Four Months Opiate Free

[Ella789]

  After four months post-opiates, is it safe to say that any of the cravings I still have are phychological ?  My Dr. doesn't want me to use anything other than the Naltrexone that he has prescribed.  I supose to subsittute taking the Nal versus an opiate, to trick my brain ?    Perhaps to learn to just go on with my life knowing that after a few years I will have "learned" another way to live ?    I take the Naltrexone but am I wrong to think that this is just to keep me from useing again and no other reason?  It has not been the problem as far as I am concerned, I don't take or even try to take them,  so why should I continue with the Naltrexone.?  And why would my Dr. not let me try the Bup ?  He says he can not write the prescription only an addiction spec.,  are the laws still like that ?
Thank you for your reply.

Ella

[J T Junig, MD PhD]

Naltrexone has mixed data as a craving-reducing agent;  it is much more effective at reducing alcohol cravings than opiate cravings.  I have taken it myself;  it is often given in the first 6 months after treatment.  Here is how it reduces psychological cravings:  if you get the tiny germ of an idea about using, the idea is quickly beaten down by realizing that even if you did use, it would have no effect.  In that way, the craving reduction is really a ‘psychological’ thing, not a ‘chemical’ thing—as is the case with buprenorphine.
If you are maintaining sobriety, I would be very reluctant to go on buprenorphine—unless the cravings were really bothering you so much that you couldn’t stand it.  Once you are on buprenorphine, you are making a very long-term choice—you are choosing to treat your addiction with a (possibly) permanent medication, rather than treating it ‘naturally’.  Understand that I am a big fan of the ‘disease theory of addiction’, and I think that a chronic disease deserves a chronic medication.  But like with all diseases, we should always use the least-invasive treatment possible.  And from you current description, that would be Naltrexone, not buprenorphine.
You do NOT need to be any kind of specialist to prescribe buprenorphine or Suboxone.  You DO need to have a special certificate from the DEA, but any doc can get that certificate if he takes the course and has a relatively clean prescribing history.  To be even more confusing… ANY doc can prescribe buprenorphine, Suboxone, or Subutex, as long as they are NOT treating addiction.  The certificate is to get around a law that bans treating opiate addicts using opiates.  ANY doc can prescribe Suboxone to treat chronic pain, for example.  The problem is that many pharmacists (and docs) don’t understand this situation.  It isn’t that it is too complicated—I blame doctors’ relative lack of interest in treating drug addicts for a lack of desire to learn about the medication and how to use it.  Shame on us.

[abby10]

Shame on doctors for not understanding how to help people withdrawal adequately from benzodiazepines.

abby

[Ella789]

  Thank you so much for your reply,  that means alot to me.    

  I think I have tryed to start the cycle again of whether to just try to manage my chronic pain (SLE) fibro and CFS  or to go back to some type of opiate med.  I remember too well where that led me.  I do know my pain is real, legitamate, ect. but it was just too hard to be opiate dependent and loseing (?gaining) tolorance to the med.  That last year of taking them was a constant battle just maintaining the prescribed doseage.  The mental is the hardest part of recovery esp. with chronic pain, again, I still do not know what to do abt. it.   At least now with your explaination, I will choose to remain how I am for now, opiate free.

  I am excited abt. the new Lupus drug in the news this Monday.  Benlysta,  I truly hope it is one that will give me some relief with my symptoms.

God Bless

Ella