A couple people have written to me saying that while I sound a bit ‘defensive’ and as if I am taking things personal, they like it when I let my true feelings out– including my anger.   If you are one of those people…. read on.  I will say, though, that I realize that there are times to maintain one’s composure.  I’m not the type of person who will excel in that environment.  When I worked in the prisons there were the inmates– people who had great difficulty holding back their anger– and the administrators– the shy, quiet people who would smile and shake your hand and then write you up for acting too ‘aggressively’ and hurting their feelings… or, if they read the manual would say that the work environment was ‘hostile’.   Funny–  I always felt safer around the inmates than around the administrators!
But that has nothing to do with anything…. accept maybe making a preemptive excuse for my behavior with the following posts.  The first post is from a reader/writer who defends the object of my last post.  I took his post and moved it from the comments to up here.
The comment: “I have put offers out on some of the Subox-hater sites asking for someone with 5 years clean to talk to me– and so far, I haven’t found a soul.”
Now doc that’s not quite true. Lots of people are clean and sober without your magic pills.
Your arrogance never fails to make me cringe.
“What makes 7 years think that all the withdrawal is just Suboxone’s fault?”
Ummm because it is Suboxone’s fault…clearly. The guy wasn’t withdrawing from narcotics of 7 years ago. Surely you learned that in your PhD training.
I still don’t understand why you think meetings are such a bad thing…as if they were a prison sentence. I happen to enjoy them- Being clean and sober is so much more than just avoiding cravings by popping a couple sublingual pills everyday. It’s just not that simple folks.
Eight years clean and sober…Sub-free.

My response:
Please don’t put words in my mouth.  There is nothing ‘magical’ about buprenorphine.  I do not call them magical, and I don’t call them a ‘miracle’.  I often point out that they do NOT CURE ADDICTION;  they induce REMISSION as long as they are taken, if used correctly.
As for your boastful claim, that’s great for you– the 8 years part.  It is no guarantee that you will make ten– I felt pretty sure of myself at 7 years, and realized later that even someone as ‘arrogant’ as myself can lose my way.  But even if you do remain sober the rest of your life, that puts you solidly in rare company.  I am med director of a 50-bed residential center that HATES Suboxone, and never uses it– not even for detox.  Suboxone gets in the way there– people think that they will be done with their withdrawal in a few days, and they aren’t.  We added two weeks on just for people coming off opiates, including Suboxone.  My beef is with those who place blame on Suboxone when they should be taking responsibility for their own addiction.  To be frank, if you could read what I write without looking for a reason to disagree with me you would see that everything that I say is geared toward sober recovery.  The person who blames 7 years of Suboxone for her misery, while acting like her 10 years of addiction were meaningless, is trying to completely pass the buck.  SHE (not he) is an opiate addict;  that is the cause of her misery.  She wants her misery to be due to Suboxone.  All Suboxone did was give her 7 years to avoid the inevitable.  For some people, that is a great thing;  it can allow the person to save money for definitive treatment, it can allow people to make amends to others and recover marriages.  There is nothing lost from taking Suboxone– she was faced with a choice– sober recovery or Suboxone’s easy way out.  Like most addicts, she chose the easier, softer way.  But it is disingenuous for her to now complain about the choice that SHE made.  It is so much easier to blame her past doctor, or Suboxone.  She continues to change usernames every day and post the same garbage, and not ONCE has she taken responsibility for her own behavior.  Just a question for you:  we have on the forum the rules posted that say ‘this is NOT the place to debate the pros and cons of Suboxone.  This is a place for people who have made that choice, or a different choice, to discuss Suboxone, methadone, or sober recovery WITHOUT being criticized for their choice.’  She ignores that rule, and interrupts discussions with her vitriol and bile.  Is that how you learned ‘good recovery’ works in NA?
I went to, I don’t know– a bunch of meetings during a five, and then another 5 year period.  One or two per week– sometimes more.  I quote the twelve and twelve all the time.  And from a step based recovery perspective, our ‘7 years’ friend is an embarrassment.  If you don’t agree with that, then I don’t know what meetings you are going to and enjoying.  The idea is to be an example.  What is she being an example of, exactly?
I don’t understand a couple of your comments;  you said about her withdrawal that  ‘it is Suboxone’s fault, clearly’… followed by some sarcastic comment about my PhD in neurochemistry.  I stand by my point. She is NOT just coming off Suboxone!  Yes, the last 7 years were buprenorphine (as I wrote, 7 is not possible–  I sent her a copy of the Federal Register dated May 22, 2003, announcing that Suboxone would soon be available in the US– so whatever you want to think of her, she is exaggerating by at least a year).  But she was on 10 years of other opiate agonists before the  (4-6) years of buprenorphine.  There IS a connection between the length of time on an opiate and the severity of withdrawal, and my point is that all things being equal, coming off ONLY 7 years of Suboxone is less miserable than coming off 10 years of agonists FOLLOWED BY 7 years of Suboxone.  The frontal lobes show decreased glucose metabolism during PAWS, which is probably related to the reduced insight and impulsivity that make early sobriety such a dangerous time for relapse.  This brain hypofunction is worse after longer opiate use than after shorter use.  The dysfunction is not from cell death, but probably from longstanding changes in firing patterns of neurons that become more and more entrained, the longer the aberrant signals are maintained.    So as I wrote initially, she is NOT just coming off the buprenorphine;  she is coming off the additive effects from 16 plus years of opiate use– the majority of the time using agonists.  No PhD needed to understand that–  simple addition is all you need to figure it out!
I do not say bad things about meetings.  If you read my blog much, you will come across the comment often that AA saved my life– twice.  I also have written in many columns that AA is great for those who want to go to meetings.  I disagree with forced attendance because in my opinion, AA can be taken two ways;  it can be taken in by the casual observer, and maybe some points will be taken in about how addiction progresses and how difficult sobriety can be.  But the other way it can be taken in is the ‘life saving way’– the way I took it in the first time quickly, and the way I took it in 7 years later after a great deal of very hard work.  To take it in the second way a person has to change his or her personality– and to do that, he must ‘cling to AA the way a drowning man clings to a life preserver’– to paraphrase AA.  That second type of experience, in my opinion, does not happen with people on Suboxone.  It requires the open mind that comes from DESPERATION– and people on Suboxone are not desperate!
If you read much of what I write, you would know all of this.  Like most of the flamers, you pick and choose certain posts or sentences and come to conclusions that completely miss the point of why I write, and what I write about.  What I find interesting is the role of ‘insight’;  it is impossible for a person on Suboxone to go to AA and have the same ‘insight’ that a person who is sick, in withdrawal, and desperate will have when reading the steps.  Similarly, it is impossible for someone like you, proud as a peacock over your sobriety without Suboxone, to have insight into the experience of those who choose medicated recovery.  You, and the others who write the same things that you just wrote, have your own blinders on–  they just point in a different direction.
I suppose I should point out that you made a comment about MY arrogance, and you close your note with a boast of ‘eight years clean and sober– sub free’.  Who is being arrogant?!
Everything that I do– putting up with people like you who call me ‘arrogant’, all while boasting about your OWN superior brand of recovery– is, believe it or not, because I have seen the people harmed by people like you.  I have talked to people who went to NA and got badgered off Suboxone– many people are ashamed and very suggestible early on in treatment, so it is easy to lead them astray.  That is one reason why twelve step programs caution against taking another’s inventory.  And yet, here you are, boasting about how YOU did it.  Look at what you wrote:  ‘Being clean and sober is so much more than just avoiding cravings by popping a couple sublingual pills everyday. It’s just not that simple folks.’  Sure sounds judgmental and arrogant to me!  I see those people after they stop the Suboxone and relapse, and spend 6 grand on drugs, almost die…. (thinking of the latest person this happened to)…  And then I get mad and keep writing what I write.   And when I get mad I feel free to write what I really think:  that stupid jerk ‘recovery-snobs’ like yourself make me HATE NA– not for the program itself, as the program was sound… until too many jerks like you came around.  And to you, it is more important to strut around with your 8 years than to truly listen to the pain of other people.  Only about 5% of opiate addicts get clean through step programs– a tiny fraction.  Many of the rest of them die, you dumb-ass.  Some of those people were friends of mine.    So either wipe the smug self-proud smile from your face, or take it somewhere else.  These people need help, and believe it or not, one size doesn’t fit all.  Heck, I imagine I’d have trouble finding anyone who wears YOUR hat size!
I used to wonder why there are people like you who can’t just mind your own business, but have to butt in where you aren’t welcome.  Then I realized that you have to come where you aren’t wanted, because you aren’t wanted anywhere!   I think of ‘7 years’– she has spent the last three or four days changing her IP address, registering and re-registering, spending hours to get her post on the forum…. and there are a bunch of us moderators who just delete it as soon as she puts it there.  What kind of great, solid recovery she must have- spending hours at the computer, making up phony names to get her post up for 30 seconds.   And here you are– supposedly living great recovery, and yet after 8 years you are still lurking around blogs intended for people with questions about Suboxone.  Sounds like some great recovery you got going there, dude!


caracutro · May 20, 2009 at 9:47 pm

I just want to say that I agree with the doctor completely. I have been opiate addicted on and off for the past 12 years. IV Heroin user among other things. I have also been in a methadone program. In 2005, after the birth of my son, I got addicted to pain meds. I had a clean pregnancy, by the grace of god. I had never been to meetings, rehab or used 12 step methods to stay sober up until this point. All my periods of “sobriety” were spurred by geographicals or cold turkey kicking nightmares. With a new born baby, desperation was at the forefront of my experience. I wound up in AA when he was 9 months old. I clung to AA like it was a life preserver, I ate, drank and slept AA. I loved it. I still do love it. I stayed sober for almost 3 years. I relapsed about a year and a half ago and within 2 months I was at a doctor’s office getting on Suboxone. I am a full time student and working mother. I cannot afford to have my life stop the way I know it will if I kick the old fashioned way. At least not right now. I am fully aware of the reality of my situation and of what most people, especially righteous AA/NA types, think I should or need to do. I still take things one day at a time and I am grateful as HELL for Suboxone. It has allowed me not to lose everything I worked so hard for when I got sober the first time. It allows me the opportunity to stabilize and plan out the next phase of my life in recovery without the horrible suffering that can accompany opiate addiction. I realize that this can be viewed as a double edged sword. The intense suffering opiate withdrawal afforded me, gave me the amazing desperation and then gratitude essential for a spiritual experience like the one described in the Big Book. I believe that I am right where I am supposed to be and that whatever intelligence there is out there in the universe, that it has a plan for me. Part of this plan involves a relapse after 3 years of sobriety and the experience of Suboxone under my belt, for whatever reason, to help other’s who suffer. To help others. Thanks Doc for all your insight about recovery AND Suboxone. I used to be a little arrogant with my sobriety, I was so afraid to lose it, and wanted to believe that I was different. Now I know different. I see how I rode around on an AA high horse a little and it’s easy to do. Hind sight is 20/20. Keep up the good work.

SuboxDoc · May 21, 2009 at 8:11 am

Thank you for sharing. I was there too– I imagine most addicts pass through that stage eventually. Thank you for reading my post– I just looked it over and it is a bit hard to follow, as I was falling asleep as I typed it!
I’ll add for everyone that if you are on Suboxone, the main issue I see as important to think about is the ‘shame’ issue. I encourage all of you to take to heart the fact that you have an illness- and you deserve as much consideration, sympathy, and medical care as anyone with any other illness. You have NO reason to be ashamed. If you are taking steps now to avoid the harm caused by addiction, then you are doing the RIGHT THING. You have been punished enough!

angelo212 · August 2, 2009 at 5:11 pm

You gave him hell Doc. You are so right word for word.I love to hear his response to what you said. I’ll never get off suboxone. If I do I’m doomed. I know myself and feel I’ll never be ready. I’m week and the dope is plentiful in the New York New Jersey area.

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