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Is Suboxone right for me?

I've been taking pain pills for the last year. Percocet, vicodin , and morphine sulphate for pain. I recently had surgery for the pain. The pain is gone back now when I stop taking the pills, I have excruciating withdrawals. @ 1 1/2 months ago, my doctor put me on 90 mg of morphine sulphate per day. He has now switched me to Suboxone to help with the w/d. My prescription is 2 mg one or two per day as needed. I want to start taking it tomorrow morning but all I have read are horror stories. Can you please tell me the best way to take this and how much for how long so I can be pill free. I really don't want to take Suboxone for very long if I don't have to. Thanks.
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666151 tn?1311114376
I don't know what to make of the horror stories;  given the destruction I have seen from opiate addiction, I see Suboxone as a Godsend, as do most addiction docs who practice with the medication.  My Suboxone practice is a fraction of my total practice, but is the most rewarding by far, as the people do well and are grateful;  they thought they were going to have no life at all, and the med gave them their lives back.  I have a stack of Christmas cards and e-mail messages from happy people, from that portion of my practice.

Some people accuse me or others of being 'greedy'-- in it for some pile of money, rather than for the real reason-- which is because it is something that saves lives and gives people their spouses, parents, and children back!  There is a shortage of psychiatrists and a shortage of Suboxone-certified docs, and new docs can have only 30 patients for the first year--  if I advertise, I will get that many calls from new patients in one or two days!  I am currently closed to new patients, and since I am a firm believer in long-term use of Suboxone, I don't need new patients.    Like most Suboxone docs, if I wanted to make a bunch of money, I would get people off Suboxone quickly so that I could do more 'inductions', which are generally the most expensive part of treatment.    

It is late at night for me, and I am therefore rambling a bit... but my point is that most doctors out there treat addicts like 'second class citizens', and when I talk to psychiatry residents (I teach in a residency program) there is little interest by most of them to work with addicts-- they tend not to like addicts, as addicts tend to lie, lose their tempers, and when they are actively using they do NOT pay their bills!  So I see the docs who are willing to work with addicts, to put up with 'addict garbage', to try to help addicts-- as generally nice, caring docs.  There are easier ways to make a buck in medicine, I promise you!  So I don't get the anger at Suboxone and at Suboxone-certified physicians.

That said...  you are doing what I suggested another addict was doing a couple posts ago-- engaging in 'fantasy thinking' that you can somehow become a person with no interest in pain pills, or at least the ability to stop taking them.  My period of active use was shorter than yours, and to my surprise, my brain has been changed in ways I never would have expected.  After 8 years of sobriety and aggressive treatment, the opiate cravings still came and went as often as they did right after treatment.  And 7 years after my first treatment, and after 5 years of a couple thousand AA and NA meetings-- I did what I never thought I would do when I relapsed.  

You will read posts like 'Suboxone should only be used short term'.  Those comments are NOT consistent with what we have learned about opiate dependence, and about treatment with or without buprenorphine.  Opiate dependence has NO cure.  Suboxone INDUCES REMISSION of active addiction by eliminating the obsession with opiates.  Stop the Suboxone, and the addiction is still there.

Does this mean that it is only 'covering something up'?  Not in my opinion-- not anymore than insulin is 'just covering up' diabetes, or inderal is 'just covering up' hypertension.  In medicine we generally manage illness-- cures are rare.  And addiction is no exception.  But look at bipolar, or schizophrenia, or depression, or OCD... or Parkinsons, Tourettes, epilepsy, HIV, coronary disease, high cholesterol, GE reflux, Crohns disease....  pick a chronic illness--  and for EVERY ONE, the person will be on medication for LIFE.  Why do people expect opiate addiction to be different from all of these other illnesses?

Many of my patients on Suboxone started out with a desire to be 'pill-free', but found that on Suboxone they had less mood variability, fewer cravings, etc... and so they decided to just stay on it.  I have had some people taper off, and come back at some point without relapse but asking to go back on, as they found that they were thinking about opiates all the time.  Again, addiction is not about how much drug you use; it is about how much you think about using the drug.  We know that people who use Suboxone for less than 6 months and then stop have a very high relapse rate-- unless they spend 3 months in residential treatment after stopping the Suboxone.

Another plug... read my blog for more info- SuboxoneTalkZone.com.  I talk quite a bit about the treatment options.  I went through the 'traditional' treatment, so I am not of the mind that 'everyone needs Suboxone'.  But the success rate with Suboxone, at least by my observations, is much higher than that of traditional treatment-- and I am talking about residential treatment of at least 3 months when I talk about 'traditional treatment'.

Finally, one reason for the horror stories from taper experiences is because the drug is quite unique-- it is a partial agonist, it is extremely potent, it has a long half-life, and it has a 'ceiling effect'.  There are some very unique things that must be done when tapering off Suboxone, or else you are smacked with a great deal of misery right at the end of the process.  Again, I go into this on my blog in an article entitled 'think micrograms'.  You can search for it on the site.

Opiate dependence recently killed another 15-y-o girl in Milwaukee;  I see obituaries of your people frequently in our state, and I know that many of the deaths were from opiates-- either overdoses or suicides.  I am grateful to have another tool in the fight against addiction.

Take care,
Jeff J
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