A person replied to the ‘hole’ discussion with comments about methadone.  I will post the other person’s comments in Part 1, and then my response in Part 2 later today. 

Suboxone talk
Suboxone Tabs

My response consists of my opinion– an opinion based on 1. My own experiences with opiates (not currently active, thank God); 2. My experiences treating over 150 people with Suboxone over a two-year period; 3. My PhD work in neurochemistry as a ‘grind and bind’ man, studying receptor mechanics at the molecular level; 4.  My ten years as an anesthesiologist in the OR and labor floor (where I gave patients opiates including buprenorphine)  and in the pain clinic (where I prescribe methadone and other opiates); and 5. My residency and practice in psychiatry and my own psychodynamic therapy, where I learned to respect the power of the unconscious side of personality.

In other words, my opinion is my opinion, but it is based on a great deal of education and experience.  I do my best to keep an open mind.

The post:

I have heard often from Suboxone patients this same thing–that this “hole” seemed to be helped by subs at first, but then it slowly doesn’t work. This could be attributed to tolerance-however dose increase don’t appear to help.

I have also heard the opposite-from a very dear friend who is thankful still, a year later, that her “hole” seems to have closed up because of her time on Suboxone.

I think R may find better luck with Methadone. See I don’t necessarily believe as the “Experts” do that Suboxone is better for less tolerant and methadone better for “heavier” users of short acting opiates. I believe that if you were a person who, while in active addiction, could take just enough to get high and be happy and content to save the rest you may do very well on Subs. However, if you were the type that was reaching for more before you even let the first pill, line or shot take effect–essentially you were the type of addict who loved to OVERFILL the “hole” then methadone might be for you.

If you look at this “hole”-lol- theory you could consider that suboxone has a ceiling effect and can only fill that hole to a certain point–which for the first group of people is just enough to be content, but for the second group is inadequate. Methadone seems to take up more “room” in the hole, therefore it fills past the point of Suboxone’s celing and there comes a point in treatment where you stop craving to OVER FILL the “hole”. That is a magical place to be when you’ve craved “filling the hole to the brim” most of your life.
Of course, this all might not make a whole lot of sense to anyone that hasn’t walked around feeling half whole their whole life.

Part 2 coming…

By the way, for those of you who enjoy reading my comments, please visit my practice, Fond du Lac Psychiatry, at http://fdlpsychiatry.com .  You will find links to my weekly radio show (send an e-mail to discuss on the air!) as well as things I have written about psychodynamic psychotherapy.


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