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?


zenith · January 6, 2009 at 5:20 am

I wanted to comment on yesterday’s blog about the pharmacist, but for some reason I could not read the socnd part of his letter to you, nor the end of the blog entry. So, I will post today.
Although you and I have disagreed in the past regarding methadone (I am a methadone patient and I think Sub is great–but also feel methadone is great and has worked wonderfully for me), this is not about that. You stated that you usually attend AA and were not aware of NA’s stance about medication assisted treatment. I wanted to let you know, if you were not aware, of their publications regarding this:
(the above pamphlet was written before the advent of Suboxone but is held by current NA standards to be pertinent to Suboxone patients as well as MMT patients)
and more recently:
and here is a link to a recent thread on an NA support forum regarding this topic:
Personally, I agree with the remarks you made on your blog entry. NA, of course, has the right to feel any way they choose to about sub or MMT–that is their business. However, I thought you might want to know what their official stance was on medication assisted treatment prior to suggeting people go to their meetings while on Sub. As far as I know, AA has no such policy, although there are some members in certain groups who disapprove personally.

Stace · January 6, 2009 at 8:03 am

hmm, for some reason I can’t get past this part of your blog
“Fairly civilized.. but keep reading:”
end of page… I want to keep reading, just can’t!!!
I find it ironic – your post from the pharmicist. Only bc I just recently commented on how I feel others perceive me ie: the ppl at my pharmacy etc..
I doubt it seriously they do think those things about me, however since our chat about that, more and more each day I wonder why I feel that way! Honestly I don’t give a mouse poop about anyone’s comments on suboxone they can eat that poop… and I think if they haven’t been in our shoes who the hell are they to judge? How do they know all this wordly knowledge – I mean whose to say if someone in NA/AA tried Suboxone, there lives would change for the bestest way possible and life would be worth living again.. and I feel really bad for your patient in NA that’s ashame that grown adults that are in the same sitituation can be that disrespectful and hurtful (by hurtful I’m not just meaning by being a big meany nope I mean they’re actually HURTING THAT PERSON BY TELLING HER THAT AND SHE GETS OFF THE SUB AND RELASPES!!! Such a scary thought. I sure hope she’s doing better now.
Ok again I’m everywhere I can’t remember what I wanted to post about orginally so I’ll end it here 🙂
Have a great day

armme · January 7, 2009 at 5:24 am

One thing I try my best to keep in my head at all times is that I represent a small portion of people who actually feel comfortable admitting that they are a medication assisted treatment (MAT) patient. How I talk and what I say can CHANGE the way people think about the treatment.
For instance, at the hospital where I work I let people get to know me before I explain why I have a “Doctors” appointment once a month I have to leave work for….and when I do the response is always “YOU were a drug addict?”. …and I know when this happens I change not only the way people view MAT, but also the way they view addiction. I am not, and never was, a homeless “junky” who begged, borrowed and stole to feed my habit. (Well, I might have borrowed a whole lot! lol)
You have to remember that every time you go to the pharmacy, Stace….it will make you feel better about the whole situation, I promise. Those people do not know you, or your story and they couldn’t possibly know you well enough to judge you.
Doc, I love the comments at the end….there are so many folks I would love to say “why are you judging my recovery and since you are judging my recovery how can you possibly be happy in yours?”
In what other illness would grading the recovery of someone elses sickness, make you less sick yourself? In what other illness would a complete absence of symptoms (the majority of time) in a patient be considered “less” of a remission/recovery then someone who constantly having to fight those symptoms (or “live with” them) like so many folks in traditional treatment have to?

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