I received an e-mail asking for help some time ago– I no longer have the original e-mail, but I do have my comments in response to the e-mail.  I will post them because there were a number of teaching points that came up in the letter.   Specifically, my first though with the message was how typical it was;  opiate addiction always leads to the same place, and addicts have the same series of ideas and thought patterns, the same desperate attempts to find a way out of the hell that is active opiate addiction. In the letter the addict tries to run things and to address things scientifically and medically.  It reminded me of my own desperate struggles when I read every article on addiction that I could find, thinking it would help me.  It didn’t, by the way.  Note the AA saying that ‘nobody is too dumb for recovery… but some people are too smart for it.  The message:
I am hoping for some help! I have tried suboxone several times, never my own script but aquired through other addicts.
This never works by the way.  One cannot treat addiction through addictive behavior.  There are no ‘shortcuts’ to getting better.  Yes, Suboxone is a bit of a shortcut itself, but it must be used as a medical tool– just one part of the treatment process.  A person going on Suboxone must embark on a new life that includes ALWAYS following directions for prescriptions.  Always.  No more ‘I’m different than other people– I need more than most people’.  No more ‘I know what I really need better than the doctor does’.  If an addict going onto Suboxone doesn’t know these things, the doctor must educate him.  Suboxone is different, but if an addict uses it without direction it is just another abused drug.  Watch what happens:
The first time 3 yrs ago it was a miracle i felt wonderful but I only had enough to do a 5 day detox, at this time i was taking vicodin and occasional oxy. Of course I ended up back on the pills due to paws which at the time I had no education regarding thid part of addiction nor have i ever heard of it.I thought if this is what being sober is than I cant stand it due to lack of energy, constant fatigue and depression.
‘PAWS’ is ‘Post acute withdrawal syndrome’ by the way.  I wouldn’t consider this to be ‘paws’ though, as it is too early to fit into that category.  Acute withdrawal from opiates takes weeks, not days.  Acute methadone withdrawal can go on for months.  ‘Paws’ comes on after withdrawal ends, and often after a pleasant honeymoon period when the addict thinks he is out of the woods.  Then things start going downhill… reality sets in and the addict realizes that while it is great that he is getting help, nobody else really cares– his wife is still pissed at him, his credit card companies still want their money, or the hepatitis he caught from the needle is going to be a life-threatening illness.  So paws consists in part of mood and anxiety symptoms.  The person still isn’t sleeping, and appetite hasn’t returned…  muscles are deconditioned… and the cravings set in.  All of this can be considered part of paws– a ‘syndrome’ by the way…  in medicine, when something is called a ‘syndrome’ it is usually something that is poorly understood and poorly defined.  Such is the case with ‘paws’– people who use the term often are talking about different things.

I’ll also add that this person didn’t relapse because of ‘paws’. He/she didn’t relapse at all.  He never stopped using– he just played around with a new drug for awhile.  This is NOT just semantics; there is nothing in the story that looks anything like sobriety.  Not yet anyway.
My 2nd attempt was after becoming very addicted to oxy’s I am a proffesional and I am working towards a degree in the health care field si I know I cant continue to live this way. This time i got enough to last me until I could get my own, well heres what happened I was fine until I realized that I could still get high when i felt like it I was taking 4mgs a day of sub and then towards the evening I would do an oxy 80 or 2 I thought o.k. I can do this occasionally and feel no pain when I dont want to WRONG I sonn was using oxies every day while dosing every other day on the suboxone and when I tried to stop this and just use the sub I was horribly sick for wks also I began suffering from horrible depression.
Again, all of this is just playing with drugs.  No commitment to a changed life;  no asking for help from someone else.  I will throw in that people who work in health care are difficult to treat, as they try to treat themselves rather than let themselves be treated.
Now i have chose to quit the suboxone thinking it was causing my horrible depression WRONG again it has been 3 weeks and   horribly depressed so heres my plan I know now more than I ever did in my life that this has to stiop I have to get clean I am willing to do anything to get it together without turning back meetings, prayer, church anything to get out of this hell i am living! I want to try the suboxone again right this time. I am going to get a hotel room and try and wait the whole 24hrs and then take the suboxone. My question is do you think that this time it will work? I mean do you think I messed it up while abusing opiates while on it for about 4 months? I am trying to make sure i keep my dose low on opiates now well as low as i can tollerate so I have a better chance of having a better outcome when starting the suboxone this time. I have never been more serious in my life I have researched this for weeks and one thing I dont understand is why I was able to use while on suboxone without the blocking effects I know i was feeling the oxys.
The reason is because you were on a subtherapeutic dose of Suboxone, and you probably were not taking it completely correctly.  The effects at the receptor are all about competition;  a high dose of a potent opiate will out-compete a low dose of buprenorphine, particularly if it is not taken correctly.
This is my last chance or i will end up at the methadone clinic and I definately don’t want that please tell me how I can make this work after playing so many games with my sobriety and the suboxone. PLEASE HELP ME FIGURE THIS OUT!!!!!!!!!H
Nothing to figure out.  In treatment people often say KISS:  keep it simple, s..s..stanley.   Getting clean is not about working ‘harder’.  It is about being treated.  It is about letting go and stopping the constant running of the show.  I don’t know if Suboxone is going to work at this point– I know it won’t if you just do the same thing again, taking it on your own without a prescription, treating yourself.  You must understand that the addict is in charge of your mind;  you cannot out-think the addict on your own.  You have access to your conscious mind;  the addict has that but also has access to all of your unconscious mind.  The addict knows all of your weaknesses;  all of your deepest secrets and fears.  How do you expect to take that on?
When people start Suboxone there is a lot more going on than just blocking receptors;  they are making a commitment to a new life.  In my experience once that person starts using, he quickly is right back to the same old thing– trying to use willpower, which is useless with opiate addiction.
My recommendation is to get help from someone who has experience treating addiction, and to do everything you can to stop treating yourself. The best, state of the art treatment out there is all around you– that being AA and NA.  But it doesn’t work to try to ‘use’ AA or NA.  Rather to get better you need to let go and recognize that you are lost.  Stop digging.  Skip the Suboxone and instead go to a meeting every day.  Recognize your powerlessness over opiates, and recognize that they are poison for you, and let them go.  Some lucky people will just ‘get it’ all of a sudden– I was that lucky my first time around, but not the second.  It takes utter desperation, and with a leap of faith a person simply says ‘I am done fighting’.
It is hard to explain, but I think I have said enough for it to be figured out if you are ready, and truly desperate.
Let it go.  You can’t take opiates anymore.  You can rest now, because the fight is over.  You lost, but that’s OK.  It’s done.
Suboxone Talk Zone


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