I frequently point out the lack of outrage over the epidemic of opiate dependence and the consequence of that epidemic.  I live in ‘middle America,’ and sometimes it seems that everyone I know has some connection to opiate dependence– a relative who is an addict, a friend who died, a parent who is in prison.  My perceptions are admittedly distorted by the work that I do, but I don’t know who has the more accurate perceptions; me or the people who seem surprised to hear that most high school kids know where they could get heroin.  Addicts who I treat who come down from the U.P. of Michigan tell me that heroin is very easy to get up there now, even cheaper than oxycodone.  I guess that’s to be expected, given the horrible economic situation up there.  One thing is certain though– SOME people are making money!  In my part of Wisconsin, oxycodone generally sells for 60-80 cents per milligram;  the average user that I see tries to find one or two ’80’s’ per day, ending up with a habit that costs over $100 per day.  Given the number of people actively using, there is a LOT of money going into someone’s pockets!  Of course much of the oxycodone on the street is bought by insurance coverage and then stolen from grandma’s medicine cabinet by her granddaughter, who replaces them with plain tylenol tablets…  but the herion money is probably leaving town, eventually finding its way back to Chicago.  Sorry, Chicago.  We have to blame SOMEBODY.
Many diseases have prominent celebrities who put on pink ribbons and fight for funding.  Not so for opiate dependence, even though the deaths from opiate dependence must rival those from breast cancer.  I’ll have to look at the numbers.  But celebrity opiate addicts tend to end up like Kurt Cobain or Michael Jackson– or slink off to rehab and later proclaim themselves cured.  Anyone who watches knows that there is no cure for opiate dependence, and the celebrity addicts only go back to rehab again as society goes ‘tsk tsk’.  Society doesn’t say ‘tsk tsk’ when someone’s breast cancer comes back.
I found an interesting web site called ‘informationisbeautiful.net’ where information about a variety of topics is presented in visual form.  Below I have a couple images from the site using data from the UK on deaths from overdose of a number of substances.  The images are relevant to the current discussion, as he compares the death rates to the reports about deaths due to the substances in the National media.  At the web site he discusses data collection;  I won’t make conclusions on the data but rather simply let is provide ‘food for thought.’  After viewing the first image be sure to contine to the next image down.
Opiates have the highest death rate of a range of substances.
In the next image he manipulates the data slightly to add a denominator to the information– he provides the number of deaths per user of the substance.  Again, I will let people truly interested in his findings visit his web site to look into whatever assumptions were made and which data sources were used.  I would like to again leave the data without much comment, in part because I don’t really know how to explain the high rate of fatalities among methadone users.  I will point out that use of methadone in the UK may be quite different than in the US, because in the US the medication is prescribed in two ways– as a cheap opiate for chronic pain management, and as a maintenance agent for opiate dependence.  In the latter case, prescriptions for the medication are regulated very closely (actually ‘prescription’ is not even the right word, as addicts must personally pick up their dose of methadone each morning for at least the early part of their management by a particular clinic).  I should also point out that Heroin is a pain medication in the UK that is prescribed by physicians (as well as a ‘black market’ substance), whereas in the US all Heroin is illegal and cannot be prescribed for ANY indication.  Finally, paracetamol is the Brit’s term for acetominophen, or Tylenol.  The graphic:
Methadone deaths per user lead the pack for deaths from substances in the UK.
I do have a couple final comments.  On other blogs or in response to my videos I sometimes come across remarks by people who are ‘anti-suboxone’ that ‘the problem with treating addicts with buprenorphine is that you then can’t get them off buprenorphine, and you have another problem to deal with’– that the addicts are ‘addicted to buprenorphine.’   I find that argument to be faulty for a couple reasons.  First, ‘addiction’ is not so much about the taking of the substance as it is about the obsession with the substance.  An addict who is properly treated with buprenorphine loses the obsession for opiates– something that is amazing to witness at the first follow-up appointment, when the addict sometimes cries over how wonderful it is to be freed from the obsession to use.  So I don’t see buprenorphine as a ‘replacement’, and I don’t see the physical dependence on buprenorphine as ‘addiction’ any more than people taking effexor or propranolol are ‘addicted’ to those medications (which also have withdrawal symtoms of stopped abruptly).   But even beyond that consideration, given the high mortality rate for opiate dependence, when people complain about taking buprenorphine I am always tempted to say ‘compared to what?’   People are DYING from this disease– frankly I don’t CARE if they get dependent on buprenorphine.  I am on the record here over and over with my opinion– that buprenorphine should be a long-term medication.  Use it to keep a person alive during his or her 20’s, and then worry about tapering off– and if the person cannot taper off, so be it!  It beats death.   And any parent of an addict in his or her 20’s knows that a string of ‘sober’ treatment centers and repeated relapses is NOT a great life… assuming the person even manages to stay alive.  We are left with comparing the two options of taking buprenorphine and living or avoiding it– and likely dying.   A pretty easy choice to make in my opinion.    I have to wonder what the people making arguments about ‘the problem with buprenorphine’ think about all of the problems with chemotherapy…   if a person’s child develops leukemia, if you treat him with chemotherapy he may end up sterile, and with an increased risk of a different cancer years later.   Would you recommend avoiding using chemotherapy to save his life now?  What’s the difference?
As always I am interested in your comments here and over on the forum.  We’ll talk again in 2010!


gasman · December 27, 2009 at 4:28 am

After 26 months of treatment, my only comment is: How do I come to terms with this for the “rest of my life?” In “active addiction” there was always something wrong with me. Now I take a pill daily to “fix” what is wrong with me. I don’t always view that fix as such a good thing, it’s just better than the alternative. I won’t list all the negatives here, a quick internet search would do that much faster. I just need to say that once the “glow” wore off and I got back to the daily grind I started to feel like I had just added a new set of responsibilities to deal with on a daily basis. IE: take pill,take laxative,keep doctor appt.,keep counciling appt.,make sure I have enough money to pay for all of those.
Don’t get me wrong,Suboxone saved my life and most importantly, it saved my marrige. Something I will always be thankfull for.
But it is still an opiate,all be it a very potent and very long acting one, with all the costs and”benefits” of every other opiate. It is just”legal”.
As a user and abuser of opiates for 39+ years, most of the time I just feel like – Is this all there is?!

MandaWhite · January 8, 2010 at 3:02 pm

I agree, exact same boat here, been on Sub. for 6 months now, I am VERY grateful… scared if I stop taking it I will relapse and then die. In essence Sub. saved my life…but will I be on it forever? Don’t know.
On another note, thanks doc for backing Sub., hardly anyone else does. So sick of all the people that bash it, I would likely be dead if it weren’t for Sub.

SneakyElephant · March 7, 2010 at 3:08 am

Hi Doc, I just love your site! As a ‘Brit’ I just wanted to add a couple of comments regarding this most interesting article .
First, I can tell you the reason that so many UK addicts die from methadone: THEY ARE ALL USING HEROIN AS WELL! At the pharmacy where I pick up my suboxone, there are always several people also collecting their daily dose of methadone, which must be consumed in the presence of the pharmacist. Upon leaving the premises, they then congregate in the doorway of the pub next door, and phone around all the local dealers to see who is holding. There then follows a loud discussion about who sells the biggest bags, who has good gear and whose stuff is crap, then they all have a big argument about money. Once the dust settles they all head off to the dealer of their choice. Please understand that it’s not the same faces every day, I see different ones on each occasion. In fact I know and have scored with many of them personally in the past.
Another reason for the high mortality rate is that many of them are also using benzos and/or crack on a daily basis. Indeed the crack is responsible for their getting turned on to smack in the first place. It is common practise here for a person without a pipe handy to smoke crack on a sheet of foil, in the same manner as chasing the dragon. Of course when it melts crack is colourless, so the dealer will blithely enquire if they would like a ‘bit of colour’ in it so they can see what they are smoking. No prizes for guessing what provides the colour! Within a couple of weeks of this, the poor bastards are now scoring a bag to go with their rocks. This is not conjecture on my part, I have known personally many people who have gone this route. Many of these guys and girls succumb to respiratory failure in their sleep, surely due to the depressive effects of the drugs upon the CNS.
As far as heroin being a medically prescribed drug, well yes in theory that is the case. However, in 9 years of active heroin addiction I have yet to see pharmaceutical diacetylmorphine hydrochloride for sale on the street. Just about all the gear we get here is very potent (minimum 40% heroin content) smokeable Afghani or Pakistani stuff. On rare occasions or in times of severe drought one may come across a bit of China White, but never the pure medical article.Also, neither I nor any of my aquaintances have ever heard of anyone being prescribed heroin even for chronic pain management. As in the USA various tablets are used for the purpose including morphine, but NEVER heroin. Some of our more enlightened politicians are seeking to reduce the crime rate by pushing (no pun intended) a Parliamentary bill allowing doctors to prescribe heroin to registered addicts, but to be honest they don’t stand a snowball’s chance. Still, it gets their faces in the press and on tv.Anyway, you should never believe anything you read in the British press, they are the biggest bullshitters on the planet. Want to read about Mother Theresa’s coke habit? How about the Pope’s 12 illegitemate children? You pay for it and they will write about it.
I hope that this has been of some help to you, thanks once again for a very helpful and unique site.

angelheart · March 14, 2010 at 2:26 pm

please somebody help! i am going to start a sub treament for my benzo anf kratom habit. it’s a 2 -4 week treatment. just really scared about, is that long enough to create a habit or at least minimize WD symptoms. if i am not not in the forum could someone direct to right one. Please anyone eevryone help with feedback! ernie

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