I guess I do get irritable sometimes…  but I’m getting better at controlling my anger as I get older.  One cool thing about a blog is that I can go back and see what I wrote years ago.  In this case, I was looking for a post about telling the difference  between opioid toxicity (from taking too much) versus opioid withdrawal. In that post I suggested looking at the size of the pupils.  The name of the post, in case anyone is interested, is called ‘abres los ojos’– the name of an old Penelope Cruz movie and spanish for ‘open your eyes.’

Penelope Cruz sounds very cool, by the way, when she whispers ‘abres los ojos…’ as you can hear at the beginning of the movie trailer.  The movie was remade and called ‘Vanilla Sky’– again with Penelope Cruz, but this time with her speaking in English.Am I the only one who cares about this stuff?!

The post BEFORE that one was from a time– 2009– when people often wrote to tell me how misguided I was for recommeding buprenoprhine.  Those comments, at a time when so many young people were dying from overdose, would really get to me.  I’ll share the exchange, for old time’s sake.  For people who enjoyed my older, feisty posts, they are still out there– you just need to keep hitting the ‘earlier posts’ button!

The post:

This guy doesn’t like Suboxone– or the horse it rode in on.  He has been trying to write angry posts under my youtube videos, but I have been blocking them– His feelings about Suboxone popped up on one of the health sites out there this morning, catching my attention through ‘Google alerts’ for Suboxone.  It must be the same guy, because the complaints are the same, the language is the same, and in both cases the screen names are related to frogs(!).  I will go ahead and post his comments, and then my response, so that he can relax– knowing that he has done his part in the epic struggle over Suboxone.

Celebs Riding Horses! | Celebrities, Penelope cruz, Celebrities female

Ive looked all over the internet and still have not found more then 5 people who have quit suboxone like i have. I took it for 12 months tapered down to 2 mg and quit 5 days ago..Basicly i am writing this due to the fact that i am really pissed at the fraud i feel is being commited by the drug maker of suboxone. I was taking 15 10 mg a day of percocet and 10 mg a day of norco a day b4 i got on sub. Anyways the reason i am so pissed is that these last 5 days have been the worse 5 days ive ever had.My Dr says oh youll just feel little tired for a few days is all.. ya right… 5 days of not being able to move,anxiety,depression you name it.. and no i am not crazy i took pills for shoulder injury so i have an idea where these feelings come from and its the good ole subs that all these Drs are making a fortune off. You must remember that out of all My drs patients i am like the only one whos quit totaly and can actually sit here and tell you what its like.. Its terrible and after considerable thought i think people need to know this sub is just another opiate and what gets me is the withdrawls are even worse then reg opiates. I CLOSE WITH ONE LAST COMMENT: ITS ALL ABOUT THE MONEY WHEN IT COMES TO SUBS: Think twice before some slick talking Dr wants you on it.. its far from a magic pill. Just ask the few of us out of 1000000,0000 people who quit the phoney stuff.

There is no magic pill for addiction to pain pills and if you think sub is then think again..One last thing, try and ****** suboxone withdrawls and guess what youll find??? first 50 sites pop up are paid for by the drug maker of sub and you have to dig to find real facts from patients with experience.. Drug maker pays big bucks to keep all the info ” positive” on subs… They are no dam different then the crooks on wal-street !

My Response:

Before my answer, a quick comment–  I do like the ‘crooks on wal-street’ remark;  I haven’t seen that ‘play on trademark words’ before.  I am assuming that he was making a joke–  he had to be, right?

OK, here is my response.  As usual it is a bit ‘snotty’– but you have to remember that I get this garbage all the time, and it gets old:

I am sorry to be the one to break this to you, but you are an opiate addict. Moreover, you will always be an opiate addict; hopefully you will be an addict ‘in remission’. The brain pathways that make up ‘addiction’ are laid down in a manner that involves memory processes; becoming a ‘non-addict’ would be like forgetting how to ride a bike. It cannot happen. Again, you can be in remission, but with opiates, that is very difficult– and unfortunately very uncommon.

Many people write about how they used will power or vitamins or some other silly technique to quit opiates– once they have gone over 5 or 10 years, I am interested in listening to them. It is easy to quit using for a year– it is another thing entirely to quit using for 10 years. I got clean in 1993 and felt pretty proud of myself… I quit through AA and NA, not Suboxone. I worked with opiates the whole time, giving patients IV fentanyl, morphine, demerol, etc in the operating room… but in 2000, thanks to a little market in the Bahamas that sold codeine over the counter, I relapsed. I ended up losing almost everything, including my career, all my money, a vacation cottage, my medical license…  Look up ‘mens health’ and ‘the junkie in the OR’ and you will read my story.

There is no ‘fraud’, no ‘slick doctors’. There are doctors trying to help, and some work harder than others to keep people on track. We now know that Suboxone is best thought of as a long-term treatment, just like most other illnesses; we treat diabetes, hypertension, asthma, etc with long-term agents; if you stop your blood pressure meds abruptly you will have ‘rebound hypertension’ that can be very dangerous… Suboxone is similar to any other treatment. The thing is, pharmacy companies never used to care about addiction; the money is in treating other illnesses– just watch the commercials on TV! The money has been in viagra-type drugs! Suboxone is the first generation of opiate-dependence medications; the next wave will have fewer side effects, and so on. That is what happens with every disease. I am glad addiction finally has the attention of pharmaceutical companies. As for ‘slick docs’, there are many easier ways to make a buck in medicine! I am at the ‘cap’ of patients; the money I make treating patients with Suboxone is a tiny fraction of what I made as an anesthesiologist; I could drop the Suboxone practice tomorrow and take one of the 30 jobs in my area frantically looking for psychiatrists and make as much or more money.

Yes, there probably are some ‘bad docs’ out there– there are ‘bad everythings’. But a bad doc will make a lot more money treating ‘pain’ using oxycodone than treating addiction with Suboxone! For one thing, there is no cap on pain patients! And when a doc wants to prescribe Suboxone, he/she can have only 30– THIRTY– patients for the first year. Hard to get rich on 30 patients!

Suboxone has the opiate activity of about 30 mg of methadone. When tapering off Suboxone, the vast majority of withdrawal symptoms occurs during the final parts of the taper– the last 2 mg. That is because of the ‘ceiling effect’. But you are not just tapering off Suboxone…

Do you remember when you started Suboxone, how lousy you felt, and how Suboxone eliminated the withdrawal? YOU NEVER FINISHED GETTING OFF THE STUFF YOU WERE ADDICTED TO. There is no ‘free lunch’; Suboxone allowed you to avoid all that withdrawal; if you stop Suboxone, you have to finish the work you never finished before– going through the withdrawal that you ‘postponed’ with Suboxone! Welcome to the real world– you likely abused those pills for years, and if you don’t want treatment with Suboxone, you had better start a recovery program, or you will be right back to using again.

Human nature can be a disappointment at times… When I ‘got clean’ after my relapse 8 years ago, I was just grateful to be ‘free’– even for just a few days of freedom! To get to freedom, I was in a locked ward for a week, no shoelaces (so I wouldn’t hang myself!), surrounded by people who were either withdrawing or being held to keep them from self-harm (it was a psych ward/detox ward combined). After that, I was in treatment for over three months– away from my family all that time, and I couldn’t leave the grounds without an ‘escort’ (no, not that kind of ‘escort’!). Treatment started at 6:30 AM and ended at 10 PM. The rare ‘spare time’ was used to do assignments. After those three months I was in group treatment for 6 years, and also AA and NA meetings several times per week. I still practice and active program 8 years later– I know what happens to people who stop: they eventually relapse, and some of them die. I AM NOT EXAGGERATING ‘FOR EFFECT’ HERE.

I had better stop or I will spend all of 2009 with this post… My final comment: Most of what you are feeling is not ‘Suboxone withdrawal’. I have watched many people stop Suboxone; some have bad withdrawal, some have NONE. When you talk about ‘anxiety’ or other problems facing life on life’s terms, you are experiencing life as an untreated addict. ADDICTS WHO SIMPLY STOP TAKING THEIR DRUG OF CHOICE FEEL MISERABLE!!! That is not withdrawal, and it doesn’t go away! Suboxone held things ‘in remission’ and allowed you to pretend you were not an addict; it is NOT a cure. So now, off Suboxone, you will see what it is like to live life as an opiate addict without treatment– and if you don’t get treatment, you will likely relapse. You will relapse because untreated addicts find life intolerable.

My human nature comment– everyone wants good things, but nobody wants to do the work to get them… (I’m in a bit of a mood today I guess– sorry). Recovery from opiates has always taken work– very hard work. And even then, success was rare– most people had to go back to treatment over and over and over before finally getting it. If people stopped working, as I stopped working in 1997, they eventually got sick again. Enter Suboxone: now you can have instant remission from active addiction! So are people grateful for that fact? That now, instead of years and years of struggle, they can take one pill each morning and hold their addiction in check? NO. Now they complain that ‘I don’t feel good when I stop Suboxone!’. Sorry, but a part of me says ‘poor baby’. You have a fatal illness, and you think you are done with it… you will find going forward that you will either use, or you will take buprenorphine or a new medication along the same line, or you will be attending meetings for life. Those are your three choices– pick one.

If you find a 4th choice, tell me about it in 5 years. I would like to hear how you did it, and yes, I hope you do find it (rather than die using). But I looked for that other path myself for years and never found it, and so did millions of other addicts.

Back to the present…

Phew.  Makes me tired just remembering those days.  Since then the number of deaths have only gone up, but at least there is a better acceptance for treating opioid dependence using effective medications— at least for people ready to accept that help.


rosiegowns · March 16, 2012 at 10:46 pm

thank you so much for this blog…I am the mom of an addict…been through so much. My daughter got into the methadone program for opiate addiction…vicodin lastly…and now after 2 years at 15 mgs. has gotten down to 40 and is about to go onto suboxone. I’ve read crazy stuff, so it’s good to read your logical, medically sound take on the whole thing. Do you find that getting off the methadone will enable her to get some of her life back (as she has been sleeping it away for two years) ? I’m at a loss here because I’m supporting her (she lives 3,000 miles away and won’t come home) and there doesn’t seem to be any possibility of her leading a productive life. I know I’ve enabled…her psych told me to wait and let the suboxone start up and perhaps she’ll wake up a bit…just lowering the methadone has seemed to bring up old memories for her…but I’m getting old and she is 30 now! thoughts? (no yelling…I do feel stupid around this…my excuse is overcompensating for my abusive parents :)) thanks sos much,

rosiegowns · March 16, 2012 at 10:49 pm

no, the methadone was at 125 mgs.
previous use was oxycontin (prescribed at 21 …thanks a lot), previous crystal meth, and everything but the needle

Laura · April 28, 2012 at 7:41 am

I am a chronic pain patient, I found myself in this situation after 22 years of nursing in ICU, ER and Trauama. Who said nursing wasn’t a contact sport anywho? After 22 years, I found that my back pain was getting worse, so much so , that it was no longer backgroud noise in my brain and body. The pain started screaming at me. Before treatment, I could not stand for longer than 5 minutes for anything. Cooking was a big adventure. Cleaning was even a bigger adventure. Changing the sheets on the bed took all day. I had to plan all of my activities of daily living around my pain. Enter my first experience with opiates for me, as I had never used them for myself and I only knew what was in medical journals and text books (I was working n my Masters in Nursing. The pain got especially unlivable after I was severely beaten by my husband. He tried to kill me, I think he would have had I not escaped the apartment. Being beaten in the head and kicked all over with steel toed boots does not lend itself to an improvemnt in pain issues. Two days after this event (husband in jail nver to return to my apartment), I woke up an could not move. Scared, I called the ambulanceand went to the closest ER 22 miles away, and the ER docs were not very sympathetic to my plight and refused to give me anything for my incapacitating pain. Since I was on disability for psychiatric reasons, it seems no one believed the crazy person. I began the search for someone to take care of my pain issues. As soon as my Medicare kicked in, I made an appointment with the only pain doc in the small rural town. Prior to my arrival at his ofice for my forst visit, hehad all of my ER records and knew every thing I went through as I was quite vociferous as to my needs. Anywho, making a long story shorter, this angel of a doc managed my pain for 8 years. I respected him and we
hen we talked it was peer to peer as I was not stupid and learnd th pain problems from him. Next I moved to Florida, and good grief, everything was different down here. The first pain doc I went to told me I was way over medicated and cut my oxy pills by 1/4th. Well I could manage with 120 pills a month of oxycodone 15 mgs. I then had the problem of my arthritis progressing and my nerve pain in my arms getting worse. I needed a pain management doctor I was told. Went to see the pain managemnt doctor who switched me to Fentanyl patces 50 mcgs every other day. If I wasn’t an addict before, I certainly was now. Then because of an honest misunderstanding, I was discharged from his practice and labeled a “drug addict”. Off to the next pain doctor, which I found out was in the same practice as my prior doc, so she copped an atitude regarding my pain issues and refused to listen to me. I found out after my first suboxone, that she had kept me in a constant beginning of withdrawal and seemed to delight in this situation since she refused to increase the fentanyl or give me any breakthrough meds. I won’t tell you the names I clled her on my way out of her office, never to return.
Enter my psychiatrist, who told me I was a sweet woman, was not a drug addict and told me he would manage my pain with suboxone. Well fear of the unknown is the most important part of my switch from fentanl to suboxone. I went to drugs.com to find answers and was advised to look up your you tubevideo clips. They certainly answered most of my questions. And I thank you for alleviating most of my questions. So I have embarked on my suboxone adventure, never planning to get off of it. Knowledge is power. I read everything I can find regarding you and suboxone.
Thank you for all of past experiences and you thoughtful sharing of such,

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