Mean Streak

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.
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… ****** ‘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.

As Promised– A person who hates psychiatrists and suboxone.

This is the letter I referred to yesterday… check this out.  Interesting perpective… if you live on Mars anyway.  My answers are interspersed with her questions.
Are you a psychiatrist? yes, I am a Board Certified Psychiatrist. I find this website disgusting…the picture of a person with a needle about to shoot upI have thought about that picture from time to time—about whether it is appropriate. I don’t want to glamorize drug use, and hope it does not do that. I want it to be disgusting, so I like this writer’s feedback. I don’t know if she has any understanding of addiction, but opiate dependence, as many of you can attest, is not glamorous! It is disgusting—not in the way the patient suggests, as she sounds like she would be happy to have more stigma imposed on the treatment of addiction, when if anything the stigma already present keeps many people from seeking help. As for the picture, opiate dependence is disgusting and more—it killed a friend of mine, it destroyed one of my careers (as an anesthesiologist), almost ended my marriage, and caused tremendous pain for my family over the years. At the same time, I want to attract people to this blog, and the picture grabs the attention of most opiate addicts. and all your jargon about suboxone which is just another terribly addicting opiate drug As regular readers know, buprenorphine, the active ingredient in Suboxone, is a ‘partial agonist’ at opiate receptors. The result is a completely different effect on a person when taken in sufficient dose: the complete elimination of the desire to use. I got clean in a locked psych ward, ‘kicking it’ over a hellish week and then going into three months of residential treatment followed by years of group therapy, AA and NA meetings… many people die before going into such treatment. The treatment cost me $15 K per month— and is likely even more costly now as this was almost 10 years ago. We sold our vacation cottage to get by and to pay for treatment. I’m not complaining, as I am grateful to be alive. But I am trying to put Suboxone into context—now we have a way to intervene much earlier in the addictive process. It does not ‘cure’, but it sure beats using. It costs a lot less than using also! I am sure you are making a lot of money off of these people who are fooled into the “miracle drug” talk. How many people do you have on this drug as well as benzos? Hmmm…. If you read many of the posts at this site you will see that I hate benzos. I often give my opinion about them—that they turn manageable anxiety into an unmanageable anxiety disorder. How do they do that? By creating tolerance for their effects. After a person becomes tolerant to Xanax, for example, the person develops anxiety every time their last dose wears off. What else did you accuse me of… Oh yes.  You are sure I make a lot of money from the ‘miracle drug’ talk. I guess that depends on how one defines ‘a lot of money’. I make a lot more than I did at my job at True Value Hardware in Beloit Wisconsin, but I was only 16 years old so my expenses were lower! I borrowed $120,000 after college so that I could go to med school, so I spent all my True Value money and also all the money I made working at Taco Johns (sort of like a ‘poor-man’s Taco Bell’). I made tons of money as an anesthesiologist—half a million per year! It is a frightening job—you get these tiny peewee babies who need their stomachs cut open for repair of pyloric stenosis and it is SCARY—all anesthesiologists are scared for that one, and if they aren’t, they should be. Who wants to tell a mother that you killed her newborn? So that paid very well, and I liked it very much… I liked the trauma, the blood, the anger at times as I argued with surgeons over how much more surgery and blood loss a patient would tolerate before everything goes to hell (anger doesn’t have to end a friendship, y’know?). Opiate addiction took that career from me. You want to guess how long it took? I was a good anesthesiologist– and good at working with others.  I was elected Chief every two years; I was the most requested anesthesiologist in the group; I was on all the hot-shot hospital committees; I was called for the ‘tough cases’… how much opiate use did it take to destroy ten years of what I considered a solid career? About five months of use. That’s it. Anyway, then I made nothing at all two for two years… we had to sell the vacation cottage that my kids really loved—still hurts to think about it. Then as a resident in Psychiatry I made about 40K per year—more than True Value anyway! Now I am making about what solo psychiatrists in Wisconsin make. As far as the ‘miracle drug’, I don’t call it a miracle because I have high standards for miracles. But for people who have not experienced many miracles, Suboxone is pretty wonderful.  They are afraid that they will never be free of the horrible obsession that is destroying them, and then Suboxone frees them— they are the ones calling it a miracle. You should read some of their stories more closely—you might me impressed.. How many people do you “subjectively” diagnose as BIPOLAR, ADD, SAD, OBSESSIVE COMPULSIVE DISORDER and all the other worthless diagnosis you need to put down for a diagnosis so you can milk the insurance companies and then get people addicted to stuff to create more of an income for yourself? That is an insulting question, don’t you think?  I thought maybe deep down you liked me… but now I am starting to wonder!  I hate to label people, particularly with the ‘bipolar’ label. One thing that really bugs me is a case where mom and dad fight every night, and sometimes even take a swat at at their kid. The kid starts acting out, so that mom and dad focus on him—  when he gets in trouble it seems from the kid’s perspective that the parents are getting together and worrying about him, which is better than them fighting. So the kid is selflessly helping the family, in a way acting like the smartest person in the family… and he gets labeled ‘bipolar’, gets put on depakote which makes him morbidly obese so he gets picked on…. No, I don’t like to place labels on people, especially bipolar which is mostly, in my opinion, overdiagnosed in children.  I think many kids labelled ‘bipolar’ really have Borderline PD. By the way, writer, you sound a bit ‘borderline’. No big deal, but I just get that impression… Oh, one more thing. I collect at the time of service, so I don’t milk ‘insurers’. I bill insurers, but only as a favor for the patients have already paid their bills. And if a person wants to make money doing this you don’t carry people for long term as I do, because their is a limit on the number of people you can carry. Instead, the people who make lots of money from Suboxone tend to use it to detox people only, then send them out again.  Those people all relapse, but the doctor can keep the high- paying new patients rolling in. Do you tell these people how hard it will be to get off of this drug and that it is an opiate? Well, it isn’t really an opiate. I guess it depends on your definition of ‘opiate’. Does it stimulate the opiate receptor? Yes, to some extent. Is it structurally similar to other opiates? No, it is not. I tell people the truth—that on the drug they will be ‘in remission’, assuming they take it only once per day, as directed. I tell them to consider it a long term medication. I tell them that I don’t have great options once they are on Suboxone, but that one thing is clear… they are better off on Suboxone than they were before Suboxone. They are spending a fraction of what they used to spend. Their mind is free to think of other things. Their moods have improved.  By all accounts it is not that hard to get off; most of the people I helped taper off Suboxone did well and said it was easier than coming off of true agonists. I am coming up with a recorded plan of action for people on Suboxone by the way… and yes, I will be selling it for a reasonable price. Yes, you could find the information here and there, but if you purchase
it from me it helps me to justify the blog.  Plus, I do have some unique ideas I think– something positive from the ashes!  So readers, consider checking out one of my recordings! I guarantee that there will be a class action lawsuit about this drug. No one is telling the truth about it and creepy, lying doctors like yourself are the first ones that should be sued.How can you live with yourself? Your are a money grubbing greed driven disgust. Creepy?  OK, that’s enough– it looks like our friendship is over.  Baby, my life is an open book. You can read about me on my web site—how I dove into the cold current of a river and saved the life of a woman ( with schizophrenia, ironically) when I was 19 (photos of the articles can be found here). You can read my publications as a scientist on my primary practice site, fdlpsychiatry.com. And you can read about my fall from grace, documented in men’s health. Just google ‘the junkie in the OR’’ and that is me! I am truly blessed by the jobs I have had—I had the opportunity to save the lives of several people as a physician, including a thirteen year old by who nobody else could intubate—and I did. He had hung himself in the midst of one of your imaginary psych diseases, called depression. I know three people who died last year, who were not on Suboxone, who would be alive today were they on it. My only regret is not pushing it on them.  How can you live with yourself? Your are a money grubbing greed driven disgust. Ahem… the more I think about it I realize you don’t even know me… Selling tapes about opiate treatment? How kind of you to offer payment with PAYPAL. You prefer Google Checkout? Opiate addicts spend from $100 to $300 per DAY on oxy… a twenty dollar tape is a bargain. Thanks for another plug.  I have been through addiction, almost died from it… I have been through the decisions… I’m a pretty good source of info. Patients pay $350 to sit with me and hear the same thing, so the recordings are a good deal. Maybe this will be proof that someone can use when they sue you for lies about the drugs you prescribe.Now you are losing me. Tell me a lie, just out of curiosity… because I don’t know what you are thinking about or referring to, and frankly I’m worried about you just a bit! Psychiatrists are such a worthless joke..you create your patient base with crap diagnosis’ and writing scripts. Your entire practice is just a big lie! You are all predators!
Thanks for the message. This will probably piss you off, but you’re probably always pissed off, so… lady, maybe you should see a psychiatrist? I think you might have issues!
SD