On Suboxone, Confused, Wanting to be Pregnant

A person added a comment asking a question related to pregnancy. I have moved her comment/question up here:
Please help. I am confused by the information I am finding on the internet. I am on Suboxone, it will be 2 years in April ’09. I was planning on getting off Suboxone this summer — as I teach & summer would be the best time to try to get off this med. The reason I am pushing to get off Suboxone right now is because I want to have a baby. And of course it would be in the best interest of the baby to be off. Here is the problem —- FIRST, I may be pregnant right now. This terrifies me because I was pregnant last November & I had a miscarriage. I have one child, so I know I can be pregnant. The OBGYN said I could have miscarried for a number of reasons, it didn’t necessarily have to do with Suboxone. IF I AM PREGNANT, what should I do? I suffer from chronic pain — which is what lead me to become addicted in the first place. With Suboxone I was able to live a normal life, without a high. And so I am terrified to be WITHOUT the drug & terrified to be WITH the drug. Any advice from anyone, especially any woman who delivered a child while on Suboxone would be a blessing. PLEASE, PLEASE, help me…I am terrified.
My Thoughts:
There certainly is a great deal of confusing information out there– it is concern about that mess that fuels my blogging.  Something to notice about the information– there is something about having an addictive disorder that causes people with no training to consider themselves ‘experts’.  The phenomenon is somewhat unique to addiction;  you don’t people with heart disease or prostate cancer arguing with physicians over which treatment is best– at least not in a way where the person with no medical education is putting out advice counter to the medical experts, and people are trying to decide which one to choose!  Then again, you don’t see patients with heart disease who are managed medically get their undies in a bundle over the fact that some other patients are being managed surgically!  Only with addiction do we have both of those things– 1.  An intense nosiness of some people about the treatment choices of others;  and 2. People with no training in addiction treatment, no years spent learning about how the mind works;  no education or research into mechanisms of tolerance at the receptor level…  who based on their own (often limited) sobriety feel confident enough about their knowledge to make recommendations to others.  Intrusiveness and ignorance–  THAT’S a dangerous combination if there ever was one!
Anyone see The Apprentice tonight?  Wow– Trump doesn’t like drunk drivers very much, does he?  I was in a bookstore the other day and I browsed through one of his books– he has a bunch of them, but they are all pretty much the same– this one called ‘Think big and KICK ASS!’ I’ll confess to something… one of the reasons I looked though it is because of the comments that I sometimes receive on this blog.  A person wrote the other day something I considered helpful– he wrote that I seemed to take another person’s comments about Suboxone personally.  One thing I have learned as a psychiatrist:  a person cannot figure himself out, no matter how smart or insightful or deep he may be.  If you want to understand yourself– REALLY understand yourself– you need to listen to others, and to accept what others are saying.  At least when you hear it more than once, anyway.  The writer was correct;  I do take the comments personally… and that bothers me.  If anyone is an expert with Suboxone and opiate dependence, it should be me– (geez, I get a bit uncomfortable saying that).  After the person’s comments about taking things ‘personally’ I realized that it is tough to be an expert;  people always take shots at the person who takes a stand, whether the stand is based on facts, morality, idealism… if you are going to ‘put it out there’, people are going to try to cut it off.  Gosh, this is running on forever….  OK– I read Trump’s book because I wondered how he ‘feels’ about all of the stones thrown his way.  No, I am no Trump!  But reading his book I realized that the awkward, lonely feeling of being an ‘expert’ happens to other people as well, and the way Trump recommends dealing with them is to just talk LOUDER, assert your expertise more STRONGLY, and GET EVEN– ALWAYS!
I would never be able to pull all of that off… but I will try to let things roll off my back a bit more.  I’m not sure whether it is good advice to keep boasting about one’s expertise;  it works for Trump, but he has become a bit of a caricature of himself.  Plus there can only be one ‘Trump’!
Sorry about going on a bit.. So, why is it that addicts tend to act like ‘experts’?  I think a big reason is that addicts are playing doctor all the time, when they are using!  No addict ever reads the instructions on a bottle of pain pills– sometimes I will tell a patient to ‘take the pills as they are prescribed– as written on the bottle’ and the person acts as if the concept has never occurred to him!  This brings us to a point about ‘getting better’ on Suboxone, or in Recovery without Suboxone:  you must stop treating yourself as your own physician.  Even doctors must stop playing doctor on themselves.  This is a boundary critical to sobriety;  once a person starts to treat himself, he is on a slippery slope that leads back to using– eventually if not right away.  But back to the point of the original question:  as to the confusing mass of information and the contradicting comments across the web, I strongy recommend that you screen out the medical comments made by people who are not trained in medicine.  That’s not to say that a person’s experiences are not useful;  but often the experiences are translated into comments that are simply silly.  Whenever you read anything about ‘endorphins coming back to normal’ or needing ‘amino acids to remake neurotransmitters’, you are reading nonsense.  I have a PhD in Neurochemistry, and I can tell you with complete certainty that WE HAVE NO IDEA what ‘endorphin levels’ do during addiction, especially at the synapse, where all of the action occurs.  Yes, I could come up with a neat story about what they ‘might’ do… but when I do that, I will try to say ‘this is all just made up on my part’.  Unfortunately the people who know the least seem to make up the most complicated, detailed stories– and act the most certain about them!
I will take on the pregnancy issue in my next post, since I wasted the night with this other stuff.  I don’t want to simply repeat myself though, so please search the blog for ‘pregnancy’, as there are a few posts already.  One of the posts includes several articles about having babies while taking Suboxone.  A couple quick points:  the least safe thing is to be on nothing, and relapse once or several times, exposing the baby to several drugs and possibly to hypoxia or toxins.  The safest thing is to be in solid recovery, off all medications.  Somewhere in the middle like buprenorphine and methadone.  I have seen no published evidence (or anecdotal evidence) for miscarriage caused by buprenorphine or naloxone.  I have had six patients who were on Suboxone throughout their entire pregnancies;  the only sigificant problems were related to fear on the part of uneducated doctors– by that I mean doctors who should have/could have read up on buprenorphine ahead of time, and didn’t,  and so they treated the newborns as if they had been born to mothers on methadone– despite evidence that the NAS (neonatal abstinence syndrome) is much more mild with buprenorphine.
Finally, in the right sidebar you will see a list of news stories about Suboxone, including one relating to pregnancy;  I might write about the article at some point as an example of a very bad ‘study’ in a throw-away journal.  There is no randomization, no control group– a subset of 15 babies are described, out of a patient population of 150… with no description of why they chose THOSE babies.  There are also many confounding factors– for example, the fact that many of the babies were in special education later in life– we know nothing about their addict-mothers, their upbringing, their nutritional status, whether they were physically abused, etc.  One can always find data to support a certain position– particularly if there is no need to explain where the data comes from!
I do recommend that women trying to become pregnant or who are pregnant change from Suboxone to Subutex;  we don’t know of danger from the naloxone, but it is always good practice to expose the baby to as few drugs as possible, and since Suboxone and Subutex work in an identical fashion there is no reason to stay on Suboxone.
More later…
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