s understandable when you’re eager to help family members or friends recover from drug
However, if your eagerness leads you to sign them up for rehab or choose addiction recovery
programs without running it past them first, then you are overstepping your bounds.
Entering rehab is a major decision that no one should ever force on a person facing addiction
problems. For treatment to have a much better chance at success, it must be something that they
should choose for themselves, not by anyone else.

Assuming That Addiction Is Gone After Completing Rehab

Some might assume that completing a treatment program means a person is cured of his or her
drug addiction. However, as mentioned above, drug addiction recovery is a lifelong process.
It’s not unheard of for former drug addicts to be sober for years but end up relapsing after
something like a memory or sudden access to drugs triggers their cravings.
If anything, we all need to be consistent in our support for their recovery.
Over time, we should keep on helping them avoid social gatherings where people might use
addictive substances and build relationships with sober friends, among other things.
Rebuilding their lives is key to their full recovery, and we should be there for them every step of the

Neglecting Your Own Well-being

The recovery process takes a lot out of the person recovering from addiction. What many don’t
realize, however, is that recovery takes quite a toll on the people providing them support, too.
Worse, people helping a friend or loved one recover tend to forget about their own well-being in the
If you intend to help someone on their lifelong journey towards recovery, you have to attend to
your own needs, too.
Take the time to take care of yourself physically, mentally, and emotionally, even as you do the
same for someone else.
Eating right, getting enough exercise, and enjoying life, in general, makes you healthier and happier,
which will enable you to provide continuous and consistent support for a friend or loved one in
addiction recovery.
Addiction recovery may not be the easiest thing in the world, but by avoiding the mistakes listed
above, the entire process can go a bit smoother for everyone, and that’s always a win.

Learn more about our outpatient treatment program or detoxification programs.

Review of NAD+ for Detox, Recovery and Post Acute Withdrawal


Hello. I’ve had a history of using drugs and alcohol and I’ve been clean and sober for almost five months, but I was still experiencing a lot of brain fog and a lot of just not certain with my own thoughts, not being able to trust myself. So I decided to come and see Dr. Starr And to do the NAD+ therapy. And I’ve been doing it for a few days now and each day I’m seeing great progress, feeling a lot of clarity. It was recommended to me by a friend who did it, who experienced great results. And I can say from experience now that this has helped me in ways I never even expected what it looks like each day as you come in and the beautiful Arroyo Grande day, they check your vitals and they give you a little infusion and throughout the day it’ll be dripping.

It could take anywhere from four to maybe eight hours depending on how you take it and you have this feeling inside of your body where, at least for me, I felt like a heaviness, but it just felt extremely healthy. I felt like I was getting out of a steam room or something of that sort. So after doing it for a few days, now I can tell it’s definitely progressive as I’m feeling better each day, I have an increased curiosity like into when I was 16 years old and everything seems fresh, everything seems new, and I highly recommend this to anybody and everybody was able to do it as I’m feeling great, better than ever before. So I think Dr. Starr and the whole staff here, it’s been a great experience.






The Ken Starr MD Wellness Group is the place to learn about addiction recovery strategies that have the ability to help you attain freedom. We’re innovative leaders in the treatment of medical detox, recovery, and wellness care. The Wellness Group provides substance abuse treatment, detox, counseling and Ketamine treatments. Come visit us on the California Central Coast.

Ken Starr MD is an expert in NAD+ treatments, Board Certified in Addiction Medicine and an experienced Ketamine provider. We Biohack recovery and detox so our patients can live their best life.


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Disclaimer: This video and channel is not intended to provide and does not constitute medical, legal, or other professional advice. No physician-patient relationship is formed by the public watching this video.

When Can I get a Vivitrol Shot?

Click here to watch in Youtube

Speaker 1: (00:02)

Speaker 2: (00:08)
Hey Dr. Ken Starr here, I want to answer the question for you. When can I get Vivitrol? This is important and I’m talking about for opiate dependence, not alcohol use disorder, which is a different topic altogether. You can only get Vivitrol when you are fully detoxed off of opiates. Okay. A lot of patients who come to the clinic are a little bit confused about the difference between Suboxone and Vivitrol and so forth. If you are on an opiate, whether it’s a pain pill or heroin or fentanyl or methadone or Suboxone or buprenorphine, if you have that in your system, you take Vivitrol or naltrexone that binds that receptor so it’s a much stronger magnet than any of those other substances. Much stronger magnet, much less activity precipitated withdrawal. No bueno, nosuper sick, right? If you’re on Vivitrol or you’re on naltrexone, you’re stable on it and then you use opiates, then it’s a blunted response.

Speaker 2: (01:01)
Now obviously it depends on the dose, but in general those receptors are occupied and there’s a cover over them. So if you use opiates, then it’s, it’s blunted and you have less effect. Um, sometimes even no effect. So the manufacturer’s recommendations, seven to 10 days, lots of drug and alcohol doctors will do it shorter than that, but the patients have to know that there are risks for precipitated withdrawal. If you’re considering this, you might want to do a test dose of a small amount of naltrexone first, but it’s enough that when you stop using opiates on your own, you have a natural slow kind of off-gassing of opiates at your system. That’s why withdrawal is days and days and days. If you were to take Vivitrol too early or naltrexone too early, it just super sick right away precipitated withdrawal. That’s what you want to avoid.

Speaker 2: (01:50)
All right, so the question is when can I get Vivitrol? Wait, as long as you can wait, as long as you can maybe have your provider give you a test dose of Narcan or naltrexone, which is a shorter-acting version of the same, and then you can do it. Now if you get a Vivitrol shot, remember that it doesn’t even work for several hours and it doesn’t get to a high level, a peak level for seven days or longer. So keep that in mind. But it’s great medicine for early recovery. It’s a great insurance policy if it’s something you’re thinking about and you’re motivated. Do I love it when my patients do a Vivitrol shot every month, then I don’t need to worry about them. I said, 28-day life insurance policy. They like it, their family likes it. Um, it’s great, but just don’t get it too early, lots of patients that we’ve seen over the years have had precipitated withdrawal. That’s it for now. Okay. Be careful with naltrexone. Be careful with Vivitrol. Make sure your detox before you take it. Thanks.

Alcohol Recovery with NAD+ | Brain Restoration Therapy


View on YouTube


My name is Pam, I am an alcoholic. I’m sober over 60 days right now. And I just wanted to tell you how fabulous my experience has been at Ken Starr and the addiction center. My treatment here has been fabulous. Everybody from reception to counseling to setting up my… my direct experience has been wonderful. And what’s been really great is I know that I’ll get lifelong support for my sobriety and everything else that the program has done that I can continue that.

The great change in me… well, first, I’ll tell you, I just went to Betty Ford for 45 days for pain and alcoholism. That was a great experience. I didn’t think I could possibly feel better after that, because I thought I was 100%. But when I came here, my… all of my parameters from physical pain, anxiety, depression, craving to drink, all of those on a scale of 1 to 10 are 0 right now, which is a huge thing for me. I drank for 7 years, and so this is a huge change. 

The other thing that has really changed for me is the ability to experience great joy. So, I wake up every morning, I’m joyful and happy. My sleep has improved since I’m here; that helps a lot. And I, not only do experience joyfulness, I’ve had that spiritual awakening since I came here. I became open to that. And this is the best I’ve ever felt with my conscious contact with God, my serenity, my sense of calm, my sense of purpose. 

When I came here, I had an irrational fear of relapsing. I don’t feel that anymore. It’s just a huge improvement for me. And I can’t tell you enough about the support, the group support here, the individual counseling and therapy, developing a relapse prevention plan and exit plan for what I do out in the real world once I finish this. So, I can’t tell you enough how great this experience has been for me, knowing I can come back for any future needs that I have, and that’s really reassuring. 

So, I hope you’ll consider coming here. I will come back if I have any problems. I know they’re here for me emotionally, spiritually, in terms of cravings, if that should come up, physical pain. And I know that I… you know, I always can come back for that. I’m really excited. I hope you’ll consider coming here.

10 Day Withdrawal Free Opiate Detox with NAD+


Click Here to Watch the Video on Youtube



The program is fantastic!

I was very skeptical coming into it you know, not knowing too much about it considering I’ve been through traditional detox before for opiate addiction and I am floored by the results!

I feel so much better after a 10 day detox than I would if I had gone anywhere else.

My cravings are at a minimum and my withdrawal symptoms were almost non-existent throughout the entire process.

More Proof that Lofexidine ( Lucemyra) is a Big Waste of Money


A while ago I wrote a blog about Lofexidine ( Lucemyra). I basically said that there’s not a ton of data but what seemed clear is that it’s crazy ridiculous expensive and really not any better than Clonidine. At a 1000X higher price. Well, I proved to be right.

Dr. David Juurlink MD Ph.D. from Sunnybrook Health Sciences in Toronto, Canda wrote a terrific summary of the most complete, robust up to date study on lofexidine. Just published in the May/June 2019 edition of the Journal of Addiction Medicine. ” Safety and Efficacy of Lofexidine for Medically Managed Opioid Withdrawal: A Randomized Controlled Clinical Trial” Fishman MD, Tirado MD, Alam MD.etc. al.

This was a multicenter Double-blind placebo-controlled study of 603 patients at 18 different US Centers. Keep in mind two of the authors are paid consultants to the manufacturer of Lofexidine. What did we learn?

  1. Lofexidine does slightly reduce withdrawal compared to placebo.
  2. As mentioned in my previous blog,  Lofexidine and Clonidine are pharmacologically and structurally similar
  3. A review of all randomized trials comparing lofexidine with clonidine in patients suffering opioid withdrawal have shown the reduction of withdrawal symptoms are the same.
  4. The benefit of lofexidine on withdrawal is maximal by day 2. No difference from placebo is evident by day 7.
  5. Clonidine has slightly more side effects such as light-headed, dizzy and drowsy.
  6. 7 days of Lofexidine in the US is about $1700 compared to $1 for Clonidine

” In short, lofexidine can be viewed as a slightly safer version of clonidine that offers patients with opioid withdrawal marginal clinical benefit for perhaps a few days, at a cost of more than $3000o over a typical 2 week treatment period.”.


Drug company price gouging for a “me too” drug for the most desperate and vulnerable of patients.


Ken Starr MD

Helping Your Loved One Through Addiction

This weeks post is from our guest contributor Bethany Hatton.

Helping Your Loved One Through Addiction


Getting Back on Track in Recovery

This weeks blog comes to us from our guest Bethany at

Anyone who’s ever struggled with a drug or alcohol problem knows that checking yourself into rehab and maintaining sobriety is only half the battle. Getting your life back on track can be even more daunting. But before getting started, it’s important to release the shame of the addiction itself, or it can be impossible to have the confidence and fortitude to move forward. Once you let go of shame, it’s time to focus on repairing your life. Here are the key things that should be on every recovery survivor’s to-do list. (more…)