In my last post I mentioned some of the other blogs out there… one such blog is ‘subsux’.  First let me say that I find the name funny– I waste money buying interesting domain names, and that one is certainly catchy.  But beyond that compliment, I don’t agree with anything there– I visited and read through some of the posts, and found a great deal of nonsense, mixed in with some anger and resentment, and sprinkled with ‘holier than thou’ attitudes toward recovery.
Before going off on attitudes I want to correct something I read at that blog.  I read the same thing at a different blog as well, in a comment signed with the name  subsux.  The comment said that ‘it is illegal to prescribe Suboxone for pain in the US’.  This is a perfect example of what I have been griping about lately when I write about ‘misinformation’– the comment is simply wrong!  Not only is it wrong– it isn’t even close!  It has NEVER been ‘illegal’ to use Suboxone for pain, or to use any buprenorphine product for pain, at least in the US– I don’t know about elsewhere, but the writer specifically stated ‘in the US’.  IN FACT, doctors don’t even need the DEA waiver to treat pain with Suboxone!  ANY doctor can treat pain with Suboxone, providing they can prescribe any scheduled narcotic.  If a doctor can write for vicodin, he/she can write for Suboxone!  If the doc is treating opiate dependence, he/she needs a DEA waiver.  He DOESN’T ne ed the waiver for using Suboxone ‘off label’ to treat pain, or even to treat depression!  Unfortunately, many docs do not know this fact, and neither do many pharmacists, so it can be hard to get docs to write it for pain.  But that is a far cry from being ‘illegal!’
The comment was from a person who claims to be ‘from’ the blog– I don’t know if it is from the blog owner, but my guess was that it is from the blog owner.  Why would a person write something like that?  Again, it is very far from the truth on numerous fronts…  any doc reading it would recognize it as a BS comment simply because the medical system doesn’t work that way, where it is ‘illegal’ to prescribe drugs for one thing and not another.  The only case like that I can think of involves agonist opiates;  it IS illegal to prescribe agonists like methadone or oxycodone to treat ‘withdrawal’ without a special license (the one methadone clinics have).  Even then, the use is highly restricted.  There are exceptions, but the exceptions are narrow;  a doctor can DISPENSE a narcotic to treat withdrawal for up to 72 hours.  Note that he/she can’t PRESCRIBE the narcotics– only DISPENSE them.  The blog writer is so wrong that it can’t just be a ‘mistake’.  Instead the comment must be ‘willful BS’.  Why would a person write something, with deliberate intent to deceive the readers?
I don’t know the answer, and I don’t know why is there so much anger about Suboxone out there.  I get some of it– the people who write that their recovery is better than someone elses– because that is just human nature.  Insecurity breeds contempt.  I get the methadone lobby recognizing the destruction of their industry by the introduction of a ‘better mousetrap’.  But I don’t understand most of the silliness out there with Suboxone.  I do caution you to be very, very careful about what you believe.
The good news for pain patients is that soon, buprenorphine will be widely available for the treatment of chronic pain.  There are a number of studies going on right now– in fact, I encourage you to check out clinicaltrials.gov and search under ‘buprenorphine’– studies on pain, buprenorphine patches, buprenorphine implants, combining buprenorphine with SSRIs…  there is a great deal of excitement out there about the use of buprenorphine, and for good reason.  I find it to be a wonderful alternative to opiate agonists in pain patients because it allows the patient to avoid losing his mind to opiates.  The medication just doesn’t get inside the person’s head the way that agonists do.
With all this talk about buprenorphine, and my blog, and my clinical practice, I must really love buprenorphine… right?  Wrong.  I would much rather treat chronic pain with medications that have NO opiate effects, if possible.  I would also MUCH rather have an opiate addict discover AA, NA, or any other 12-step program, and use that to get and stay clean.  After all, that is how I did it.  But I recognize that I had a special situation;  I was being drug tested by the state twice per week;  I had to complete an ‘open-ended’ treatment program in order to have any hope of working as a doctor again (and they kept me for over three months!); and I had to stay in aftercare for at least 5 years in order to work as a doctor (I was in formal aftercare for over 6 years, and I still go to meetings).  Most addicts don’t have the same situation– and most addicts don’t go into residential treatment until they lose virtually everything they own.  Many die before getting there.  And so I am thrilled that Suboxone can help even THOSE people– the people who used to just die, get buried, and get forgotten.  Is Suboxone a perfect, all-in-one solution for opiate addiction?  Of course not.  But wow– what an amazing step forward  it is for many, many people.


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