I received a nice message today in a comment section; I am posting the message and the thoughts that it generated. The primary topic of this post is the anger that is often directed toward the use of Suboxone.
The nice comment:
Hi Dr. Junig, my name is Jane XXXXXX. I have been reading this blog for a couple hours now, and have been searching the whole site trying to figure out how to email you. So far no such luck, and I hope you don’t mind me writing this to you in the form of a comment on a completely unrelated subject. Anyway, I wanted to thank you, sincerely, for the understanding and insight you’ve provided to so many people, myself included. I’m 19 years old and have been struggling to keep myself clean for the past several months. I’ve battled a heroin addiction since the age of 17, and in a way I feel that it’s grown into my identity as I’ve become an adult. That’s not something very many people can wrap their minds around, which seems to make a lot of the hard work that’s put into staying off of drugs go unnoticed, and unappreciated. I realize that the road to recovery is long, and one that you tread upon from the inside of yourself, not based on the recognition from others. However, I do believe that it helps a great deal to have someone in your corner. Thank you for all your help and for seeing that we aren’t just “addicts”, but people who have lost their way somewhere along the line, and for genuinely caring that we are now on the path to a better life. Please don’t stop helping, you’re doing a wonderful job!
My very long-winded answer:
Thank you very much for your nice comments! When a person makes comments, I receive an e-mail with the person’s comment and e-mail address—I always cringe a bit before I open the message, because usually it is usually negative and often nasty and insulting. That makes a note like yours even nicer to read!
I don’t know what fuels the anger of those who write mean things. I suppose some of it comes from the anger that some people have toward anyone who is a self-professed expert on the internet. But the anger toward Suboxone… I remember how horrible I felt during my actively-using days; I think of the friends I had from treatment who have since died from their addiction to opiates, knowing that Suboxone would have kept them alive; I see people in my practice who come in completely broken, and in as short a period as a month are human beings again… I would think that all addicts would be thrilled to finally have the pharmaceutical companies interest, whether or not they themselves used Suboxone! But instead, the addicts who are sober through 12-step programs accuse people on Suboxone of being in ‘lesser recovery’.
I try to let go of resentments, as I myself am a ’12-stepper’ and I know that resentments are a pathway to using… but you probably read my negative remarks about a couple other web sites. There is an ‘institutional’ drive against Suboxone at the two sites I mentioned in my posts; through my alerts from Google I see daily posts from new visitors to those sites, asking about Suboxone; they receive a chorus of replies that are negative and inaccurate. They list side effects that I have never seen in my large practice, and that are often inconsistent with the known actions of buprenorphine (many people don’t realize that buprenorphine has been around for 30 years, and so it isn’t hard to recognize the posts that are simply making things up!). I don’t know what motivates the people there, but they have made it impossible to post accurate information about buprenorphine and Suboxone; they will simply delete posts they don’t like. I received an e-mail from someone at drugs.com that would be funny if not for the misery that results from the practices there—the note started with angry expletives, and finished in a way that might be telling:
I’ve been clean and working with recovering addicts in my ministry for a long time. God is pleased with me. I do what I do for His approval not yours. If you don’t like me I can’t help that. God bless. And don’t you dare post my email address or we will have legal issues I assure you. I will turn you over to authorities if you post my email address online. That is a promise.
Authorities? WHAT authorities? Anyway, you can see why it is so nice to get your kind message!
I suppose I should be at a meeting right now instead of getting worked up again… but I think instead I will make this a post that addresses the issue of anger at Suboxone (note—this is a classic example of addictive behavior— recognizing what one ‘should’ do but instead doing what one ‘wants’ to do. I am an addict, after all. One goal in recovery is to recognize one’s own addictive behavior and correct it) (note to the note: You just read a second example of addictive behavior—intellectualizing the problem as an excuse to avoid the correct behavior! See? Recovery CAN be fun!). The God note above seems to come from a self-righteous person who sees only one way to become clean and sober. I receive many similar letters, but my point with this one is that the person writing it has the power to screen posts at drugs.com— which is why I see that site as potentially dangerous to an addict who is stumbling around looking for help, who may just stop taking his/her Suboxone in response to advice from some nut.
Most of the angry letters come from people who think addicts are weak or lack ‘will power’—who think that ‘addict as a disease’ is still a ‘concept’. Here is one of those messages.. I will leave the misspellings in it so that you get the full sense of the writer’s intelligence!:
I know a lot more about addictions then you think, I was or I should say I am an addict, once an addict always an addict the only difference is if you use or not. I choose not too. Your making excuses, and you get as defensive as the addicts I know there is no magic pill that will cure a drug addict,and if you have people using sub. instead of oxy what is the difference??? Nothing, except an addict can get suboxone from a doctor who thinks he is helping these people who will lie,steal and take down anyone and everyone in their lives to stop the withdrawals and get something wether it be suboxone or what ever is going around their area. No you don’t stop using insulin, but a diabetic has no choice they are diabetics no one offered them the option of would you like to have diabetics or not. Addicts have a choice and they choose to use. There was something troubling them in the first place or they wouldn’t have started using drugs period. Happy well adjusted people don’t use to the point of self destruction. Sure I would love to get a bottle of oxy’s when I am having bad times because they take all the pain away mentally and physically. No problems, just peace. Maybe I’m different then most but when I was taking oxy’s and I noticed I was having withdrawals I threw the rest of my pills away and haven’t touched one in years. So what you are saying is that even after the psychical withdrawals of pain killers the psychological addiction will be with you for ever?? Hmmmmm… That’s where therapy comes into play but then again I don’t know because I haven’t had any problems with drugs. I guess crack addicts should just get diagnosed with a.d.d so they can be a life long member of the addarall club. I know that’s different crack addicts are low lives and they are not the same type of people who use pain killers heard it all before. The truth is the truth if someone is using one drug to stay off another and the drug is an opiate or opiate substitute they are still using. Until a person can stand alone without any drug or substitute and until they can learn to handle life and all the ups and downs straight they will always be at great risk of falling back into their old habits. I have seen it time and time again and I ask why if the withdrawals are so painful do so many people take suboxone for a few months and switch back and forth from sub’s to oxy’s? The pain can’t be as bad as they claim or they wouldn’t go back and forth. That is just stupid and selfish. So anyway I guess I don’t have a clue so good luck to you and your practice.
Do you think he really meant that last part about ‘good luck to my practice’?
I also receive angry letters from people who see Suboxone as a threat to methadone. I try to remain neutral toward methadone; it wouldn’t be my first choice, but if it saves someone’s life, who am I to judge? I DO take issue with comparing buprenorphine and methadone as ‘one and the same’; partial agonists are not the same as agonists. When I hear the comparison, I make the point that if anything, buprenorphine is similar to an antagonist—like Naltrexone. When people leave traditional, step-based treatment programs they are sometimes put on Naltrexone as a ‘safety measure’ so that they know that even if they used, they wouldn’t get ‘high’. I have never heard objection to the use of Naltrexone, even from the most die-hard advocates of ‘total sobriety’. There are a couple problems with Naltrexone; one problem is that the person taking it has cravings for opiates. What if we took Naltrexone and added a small amount of opiate activity—not enough to get ‘high’, but just enough to prevent cravings? Another problem with Naltrexone is that it doesn’t last very long in the body—a person can skip a dose and then use the same day. What if we made Naltrexone longer-acting, so that it stuck around for three days? And what if we made it have a small amount of withdrawal, to make it less likely that the addict would stop taking it? If we did all of these things to Naltrexone—made it treat cravings, made it longer-acting, and made it create withdrawal when discontinued—we would have… Suboxone!
I receive letters from non-addicts; some are genuinely dumbfounded over a person not being able to stop something that is so obviously self-destructive. Many of the non-addicts who write clearly have anger left over from dealing with an addicted family member; if some of those writers had their way, anyone who meets criteria for ‘addiction’ would be put to death, or at least banished to some miserable place to live with all the other losers of the world. I receive letters from health professionals in the mental health field who see Suboxone as only a band-aid over a neglected wound; to those folks I say that Suboxone is always only part of the answer. But I also point out that while I am a big fan of self-insight, ‘counseling’ has a poor record when it comes to treating addiction. One-on-one counseling is often used by addicts to self-justify addictive behavior like I mentioned earlier– ‘yes, this is bad, but since I understand myself it will be OK’. The best counseling or therapy for addicts is group therapy, so that addicts can call each other on their sh#@.
The remaining letters are mostly from addicts who are still in the learning process, ‘collecting research’ as we say at meetings. I see these people in my practice and struggle to help them, which is essentially the work of treating addiction. They still think that once they get past the physical withdrawal, everything will be OK. They want to take Suboxone just for a few weeks as a bridge to sobriety, but they don’t see any need for meetings or other treatment. When I tell them that the physical withdrawal is the EASY part, and that they will almost certainly return to using, they either become angry or tell me that they are ‘different from those people’—that unlike ADDICTS, they used only because of (insert pain, anxiety, depression, loneliness, unemployment, bad spouse, bad boss, bad weather, wrong season, bad parents, or bad children). They tell me that they have ‘fixed’ the problem, so everything will be fine. They don’t yet understand that the addiction is both ‘chicken’ and ‘egg’—that they use because of their problems, but more importantly they have problems because they use! I tell them what happens in ‘late-stage addiction’: the addict hates using so much that he/she will be able to get through withdrawal; while sick, the addict will remember that hatred of using and use the hatred to stay clean… but as soon as the sun comes out and the withdrawal passes, the addict returns in full force and uses again. This stage of addiction is particularly demoralizing (been there, done that) because the addict is almost always sick; it is also a time of intense emotional ups and downs, big hopes and promises to self and others, periods of relief… and then regret, secrecy, broken promises, anger, shame, and disgust. Spouses say “how COULD you?” Addicts feel like they are going crazy. Enter loneliness, self-disgust, despair… no wonder suicide is so common in late-stage addiction.
Before Suboxone, a few of the people who reached the point of despair would find Recovery through treatment and/or the steps. Now, with Suboxone, we can save many, many more addicts, often long before they reach such misery. Is Suboxone perfect? Of course not! What medication is perfect? It did not come with a ‘cure’ attached. Too bad, so sad. But what a huge step forward it represents! And I am thrilled that Suboxone has caught the attention of capitalism, because suddenly the bright minds in Pharma see that there is MONEY to be made treating addiction. Build a better mousetrap—invent BETTER medications! And the company that finds a treatment that gets to the core of addiction will deserve the huge profits that will come their way.
I had better stop and get back to my ‘real’ job! But thank you, Jane, for your nice comments, and for sparking this morning’s post. I wish you all the best in your own recovery.