how can i help

[mtgoat911]

so i just started sponsoring another sub patient, in the past i have found this to be very difficult, last night we had a book study and my sponsee nodded out as she was reading, she is currently on 6 mgs once a day, and wants to start the steps, i have been on sub myself, went to meetings but was told i needed to wait until i was clean to work the steps, i am more interested in your personal experience as an addict then a doctor, when you were on sub did you work the steps? or were you told the same thing i was, too wait until you were detoxed? there has been such a rapid increase of sub patients coming into the fellowship, i am afraid they are being ignored!

[Jeffrey T Junig, MD PhD]

I recognize that my opinion will be in the minority in this particular discussion, but I also think that my opinion will be supported by how things play out in the future.  I used to get many nasty messages from people for my blog, Suboxone Talk Zone;  I don't get near as many anymore, and I'm not sure why-- but since my 'visibility' has gone up if anything, I think that there has been a change of public perception on the issue.  I do ask that people take the time to hear where I come from;  understand that I went through step-based, sobriety-based treatment twice, in 1993 and again in 2001, and in both cases they were life-affirming, wonderful experiences.  My only problem with them is that I don't think they are particularly great ways to keep people clean, or to get people clean in the first place.  They are great for self-discovery, for taking on the challenge to change one's life, for learning to look at one's self critically, for learning to tolerate having feelings... all of those important things.  But I was clearly a very lucky person to have been able to get clean that way.

As most people know, I am med director of a residential center that does NOT use Suboxone;  they see Suboxone as an ugly orange cruddy substance leaking from an addict's nose.  But they only see the addicts who were never prescribed the drug, and who never learned to take it properly.  They never learned the POINT of Suboxone, which is to extinguish the conditioning that makes up addiction.  I strongly teach my Suboxone patients to NEVER take Suboxone out of 'need'.  It should be taken ONLY automatically, and ALWAYS in a high enough dose so that a person can go 24 hours without using more Suboxone or any other opiate.  When people take it correctly, I see them do very well-- certainly as well as the people doing stepwork.

This is sure to rile some people, but I'll be frank...  when I started treating with Suboxone I expected to see 'dry drunks'.  That is NOT at all what I saw in people who used it correctly.  I saw people working more than full-time, happy for the first time in years, taking on challenges in their marriages, taking on personal challenges...  I have known many people who went through traditional treatment, and I still attend an occasional meeting after 8 years clean (I've been an opiate addict for 16 years), and I see people at meetings who constantly struggle with staying clean.  Constantly.  And I see people on Suboxone who come into my office with tears on their faces, saying "I never thought I would feel this way again".  So... I'm a believer in Suboxone.  Do some people abuse Suboxone? Absolutely.  And three kids died in Milwaukee in March from combinations of Suboxone and other respiratory depressants.  But DOZENS of kids died from other opiates in that same time period, many of whom had attended meetings and even been through treatment.

One of my most tragic cases was a young man who had been kicked out of the local hospital treatment for coming up 'dirty' on a urine test-- something I consider barbaric, sort of like kicking people off chemotherapy if their cancer comes back.  This guy came to me and didn't want Suboxone because he had only been using a short time-- a couple months.  And I agreed with him.  He didn't need detox, as he wasn't using regularly.  I wanted him to go to residential treatment but before I could get him there he got a great job-- the type of thing that he wanted to spend his life doing.  He was so happy-- he insisted 'now I will never use-- I have so much going for me!'  I tried to get him to put off the job, to do treatment first, but he wouldn't... and neither would anyone else in that situation.  Two months later in a Chicago suburb his roomie noticed his car still in the driveway at 8 AM-- he usually left by 6-- and found him in bed, dead from a methadone overdose.  I still see his parents a year later for grief work.

People in 'sober recovery' often relapse, and people on Suboxone sometimes relapse.  The ones on Suboxone don't die;  the kids in Milwaukee who died were not tolerant to opiates or to Suboxone.  People in 'sober recovery' often DO die during relapses;  they use, they feel very ashamed, and so they use more, they feel more shamed, all the horror returns to mind, and suddenly they just want to blank out.  And many die from using too much.

I'm going on way too long...  I do therapy on all of my patients on Suboxone, but I do it myself in most cases.  When I send patients to AODA counselors, everyone just gets confused over what to do.  I will give my suggestions, but first let me say that of my 100 patients, it is very rare to have a person 'nodding off' from Suboxone.  I would be very suspicious that such a person is on a benzo, or on something else.  People develop a pretty complete tolerance to buprenorphine, and side effects are unusual after a month or two.

How for a sponsor to help...  I'm sorry, but the idea that people on Bupe should be stuck in 'step one' the whole time is just ridiculous, and sounds more like an ego problem of the sponsor than a reasoned approach to treating a fatal disease.  In my opinion, the whole 'I'm cleaner than you' thing just must go.  The facts don't lie-- kids in their 20's who go through residential or other step-based treatment have a HORRIBLE success rate.  I just read an article about a long-term study involving naltrexone implants after treatment;  the study started with over 600 young people and by the end of 6 months only 50 were still following up, and 2 were dead.  'Sober recovery' does not have any bragging rights, and should be open to ideas-- and again, this is from someone who loves the idea of the steps for the good they can do.

I see a huge difference in addicts, related to age.  People over 40 do great on Suboxone; they take it once per day and never have a problem again.  I test their urines and all they take is the Suboxone, and they remain grateful for the gift that the medication has given them for a long time.  People in their 20's are different;  they lose their cravings for drugs, but keep their cravings for chaos.  They complain of being 'bored'.  Their urine shows other substances, esp. benzos.  They are a tough patient group.  

As for how to relate them to the steps, they must be seen individually and with an open mind.  Some older addicts feel as if they never had a drug problem, and they do NOT have permanent character defects that require constant stepwork.  

The way I see it, people off buprenorphine NEED meetings to reinforce their powerlessness, which helps reduce their cravings.  People on buprenorphine have a medication that does that for them, so they have less nees for meetings.  People on bupe don't know how meetings work and I have heard disappointing stories about some jerk at  a meeting treating a person on bupe like an idiot for not knowing the steps by heart... but knowing the two people, I would put much more money on the sobriety of 'my guy' than on that jerk at the meeting.

Thanks for your thoughts on the topic, and thanks for those of you who stuck around long enough for all of mine.  I will post something in my blog section that I have posted elsewhere-- it is about how I see the relationship between bupe and the steps.  I see things as more 'dynamic' now-- take away the cravings, and the good things return-- rather than addicts being permanently damaged if they don't ever do a good step four and five.

Peace, everyone-- we're all the same.

Jeff J

[mtgoat911]

dr. j i see that you were here, just wanted to bump this question up

[theeagle]

mtgoat - - you sure she is doing the proper dose and not supplementing with another substance?  I would have loved to have copped a nod on 6mg of sub in another lifetime.......just thinking......

[mtgoat911]

no her dad is giving it to her, he has been clean for 20 yrs,

[nicole179]

i just wanted to comment on your question, i was told by my NA sponsor that i could work step 1, over and over if i had to until i realized that i was powerless over any substance, sub's included, but i would have to be clean to move forward with the steps.  i have heard many people say exactly what you said, but i too think that doing nothing is no help to an addict who is showing up and willing to do some work.  i was given reading assignments from the books and IP's, as well as writing assignments on relationships, feelings, etc.  it took over a year in na to get off sub and move past step one.  i went to at least 1 meeting a day everyday.  my sponsor ended up relapsing after 5 years clean, and i never got another one, eventually after 2 1/2 years clean i used and ultimatly went back on sub which i am still taking. i tend to agree with theeagle, as far as the nodding out. i have not encountered someone taking it, and only it, correctly that has not adjusted to it in a short period of time and stopped having effects such as that.  but perhaps the dr. has more info on that. that is my experience, good luck.

[mtgoat911]

thank you for sharing your experience, so many people are coming to na on suboxone, and rather than turm my back on them i would like to find a way to help
as far as nodding on suboxone, i have never seen someone on suboxone who did not nodd, i worked in a treatment center where the patients were given a controlled dose and i could tell when they took it, i have also had the nodds from suboxone myself, but i also remember the denile i had when i was on the sub., i would tell people that i was not nodding just sleeping
i was hoping the doc would share is expereince taking sub and going to meetings, i get the best advice from people who have been in meetings on sub, thank you so much for talking about that, i have been worried about this for over a year

[NautyOne]

Hi Goat!

With all due respect, I think that would be one heck of a long post.  I'm sure the doc is more interested in answering posts then posting about himself.  I am sure he has a pretty busy schedule.  As much as I love Dr. J.  His job is to answer questions for others and not himself.....

I don't think I could ever be that intrusive as to ask the forum doctor to explain his private struggles.  I think if you read some of his earlier posts, you might find the information your asking for.  In the beginning he did "elect" to talk freely on his own about himself, and I believe I do recall reading something in regards to the nature of your question.

As far as NA & AA......Nicole gave you a great response.........

Sincerely,
NautyOne..............

[mtgoat911]

dr. j shares his experience with drugs on his forum all  the time, did not think asking him about his experience with suboxone and the steps was intusive or a waste of time, its rare to find a doctor who is so honest about his life and one who helps addicts that actually knows what they are going through, but whatever, this thread was to help a friend not upset anyone, soory for those who think its a stupid question, i myself find it very relavent to my life and what i am doing with my recovery, oh well i find my question more interesting then another detox question, to each his own

[NautyOne]

geez, I kinda sounded like an a-hole, ......ya think?.......my apologies.

luv,
nauty........

[flmagi]

I'm going to add my minor observations of the "nodding off on Sub" issue.  My 2 sisters and myself are all on Sub, all at different levels and for over a year. During the first week of Sub, there was a definite nodding thing going on, then our bodies adjusted. Also found if the wrong dose (To much or to little) was taken, that could cause nodding too.  But now after being on a maintenance dosage for over a year, my sisters and I have come to the conclusion that Sub is "motion activated". lol. If you're moving around, working or whatever, you're not tired, but if you sit or lay down or are bored, then sleep sets in very easily.  So if you're sitting around with a person on Sub and they seem tired and like they're gonna nod off, try getting up and walking and talking.  Or add a little more interest to your conversation.
These are just our observations.

[mtgoat911]

thank you dr. j, maybe she is also taking a benzo, did you goto meetings on suboxone?
i have been guilty in the past of shunning people on sub., part of the reason was because i loved sub in active addiction, so it was safty for me in the beginning, now i do not jones when someone tells me they are on a drug i like, and the other part was that i did not understand, this weekend at an na campout my good friend just came out and told me she was on sub.,  so you see now its not just people who come into na that are on sub its my close friends
i know in the past we have not seen things the same way, but now its like i surrender sub is here to stay, its  prescribed more and more, pretty soon everyone who goes through rehab will be placed on sub., so i can fight it or find a way to help,
i am actually going back to work in a rehab that uses sub., so its time to make alot of changes of how i respond to people on sub,and the doctors who markey it and prescribe it, i have learned that the initional response can make a huge difference as to when and how  people on matience will come to meetings or ask for help

[LateAugust]

I have written a bazillion posts on Suboxone and the impact it has had on my daughter's life.  She had an incredible oxy addiction and anything else she could get her hands on....    She is only 22 and has gone thru rehab 3 times.  The third time she was under the care of a Suboxone Doctor prior to in patient,  followed by IOP,  group meetings and mandatory NA/AA meetings,  I do not want to be redundant and it is so simple to find or read my previous posts regarding Suboxone treatment.  However, the Sub allowed her to retain her focus on sobriety for the first time....  and to date almost 7 months later she is still clean.    I personally find it extremely offensive when I do post, albeit very carefully knowing the addiction forum will be ready to pounce,  and am told she traded "one drug for another drug", when people have not a clue of her/my eperience.     Tell me that after you have lived in my shoes or that of my daughters for the past 3 years and thru the complete hell of opiate addiction and all of it's destruction.

I will say, one more time,  she has not,  at any time on Suboxone, nodded off during a conversation,  has not been late for one class at school, nor has she missed one day of work, or any of her after care treatment which is quite intensive.    And trust me  when she was using oxy  or other opiates I saw her "nod off" on numerous occasions.  This is not even close to my first experience with her opiate addiction, and I am not so naive to NOT know the difference.  In fact,  as before her oxy induced sleep,  she is an insomniac.  The Sub certainly has not helped her sleeping pattern.

She has a sponsor in NA/AA  actually AA  that knows she is on Suboxone.  This woman has been a tremendous asset to my daughter, totally without judgement of Suboxone, and I am grateful for her and the unconditional support she has given my child.  My daughter is currently working on her 4th Step,  is a "greeter" at the meetings because of her positive attitude,  and as her counselor has told me,   other than her counselors, her doctor and her sponsor, it is absolutely no one's business if she is on Sub or not..... what IS important, is that she for the first time in rebuilding her life in a very positive, productive and healthy manner.  I have found Al-Anon  and AA/NA to be much less judgemental re: Suboxone than I ever expected.  Perhaps,  we werejust  lucky.

[mtgoat911]

lateaugust congradulations on your daughters success, the sub worked well for me in the begining then my body started craving it, i wanted to take my dose earlier and then it got to be that i wanted to take more than i should, eventually the narcaan/revia whatever you call it started causing elavated liver levels so i had to stop taking it, thats when i discovered how similair suboxone wd was to methadone wd, in a way i am glad that i took it, i honestly do not regret being put on suboxone, it serverd a purpose, kept me high enough to function when it stopped working i quit, i do regret having to go through that wd process