It's the Paradigm, Silly!

I talk quite a bit about the letters from ‘flamers’, but don’t often mention the messages of support from grateful people on Suboxone, and the nice comments from my patients.  I enjoy speaking to patients on Suboxone about the things said for example by the silly pharmacist in the last post, and as I try to explain things I realize that they KNOW– and I can say:  ‘well- you know how it works!  You’ve TAKEN it!’  And they nod their heads with recognition.

The primary purpose of 12-step groups is supposedly to help addicts;  some groups seem more concerned with something other than ‘help’.  Suboxone, as I have said many times, is not perfect… but it is a great step in the right direction.  If we DID have the perfect medication– say a medication that instantly cured addiction– would NA be for it or against it?  Given those comments in the last post, you have to wonder!  Even with the imperfections of Suboxone, we have a medication taken once per day, with relatively few side effects, that instantly virtually eliminates the desire to use opiates, that maintains it’s actions long-term, that has no known serious toxicity…   And the complaint of people is… it is hard to stop.  To which I say… GREAT– BECAUSE WE DON’T WANT PATIENTS TO STOP IT!  One problem with naltrexone ‘treatment’ (among many other problems) is that the addict can (and does) simply stop it, and use the same day– you can’t do that with Suboxone!

People with awareness of the harm done by addiction, who have minds open to to the progress of science, understand the new paradigm for treating opiate dependence. 

To elaborate: Some of the mis-statements of the anti-Suboxone crowd relate to their confusion over ‘addiction’ vs. ‘physical dependence’. Suboxone does cause physical dependence– if you stop it abruptly you will have significant withdrawal, as with other opiates. BUT… ‘addiction’ is a different issue. Psychiatrists think of ‘addiction’ as the ‘mental relationship with the drug’. Suboxone, when taken properly, eliminates ‘addiction’– or at least holds it in remission;  people who take Suboxone clearly notice that their relationship with opiates– their obsession over them– quickly vanishes. Too often people equate ‘recovery’ with the amount of drug taken or NOT taken; a person can be free of alcohol and be in a ‘dry drunk’ and not in ‘recovery’; Similarly, a person can take Suboxone and be in recovery–as ‘good’ of recovery as any other recovery!

It is true that if you stop Suboxone you will have withdrawal. On the other hand, if you take 8-16 mg of Suboxone once per day, in the morning, you will no longer think about opiates, and they will no longer control your life. THAT doesn’t happen with methadone or with other opiates–and frankly it doesn’t happen with NA either.  Rather, it is a function of the partial agonist effects of buprenorphine. This is the ‘new paradigm’ that has impressed and provided hope for the scientists and physicians looking for a way to reduce the harm done by narcotics.

If you look at ‘addiction’ as the ‘mental obsession for the drug’– and I believe that is the appropriate way to look at addiction, as it is the obsession that destroys intimacy with others, leads to criminal behavior, and demoralizes the addict– if you use this definition, I see a strong argument that a ‘Suboxone recovery’ is BETTER than ‘NA recovery’. Why? Because with NA, the relationship with the substance is often still largely present.

Who is more ‘recovered’: the NA addict who talks about his addiction constantly and attends meetings three times per week… or the Suboxone patient who takes a vitamin pill and a Suboxone tablet each morning, and hasn’t had a thought about using for weeks? The NA addict who crosses the street to avoid walking past a bar… or the Suboxone patient who has lunch in the bar without any fear of falling down a slippery slope that leads to using? The NA addict/pharmacist who hovers over blogs about Suboxone and boasts over whose recovery is better, or the Suboxone patient who no longer needs to meet three times per week with such judgmental people?