Clean Enough, Chapter 1.3: Bias of the book

Introduction
Bias of the book
You will notice the several times throughout the book I take issue with people over what they say about buprenorphine treatment of opiate dependence.  On my web sites I have been told by those who favor ‘total sobriety’ that I am biased in favor of Suboxone.  I don’t know how to best respond to those characterizations.  I have reviewed the studies related to buprenorphine and Suboxone and become sufficiently educated to understand and critically evaluate those studies.  I have experienced opiate dependence for 17 years and experienced treatment failures and treatment successes.  I have experienced relapse and watched friends relapse and in some cases die from addiction.  I have worked for years with addicts in solo practice, in the Veterans Administration setting, in prisons for men and for women, and in residential treatments that do not use Suboxone at all.  After all of these experiences, I have strong opinions over which treatment methods are more effective than others.  Does favoring the more effective method make me ‘biased’?
But my problem with the ‘bias’ accusation is more complicated than choosing winners and losers.  The people who speak of ‘bias’ usually present a choice between Suboxone and ‘being free of drugs’.  We know, and they should know, that being free of drugs is not a real choice. People who are addicted to opiates and who want to stop have always required intensive residential treatment for a period of 90 days or more.  Even with that intensity of treatment, one-year sobriety rates hover around 50%– much lower for 5 years of sobriety.  But opiate addicts who have not yet experienced treatment are living in a fantasyland where the second choice is to just go back to the person they were before their addiction.  If only!!  If the person considering ‘bias’ were to live in the real world, the choices faced by opiate addicts would be Suboxone, 90 days of residential treatment, jails, institutions, or death.  Forced to deal with the truth of the matter, many people would appear ‘biased’ in favor of Suboxone.
The reason addicts adopt a distorted set of choices is because of ‘denial’, the process where the mind refuses to see the horrible reality of a situation, perhaps to protect the mental state of the person carrying that particular mind around.  The result is a bit of insanity that compares active addicts to people drowning in the middle of the ocean.   Floating in the water around them are life jackets– the life jackets representing Suboxone.  The life jackets would hold the people afloat, but they smell bad and look funny.  Plus, there are several people treading water yelling ‘if you put on a life jacket, you aren’t really swimming on your own!!’   So while some people put on the smelly life jackets and live, another group insists on swimming for shore, 1000 miles away, confident that they will make it.  Some people are safely floating in a life jacket, but are made to feel weak and guilty by the swimmers… so they remove them and join the swimmers, setting off on the 1000-mile swim for shore.  In the end, one or two of the swimmers caught a good current and somehow made it to shore alive, but the vast majority of them drowning later that day, a couple miles from the empty life jackets that could have saved them.   I am strongly in favor of life, and of life jackets. 
I receive e-mails asserting that people are better off when they are completely free of narcotic substances.  On that point I completely agree—unless the people have a chronic illness that demands treatment.  When I am feeling sarcastic I will say that an addict living free of substances is a great thing… and so is ‘world peace’!  Heck, I would prefer if a person taking ten medications for heart disease was free of all heart medications and was ‘normal”!  But many people would not survive without their medications.  If one of my patients wants to go off Suboxone, I will share my honest opinion of the person’s odds, and then help him do what he wants to do.  I will point out the risk of relapse, and hold a spot open for some time in case active addiction returns.  One nice thing about Suboxone is that is does allow a ‘trial of sobriety.’  In the days before Suboxone, relapse meant months or years of misery.  But now a person can try sober recovery, and if active use returns he can high-tail it back to the safety of Suboxone.
I hope that you find the information in this book valuable to your understanding of addiction, and helpful in your search for answers for you and your loved ones.