For the sake of a good night’s sleep I will share the post I just left with my good friend over at ‘arm-me’ blog– see the blogroll for the link. The conversation there arose over the recent Suboxone-related deaths in Milwaukee, Wisconsin, and I was responding to a writer who made the bold claim that ‘spiritual based’ treatments were superior to non-spiritual treatments, and that Suboxone is OK but only if used ‘short-term’– a statement oft-read on the internet that is based on… well, based on nothing at all.
I would be interested in the reference for the comment about the ‘higher rate of success for Faith-based addictions programs’. I work and lecture in the field of addiction– and have been dealing with opiate dependence for over 15 years– and I suspect the comment is more anecdotal than ‘proven’.
Twelve step programs save my life twice– in 1993 and after my relapse, in 2001. I now am medical director of a large treatment center that does not use Suboxone; I also treat opiate addiction WITH Suboxone from my office practice. I have lost friends to opiate dependence; I have seen many more deaths of patients who had gone through step-based treatment at some point in their lives. And we all have seen many, many deaths from overdose in people who never went to treatment—which is by far the largest group of opiate addicts. While step-based treatment worked for me, it does NOT work for most addicts. Yes, it COULD work—just like we COULD have ‘world peace’. The truth of addiction, known to all who work in the field, is that addicts do not seek help, particularly residential, spiritual-based, or step-based help—until they are at the end of a series of horrible consequences. Even then, many patients enter treatment centers with tears on their faces, saying they will do ‘anything’ to get clean… only to check out the following morning with resumed cockiness and denial. Even opiate addicts who finish 30 days or more of residential treatment have a low rate of lasting sobriety. The FACT of addiction treatment is that before Suboxone, opiate addicts entered treatment only after losing almost everything, and many died before getting to that point. And the tiny fraction of addicts who do enter treatment have a high rate of relapse, to the point where an opiate addict receiving treatment and never having a relapse is quite rare.
I went through treatment with other doctors—people with a high motivation to succeed as their licenses are on the line, and they are being constantly monitored. Even that group of addicts has a high rate of relapse, and since my treatment in 2001 I have seen a number of my treatment-colleagues fall by the wayside.
Enter Suboxone. My point with the prior comments is that it is not as if we had great treatments already; the existing treatments for addiction are NOT used by the vast majority of addicts, and even when used the techniques only work in a select, lucky few. Suboxone allows the treatment of opiate addicts FAR earlier in the course of their addiction, before the severe consequences that are necessary for the other treatment options. The ‘drug for a drug’ argument is valid only for those ignorant to the actions of Suboxone; buprenorphine, the active substance in Suboxone, attacks the obsession to use DIRECTLY– in essence treating the very nature of addiction itself. To be frank, it is difficult to imagine a better, or more effective medication to treat opiate dependence—even the withdrawal from buprenorphine that some addicts curse is in reality a blessing, as it assures compliance with the medication. Naltrexone, for example, is an opiate blocker that has NO agonist effects and NO withdrawal; it is largely ineffective for opiates (although it does help with alcoholism) in part because it does not reduce the obsession to use, and in part because it can be discontinued easily, allowing relapse.
Similarly, the comment that buprenorphine should be used ‘only short-term’ is a sure sign of a person who does not read the literature, and who does not understand the disease concept of addiction, but rather is stuck in the world of shame-based treatments. Opiate dependence is a chronic, relapsing, fatal condition—why should it not deserve treatment? Why the concern about being ‘clean’, when we don’t demand the diabetics be ‘clean’ from insulin? But the obvious comparisons aside, the simple fact is that short-term use of Suboxone has clearly been shown to be a waste of time—the relapse rate is virtually 100%! And still, people keep repeating the same thing… that Suboxone use should be ‘short term’. I would love to see those addicts in their docs office, being told that they would receive medication for their heart disease for ‘short term only’—after that they would avoid heart attacks through prayer. The success rate for treating coronary disease with prayer is likely similar to the success rate of short-term use of Suboxone for treatment of addiction!
People on Suboxone: I have seen many patients talked off of their medication by someone on the internet or at NA, only to return to my practice, sheepishly, 6 months later—if they survived the experience. I am not being dramatic; they do NOT all survive being talked off their Suboxone. The people on the web who induce guilt in people on Suboxone are true messengers of death; they do not see, or have any idea, of the lives of the people who they have impacted in such negative ways. Go on any health message board and read the posts over time—you will see people writing about their tapers and relapses for YEARS—and others who simply disappear, no doubt after relapsing and assuming THEY did something wrong. I hold the anti-sub zealots responsible; I have yet to personally meet anyone helped by those people, and I know literally 100’s of patients taking Suboxone, free of guilt and shame, enjoying their lives, and grateful to FINALLY have an effective medication for such a horrible disease.