Getting off Suboxone, Continued…

Thanks BC for this post and discussion point:
I often wonder what’s up with the people who say that Suboxone w/d is the Worst! Thing! Ever!
Maybe they never really went through w/d’s before, so they don’t have much to compare it to? It seems that some people carp on how long it takes to feel “normal” again, but I wonder what they are doing in terms of self-care.
Many of the websites I see (I subscribe to the same Google alerts as you) say stuff like – Only take Sub for 2 weeks max!!!! Otherwise it will take you six months to get off of it. Which makes no sense to me.
Anyway – I’m trying to taper off because my insurance will only cover Sub for 12 months. They say there is no evidence that it should be used longer than that, which is news to me, but that’s what it is. I could try to appeal, but I want to be prepared to be cut off anyway.
I could just try to pay, as I’m at a low dose now, but I returned to college and between that and certain other chronic-health issues, I just don’t have much money.
I really like reading your blog, because it’s nice to hear the opinion of someone who knows of what he speaks, but you are frankly starting to scare me. Do you know of anyone who has successfully made the transition from Suboxone treatment to “sober recovery”?
My doctor has only had a few patients even get off of Sub, but he says if anyone is a good canidate to make it, it’s me. Somehow I don’t find that terribly comforting. If you have any success stories, would you mind sharing them?
thanks, bc of Diary of a Quitter
My Response:
Hi BC,
Thanks for the nice comments that you have made and for your support.    Some days I feel that I am too ‘invested’ in the debate over Suboxone;  the anti-Suboxone people seem to be getting louder, and at the same time they are getting more stupid.  You may have seen the post today on Google Alerts from Drugs.com:  Should I taper off Suboxone using methadone?  The denial of opiate dependence couldn’t be more obvious!  I went to the site to read the post–  Drugs.com ‘banned me’ but I just use an ‘anonymizer’ and I can post all I want (I was banned for having SuboxoneTalkZone in my signature– I got this strange e-mail from a guy talking about God and his ‘mission’, interspersed with profanities and comments like ‘I’m doing the Lord’s work and you’re Jack Shit’–  must be an interesting church those Drugs.com folks go to…).  Where was I?  Oh–  the guy who asked about tapering off Suboxone using methadone wrote ‘I don’t intend to become addicted to methadone– only to use it for about 7 days’.   Maybe that was MY problem– I should have tried ‘not intending to get addicted’.
I think my comments will only continue to scare you, but I don’t think they should.  The way I look at it, the bottom line is that opiate dependence is a life-long condition. I don’t know if you have read my story, but I was ‘clean’ throughout the 1990’s without sub.  Today I was sitting in an AA meeting as we discussed ‘step 5’, and someone was saying how not completing step 5 will eventually lead to relapse.  I remembered how things were in the 1990’s, before sub; an opiate addict who relapsed was ‘up a creek’ with little hope of getting clean again.  I used to have nightmares that I had relapsed, and that I was heading for death from my addiction.
Now, Suboxone has helped many people, but at the same time it has changed the bottom line.  Opiate dependence no longer has to be fatal;  there is another option.  For people who come from the time of no options, Suboxone is pretty amazing.  But the newer crowd– people getting addicted more recently– don’t have the same gratitude for the medication, and maybe they don’t have the same respect for the danger of opiate dependence.
I have had a few people choose to leave Suboxone– about 6-8 who I can think of, out of about 150 people started on Suboxone in my office.  I don’t know how they are doing long-term, as people who do well tend to disappear (as do people who don’t do well).  I don’t know of anyone who has relapsed from that group, but that doesn’t mean a whole lot.  But if they did relapse I wouldn’t blame the fact that they took Suboxone;  I would blame the fact that they stopped it.  I always tell people who present with opiate dependence that they have a life-long illness that will need life-long treatment.  They can treat it with Suboxone, or they can treat it through the process of changing their personality by working a 12-step program.  There is no cure.
That stinks about your insurer.  We have one local insurer who limits people to two years, but the rest cover people indefinately– at least so far.  Opiate dependence is a disease by any criteria;  I see stopping treatment at 12 months a consequence of stigma.  Can you imagine an insurer saying they will cover insulin, or blood pressure medication, for only 12 months?
I have given a lot of thought to how to get a person ready to stop Suboxone.  I look at the things that were accomplished during my residential treatment, and try to find ways to do the same thing for addicts getting ready to stop Suboxone.  This includes working on boundaries, emphasizing the need to respect ALL directions on prescriptions, working on balance in life that includes exercise, good sleep, good diet, and a support system; identifying ‘triggers’ for using; finding ways to fill one’s time;  having a ‘daily plan’, rather than just ‘bumming around’ day after day…  All of these things were ‘given’ to me in my treatment, and they all helped keep me clean.
Then there is step-work and meetings.  We really know of no other way to keep people clean.  There is so much good information at meetings… I have considered requiring attendence for Suboxone patients but I don’t, in part because people don’t benefit much from meetings that are forced on them.  So instead I try to take the things that are taught through the steps and get people to apply them in their daily lives.  It is hard to say whether that works or not;  it is very hard for people to change, unless they are truly desperate.
For you, I wish you the best with your ongoing recovery, and I have to put in a ‘plug’ for AA and NA.  They did save my life– a couple times.  They take work, but the work pays off– in the same way that it takes exercise to get into shape.  All of the hard things about going to meetings have benefits to them–  tackling the fear of walking in that first time gives the satisfaction that comes with facing our fears, for example.
Suboxone does go generic in 2009, so hopefully it will be cheaper at some point.  Even at its current price, it is much cheaper than using, particularly if you factor in the total costs of using– so if God forbid you find yourself in a relapse, don’t waste any time debating the issue– just get back on some form of buprenorphine.  Watch for ‘probuphine’, an implantable buprenorphine delivery system that is in human testing.
My tape directed at ‘sobriety after Suboxone’ goes into the AA and NA issue in a bit more detail, and talks about what I see as good personality features or bad personality features for going off Suboxone.  If you check it out, be sure to provide some feedback in relation to your experiences.
I wish you the best out there BC.  Please keep in touch– I will watch for you over at your blog.
SuboxDoc