Future of Suboxone

[GA Guy]

Thanks again Doc for all of your help. I bought a copy of your audio seminar called "I'm on Suboxone...Now What". And, I found it to be the best hour on Suboxone I've ever heard. I HIGHLY recommend people going to your website and obtaining copies of your other seminars if they're thinking of going the Suboxone route. It's a small price to pay for the wealth of information you provide. No, for my question....you mention the future of Suboxone for many things. Can you give us some ideas of where the opiate addiction research is going with regards to Suboxone and Bupe in general. Do you ever think it would be given for general short term pain relief such as broken bones and tooth extractions? Or would Bupe be too high powered for that? I look forward to your thoughts.

[J T Junig, MD PhD]

Thanks for the plug!  I made those tapes just so that every now and then I could avoid repeating myself-- and just say 'check out this tape'!  

As far as the future goes, I have said this before but if you go to clinicaltrials.gov and search for 'buprenorphine' (the active ingredient in Suboxone) you will get some idea of what people are looking at.  One thing that was so frustrating about the flaming that I was getting here was the disconnect from the view of Suboxone by the professional and scientific community.  The way it is seen by many 'in the business of treating addiction' is that addiction has for too long been ignored by 'real' science.  Yes, money is poured into the black hole of inner-city detox centers, where the success rate of treatment is probably under 5% (I used to work in a crisis center and send people to 'those places'-- almost every single patient simply cleans up and hits the street to use again-- all of the money for 'treatment' going to provide some sandwiches and warm showers).  Meanwhile, the 'real diseases' like breast cancer get millions and millions of dollars to spend on research into better treatments, earlier diagnosis, etc.  

There are always the people who talk about 'will power' and addiction as a 'moral weakness'-- but it is rare to find addicts with 10-20 years of sobriety based on 'will-power', although the people that are running on will-power tend to be loud and sometimes monopolize the conversations.   Examples include the anti-AA movements over the years;  Audrey Kishline of Moderation Management was in Newsweek and Time, and on the Today show...  her book about 'drink counting' was a hit until she killed a family driving drunk, and she is still in prison today.  For long-term sobriety we have only the steps.  There will be some angry replies to that comment... but it is no accident that the vast majority of residential treatment centers are step-based, or that licensing agencies expect that type of treatment for impaired professionals.  

Enter Suboxone.  Say what people will, it is really an amazing medication.  The company that makes it has made some money-- a fraction of what they could have made if they had been more aggressive in their marketing-- but it has grabbed the attention of the US Pharma companies.  Some people hate capitalism, but in the case of science, capitalism drives discovery. It takes industry dollars to move applied medical science forward-- and finally that is happening in the case of addiction.

I have two posts worth reading on my blog, suboxonetalkzone.com-- the last two posts-- in the second one I put forward the question to ponder...   if science 'cured' addiction with a pill, would people be in favor it it?  Suboxone is pretty darn close to perfect-- people who take it properly know what I am saying-- it makes a person 'normal'.  Yes, there is some diversion;  yes, there are treatment failures-- although many times the patients who fail didn't follow instructions closely, instead trying to 'treat themselves'-- which doesn't work with this medication.  But a medication that, when used properly, doesn't cause a 'high', doesn't have serious risks or toxicity (compare it to chemotherapy!)... and yet there is this strange anger directed toward it.

Another area of disconnect-- I received an appropriate comment from a regular here about the diversion of Suboxone--   people have no idea, the extent of efforts to understand and correct the diversion issue.  I will copy some of my note to him:

There are a number of studies looking at diversion-- none perfect, but many people are trying, from the manufacturer, to NIDA, to NIH, to SAMHSA.  Many addictionologists-- Suboxone prescribers and also people who run sober-based treatment centers, myself included-- provide data to different central areas that are running studies--  questions include, out of all of the patients presenting for treatment of opiate dependence in the last 90 days, how many--  
- have taken Sub that was prescribed
- have taken Sub 'on the street'
- how was it used e.g. to get high, to do a detox, to prevent withdrawal, etc
- how many patients used Sub as their 'first opiate'
- for people that used Sub, how long was the person using before trying Suboxone?
etc... The surveys are 4-5 pages long, and take an hour to complete--   and every now and then a study will share preliminary data.

I am also part of a study that ends at the end of January, that takes new Suboxone patients and pays them to participate in similar surveys-- the one I am doing pays $225 for 6 interviews over 6 months, one per month, asking tons of similar questions.

Smart people are studying addiction, trying to really make a difference out there, recognizing the billions of dollars of cost to the US economy each year from addiction and the horrible toll that addiction has on people.

I want to wrap up for now, but to give you an idea of how the scientific and medical community view buprenorphine, check out the ATTC--  it was established by SAMHSA, the Substance Abuse and Mental Health Services Administration--- and the home page is here: http://www.attcnetwork.org/index.asp#   Go to 'what we do' and click on 'science of addiction'.  And again, check out clinicaltrials.gov.  Those two places will give you an idea of where things are right now, and where they are heading.  As you will read, this is an exciting time-- people who have worked for decades fighting addiction finally see some daylight.  

For those who are 'anti-Suboxone', please avoid the usual flood of angry comments--   I am answering a question about what is going on with buprenorphine research.  For readers who want to debate the issue, please visit the community forums about addiction-- you will find plenty of people to argue with or agree with.  

I am not 'only about Suboxone';  I am the medical director of a large sobriety-based treatment center-- a very good one, actually, which you can read about here:  http://novaoshkosh.com
My own recovery is 'step based'.  But after 5 years of sobriety I stopped meetings... and about 4 years after that I relapsed, as most opiate addicts do when they stop meetings.  Up until a few years ago, I told every opiate addict that he had one option. Now the same person has two.

Thank you for your question and comments,

JJ

[allaboutmary]

Dr. J.,

Just want to send you a HUGE THANK YOU !   So many times I've wanted to suggest people check into Suboxone, but have not for fear of the attacks by Anti-Sub community here. It's so sad when you can hear the posters hopelessness, and they have tried so hard, only to relapse.
I have no doubt you are saving lives here with your generosity of time and information.
Again, Thank you !

[ige]

HI I WOULD LIKE TO KNOW IF (SUB) IS GOOD TO HELP WITH HEROIN ADDICTION I WANT TO HELP MY FATHER OFF DRUGS HE HAS BEEN USING FOR TO MANY YEARS AND HE HAS COME DOWN WITH SOME HEALTH ISSUES NOT DRUG RELATED WELL WHO KNOWS DRUGS DO MESS YOU UP IN THE LONG RUN. WELL AS HIS ONLY CHILD I WANT TO HELP HIM REHAB AND OTHER CENTER'S ARE ALL ALIKE AND AS MENTIONED ON THE OTHER POST ONCE YOU TRY AND GET INVOLVED WITH THE SAME PEOPLE AND ENVIORMENT YOU START USING ANGAIN SO CAN SOMEONE TELL ME HOW I CAN GET HIM TO A DR. THAT PERSCIBES THIS IN N.Y.C..

[flmagi]

Cookie,   If you are feeling fine and have no cravings, then what you are taking now should be your highest dose. You should actually be trying to lower your dose at this point to a low maintenance dose. Or are you looking to feel even better? If so, you're still searching for a high. This is what using Sub is suppose to be breaking you of.  No more looking for a high, no more taking pills every few hours etc.  Make sure you're getting some recovery support....NA, Counseling etc.

[marcatj]

hey cookie, if the doc doesn't answer for awhile, if you trust your own doc, a good rule of thumb is to go by what he/she says... and of course, the best way IS under a doctors supervision.

but hopefully doc j will see your question.  for me, i just always trusted my body (and my doc)... how it felt on each dose (as i adjusted/tapered, etc.)  that always worked for me...

i know others on much higher doses that would have laid me out! so i think its pretty personal to each person... but hey, i'm not the doc.  and you didn't ask me.  i just wanted to let you know what i found helpful...

good luck! to you...
warmly,
mj

[cookie200803]

I have been on soboxen for 3 months and i am feeling well. Absolutely no cravings for percocets.which was my problem. what is the highest dose i can take?

[marcatj]

same here - Sub saved my life.  and alot of other folks i know.

i don't get the anger either. it's so bizarre...  alot of times in the past here, it was from people who'd never tried it.  there was also alot of info on the boards here for some time  about sub, how it "should" be used, etc. - so i think it formed strong opinions in other people - but none of it was from medical professionals...  altho i'm certain many were well meaning, there was so much info that people simply didn't have.

i have to think the people who get so angry about it have a) never tried it  b) stand a pretty good chance at relapse themselves, as that's alot of control (and anger) to be exerting, instead of just "living and let live."

thanks for bein' here, doc!
:-)
mary