Jeffrey T Junig, MD PhD
Jeffrey T Junig, MD PhD
Male, 49
Fond du Lac - WI
Specialties: Psychiatry, addictions, Chronic Pain Treatment, Anesthesiology, buprenorphine
Interests: neuroscience, Psychodynamics, writing, Entrepreneurship, teaching, Psychiatry, psychiatrist, wisconsin psychiatrist, psychotherapy, telepsychiatry, tele-psychiatry, telepsych, tele-psych, telemedicine
Male, 49
Fond du Lac - WI
Specialties: Psychiatry, addictions, Chronic Pain Treatment, Anesthesiology, buprenorphine
Interests: neuroscience, Psychodynamics, writing, Entrepreneurship, teaching, Psychiatry, psychiatrist, wisconsin psychiatrist, psychotherapy, telepsychiatry, tele-psychiatry, telepsych, tele-psych, telemedicine
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Suboxone's Complicated Relationship with Traditional Recovery
Jul 25, 2009 11:25PM
- 25 comments
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By now almost every opiate addict has heard of Suboxone, the relatively new medication for opiate dependence. I initially had mixed feelings about Suboxone, my opinion likely influenced by my own experiences as an addict in traditional recovery. But my opinion has changed over the past two years, because of what I have seen and heard while treating well over 100 patients with buprenorphine in my clinical practice. At the same time, I acknowledge that while Suboxone has opened a new frontier of treatment for opiate addiction, arguments over the use of Suboxone often split the recovering and treatment communities along opposing battle lines. The arguments are often fueled by petty notions of ‘whose recovery is more authentic’, and miss the important point that buprenorphine and Suboxone can have huge beneficial effects on the lives of opiate addicts.
For clarification, the active ingredient in Suboxone is buprenorphine, a partial agonist at the mu opiate receptor. Suboxone contains naloxone to prevent intravenous use; another form of the medication, Subutex, consists of buprenorphine without naloxone. In this article I will use the name ‘Suboxone’ because of the common reference to the drug, but in all cases I am referring to the use and actions of buprenorphine in either form. The unique effects of buprenorphine can be attributed to the drug’s unique molecular properties. First, the partial agonist effect at the receptor level results in a ‘ceiling effect’ to dosing after about 4 mg, so that increased dosing does not result in increased opiate effect beyond that dose. Second, the high binding affinity and partial agonist effect cause the elimination of drug cravings, dispelling the destructive obsession with use that destroys the personality of the user. Third, the high protein binding and long half-life of buprenorphine allows once per day dosing, allowing the addict to break the conditioned pattern of withdrawal (stimulus)-use (response)- relief (reward) which is the backbone of addictive behavior. Fourth, the partial agonist effect and long half life cause rapid tolerance to the drug, allowing the patient to feel ‘normal’ within a few days of starting treatment. Finally, the withdrawal from buprenorphine provides a disincentive to stop taking the drug, and so the drug is always there to assure the person that any attempt to get high would be futile, dispelling any lingering thoughts about using an opiate.
Different Treatment Approaches
At the present time there are significant differences between the treatment approaches of those who use Suboxone versus those who use a non-medicated 12-step-based approach. People who stay sober with the help of AA, NA, or CA, as well as those who treat by this approach tend to look down on patients taking Suboxone as having an ’inferior’ form of recovery, or no recovery at all. This leaves Suboxone patients to go to Narcotics Anonymous and hide their use of Suboxone. On one hand, good boundaries include the right to keeping one’s private medical information so one’s self. But on the other hand, a general recovery principle is that ’secrets keep us sick’, and hiding the use of Suboxone is a bit at odds with the idea of ’rigorous honesty’. People new to recovery also struggle with low self esteem before they learn to overcome the shame society places on ‘drug addicts’; they are not in a good position to deal with even more shame coming from other addicts themselves!
An ideal program will combine the benefits of 12-step programs with the benefits of the use of Suboxone. The time for such an approach is at hand, as it is likely that more and more medications will be brought forward for treatment of addiction now that Suboxone has proved profitable. If we already had excellent treatments for opiate addiction there would be less need for the two treatment approaches to learn to live with each other. But the sad fact is that opiate addiction remains stubbornly difficult to treat by traditional methods. Success rates for long-term sobriety are lower for opiates than for other substances. This may be because the ‘high’ from opiate use is different from the effects of other substances—users of cocaine, methamphetamine, and alcohol take the substances to feel up, loose, or energetic—ready to go out and take on the town. The ‘high’ of opiate use feels content and ‘normal’— users feel at home, as if they are getting back a part of themselves that was always missing. The experience of using rapidly becomes a part of who the person IS, rather than something the patient DOES. The term ‘denial’ fits nobody better than the active opiate user, particularly when seen as the mnemonic: Don’t Even Notice I Am Lying.
The challenges for practitioners lie at the juncture between traditional recovery and the use of medication, in finding ways to bring the recovering community together to use all available tools in the struggle against active opiate addiction.
Drug Obsession and Character Defects
Suboxone has given us a new paradigm for treatment which I refer to as the ‘remission model’. This model takes into account that addiction is a dynamic process— far more dynamic than previously assumed. To explain, the traditional view from recovery circles is that the addict has a number of character defects that were either present before the addiction started, or that grew out of addictive behavior over time. Opiate addicts have a number of such ‘defects.’ The dishonesty that occurs during active opiate addiction, for example, far surpasses similar defects from other substances, in my opinion. Other defects are common to all substance users; the addict represses awareness of his/her trapped condition and creates an artificial ‘self’ that comes off as cocky and self-assured, when deep inside the addict is frightened and lonely. The obsession with using takes more and more energy and time, pushing aside interests in family, self-care, and career. The addict becomes more and more self-centered, and the opiate addict often becomes very ‘somatic’, convinced that every uncomfortable feeling is an unbearable component of withdrawal. The opiate addict becomes obsessed with comfort, avoiding activities that cause one to perspire or exert one’s self. The active addict learns to blame others for his/her own misery, and eventually their irritability results in loss of jobs and relationships.
The traditional view holds that these character defects do not simply go away when the addict stops using. People in AA know that simply remaining sober will cause a ‘dry drunk’—a nondrinker with all of the alcoholic character defects– when there is no active recovery program in place. I had such an expectation when I first began treating opiate addicts with Suboxone—that without involvement in a 12-step group the person would remain just as miserable and dishonest as the active user. I realize now that I was making the assumption that character defects were relatively static—that they develop slowly over time, and so could only be removed through a great deal of time and hard work. The most surprising part of my experience in treating people with Suboxone has been that the defects in fact are not ‘static’, but rather they are quite dynamic. I have come to believe that the difference between Suboxone treatment and a patient in a ‘dry drunk’ is that the Suboxone-treated patient has been freed from the obsession to use. A patient in a ‘dry drunk’ is not drinking, but in the absence of a recovery program they continue to suffer the conscious and unconscious obsession with drinking. People in AA will often say that it isn’t the alcohol that is the problem; it is the ‘ism’ that causes the damage. Such is the case with opiates as well—the opiate is not the issue, but rather it is the obsession with opiates that causes the misery and despair. With this in mind, I now view character defects as features that develop in response to the obsession to use a substance. When the obsession is removed the character defects will go way, whether slowly, through working the 12 steps, or rapidly, by the remission of addiction with Suboxone.
In traditional step-based treatment the addict is in a constant battle with the obsession to use. Some addicts will have rapid relief from their obsession when they suddenly experience a ‘shift of thinking’ that allows them to see their powerlessness with their drug of choice. For other addicts the new thought requires a great deal of addition-induced misery before their mind opens in response to a ‘rock bottom’. But whether fast or slow, the shift of thinking is effective because the new thought approaches addiction where it lives—in the brain’s limbic system. The ineffectiveness of higher-order thinking has been proven by addicts many times over, as they make promises over pictures of their loved ones or try to summon the will power to stay clean. While these approaches almost always fail, the addict will find success in surrender and recognition of the futility of the struggle. The successful addict will view the substance with fear—a primitive emotion from the old brain. When the substance is viewed as a poison that will always lead to misery and death, the obsession to use will be lifted. Unfortunately it is man’s nature to strive for power, and over time the recognition of powerlessness will fade. For that reason, addicts must continue to attend meetings where newcomers arrive with stories of misery and pain, which reinforce and remind addicts of their powerlessness.
The Dynamic Nature of Personality
My experiences with Suboxone have challenged my old perceptions, and led me to believe that the character defects of addiction are much more dynamic. Suboxone removes the obsession to use almost immediately. The addict does not then enter into a ‘dry drunk’, but instead the absence of the obsession to use allows the return of positive character traits that had been pushed aside. The elimination of negative character traits does not always require rigorous step work— in many cases the negative traits simply disappear as the obsession to use is relieved. I base this opinion on my experiences with scores of Suboxone patients, and more importantly with the spouses, parents, and children of Suboxone patients. I have seen multiple instances of improved communication and new-found humility. I have heard families talk about ‘having dad back’, and husbands talk about getting back the women they married. I sometimes miss my old days as an anesthesiologist placing labor epidurals, as the patients were so grateful—and so I am happy to have found Suboxone treatment, for it is one of the rare areas in psychiatry where patients quickly get better and express gratitude for their care.
A natural question is why character defects would simply disappear when the obsession to use is lifted? Why wouldn’t it require a great deal of work? The answer, I believe, is because the character defects are not the natural personality state of the addict, but rather are traits that are produced by the obsession, and dynamically maintained by the obsession.
Combining Suboxone treatment and traditional recovery
Once the dynamic relationship between use obsession and character defects is understood, the proper relationship between Suboxone and traditional recovery becomes clear. Should people taking Suboxone attend NA or AA? Yes, if they want to. A 12-step program has much to offer an addict, or anyone for that matter. But I see little use in forced or coerced attendance at meetings. The recovery message requires a level of acceptance that comes about during desperate times, and people on Suboxone do not feel desperate. In fact, people on Suboxone often report that ‘they feel normal for the first time in their lives’. A person in this state of mind is not going to do the difficult personal inventories of AA unless otherwise motivated by his/her own internal desire to change.
The role of ‘desperation’ should be addressed at this time: In traditional treatment desperation is the most important prerequisite to making progress, as it takes the desperation of being at ‘rock bottom’ to open the mind to see one’s powerlessness. But when recovery from addiction is viewed through the remission model, the lack of desperation is a good thing, as it allows the reinstatement of the addict’s own positive character. Such a view is consistent with the ‘hierarchy of needs’ put forward by Abraham Maslow in 1943; there can be little interest in higher order traits when one is fighting for one’s life.
Other Questions (and answers):
-Should Suboxone patients be in a recovery group?
I have reservations about forced attendance, as I question the value of any therapy where the patient is not an eager and voluntary participant. At the same time, there clearly is much to be gained from the sense of support that a good group can provide. Groups also ’show’ the addict that he/she is not as unique as he thought, and that his unhealthy way of visualizing his place in the world is a trait common to other addicts. Some addicts will learn the patterns of addictive thinking and become better equipped to handle their own addictive thoughts.
-What is the value of the 4th through 6th steps of a 12-step program, where the addict specifically addresses his/her character defects and asks for their removal by a higher power? Are these steps critical to the resolution of character defects?
These steps are necessary for addicts in ‘sober recovery’, as the obsession to use will come and go to varying degrees over time depending on the individual and his/her stress level. But for a person taking Suboxone I see the steps as valuable, but not essential.
-Where does methadone fit in?
Methadone is just another opiate agonist. A newly-raised dosage will prevent cravings temporarily, but as tolerance inevitably rises, cravings will return. With cravings comes the obsession to use and the associated character defects. This explains the profound difference in the subjective experiences of addicts maintained on Suboxone versus methadone, and explains why in my practice I have many patients who have switched to Suboxone, but none in the other direction.
The downside of Suboxone
Practitioners in traditional AODA treatment programs will see Suboxone as at best a mixed blessing. Desperation is often required to open the addict’s mind to change, and desperation is harder to achieve when an addict has the option to leave treatment and find a practitioner who will prescribe Suboxone. Suboxone is sometimes used ‘on the street’ by addicts who want to take time off from addiction without committing to long term sobriety. Suboxone itself can be abused for short periods of time, until tolerance develops to the drug. Snorting Suboxone reportedly results in a faster time of onset, without allowing the absorption of the naloxone that prevents intravenous use. Finally, the remission model of Suboxone use implies long term use of the drug. Chronic use of any opiate, including Suboxone, has the potential for negative effects on testosterone levels and sexual function, and the use of Suboxone is complicated when surgery is necessary. Short- or moderate-term use of Suboxone raises a host of additional questions, including how to convert from drug-induced remission, without desperation, to sober recovery, which often requires desperation.
The beginning of the future
Time will tell whether or not Suboxone will work with traditional recovery, or whether there will continue to be two distinct options that are in some ways at odds with each other. The good news is that treatment of opiate addiction has proven to be profitable for at least one pharmaceutical company, and such success will surely invite a great deal of research into addiction treatment. At one time we had two or three treatment options for hypertension, including a drug called reserpine that would never be used for similar indications today. Some day we will likely look back on Suboxone as the beginning of new age of addiction treatment. But for now, the treatment community would be best served by recognizing each other’s strengths, rather than pointing out weaknesses.
For clarification, the active ingredient in Suboxone is buprenorphine, a partial agonist at the mu opiate receptor. Suboxone contains naloxone to prevent intravenous use; another form of the medication, Subutex, consists of buprenorphine without naloxone. In this article I will use the name ‘Suboxone’ because of the common reference to the drug, but in all cases I am referring to the use and actions of buprenorphine in either form. The unique effects of buprenorphine can be attributed to the drug’s unique molecular properties. First, the partial agonist effect at the receptor level results in a ‘ceiling effect’ to dosing after about 4 mg, so that increased dosing does not result in increased opiate effect beyond that dose. Second, the high binding affinity and partial agonist effect cause the elimination of drug cravings, dispelling the destructive obsession with use that destroys the personality of the user. Third, the high protein binding and long half-life of buprenorphine allows once per day dosing, allowing the addict to break the conditioned pattern of withdrawal (stimulus)-use (response)- relief (reward) which is the backbone of addictive behavior. Fourth, the partial agonist effect and long half life cause rapid tolerance to the drug, allowing the patient to feel ‘normal’ within a few days of starting treatment. Finally, the withdrawal from buprenorphine provides a disincentive to stop taking the drug, and so the drug is always there to assure the person that any attempt to get high would be futile, dispelling any lingering thoughts about using an opiate.
Different Treatment Approaches
At the present time there are significant differences between the treatment approaches of those who use Suboxone versus those who use a non-medicated 12-step-based approach. People who stay sober with the help of AA, NA, or CA, as well as those who treat by this approach tend to look down on patients taking Suboxone as having an ’inferior’ form of recovery, or no recovery at all. This leaves Suboxone patients to go to Narcotics Anonymous and hide their use of Suboxone. On one hand, good boundaries include the right to keeping one’s private medical information so one’s self. But on the other hand, a general recovery principle is that ’secrets keep us sick’, and hiding the use of Suboxone is a bit at odds with the idea of ’rigorous honesty’. People new to recovery also struggle with low self esteem before they learn to overcome the shame society places on ‘drug addicts’; they are not in a good position to deal with even more shame coming from other addicts themselves!
An ideal program will combine the benefits of 12-step programs with the benefits of the use of Suboxone. The time for such an approach is at hand, as it is likely that more and more medications will be brought forward for treatment of addiction now that Suboxone has proved profitable. If we already had excellent treatments for opiate addiction there would be less need for the two treatment approaches to learn to live with each other. But the sad fact is that opiate addiction remains stubbornly difficult to treat by traditional methods. Success rates for long-term sobriety are lower for opiates than for other substances. This may be because the ‘high’ from opiate use is different from the effects of other substances—users of cocaine, methamphetamine, and alcohol take the substances to feel up, loose, or energetic—ready to go out and take on the town. The ‘high’ of opiate use feels content and ‘normal’— users feel at home, as if they are getting back a part of themselves that was always missing. The experience of using rapidly becomes a part of who the person IS, rather than something the patient DOES. The term ‘denial’ fits nobody better than the active opiate user, particularly when seen as the mnemonic: Don’t Even Notice I Am Lying.
The challenges for practitioners lie at the juncture between traditional recovery and the use of medication, in finding ways to bring the recovering community together to use all available tools in the struggle against active opiate addiction.
Drug Obsession and Character Defects
Suboxone has given us a new paradigm for treatment which I refer to as the ‘remission model’. This model takes into account that addiction is a dynamic process— far more dynamic than previously assumed. To explain, the traditional view from recovery circles is that the addict has a number of character defects that were either present before the addiction started, or that grew out of addictive behavior over time. Opiate addicts have a number of such ‘defects.’ The dishonesty that occurs during active opiate addiction, for example, far surpasses similar defects from other substances, in my opinion. Other defects are common to all substance users; the addict represses awareness of his/her trapped condition and creates an artificial ‘self’ that comes off as cocky and self-assured, when deep inside the addict is frightened and lonely. The obsession with using takes more and more energy and time, pushing aside interests in family, self-care, and career. The addict becomes more and more self-centered, and the opiate addict often becomes very ‘somatic’, convinced that every uncomfortable feeling is an unbearable component of withdrawal. The opiate addict becomes obsessed with comfort, avoiding activities that cause one to perspire or exert one’s self. The active addict learns to blame others for his/her own misery, and eventually their irritability results in loss of jobs and relationships.
The traditional view holds that these character defects do not simply go away when the addict stops using. People in AA know that simply remaining sober will cause a ‘dry drunk’—a nondrinker with all of the alcoholic character defects– when there is no active recovery program in place. I had such an expectation when I first began treating opiate addicts with Suboxone—that without involvement in a 12-step group the person would remain just as miserable and dishonest as the active user. I realize now that I was making the assumption that character defects were relatively static—that they develop slowly over time, and so could only be removed through a great deal of time and hard work. The most surprising part of my experience in treating people with Suboxone has been that the defects in fact are not ‘static’, but rather they are quite dynamic. I have come to believe that the difference between Suboxone treatment and a patient in a ‘dry drunk’ is that the Suboxone-treated patient has been freed from the obsession to use. A patient in a ‘dry drunk’ is not drinking, but in the absence of a recovery program they continue to suffer the conscious and unconscious obsession with drinking. People in AA will often say that it isn’t the alcohol that is the problem; it is the ‘ism’ that causes the damage. Such is the case with opiates as well—the opiate is not the issue, but rather it is the obsession with opiates that causes the misery and despair. With this in mind, I now view character defects as features that develop in response to the obsession to use a substance. When the obsession is removed the character defects will go way, whether slowly, through working the 12 steps, or rapidly, by the remission of addiction with Suboxone.
In traditional step-based treatment the addict is in a constant battle with the obsession to use. Some addicts will have rapid relief from their obsession when they suddenly experience a ‘shift of thinking’ that allows them to see their powerlessness with their drug of choice. For other addicts the new thought requires a great deal of addition-induced misery before their mind opens in response to a ‘rock bottom’. But whether fast or slow, the shift of thinking is effective because the new thought approaches addiction where it lives—in the brain’s limbic system. The ineffectiveness of higher-order thinking has been proven by addicts many times over, as they make promises over pictures of their loved ones or try to summon the will power to stay clean. While these approaches almost always fail, the addict will find success in surrender and recognition of the futility of the struggle. The successful addict will view the substance with fear—a primitive emotion from the old brain. When the substance is viewed as a poison that will always lead to misery and death, the obsession to use will be lifted. Unfortunately it is man’s nature to strive for power, and over time the recognition of powerlessness will fade. For that reason, addicts must continue to attend meetings where newcomers arrive with stories of misery and pain, which reinforce and remind addicts of their powerlessness.
The Dynamic Nature of Personality
My experiences with Suboxone have challenged my old perceptions, and led me to believe that the character defects of addiction are much more dynamic. Suboxone removes the obsession to use almost immediately. The addict does not then enter into a ‘dry drunk’, but instead the absence of the obsession to use allows the return of positive character traits that had been pushed aside. The elimination of negative character traits does not always require rigorous step work— in many cases the negative traits simply disappear as the obsession to use is relieved. I base this opinion on my experiences with scores of Suboxone patients, and more importantly with the spouses, parents, and children of Suboxone patients. I have seen multiple instances of improved communication and new-found humility. I have heard families talk about ‘having dad back’, and husbands talk about getting back the women they married. I sometimes miss my old days as an anesthesiologist placing labor epidurals, as the patients were so grateful—and so I am happy to have found Suboxone treatment, for it is one of the rare areas in psychiatry where patients quickly get better and express gratitude for their care.
A natural question is why character defects would simply disappear when the obsession to use is lifted? Why wouldn’t it require a great deal of work? The answer, I believe, is because the character defects are not the natural personality state of the addict, but rather are traits that are produced by the obsession, and dynamically maintained by the obsession.
Combining Suboxone treatment and traditional recovery
Once the dynamic relationship between use obsession and character defects is understood, the proper relationship between Suboxone and traditional recovery becomes clear. Should people taking Suboxone attend NA or AA? Yes, if they want to. A 12-step program has much to offer an addict, or anyone for that matter. But I see little use in forced or coerced attendance at meetings. The recovery message requires a level of acceptance that comes about during desperate times, and people on Suboxone do not feel desperate. In fact, people on Suboxone often report that ‘they feel normal for the first time in their lives’. A person in this state of mind is not going to do the difficult personal inventories of AA unless otherwise motivated by his/her own internal desire to change.
The role of ‘desperation’ should be addressed at this time: In traditional treatment desperation is the most important prerequisite to making progress, as it takes the desperation of being at ‘rock bottom’ to open the mind to see one’s powerlessness. But when recovery from addiction is viewed through the remission model, the lack of desperation is a good thing, as it allows the reinstatement of the addict’s own positive character. Such a view is consistent with the ‘hierarchy of needs’ put forward by Abraham Maslow in 1943; there can be little interest in higher order traits when one is fighting for one’s life.
Other Questions (and answers):
-Should Suboxone patients be in a recovery group?
I have reservations about forced attendance, as I question the value of any therapy where the patient is not an eager and voluntary participant. At the same time, there clearly is much to be gained from the sense of support that a good group can provide. Groups also ’show’ the addict that he/she is not as unique as he thought, and that his unhealthy way of visualizing his place in the world is a trait common to other addicts. Some addicts will learn the patterns of addictive thinking and become better equipped to handle their own addictive thoughts.
-What is the value of the 4th through 6th steps of a 12-step program, where the addict specifically addresses his/her character defects and asks for their removal by a higher power? Are these steps critical to the resolution of character defects?
These steps are necessary for addicts in ‘sober recovery’, as the obsession to use will come and go to varying degrees over time depending on the individual and his/her stress level. But for a person taking Suboxone I see the steps as valuable, but not essential.
-Where does methadone fit in?
Methadone is just another opiate agonist. A newly-raised dosage will prevent cravings temporarily, but as tolerance inevitably rises, cravings will return. With cravings comes the obsession to use and the associated character defects. This explains the profound difference in the subjective experiences of addicts maintained on Suboxone versus methadone, and explains why in my practice I have many patients who have switched to Suboxone, but none in the other direction.
The downside of Suboxone
Practitioners in traditional AODA treatment programs will see Suboxone as at best a mixed blessing. Desperation is often required to open the addict’s mind to change, and desperation is harder to achieve when an addict has the option to leave treatment and find a practitioner who will prescribe Suboxone. Suboxone is sometimes used ‘on the street’ by addicts who want to take time off from addiction without committing to long term sobriety. Suboxone itself can be abused for short periods of time, until tolerance develops to the drug. Snorting Suboxone reportedly results in a faster time of onset, without allowing the absorption of the naloxone that prevents intravenous use. Finally, the remission model of Suboxone use implies long term use of the drug. Chronic use of any opiate, including Suboxone, has the potential for negative effects on testosterone levels and sexual function, and the use of Suboxone is complicated when surgery is necessary. Short- or moderate-term use of Suboxone raises a host of additional questions, including how to convert from drug-induced remission, without desperation, to sober recovery, which often requires desperation.
The beginning of the future
Time will tell whether or not Suboxone will work with traditional recovery, or whether there will continue to be two distinct options that are in some ways at odds with each other. The good news is that treatment of opiate addiction has proven to be profitable for at least one pharmaceutical company, and such success will surely invite a great deal of research into addiction treatment. At one time we had two or three treatment options for hypertension, including a drug called reserpine that would never be used for similar indications today. Some day we will likely look back on Suboxone as the beginning of new age of addiction treatment. But for now, the treatment community would be best served by recognizing each other’s strengths, rather than pointing out weaknesses.
Great post ! I've been on Sub for a year and a half .It was definitely a life saver for myself and both my sisters. I wish I could have done like a few on here and gone cold turkey and been done with it, but I tried and never made it past 2 months. The huge factor for myself and I think many others is the lack of energy when getting clean. Like a true addict I have found pills to combat all other symptoms of detox.....Imodium for stomach issues, antidepressants for the depression, Clonodine for the jitters and sleep.
I feel I'm ready to come off the Suboxone but the fear of long term lack of energy has me terrified. Suboxone is much easier to taper down from (if done slowly) than the opiates. I have one request for the pharmaceutical companies.......make Suboxone in much lower doses. I find it impossible when tapering off, to get precise milligrams on a daily basis breaking either the 2 or 8 pills. So here I sit this morning with my pile of crumbs. lol
Thank you for taking the time to help us addicts.
I feel I'm ready to come off the Suboxone but the fear of long term lack of energy has me terrified. Suboxone is much easier to taper down from (if done slowly) than the opiates. I have one request for the pharmaceutical companies.......make Suboxone in much lower doses. I find it impossible when tapering off, to get precise milligrams on a daily basis breaking either the 2 or 8 pills. So here I sit this morning with my pile of crumbs. lol
Thank you for taking the time to help us addicts.
Excellent, excellent post! You've clarified so many points that have been a debate between Sub users and Non-Sub users. Thanks for the in-depth look at Sub.
I hope that perhaps Suboxone will help the recovery community as well as the medical and lay communities to view "character defects" as genetically predisposed biochemical differences in neurotransmitter function that are amenable to medical therapies as well as the traditional "mind over matter" 12 step approach.
The COMBINATION of medications such as insulin WITH diet and exercise and other life-style modifications are used in treatment of diabetes with no stigma attached. Maybe some day, we will view our neurotransmitters as we view our hormones, and realize that everyone is NOT created equal! I wouldn't be ashamed to be hypothyroid--would you?
Thanks so much for your post--I hope more treatment professionals will broaden their minds and horizons!
Anon
The COMBINATION of medications such as insulin WITH diet and exercise and other life-style modifications are used in treatment of diabetes with no stigma attached. Maybe some day, we will view our neurotransmitters as we view our hormones, and realize that everyone is NOT created equal! I wouldn't be ashamed to be hypothyroid--would you?
Thanks so much for your post--I hope more treatment professionals will broaden their minds and horizons!
Anon
I think it is a mostly thoughtfull essay but there are some problems. I know you are a very bright doc but you want to re- write the 12 steps and eliminate some? I also think you are not giving methadone it's proper due in recovery . As miligned as it is and as over used as it is (ex.- putting vicodin addicts on 100 mg), it has a place in recovery and is often the first step in an addicts recovery. It is harm reduction or replacement treatment but honestly so is sub. I believe sub can be a usefull tool in treatment but I don't think it's the miracle drug it is touted to be in this article
Recovery is so highly individual that any specific number of "steps" to take for addressing the situation are suggestions at best. The principles remain constant through any number of steps though. Sub seems to have come of age. And there is no doubt that it has saved lives. It will be quite interesting to see what path therapy takes in the next several years.
I really just stumbled on this site looking for information on peripheral neuropathy and seeing that I have been on Suboxone for three years after a 30 year nightmare on prescription drugs. I had gone through so many detoxes that I actually lost count and I find myself in a major medical center in Cleveland with a drill sergeant type of doctor asking me if I would be willing to give Suboxone a try? I have never been one to over complicate matters and know that some of my friends in all the addiction groups might suggest I am still an addict and maybe I would not argue that point, but I consider myself a straight addict that functions and is loved by my family since Suboxone. I am happy, so whats the big deal I say to myself. I must admit financially it hurts us a wee bit, but from where I was to where I am today, I just cannot describe the changes in my life and there was a bonus with this drug also. The chronic pain I suffered from since 75 has completely disappeared ! Yea I have hang ups, but I can deal with them, but again, I am happy. Why would anyone question my sobriety on Suboxone and yes, I consider myself sober in my world. There are many who would say I am not because of the chemistry thing, but I function and I am loved and I am happy. Why would anybody pop my bubble at 58 years old and starting to pay the price health wise with years of abuse. I have always worried about surgery or getting into a car crash and not being able to obtain relief because of Suboxone, but I will leave that in the hands of God. I enjoyed the doctors article immensely as he does not seem rigid in his thought processes as many doctors are, and he seems to be happy, like me.
Billy
Billy
I saw this article on the side of a page I was looking at and decided to see what it is about. I have Narcolepsy with Cataplexy and all the other wonderul symptoms that come with it. I dont actually just pass out like you see on TV, with the exception fo a cataplectic attack if i suddenly think something is very funny and Im already tired, but since Ive become very good at keeping my emotions down to almost nothing that is rare. I suffer from extreme eds all day, I cant concentrate on the simplest things, or keep track of things min-min. If I am doing something the slightest interuption will completly throw me into confusion and frustrtion, by slightest I mean something as simple as someone walking through the room. Or like every thought, idea, task etc is a small 3 x 5 pic 20ft away and Im trying to focus on one through very loud blinding bright light and the pics move around, someone walking through a room would be like all the pics start jumping irratically. This is the best way I can describe what its like to try and function being so tired every day for the last 26 yrs. Stimulants co keep me awake but they seem to make the focus factor worse.
I started seeing a sleep specialist at the U of A, he did research invovling codiene and anothe drug Im not sure butI think it was one to combat opiate addiction. Anyway he put me on 30mgs of cod. 3xs a day. What a difference! It didnt completly get rid of the problem but made things eaiser for an hr or 2 after taking it. That was in "97" now I take 60 mgs x2 day. It still helps but Im becomeing extremly tolorant to it. It worrys me for a number of reasons, 1, being that it can build up in your liver although Ive had no problems with that yet. 2, its not an approved treatment for narcolepsy or a very widly used one, there have been several more studys, with dramatic improvement in cognitive functions that only show up in diarys and things that are not measured by sleep tests. Dr.s are reluctent to prescribe it and I dont blame them.
I was wondering if one of these other drugs could be an option to the tolorance Ive built up? It also seems that while other opiate painkillers keep me awake they also make me feel dopy, codiene does not. So, so far it is only codiene that helps me to concentrate, it brings the pictures closer like to 5ft, stops them frommoving, ets rid fo the loud light so I can actually get something done and done without a bunch of mistakes. I have been trying to figure out why codiene? and what alternatives there maybe? Problem is once it wears off its like my brain just stuffs what I learned, read etc anywhere and I have trouble remembering what it was, where it was, what I read like everything just becomes a pile of stuff. I have to start all over again. Ive read quite a bit on the subject but just cant put it into detail or words.
Anyone have any ideas?
Thank you
Deborah Tyler
I started seeing a sleep specialist at the U of A, he did research invovling codiene and anothe drug Im not sure butI think it was one to combat opiate addiction. Anyway he put me on 30mgs of cod. 3xs a day. What a difference! It didnt completly get rid of the problem but made things eaiser for an hr or 2 after taking it. That was in "97" now I take 60 mgs x2 day. It still helps but Im becomeing extremly tolorant to it. It worrys me for a number of reasons, 1, being that it can build up in your liver although Ive had no problems with that yet. 2, its not an approved treatment for narcolepsy or a very widly used one, there have been several more studys, with dramatic improvement in cognitive functions that only show up in diarys and things that are not measured by sleep tests. Dr.s are reluctent to prescribe it and I dont blame them.
I was wondering if one of these other drugs could be an option to the tolorance Ive built up? It also seems that while other opiate painkillers keep me awake they also make me feel dopy, codiene does not. So, so far it is only codiene that helps me to concentrate, it brings the pictures closer like to 5ft, stops them frommoving, ets rid fo the loud light so I can actually get something done and done without a bunch of mistakes. I have been trying to figure out why codiene? and what alternatives there maybe? Problem is once it wears off its like my brain just stuffs what I learned, read etc anywhere and I have trouble remembering what it was, where it was, what I read like everything just becomes a pile of stuff. I have to start all over again. Ive read quite a bit on the subject but just cant put it into detail or words.
Anyone have any ideas?
Thank you
Deborah Tyler
Dr. Junig,
Your comments regarding methadone exhibit a lack of knowledge on your part as to its workings and efficacy. What you've come to realize about suboxone has held true for methadone since its inception of use in opiod addiction treatment in the 1960's. A patient, once titrated to an optimized and stable dose, requires very little change, if any, in dosage level during the entirety of treatment. This holds true regardless of whether the treatment episode be of short duration or even for a lifetime. Lifetime patients only require dosage modification when their metabolisms begin to change due to the aging process. And then these modifications are minor. I, myself, have been on the same stable dose for over two decades. And the reason for this is clear, made more so by the brain research of the last 15 years. It is NOT methadone's analgesic properties that are being utilized by these patients after their initial withdrawal from illicit usage, but its endorphin replacement properties. This is why there is NO "inevitable tolerance" or return of cravings as you assert. Your comment evidences only your lack of knowledge about the treatment modality and the science supporting it. Long term opiate abuse produces in many, some research suggest most, permanent changes to brain chemsitry. It is this change that drives the compulsion to use illicitly even in the face of dire consequences. It is this change that explains the high rates of relapse for the untreated. Methadone equilizes this endorphin deficiency and is endorphin replacement therapy in its action on the patient. Drs. Nyswander and Dole, the originators of the treatment knew of this efficacy, but didn't understand why. It's taken the advances in brain research to explain the essential workings and this has substantiated the efficacy realized by those early researchers. Patients experience the same feelings of "normalcy" that you describe with your suboxone patients and I would suggest the reasons are similar. There exists much prejudice and stigma associated with methadone treament. There is no "profound difference in the subjective experiences of addicts maintained on Suboxone versus methadone" as you assert. You might want to peruse http://www.thepetitionsite.com/takeaction/360731625 where you will find nearly three thousand testimonials from methadone patients that will echo those that you hear from your suboxone patients. There is no distinction and medical professionals like yourself need to resist furthering the stigma associated with this life-saving treatment.
As to why you don't see patients changing from suboxone to methadone, it does occur and your practice is most unusual if you see none of it. But the numbers are small and the reasons are again clear from the research in countries like France that have been using suboxone for nearly two decades. Suboxone's efficacy is best in that patient population whose illicit usage was not extended; roughly the two year and under segment. For those with longer illicit usage histories efficacy drops off dramatically. I would suggest it is this permanent endorphin damage that is the explanation. For this patient population methadone maintenance treatment better offers what their bodies require--endorphin replacement. And not in increasing quantities but as the same stable daily dose once that level is found according to each individual patient's needs. Among many methadone maintained patients who do switch to suboxone anecdotal evidence in the US is finding that most do switch back. This seemingly because methadone is the better endorphin replacer of the two current alternatives.
I would also suggest your review of the voluminious research supporting these assertions that can be found at our National Institutes of Health websites and also at www.methadone.org and www.lindesmith.org. Methadone is medicine and an efficacious treatment for a clearly defined medical condition. It now exists side by side with Suboxone as the best treatments available to treat opiod addicted persons, but remains the "gold standard" of the two as declared by our NIH.
Kind regards,
J.R. Neuberger
National Alliance for Medication Assisted Recovery
Your comments regarding methadone exhibit a lack of knowledge on your part as to its workings and efficacy. What you've come to realize about suboxone has held true for methadone since its inception of use in opiod addiction treatment in the 1960's. A patient, once titrated to an optimized and stable dose, requires very little change, if any, in dosage level during the entirety of treatment. This holds true regardless of whether the treatment episode be of short duration or even for a lifetime. Lifetime patients only require dosage modification when their metabolisms begin to change due to the aging process. And then these modifications are minor. I, myself, have been on the same stable dose for over two decades. And the reason for this is clear, made more so by the brain research of the last 15 years. It is NOT methadone's analgesic properties that are being utilized by these patients after their initial withdrawal from illicit usage, but its endorphin replacement properties. This is why there is NO "inevitable tolerance" or return of cravings as you assert. Your comment evidences only your lack of knowledge about the treatment modality and the science supporting it. Long term opiate abuse produces in many, some research suggest most, permanent changes to brain chemsitry. It is this change that drives the compulsion to use illicitly even in the face of dire consequences. It is this change that explains the high rates of relapse for the untreated. Methadone equilizes this endorphin deficiency and is endorphin replacement therapy in its action on the patient. Drs. Nyswander and Dole, the originators of the treatment knew of this efficacy, but didn't understand why. It's taken the advances in brain research to explain the essential workings and this has substantiated the efficacy realized by those early researchers. Patients experience the same feelings of "normalcy" that you describe with your suboxone patients and I would suggest the reasons are similar. There exists much prejudice and stigma associated with methadone treament. There is no "profound difference in the subjective experiences of addicts maintained on Suboxone versus methadone" as you assert. You might want to peruse http://www.thepetitionsite.com/takeaction/360731625 where you will find nearly three thousand testimonials from methadone patients that will echo those that you hear from your suboxone patients. There is no distinction and medical professionals like yourself need to resist furthering the stigma associated with this life-saving treatment.
As to why you don't see patients changing from suboxone to methadone, it does occur and your practice is most unusual if you see none of it. But the numbers are small and the reasons are again clear from the research in countries like France that have been using suboxone for nearly two decades. Suboxone's efficacy is best in that patient population whose illicit usage was not extended; roughly the two year and under segment. For those with longer illicit usage histories efficacy drops off dramatically. I would suggest it is this permanent endorphin damage that is the explanation. For this patient population methadone maintenance treatment better offers what their bodies require--endorphin replacement. And not in increasing quantities but as the same stable daily dose once that level is found according to each individual patient's needs. Among many methadone maintained patients who do switch to suboxone anecdotal evidence in the US is finding that most do switch back. This seemingly because methadone is the better endorphin replacer of the two current alternatives.
I would also suggest your review of the voluminious research supporting these assertions that can be found at our National Institutes of Health websites and also at www.methadone.org and www.lindesmith.org. Methadone is medicine and an efficacious treatment for a clearly defined medical condition. It now exists side by side with Suboxone as the best treatments available to treat opiod addicted persons, but remains the "gold standard" of the two as declared by our NIH.
Kind regards,
J.R. Neuberger
National Alliance for Medication Assisted Recovery
I have been on suboxone for four years. Nothing I did prior in my life could stop the craving and need for opiates - whether I'd just suffered through the hell of withdrawl or not the need was always present in my life.
I went to the meth clinic once and when I reliazed I would have to go there every day (I was too scared to almost go in the first day) I knew I couldn't ever do it. Once I realized I could see a psych doc and get a prescription for the month in a hospital setting and still be to work on time.....I knew that was for me. It wasn't just the meth vs. sub concept it was the attempting to put together a normal life.
Now, I've been at my current job for five years, my rent is paid and while nothing is perfect life is a helluva lot better when drugs were priority. I just literally no longer have any cravings or desire to get high.
I went to the meth clinic once and when I reliazed I would have to go there every day (I was too scared to almost go in the first day) I knew I couldn't ever do it. Once I realized I could see a psych doc and get a prescription for the month in a hospital setting and still be to work on time.....I knew that was for me. It wasn't just the meth vs. sub concept it was the attempting to put together a normal life.
Now, I've been at my current job for five years, my rent is paid and while nothing is perfect life is a helluva lot better when drugs were priority. I just literally no longer have any cravings or desire to get high.
I am very glad to hear that methadone is working for you, but lighten up on the Doc my good man. Both of your articles were great reads.
and I feel exactly the same as nygirl7.
I am happy, so whats the big deal I say to myself. I must admit financially it hurts us a wee bit, but from where I was to where I am today, I just cannot describe the changes in my life and there was a bonus with this drug also"
PS I completely relate to this every time I have to go to the docs and then pickup the script. Thing is I used to have no problem spending hundreds of dollars every week on drugs. My family was disgusted with me and my life was over..
It's worth the $$$$s.
PS I completely relate to this every time I have to go to the docs and then pickup the script. Thing is I used to have no problem spending hundreds of dollars every week on drugs. My family was disgusted with me and my life was over..
It's worth the $$$$s.
Thx for the articel Im´a sober alcoholic and speed abuser I have been sober 22 years but feels like shit off and on.
When I was doing my second HCV treatment ended 7 months ago and I´m SVR, the doc prescribed me tramadol to take with tylenol because o f severe headache
.
And I felt so good without feeling high just good I didn´t have this aweful controll or you might say views or takes about every thing I do and says.
Even when typing the computers table tangents I have thoughts about that, my brain is working all the time never gets any rest.
I just know I´m beginning to reach a point where I don´t can manage to be sober anymore my brain chemistry aint normal and it has never been.
I just heard about LDN low dose Naltrexone .
That it should be pretty harmles to take is naltrexone related with suboxone.
I don´t wanna take anything that interfears with my libido.
I`ve been a member in both AA and NA but the Program I believe is not the answer for me.
Ps i could have got more tramadol but I senced I had to upper the dose to get effect and also started to develop digestiv problems. So I figured its just like any other drug it ends up with I have to take a lot just to get almost normal which is my normal, which aint normal in the first place.
I went to a ordinary doc she said Naltrexone is an opiath that she wasn´t allowed to prescribe, but she fixed me an apointment with a psychiatrist in september 15.
My question is what do you think I shall ask him to prescribe me??
best regards
comeagain
When I was doing my second HCV treatment ended 7 months ago and I´m SVR, the doc prescribed me tramadol to take with tylenol because o f severe headache
.
And I felt so good without feeling high just good I didn´t have this aweful controll or you might say views or takes about every thing I do and says.
Even when typing the computers table tangents I have thoughts about that, my brain is working all the time never gets any rest.
I just know I´m beginning to reach a point where I don´t can manage to be sober anymore my brain chemistry aint normal and it has never been.
I just heard about LDN low dose Naltrexone .
That it should be pretty harmles to take is naltrexone related with suboxone.
I don´t wanna take anything that interfears with my libido.
I`ve been a member in both AA and NA but the Program I believe is not the answer for me.
Ps i could have got more tramadol but I senced I had to upper the dose to get effect and also started to develop digestiv problems. So I figured its just like any other drug it ends up with I have to take a lot just to get almost normal which is my normal, which aint normal in the first place.
I went to a ordinary doc she said Naltrexone is an opiath that she wasn´t allowed to prescribe, but she fixed me an apointment with a psychiatrist in september 15.
My question is what do you think I shall ask him to prescribe me??
best regards
comeagain
I sense that you are sitting on the edge of a cliff and the choice I made many times was to jump off and we call that relapse. I have not visited that particular cliff in several years but it may be time to take a couple of steps backwards and totally take a look at where you are at this stage of your life.
There's lots of help out there but also a whole bunch of obstacles in getting the proper treatment and in my case it was the insurance companies that do not take addiction as seriously as they should as it leads to many other illnesses that they pay out much more money for in the long run.
I don't know what to tell you as I don't know anything about you, but you sound like you are not doing so good and that saddens me, but if you are vigilant, you can get help.
The problem with me I was not vigilant and fell off that cliff a dozen times until I hit the rocks rather than sand and pray that you will scratch and crawl to get the help you need my friend.
I don't want you to end up like me in where I have been away from narcotics with the help of Suboxone, but the years of substance abuse as left me with a whole lot of physical and psychological problems that I am dealing with, but its not pleasant knowing that I could have prevented it, or maybe I could not have, as I tend to agree with you that I believe whatever happens on the atomic level in addicts brains just ain't right. It has nothing to do with smarts as I have sat with several doctors getting detoxed right along with me on several occasions.
In the correct people, Suboxone can turn lives around, but it does not help a majority of addicts as I have observed time after time, but I surely know where you are and its not pleasant and my thoughts and prayers are with you comeagain.
Billy
There's lots of help out there but also a whole bunch of obstacles in getting the proper treatment and in my case it was the insurance companies that do not take addiction as seriously as they should as it leads to many other illnesses that they pay out much more money for in the long run.
I don't know what to tell you as I don't know anything about you, but you sound like you are not doing so good and that saddens me, but if you are vigilant, you can get help.
The problem with me I was not vigilant and fell off that cliff a dozen times until I hit the rocks rather than sand and pray that you will scratch and crawl to get the help you need my friend.
I don't want you to end up like me in where I have been away from narcotics with the help of Suboxone, but the years of substance abuse as left me with a whole lot of physical and psychological problems that I am dealing with, but its not pleasant knowing that I could have prevented it, or maybe I could not have, as I tend to agree with you that I believe whatever happens on the atomic level in addicts brains just ain't right. It has nothing to do with smarts as I have sat with several doctors getting detoxed right along with me on several occasions.
In the correct people, Suboxone can turn lives around, but it does not help a majority of addicts as I have observed time after time, but I surely know where you are and its not pleasant and my thoughts and prayers are with you comeagain.
Billy
I don't really believe that a drug saves a drug addicts live in most cases. Drugs like methadone a sub can help or parcipitate the beginning of recovery but I don't want to give a drug that much credit. This doctor sounds impressive and very enthusiatic about sub, so much so in fact that I think he's on it himself or getting a kick back from the drug company. In an e mail earlier this year he didn't deny he was on it. Do I think it's wrong for a shrink or sub doc to be on sub? not necesarily but my opinion isn't the one that counts. Why not just tell the whole story.
Thx a lot for your consern muidrive it really warmth my heart.
In a way I fell more real now than I maybe never have done because I finnaly have started to realise and accept that I`m not as fit for life as many others probably are.
And whats more importent that I don´t have to pretend and convince my self and others, that maybe thats how things appears( that I`m not as fit) but it certainly isn´t how it really is.
The tramadol experince showed me, that how I felt on them this is more how my thoughts( my brain chemistry) should be like .
As a matter of fact its everybodys right to understand that they not have the right chemistry if thats the case.
Why do we lye to our selfs and others and gets activated in all kind of outside works that if we dont succeed feels even worse than before by getting more thoughts in our poor brains about things nobody should even have to bother to think about.
And if we succeeds in that ouside work ,we gets inspired of that and runs even further away from whom we really are.
ca
PS. Sometimes I wonder if I have been programmed into think that I have no rights at all and never have had from the day that I was borned.
In a way I fell more real now than I maybe never have done because I finnaly have started to realise and accept that I`m not as fit for life as many others probably are.
And whats more importent that I don´t have to pretend and convince my self and others, that maybe thats how things appears( that I`m not as fit) but it certainly isn´t how it really is.
The tramadol experince showed me, that how I felt on them this is more how my thoughts( my brain chemistry) should be like .
As a matter of fact its everybodys right to understand that they not have the right chemistry if thats the case.
Why do we lye to our selfs and others and gets activated in all kind of outside works that if we dont succeed feels even worse than before by getting more thoughts in our poor brains about things nobody should even have to bother to think about.
And if we succeeds in that ouside work ,we gets inspired of that and runs even further away from whom we really are.
ca
PS. Sometimes I wonder if I have been programmed into think that I have no rights at all and never have had from the day that I was borned.
I am a 40 year old female and on Suboxone now for two months.
I used to be a terrible alcoholic, I drank my whole life, since I was 12 years old, eventually, of course, I lost everything. Somehow I managed to stop drinking and did manager to get my life back in order. I did it, but I still never felt "normal". Anyway, eventually I tried Vicodin. A friend gave it to me to try.
I immediately became addicted, it made me feel "normal" and good, I was on top of the world. Eventually, after four years, I could see that big trouble was ahead if I didn't stop, and my main "supply" was out. I would have to soley rely on doctor shopping, and I knew it wouldn't take long before I ended up in jail. I could already see so many things were beginning to happen beacause of my Vicodin use. I was so close to losing my job when there was a random drug test. I was lucky. I happened to find out about it ahead of time. Otherwise I would have lost everything again.
So, someone told me about Suboxone. I didn't think it would be for me, I thought you would have to be a hard core heroin addict to be on it. But, I went to a Suboxone doctor and got started on it.
My life has never been better. I am able to do all of the "normal" activities of "life" and feel good. I am better at work, a better mother, and I am able to sleep at night, as well as not dread getting out of bed in the morning. It is all due to Suboxone. I am certain that there is a chemical imbalance in my brain, and Suboxone helps it. I feel wonderful.
My current doctor wants to keep me on it for about a year (like I said, I have only been on it for two months). I honestly can not imagine life without Suboxone. I haven't asked my doctor about his thoughts on lifetime maintenance, but if he isn't for it, I hope to find a doc who does believe in it and who will take me as a patient.
Any advice? Suggestions? Comments?
I used to be a terrible alcoholic, I drank my whole life, since I was 12 years old, eventually, of course, I lost everything. Somehow I managed to stop drinking and did manager to get my life back in order. I did it, but I still never felt "normal". Anyway, eventually I tried Vicodin. A friend gave it to me to try.
I immediately became addicted, it made me feel "normal" and good, I was on top of the world. Eventually, after four years, I could see that big trouble was ahead if I didn't stop, and my main "supply" was out. I would have to soley rely on doctor shopping, and I knew it wouldn't take long before I ended up in jail. I could already see so many things were beginning to happen beacause of my Vicodin use. I was so close to losing my job when there was a random drug test. I was lucky. I happened to find out about it ahead of time. Otherwise I would have lost everything again.
So, someone told me about Suboxone. I didn't think it would be for me, I thought you would have to be a hard core heroin addict to be on it. But, I went to a Suboxone doctor and got started on it.
My life has never been better. I am able to do all of the "normal" activities of "life" and feel good. I am better at work, a better mother, and I am able to sleep at night, as well as not dread getting out of bed in the morning. It is all due to Suboxone. I am certain that there is a chemical imbalance in my brain, and Suboxone helps it. I feel wonderful.
My current doctor wants to keep me on it for about a year (like I said, I have only been on it for two months). I honestly can not imagine life without Suboxone. I haven't asked my doctor about his thoughts on lifetime maintenance, but if he isn't for it, I hope to find a doc who does believe in it and who will take me as a patient.
Any advice? Suggestions? Comments?
I am so glad to see someone touch on the subject of 12 step program and suboxone. In the beginning of my recovery I was required to attend AA or NA meetings. I was nervous and scared so I attented my first AA meeting with a friend, after "sharing my story I was told that I was NOT welcome there due to the fact that I do not drink. So I then attended a NA meeting, again after sharing my story, I was told in so many words that I really wasn't welcome because I used Suboxone. Thanfully I had a great doctor who did not force the AA or NA thing on me. Many doctors who prescribe suboxone require their patients to attend some type of meetings, but suboxone is really looked down on in NA.
That was 5 years ago, and I'm happy to say that I have been clean for 5 years now without AA or NA. Yes, suboxone did play a big part for me, it really does give you the normal feeling. When you feel normal without that constant little devil sitting on one shoulder whispering in your ear, you can lead a normal life going about your daily business. For me eventually I just totally forgot about it and when I started forgetiing to take my suboxone I knew it was time to stop taking it for me.
That was 5 years ago, and I'm happy to say that I have been clean for 5 years now without AA or NA. Yes, suboxone did play a big part for me, it really does give you the normal feeling. When you feel normal without that constant little devil sitting on one shoulder whispering in your ear, you can lead a normal life going about your daily business. For me eventually I just totally forgot about it and when I started forgetiing to take my suboxone I knew it was time to stop taking it for me.
I have been a long term opiate addict, beginning with heroin, ending up on rx pain meds. I have been in & out of AA/NA for the last 20 years with varying periods of "sobriety", the longest being 3 years. Always relapsed on pain meds. For the last 4 yrs I have been on sub. I now take 1mg per day. I attend my 12 step group regulrly. I do , however have some inner conflict regarding the Suboxone use. I got off Sub. briefly, but cravings came back quickly as well as some real INSANITY!! My emotional condition deteriorated quickly, I believe there is something different in my brain chemistry thus requiring the Sub. At this point I find Sub. assists in eliminating obssession over using, BUT without the help of my recovery program, I personally feel LOST spiritually. Really wish I could resolve this inner battle regarding SUB> is my recovery AUTHENTIC?? guess I feel less than for depending on something OTHER than just the 12 steps>>>>>>>>.........
You answered one of my posts and told me to keep you posted on how i was doing. Well I got off of pain pills on april 14 and took suboxone for 9 days to curb the awful withdrawels and i must say the suboxone withdrawels werent nearly as bad as oxycodone and a small amount of methadone. I have had a problem with my throat closing up and i am pretty sure it is anxiety. I will try and go a little longer before i try antidepressants. All i am taking now that is prescription is ambien because going without sleep drove me crazy. I did slip once after i had been to the doctor and was sent for a ct scan with contrast dye of my head and neck and a barium swallow to check for reflux . Had some suboxone left and i took a quarter of a pill. I think it brought some of the depression back but i was so freaked from my anwiety symptoms that i just wanted relief. That was about 3 weeks ago and i flushed the rest of those down the toilet. I am commited to beating this and just hope with time that it gets better. Hope this post was helpful for you and thank you again for replying to my earlier post. God bless and stay strong
This has been a most interesting thread, and has cleared up several things for me, and raised some questions.
I can't help taking a dim view of the value of methadone for recovery. The reason for this is that I buried a son four months ago, a fine young man of 27, and a talented musician and composer, who died of an overdose of methadone after a 6-year addiction to that substance as his DOC.
About two years ago, after dropping out of school and moving back home, he got into recovery as a side effect of a diversion program for a DUII, and attended meetings at a local outpatient recovery center. He found a doctor who could prescribe Suboxone, and took it for nearly a year. During this time, he moved into his own apartment and went back to school, and all was going well for him until he (and the doctor) decided it was time to taper off the Sub. This was a process of several months, and when he was finally off the Sub completely, last September, he was still experiencing withdrawals, and -- surprise! -- he got some methadone from a "friend" to help alleviate the symptoms, and proceeded to OD. This happened while he and I were watching TV in my living room, and it happened unbelievably fast. One moment he was talking and after perhaps five minutes of silence he was out cold and not breathing. I called 911 and did CPR, the fire dept. arrived, and they brought him around with Narcan and sent him to the ER in an ambulance.
To make a long story short, he survived that one, and elected to get into a residential program in another city where he got on the Suboxone again (actually Subutex this time). He checked himself out AMA just before Christmas and immediately relapsed on the methadone, so he went back to the treatment center again for a month and a half.
He returned home in February, and spent the next (and last) two months of his life in a state of nearly total demoralization. He was using methadone again, but evidently was keeping it a level low enough that, while we suspected he was using, we couldn't be sure. Despite this, he had two more ODs, about two weeks apart. Both of these were at home, and ended like the first, with a trip to the ER. The situation was obviously out of control, no one knew what to do about it, and he resisted all suggestions of going to AA or NA meetings and getting a sponsor. Another three weeks went by, during which he swore up and down that he was clean. I had not asked him before this, as I didn't want him to lie to me about it, but his behavior was so irregular -- jerky gestures, skin breaking out, grandiose rants, emerging from his room only at night -- that I finally asked him point-blank, and, of course, he lied.
The final OD came when he was away from home, and the circumstances will probably always be a mystery. One of his suppliers drove him to the ER, where he never regained consciousness, despite about an hour's attempts to revive him. The supplier claimed to be a good samaritan, but I think it probably happened in his house, and he didn't want to involve himself by calling 911.
I apologize for the length of this post, which may more relevant to the Substance Abuse forum, but I think it is pertinent to the doctor's original post on the Suboxone treatment for addiction. I would like to emphasize that, in my son's case, the Sub treatment might very well have worked if there had been an understanding in the first place that it would probably have to continue for much longer, possibly many years. The analogy to diabetes and insulin made in an earlier post makes sense, except that insulin is not in itself addictive.
The events I have described here reached their peak in a very short time, and in hindsight, after his death, I realized that the next step might have been to get him in a methadone maintenance program. During those last weeks, that would have seemed too drastic, but given the outcome, obviously, it would have been one of the few remaining options.
I can't help taking a dim view of the value of methadone for recovery. The reason for this is that I buried a son four months ago, a fine young man of 27, and a talented musician and composer, who died of an overdose of methadone after a 6-year addiction to that substance as his DOC.
About two years ago, after dropping out of school and moving back home, he got into recovery as a side effect of a diversion program for a DUII, and attended meetings at a local outpatient recovery center. He found a doctor who could prescribe Suboxone, and took it for nearly a year. During this time, he moved into his own apartment and went back to school, and all was going well for him until he (and the doctor) decided it was time to taper off the Sub. This was a process of several months, and when he was finally off the Sub completely, last September, he was still experiencing withdrawals, and -- surprise! -- he got some methadone from a "friend" to help alleviate the symptoms, and proceeded to OD. This happened while he and I were watching TV in my living room, and it happened unbelievably fast. One moment he was talking and after perhaps five minutes of silence he was out cold and not breathing. I called 911 and did CPR, the fire dept. arrived, and they brought him around with Narcan and sent him to the ER in an ambulance.
To make a long story short, he survived that one, and elected to get into a residential program in another city where he got on the Suboxone again (actually Subutex this time). He checked himself out AMA just before Christmas and immediately relapsed on the methadone, so he went back to the treatment center again for a month and a half.
He returned home in February, and spent the next (and last) two months of his life in a state of nearly total demoralization. He was using methadone again, but evidently was keeping it a level low enough that, while we suspected he was using, we couldn't be sure. Despite this, he had two more ODs, about two weeks apart. Both of these were at home, and ended like the first, with a trip to the ER. The situation was obviously out of control, no one knew what to do about it, and he resisted all suggestions of going to AA or NA meetings and getting a sponsor. Another three weeks went by, during which he swore up and down that he was clean. I had not asked him before this, as I didn't want him to lie to me about it, but his behavior was so irregular -- jerky gestures, skin breaking out, grandiose rants, emerging from his room only at night -- that I finally asked him point-blank, and, of course, he lied.
The final OD came when he was away from home, and the circumstances will probably always be a mystery. One of his suppliers drove him to the ER, where he never regained consciousness, despite about an hour's attempts to revive him. The supplier claimed to be a good samaritan, but I think it probably happened in his house, and he didn't want to involve himself by calling 911.
I apologize for the length of this post, which may more relevant to the Substance Abuse forum, but I think it is pertinent to the doctor's original post on the Suboxone treatment for addiction. I would like to emphasize that, in my son's case, the Sub treatment might very well have worked if there had been an understanding in the first place that it would probably have to continue for much longer, possibly many years. The analogy to diabetes and insulin made in an earlier post makes sense, except that insulin is not in itself addictive.
The events I have described here reached their peak in a very short time, and in hindsight, after his death, I realized that the next step might have been to get him in a methadone maintenance program. During those last weeks, that would have seemed too drastic, but given the outcome, obviously, it would have been one of the few remaining options.
I JUST WANT TO TELL YOU A LITTLE ABOUT MY SUBOXINE STORY, YEA,IT WORKS ONLY IF YOU HAVE THE MONEY TO PAY FOR IT OTHERWISE,YOUR BACK TO STEALING ROBBING WHATEVER IT TAKES TO GET YOUR DOSE
Wonderful article. I have been working on recovery and trying to figure out how it works with chronic pain for years. It's exhausting sometimes. I loved the comments to your article that talked about feeling normal and happy. That hasn't been a frequent feeling for me. I have lots of goals etc., but the preoccupation with pain and/or recovery seem to prevent pursuit of same. Thanks again. Kathie
Help Dr. I need your advice a posted a comment on another blog, but I cannot contact you directly . For some reason the ask an expert forum for addiction forum won't allow me to post a new question, and I nee a doc to help me! have been addicted to hydrocodone for 11 months. I do realize that there is a deference between physical dependance and addiction,I am 16 weeks pregnant and terrified to tell my OB. I started at 3 or 4 5mg's a day and after my tolerance increased, the doc increased, the dosage and switched to lortab 10mg, and I can 10-15 a day now. HELP!!! Oh I am 25 year old stay at home mom of three boys, and hubby works 80-100hrs.a week! I live in VA. and ALL my family is in MO! So no help with the kids!! I have to do something! PLEASE HELP!! I don't want this on my medical record, or dcse and my balance with my chronic pain management doc is outstanding, so I can't get a refill!
Dr. Junig,
What are the specific guidelines for the suboxone program. Should patients get bloodwork, urine tests, a physical, should the patients spend a certain ammount of time with the doctor for the introduction visit? SHould the doctor be the only docotr to administer the suboxone to the patient? Is there a limit on how many patients a doctor can see in a day or year? When the patients pay the cash, does the doctor who runs the program keep the mone for himself, or does it go toward the practice he works for? Is there certain paperwork the patients need to fill out? Is there questionaires, etc... Thank you for your time and hope to hear from you soon.
What are the specific guidelines for the suboxone program. Should patients get bloodwork, urine tests, a physical, should the patients spend a certain ammount of time with the doctor for the introduction visit? SHould the doctor be the only docotr to administer the suboxone to the patient? Is there a limit on how many patients a doctor can see in a day or year? When the patients pay the cash, does the doctor who runs the program keep the mone for himself, or does it go toward the practice he works for? Is there certain paperwork the patients need to fill out? Is there questionaires, etc... Thank you for your time and hope to hear from you soon.
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