666151?1311114376
J T Junig, MD PhD  
Male, 60
Fond du Lac, WI

Specialties: Psychiatry, Anesthesiology, addictions

Interests: Psychodynamics, psychiatrist, wisconsin psychiatrist
Fond du Lac Psychiatry
920-923-9054
Fond du Lac, WI
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Suboxone's Complicated Relationship with Traditional Recovery

Jul 25, 2009 - 41 comments
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Suboxone

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Relationships

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relationship

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Recovery

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buprenorphine

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opiate dependence

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opioid dependence

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pain pill addiction



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.


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306867 tn?1299249709
by allaboutmary, Jul 26, 2009
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.

306455 tn?1288862071
by flmagi, Jul 26, 2009
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.

603463 tn?1220626855
by Elaine Brown, MDBlank, Jul 26, 2009
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

228936 tn?1249094248
by mr.lucky66, Jul 26, 2009
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

Avatar universal
by 122 Tactical Fighter Group, Jul 26, 2009
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.

Avatar universal
by muirdrive, Jul 26, 2009
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

807506 tn?1248649733
by sleepstate, Jul 26, 2009
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

Avatar universal
by J_R_Neuberger, Jul 27, 2009
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

179856 tn?1333547362
by nygirl7, Jul 27, 2009
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.

Avatar universal
by muirdrive, Jul 27, 2009
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.

Avatar universal
by muirdrive, Jul 27, 2009
and I feel exactly the same as nygirl7.

179856 tn?1333547362
by nygirl7, Jul 27, 2009
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.

388154 tn?1306361691
by comeagain, Jul 27, 2009
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



Avatar universal
by muirdrive, Jul 29, 2009
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

228936 tn?1249094248
by mr.lucky66, Jul 29, 2009
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.

388154 tn?1306361691
by comeagain, Jul 29, 2009
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.

Avatar universal
by centerice00, Aug 02, 2009
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?  

Avatar universal
by MsLizzyB, Aug 06, 2009
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.

Avatar universal
by gopher22, Aug 18, 2009
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>>>>>>>>.........

Avatar universal
by slippedup, Aug 19, 2009
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

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by Prospero73, Aug 28, 2009
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.



Avatar universal
by tim2tone, Aug 28, 2009
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

Avatar universal
by kat522, Aug 30, 2009
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

Avatar universal
by hot_momma520, Sep 09, 2009
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!





Avatar universal
by betterintime, Sep 17, 2009
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.

Avatar universal
by rickymudd, Apr 21, 2010
I am glad that you view addiction as a medical not legal issue, as I believe more people will come forward for help. I have been on Suboxone for over a year and after twenty years of opiate addiction and all its complications, view this treatment as I do insulin for diabetics. Necessary. Once the neural processes in the brain have been “switched on” they are always there and the desire for opiates will be present forever. I have tried every other treatment available, apart from legalized heroin, and Suboxone is the cleanest and most side effect free pharmocotherepy I have ever used. If, as you say the pharmaceutical companies will now come up with even more treatments for opiate addiction that would be great, but in the meantime why can’t we have the “Norspan Patch” and dispense with daily dosage? As they have already developed a buprenorphine patch of 10mg, 20mg couldn’t they do the same with Suboxone? Thank you for all that you are doing to educate and inform both addicts and non addicts.


Suboxone Treatment Centers Directory

Avatar universal
by HollaBackGurl, Jun 05, 2010
Hi Doc Junig,

Nueberger just whipped your ***! LOL! Why don't you take the challenge to your "observations" and respond
to contest the validity of his thesis? Silence is complicit acknowledgement.

I ain't no Holla Back Girl!

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by ebeth222, Aug 05, 2010
I have been an addict for over 8 years. My drug of choice was Hydro 10/650 and if I ran out of those, it was anything I could get my hands on. I recently got married and promised myself and husband that after the wedding and honeymoon, I would get off the pills.
I had no clue where to start because I knew what "come downs" felt like and didn't want to go that route. I went online and found out about Suboxone. I called them and had to join the HERE TO HELP PRORAM, which consists of 12 phone calls with a care coach and an informational package. I then made an appoionment at the doctor's office on July 12, 2010.
He put me on Sub with a combination of other drugs that deal with cravings, anxiety, and muscle pain. At first, it felt it wasn't working and my next appt wasn't for another 2 weeks bc he is so busy (the Doctor). I called the nurses and told them that I was still having major craving and just didn't feel right.  They called me right back and told me to up my Sub to 3 a day. I did that and things started feeling much better.
I then had my second appt with my doctor and he had also increased some of the other meds I was on because of the anxiety. I am also receiving shots in my lower back, hips, thigh, spine, neck, you name it, but these shots are helping me with my pain.
I have osteo-arthritis, fibromyalgia, scolosis and terrible cervical migraines. I have been in 3 major car accidents that has left me with a pinched siatic nerve and back and neck problems. The shots seem to help although I have only had 2 rounds of them. I get them every Monday and see my Doctor every Monday unless he is booked that week then I have to wait 2 weeks.
But not to get off subject, I have found that Sub has worked for me. I know I haven't been on it long, but I have been sober since July 12 and am proud of myself!
After reading some of these articles everyone has wrote in, my next step is to ask my Doc my plan with Sub. How long will I be on it? How will he taper me off? All of those types of questions.
And earlier I read from BETTERINTIME who wrote in about Sub and if they do drug testing,etc.   YES, they do. I have to do a drug test for them and also meet with a drug counselor. My Doc did a complete physical on me and he is the only Doc that can adjust my meds and prescribe my Sub. and other meds. I have to fill out a complete questionaire before each visit before seeing my Doc. And personally...I like the personalization of this way of getting sober and the privacy of it in a Doctor's Office. And I must complete my 12 phone calls with my care coach, who is absolutely wonderful and very informative. She even has given me a list of therapist in my area that I may want to go to. She is very helpful during our phone calls and it is all confidential.
I thought I would just share my story to those out there who are addicts because there is help out there. If anything go to HERE TO HELP online and it will point and direct you in the right direction like it did me. I am in the right direction now in my life and am living it to the fullest and making the best out of it....sober!
SERENITY: Lord, grant me the strength to accept the things I cannot change.... The courage to change the things I can.... And the wisdom to know the difference.
E-Beth

Avatar universal
by blondie2010, Aug 21, 2010
This is a wonderful site, and I'd like to chime in.  
I've been on subs for over a year with much success, after many years on escalating doses of many different opiates for pain management from major car accident and migraines.
What a blessed relief suboxone has made in my life.  No more cravings, no more pain, no more obsessive thoughts or drug seeking behavior.
My dr. did advise not using subs without supportive programs.  Its true that alcohol and drugs were but a symptom.  I very willingly go to 12 step mtgs, have a sponsor, work the steps, pray, meditate, journal, and anything else to support my sobriety.
I must admit that my use of subs is not known to everyone--it is private, as many people do not understand it's use.
It works for me, and thats all that matters.
I have a new freedom in life, am able to work on my spirituality, service to others, and those pesky "character defects" , which led me to use in the first place.  Some may argue that point, but I know that my terrible low self esteem and unworthyness, led me to addiction as a way to hide out.  It was just so damn comfy and cozy to numb-out on life during the norco/codeine/tramadol/xanex/soma/ years.  I never worked on anything except how to score.  My life was in neutral for years.
Now, thru diligent daily work  I am understanding humility, selflessness, responsibility, honesty, and my higher power.
All these came from attending meetings, where I listen to people who share their story, which is my story as well.
I truly thought I would die in my sleep from too many opiates, and now I find there may be many many more years to live !!!!
Out of isolation and in to fellowship.  Namaste ~~~~Blondie

Avatar universal
by annerriffic, Dec 06, 2010
Just wanted to chime in here... I was doing a google search about suboxone, as I may be forced to switch from methadone to suboxone soon and I came up with this blog. I was hoping that a brain like yours could help me here. A little about me:
I have been on methadone for ten years, and I have had tremendous success. While I dislike having to take it, I am on a low dose (35mg) and have come to accept that like many people with a chronic illness, I will need this medication for the rest of my life. I am okay with that, however it is VERY frustrating to me that I have to go to a methadone clinic once a month, twelve times a year, for the rest of my life, as there does not seem to be any other option for people like me.
When I was recovering suboxone was not yet an option (or if it was I was not aware of it), and methadone was the standard opiate replacement drug. If I had the choice now between going to a private doctor to get suboxone or going to a methadone clinic I would not even consider the latter, but after ten years of taking methadone and becoming a high functioning member of society with a wonderful life, I would be stupid to gamble my stability for convenience.
On the other hand, I have a family and a reputation now (the good kind)... I also have an amazing job. I fear every time I step into the clinic I am at risk of being 'exposed', as I do not want my coworkers and neighboors knowing my history by deduction. Everyone has a past, and everyone has a right to privacy.
I do want to somehow educate people that methadone is not synonymous with low life addict, and many high functioning people are on methadone but are treated like untrustworthy children by the system that warrants they are tied to a clinic for eternity in order to get the medication. The only way I can get a Rx from a doctor is if I lie and say I have 'chronic pain'. I have based the last ten years of my life on honesty, and I intend to keep things that way.
Therefore, if at all possible, I would like to figure out how to lobby to change the current law to allow doctors to prescribe patients methadone for maintenance (so that I do not have to spend my senior years still frequenting a methadone clinic once a month).  I am in my early 30’s, and hope that someday soon this may be a reality. I have worked so hard to be where I am, and feel so blessed in so many ways. This is a constant struggle for me. I feel the laws are unfair and outdated! Any ideas on how to do this?  –sick of the scarlet letter


Avatar universal
by herbgal, Mar 21, 2011
I find it better on methadone because I find that if the individual hasn't got a choice on if to use or not ion that day it will make them want to use more and then they could use on top and end up killing themselves from taking too much from trying to get a feeling from it. Obviously that being the worse case scenario my point is you can't feel opiates on suboxone. Also I have been on 95 mls now of methadone for the last 2 yrs and have been opiate dependent since I was 19 I' am now 23 so that is 4yrs and have come dow 10mls over the last month my highest dose was 140mls of methadone my longest cold turkey was three and a half months with nothing but a few pain killers and Ibs tablets this is supposed to help with tremors muscles spasms as Ibs tablets are anti-spasmodics lol didn't know tat b4 as ibs tablets work from the gut and gut spasms it's works on the other spasms too as it's use is to work on spasms lolyh . I' am starting to feel it so am starting to feel a bit urrrggg ya know I mean. Can anyonew give me any suggestions I do not want to go back up as I want off this dreaded script. I have gotta go to a methadone detox center to be gradually decreased quickly off of the methadone they give you support doing this so I may go bnut that's when I hit the 40mls zone. Can anyone help??? I know there is bo quick or easy awnser and no easy or qiuick way out thanks :P

Avatar universal
by herbgal, Mar 21, 2011
Okay don't want to make it sound like I' am not ready but I know from experience as im sure the rest of you do sometimes back in the past people haven't always known or been sure when they have been ready to come off I' am finally at that point and have been clean fr nearly 2yrs now. Have had relapses in the past but not over the last yr and half. So all I' am saying is if you are not ready then suboxone is not for you unfortunately because I wasn't ready I ended up back on methaadone and will say suboxne didn't work well for me anyways so  am better off I find but in others ways not as it's harder to get off ain' it and am stuck on methadone now so could someone please give me some advice please :)

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by hthrfthr, Jul 03, 2011
I have 123 days clean from heroin and opiates today. I chose not to stay on methadone or suboxone but that's just my choice. I know myself way too well. If I had suboxone it would be like a security blanket for me to use and not be dope sick. I attend NA and have started the first heroin anonymous group in the state of massachusetts. I know many people that methadone and suboxone has worked for. And not everyone in twelve step programs shuns those on these types of drugs. I guess that's why I started the HA group. I wanted those on methadone and suboxone to have a meeting to go to where they could feel welcome and where they could speak without the dirty looks and bad attitudes. I had four years before my recent relapse I just came back from and I know how hard it is. Herbgal, when you are ready to you will come off the methadone. Two of the people in the HA group I started are coming off their methadone since the group started three short months ago and one other girl is coming off her subs after being on them for two years. I don't know what your drug of choice was if it was heroin check out a heroin anonymous meeting. The program is awesome. I never felt like I fit in anywhere and I finally feel like I found my home in this group. Coming off methadone was hard for me but with support I think it would have been a lot smoother. Best of luck and ur in my thoughts. U can do this. I'm not trying to sound cheesy. But seriously it makes a difference when you feel welcome somewhere.

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by hthrfthr, Jul 03, 2011
Sorry herbgal I'm confused u may be on subs now I read ur other post. Anyways either way u can do it! Do u really want to go inpatient to detox?

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by J T Junig, MD PhDBlank, Jul 17, 2011
I haven't been to this thread for a long time, and so I have not responded to the comments  As for the comments about whether sobriety on bupenorphine is 'authentic', I encourage people to see addiction as the medical disease that it is. Do we question the authenticity of the health of a diabetic on insulin,or of a person on high blood pressure meds?  'Authenticity' is just a word.  Addicts deserve freedom freedom from the misery of addiction without worrying about how authentic they are.  In my opinion, a person is every bit as 'valid' when they are taking a medication to treat addiction as they are without it.  Who is keeping score on 'authenticity', anyway?

As for cost concern, Suboxone is always covered by insurers in my part of the world, and it is also covered by Medicaid.  Generic buprenorphine has gotten cheaper as well.   A dose of one 8 mg tab per day is sufficient for most people, and the generic costs $3 per tablet.  That's cheaper than any habit- but a comparison is silly, as buprenorphine is much more than a 'replacement'.  The medication actually eliminates the obsession to use-- an amazing remission effect for people caught in the misery of using.

Thanks, all, for the comments.  Please stop by my forum, SuboxForum.com , and read more.

Avatar universal
by feduponopiates, Oct 15, 2011
in July ,2011, I was admitted to the hospital for chest pain.  I had open heart surgery in Feb.  I admitted to the ER doctor that I was also having withdrawals from heroin addiction.  This was my first experience with buprenophine.  He said " honey, in just a minute, you will feel like a whole new person.  Sure enough, I couldn't believe that every symptom had just vanished!   My problem is that I have no health insurance, and there are no suboxone clinics around here who will accept me as a patient because of this.  I will say that I had a friend, who had extra suboxone, and while taking this, I not only had elimated all withdrawal symptoms, but I felt happy, and an overall better quality of life.

Avatar universal
by HalfLifer, Jul 21, 2012
Im kicking 8 years of Suboxone maintenence...Circumstances dictated that I jump off from 16 mg. a day. I am currently over 40 days since my last dose and am still experiencing withdrawal...not PAWS yet, but the sickness. I am absolutly terrified that this will not subside and that I have permanetly altered my brain chemistry. I went into rehab for a differentbdrug and was forced off the Sub at the same time. If symptoms do not subside within another month, (or longer if I can last) I might go crawling back to my doctor to resume what I can only now assume to be a lifelong requirement.

Scared Half-Lifer

Avatar universal
by justafriend185, Aug 28, 2012
I am currently trying to kick a 32mg a day habit. I recently found out that I am pregnant with my second child and I am slowly weining myself down. I am currently on 4mg a day. A quarter in the morning and a quarter in the afternoon. It is extremely hard but I am careful to not come down too quickly for risk of a miscarriage. I am already a high risk pregnancy and am more now than ever scared that I am making the wrong decision. Above all, I know that I do not want my child to be born with anything unnatural in their system. Thank you for your post Dr. Any and all advice would be needed and appreciated.


Avatar universal
by yzhealth, Jan 13, 2013
I am kicking sub right now I have been on for over 6 years it ***** ive tried to kick b4 no luck I have chronic pain carpel tunnel thorasic outlet fibromyalgia h eadaces I suck .I was on norcos for about 3 year kicked got put on sub ...I hate it. never seem to get off .right now im on1/6 of 8 mg tab.I ache I am sick I hurt I want to die but God has reason for me to live ....what the hell it is I dont know but I will stay for the end of the movie anyway I tried to end it many times .please  g
GOD GIVE ME STRENGTH! I Nver felt right normal any where AA NA was the worst .I tried many times.I either got better conections or ended up being the therPist or snubed ....how many people do you have to ask to get a sponsor anyway....lol
I do celbrate recovery ...it christ and Bible centered.
But i want to get off for my health and I feel enslaved by a pharmacutical company.....







Avatar universal
by cb17275, Apr 30, 2013
   While I agree and disagree with the various thoughts and opinions of other posters here, this is some good reading. There are a lot of different perspectives, though it does seem the OP sorta started this as an advertisement that is no doubt beneficial to his own practice. As long as readers realize that while they are reading and even making decisions about their own treatment paths its alright.
   I have been an opiate user around 7 years. I had taken opiates prior to that, but just a script of 15-20 Norcos or Percs here and there after various injuries and surgeries. I have used suboxone many times, under the care of a suboxone doctor and under my own care. And yes I believe it is a good drug and EXTREMELY effective tool for those physically dependent upon opiates.
  What the doc fails to mention, and I'm not quite sure anyone else did either? The PAWS that come with daily use of suboxone. During the 7 years twice I quit by tapering from full agonists. Once 6 months and once over a year. Both times after heavy use of Norcos/Percs, Dilaudid, Morphine, Heroin etc. After 3-4 weeks I was mostly normal, besides a lilttle depression and insomnia both times. Had it not been for injuries and one surgery, I might not have ever touched an opiate again. And I really felt like and even  KNEW THAT I COULD accomplish that.
  Flash forward 3 years and after 18months of hardcore daily opiate use. Dilaudids, Morphine, Heroin and anything else within reach... Came 6 or so months of daily Suboxone. Starting at 8mg daily, even though my doctor wanted me and prescribed me 16mg daily. I eventually tapered way down. And finally after .5mg every other day for a week, I stepped off completely. Physical WDs werent too tough. Even the increased pain levels I usually experienced during physical WDs wasn't unbearable.
  But what I soon experienced was PAWS. Post Acute Withdrawal Syndrome or Symptoms? Yea I had experienced it before. For me physical WDs from full agonists never had lasted more than a week. And yes for 2 to even 4 weeks after that I had the sleeplessness, depression, lethargy and moping around in general (PAWS). But it definitely faded after that and I was completely normal, my old self even. But after my 6 months on Suboxone even after 75 days I was still rarely sleeping, lethargic, more depressed than ever, anxious, cranky, stupid. And I was waiting, fighting so hard, thinking tomorrow morning I will get outta bed and have that clarity again. That normalcy. (Any hardcore users who have quit for long periods know what I'm speaking of) That day when you finally realize you're back to your old self. Or even that night when you look back on your day and are realize that not once did you want opiates, not once did you feel that emptyness, or even think about your recovery that had occupied your mind everyday for so long.
  Soon that 75 days turned into 150.  I tried everything short of other Narcotic drugs to combat the PAWS. Exercise, Mediation, Diet, Counciling, Team sports, a new job, supplements even Valerian root and Neurosleep, which can be pushing it for an addict. After 8 months still I wasn't getting better. For the next 3 months I was under the care of a Psychiatrist, tried 1 month cycles of different SSRI/SNRI antidepressants. Nothing. I wasn't functioning whatsoever, had serious life consequences. Employment wise, Friendship/Relationship wise, Family wise etc. Finally my shrink and I decided narcotic sleep meds was worth a try. Didnt agree with ambien. But benzos worked well and finally I was sleeping on consecutive nights for the first time in a year. And some of the lethargy symptoms got partially better. But that was it. And we're talking 18months off Suboxone. Couldn't think clearly, got agitated incredibly easy, couldn't hold down a job or any other regular daily life activities. I was still experiencing PAWS in the worst way. And I began to think and even realize that my brain chemistry had changed for life. I was completely hopeless and after suffering for so long completely destroying my life, I knew I could never get back to normal. I could NEVER quit.
  I still abstained from opiates for awhile. Went to extreme lengths to combat the PAWS. Narcotic drugs. On bad days Strong stimulants, Strong sleeping pills. I eventually realized it wasn't worth it. I was doing drugs that could and did negatively affect me just as much as opiates, but was still miserable. So I went back to opiates. And daily use. Things like my employment and finances stabilized. I made friends. Some who used, some who didn't. I stepped off a couple times. Once for 4 months, and after 120 days of misery, rolling to work late 3 times a week, walking around like a zombie etc. It just wasn't worth it for me.
  My drawn out point. Before Suboxone I knew in my heart I didn't need opiates to live. After it, I've tried and contemplated everything. And I don't believe I can ever be normal again without opiates. I use suboxone still occasionally to kill WDs. I now realized I was started on way too high a dose, as well as many others are. Even for me, after the hardest core of Heroin, Oxymorphone, Hydromorphone and Fentanyl binges.... 2mg daily is sufficient to kill all my physical WDs and most of my cravings. I know its straight up addict behavior #1 to blame everyone, everything but yourself for your drug use/addiction.But I really believe it was Suboxone that ultimately led me or even condemned me too a life where I will use opiates for the long run. I wish so much that I had started on 2mg a day, and tapered rapidly. Or that option was even presented to me. For some and even me sometimes Subs can be beneficial. But anyone thinking of heading that direction. Please realize that 8mg+ daily is NOT WORTH IT in the long run and NOT NECESSARY IMO. And if anyone reads this and takes it too heart, thats nice. If you read it and think I'm a ranting typical addict that's fine too. But if someone reads this and starts Suboxone on 2mg daily instead of a ludicrous 16mg+, it was worth it typing on the laptop for the last 40minutes.

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by achrisjaquino, Dec 15, 2014
thank you and great post everyone i have a little different what about the legitimate pain sufferer i mean do i have a low tolerance to pain please read on any please i am open to suggestions.my issue about 2 months ago i decided to quit the 200mg of morphine sulfate er i was taking 6 times a day along with 5 mg of methadone as needed for breakthrough pain. i chose a psychiatrist to help me i have inoperable spinal stenosis and bone on bone in both knees well my Dr. put me on 8 mgs. of suboxone 2mg naxolone twice a day and on some days its enough but i did not go through the hell of withdrawals to be in this kind of pain can anyone suggest a medication i can ask my dr for i cant take any nsaids due to gastric bypass surgery is a low dose of subutex a possibility or lyrica i dont think he will increase my suboxone as he reminds me all the time the goal is to get me off everything i like him but isnt part of the Hippocratic oath to first due no harm.  

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