suboxone treatment

[kboot]

thinking of suboxone treatment, anyone here have any input

[J T Junig, MD PhD]

You will find my opinion here and there, so my comments will be more educational than suggestive.

Is it an Opiate?   It depends on the definition of 'opiate';  it is not structurally related to opium, the definition of opiates that some people use-- for example heroin, codeine, and morphine are 'opiates' by that definition, but fentanyl and buprenorphine are not.  It does have activity at the mu opiate receptor, but the activity is very different from that of agonists like methadone, oxycodone, or fentanyl.  Buprenorphine is a partial agonist, which causes tolerance that is static, rather than the ever-increasing tolerance caused by agonists.  It also has a 'ceiling' to it's agonist effect.  The difference in tolerance, and the ceiling effect, are responsible for the potent reduction of cravings that patients experience when they take buprenorphine properly.

As far as 'coming off' of Suboxone, you can read my comments on the prior post about the disease model for addiction-- the understanding of addiction that is virtually universal among addictionologists, but that remains a challenge for others.  You will read comments by laypersons like 'it is OK if not used long-term';  we now have clear evidence for what most of us in the business thought was obvious;  Suboxone is best thought of as a long-term remission agent.  Patients using the medication for less than six months relapse, unless it is used as the introduction to intensive, residential treatment for 90 days or more.  There is no long term benefit to taking Suboxone for a few months;  in such cases it is just another 'opiate'.  Is it hard to stop?  Of course!!  ALL drugs that have opiate effects are hard to stop-- especially by opiate addicts!  That is another one of those things I always found a bit strange--  that a person is surprised to have trouble stopping Suboxone.  The person is TAKING Suboxone because they couldn't stop opiates-- so why would they expect to be able to stop Suboxone?  But more and more the real question to the 'stopping' issue is, why would you want to stop it?  Just my opinion, but the quest for 'total cleanliness' is a mistake for many people;  I know of at least one opiate addict who died of an overdose in his quest to 'be clean', when a few months earlier he was employed, free of cravings, and as happy as he had been in decades... until convinced he needed to stop the medication that was keeping his addiction in remission.  I see it the same as I do the teenager who has brittle insulin-dependent diabetes, who wants to be 'normal'-- so he skips his insulin.  Yes, he gets the occasional fantasy that he is 'not diabetic'... but he loses his sight in the process!  I think it more effective to help people live with what they have, and learn to ignore the shame-inducing comments of others.  If there is an addict reading who disagrees who has over five years of sobriety, I'm all ears (I'll explain why the five years in a minute).

I see my patients as the years go by;  they don't disappear if they relapse, and I usually see their obituaries if they die.  So many young people die from opiate addiction-- it is truly an epidemic.  I was in about as good a residential treatment as you will find, and I was there for over three months, followed by 6 years of aftercare-- and despite equally intensive treatment, many of my comrades-in-treatment have relapsed.  I know the 'cocky confidence' that comes early in sobriety and recovery;  I also know the profound depression that often hits opiate addicts a few years into recovery if they don't find something spiritual that turns them on.  Opiate dependence is a 'process'.  A snapshot at any one time is only a tiny part of the big picture, that will be the effect of opiate dependence on the person's life.  The reason I say 'five years' is because I think that five years is about the minimum length of time it takes in recovery for a person to get a sense for what he/she is dealing with.  I'm not saying that the person is 'safe' at five years;  I'm saying that it takes five years in recovery for things to 'play out'-- the early exuberance, the post-acute withdrawal, the late depression that hits many addicts, and the more peaceful sobriety that comes if a person successfully navigates all of these stages.

Anyone with five years of sobriety has a story worth listening to;  I like the AA saying, 'stick with the winners', because whatever they are doing is working-- and is rare.

[Bre333]

Hey, firstly, what were you taking before? And now? Also, Suboxone is still an opiate, it is very difficult to come off of. If you can tell me what you're currently taking I can try my best to give you some advice.
-Bre.